When Will Dr Muskett Write A Column On Prostate Cancer Screening?

Dr Alan Muskett, erstwhile cardiac surgeon right here in River City, and nowadays professing plastic surgery at the same general location, has treated us Montanans to a useful summary of the problems of MMI, or Male Mid-Life Insanity, and he has likened healthcare to a restaurant buffet, and a host of other useful articles to enable us commoners to get through the menu of everyday medical and surgical care, almost always with a smile on our face.

Now we are wondering when he will give us the straight scoop on screening for prostate cancer. We remember that they told us that we could dispense with PSA testing when we reached the age of 75