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Comparing Doctors- What do you think of this?

Trew
Posts: 892
Joined: Jan 2010

Please, give me some advice. On March 23, 09 I had surgery in Lansing, MI by Dr. Mashni. On March 31 I was in to his office to get the cath pulled and the path report from surgery. Dr. Mashni came in to seeme after the cath was out and told me I had positive margins, that I would need radiation or die. That has been the last time I have seen Dr. Mashni. Since then I have only seen the office PA.

About 3 weeks after the cath was pulled I was in to Mashni's office, but ony saw the PA. There was the usual blood draw, a few questions and answers and then I was told I would need a shot, it would be given to me in my stomach, laid back on the table and the nurse will come in and give it to you. There was no discussion of the drug that was to be used, no discussion of side effects, just BANG! shot given.

In following office visits I would discuss with the PA some of the side affects, etc, but never saw the doctor again. Prepaing for radiation, no doctor, only the PA.

Does this sound like a normal doctor/PC patient relationship? I am getting very confused and not sure how to handle this or what to do. I saw the PA this past week and it did not go so well. Still no doctor.

What do others think- are you having a similar experience? Or am I the only one being treated this way?

And is it too late to change doctors? Move records? I think Dr. Mashni is a good surgeon, but I am so discouraged with the follow visits.

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

Your doctor said do radiation or die? Then weeks later a P.A. gives you a shot of ????

Did you talk with a oncologist about radiation?

If it were me...I would be asking: what, why, where, when, how. I have had surgery & radiation and have learned to keep asking questions until I'm satisfied. I would lose a doctor who repeatedly turns me over to an assistant. Tranferring records is not a problem.

You were probably injected with lupron...which is basically chemical castration...you can read about side effects from recipients on this site.

Good luck in your journey.

Trew
Posts: 892
Joined: Jan 2010

I was injected with a blast of eligard- same kind of stuff. I am just wondering how much the PA is involved with other patients. Maybe i don't need to see the urologist- maybe the PA is enough and this is standard office procedure?

jmchugh's picture
jmchugh
Posts: 15
Joined: Feb 2010

To me this does not sound like the proper relationship to have with your doctor. If it were me I would get another urologist with a good reputation close to where you live. jm

marc1957
Posts: 79
Joined: Oct 2009

doesnt sound normal to me. Unless just seeing the nurses, I have often seen interns, but I always, always see the doctor as well.

If you want the names of 3 decent docs in grand rapids, they are

Tom Maatman**
Ken Shockley*
Paul Rodriguez

* - only does opens, same office as maatman, great guy, I went to him initially, but chose
Maatman for the Da Vinci

** - my surgeon, good guy

PR is a decent feller too, there are others from my work that have went there and speak highly of him as well.

I live in Hastings, not too far away from you.

-marc

bdhilton
Posts: 758
Joined: Jan 2010

I personally would not put up with this kind of treatment or should I say lack of attention and communication from my doctor or staff… You have got to feel good about who is treating you (at least in my opinion) and the only thing that should remain a mystery in life is life itself not your medical treatment…Best of luck

Ralphie62
Posts: 47
Joined: Feb 2010

There is nothing wrong with PA's, but you should always be given the choice to see your physician if you prefer. Many offices use midlevel care providers to assist with follow-up visits, or in various capacities, but you should never come to an office not knowing who you will be seeing or what your treatment plan is. I would call and ask to speak with the office manager and express your concerns, and get your records. I am a pracitioner, and we would never move a patient from the doctor's schedule to another provider without notifying the patient, and offering to reschedule the appointment if they prefer. You need someone you can trust and work closely with, not someone who doesn't have time. You are always so reasonable and kind in your posts....you deserve a better physician. Ralphie's wife

Trew
Posts: 892
Joined: Jan 2010

I am absolutely scheduled to visit with the doctor on my next appointment. That is the day I am also scheduled to get my next 6-month shot of eligard. But I want to have a serious discussion with the doc before the shot.

And for the record, my first PSA after radiation is .01. But that is a chemically induced PSA. I want to know and find out what a free standing PSA will be. Then again maybe I don't want to know that. That is why I want to see a real doc.

Everyone, Your comment have been helpful. I confess the hormone shots do effact my emotional judgment. I have been crying over almost nothing 3 or 4 times this week. Then I might go 2 or 3 weeks and do pretty well.

But that is another reason a doctor should mess with a patient on hormone shots!

lewvino's picture
lewvino
Posts: 1006
Joined: May 2009

Trew - If you haven't allready get Dr. Patrick walsh's book on Surviving Prostate cancer. You can get it online from the booksellers for around 10.00...He has a great section on positive margins and it helped me tremendously to read when I found out that I also have a positive margin. Good luck.

Larry

marc1957
Posts: 79
Joined: Oct 2009

trew

i have that book, you are welcome to borrow it........

-marc

hastings mi

Trew
Posts: 892
Joined: Jan 2010

Thanks for the offer. I may take you up on it.

I'll do an on line search later, and get back with you, probably tonight.

I do not think I am surviving that well, the book may help.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

At the minimum you should have been throuoghly told about the Drug you were going to receive, FROM the DR, not a PA. Second, your physician should have recomended an Oncologist to go see, PERIOD! Is he going to do the radiation?...I doubt it seriously.

I am curious of a few things. What was the positive margin(s)? What was your stats prior to surgery? Also, how much time passed from the surgery day until the visit he said there was positive margins and you needed radiation? If I understand you right they did not do a post PSA test without the influence of the Elgard drug so you have no idea what the real post op PSA is. Perhaps what he did with the shot is the right move to knock out the growth of the bad cells left behind but that should have again been explained. I would seriously talk frank with your doctor about what you experienced with his process or lack thereof so he can get an understanding of what he is doing to people and perhaps change his bedside manner with other patients before causing the same result as with you.

I was told you do not want to do radiation if at all possible until you have gotten back your continence and ED functions because it freezes in place the recovery at the point of radiation treatment forever never to improve from that point forward. Maybe others on here have opinions/knowledge on that....Actually my doctors PA was the one that told me that. When I was interviewing my surgeon prior to makeing a decision to go with him I said, hey if I do the PSA test and it comes back non-dectectable...why do I need to see you ....His answer...no if you go with me...you become my partner and married to me for life and I will see you every three months the first two years then if zeros every six months for another year, then every year. I liked that in one way and was thinking in the back of my mind...aha...thats how these guys make so much money.

Again, sorry you had to go through that.

Randy In Indy

Trew
Posts: 892
Joined: Jan 2010

I had bladder neck invasion with some maybe touching the bladder. Not too common.

I have heard the same stories about the incontinency issues related to radiation. I was mostly dry when I started radiaiton but the oncology depart at LLU said I could not afford to wait, I needed to be in treatment now. The Ed problem is unknown because of the hormone shots.

Sounds like you have as good doctor, Randy.

I see the doctor for real in April and I hope to get a few of these questions answered then.

142
Posts: 169
Joined: Dec 2009

It does not address radiation, but Michael Korda's book "man-to-man" is a good read to let you know that others have had some really bad days as well.
Also, Dr. Peter Scardino's book (don't have the title at hand) is in the same category as Walsh's, but perhaps easier to read.
*Found it - "Dr. Peter Scardino's Prostate Book" (2005)

Also, check your local library. They will likely have one or more of these. If you don't have a library card, it is time to sign up.

hopeful and opt...
Posts: 1315
Joined: Apr 2009

I keep a folder of my medical information, which includes tests, office visit doctor notes, etc, etc. These are mine that I pay for with my insurance...I get them every time that I'm at the doctors.

If necesary I am ready to see another doctor that I feel will benefit me........

I am also assertive when I see a doctor..........I feel that the doctor works for me....

I am interested in seeing the person with the highest level of education and experience..........not the PA or the receptionist.

Ira

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

That is what we all should be doing if not yet!

Trew
Posts: 892
Joined: Jan 2010

Yes Ira, very good idea.

I would also like to get an idea what a PA actually is and what they are quailifed to do. All this thread actually started over a discussion about Flowmax. I did not want to take the med and as I was trying to tell the PA at my last office visit for the 3rd time why I didn't want to take it, he cut me off and said, I'm telling you to just take the med. I wanted him to understand that the last week of radiation I was taking a 4 mg flomax am/pm to help with irritated bladder. It seemed to help with the ittitation some, but my bladder was shutting down. My the end of my last week of radiation I was hardly voiding any urine at all. I was almost completely stopped. At that time I stopped the flowmax, started with ibuprofen. The radiation was just ending, so that was still a constant. Within 12 hours I noticed my urine flow starting to trickle a bit better and I was feeling much better getting some of the pressure relieved. My feelings is it was the flowmax that was shutting me up since that was the only thing that changed. Yet the PA would not listen to me explain this. He just basicly told me to "Never mind, I"m telling you to take the flowmax." Well, I am a bit scared to right now. Does this make sense to anyone else?

Now, the Thursday before the Monday office visit I got a call from the urologist's nurse reminding me that I had a visit on Monday and that Dr. Mashni said to stop taking the flowmax. So I also had this he said/he said thing to contend with. That afternoon I called the office nurse and asked for clarificaton and the PA later calls back and says the docter deferrs to him on medical issues- take the flowmax. I have enough to deal with without this kind of stuff.

PAs, doctor visits, conflicting orders, hormone shots, weight gain, loss of intimacy, chills, hot flashes, memory loss, more weight gain, loss of muscle mass, loss of energy, wearing pads, effects of radiaiton, bladder irritation, up and down many times during the night, loss of sleep, did I miss anything?, and is there is reason I might be getting just a bit depressed?

And I certainly do not want any anti-depressants- more weight gain! I do hope spring comes soon!

And I do not want to take flowmax, at least not right now.

hopeful and opt...
Posts: 1315
Joined: Apr 2009

for medical documentation.........

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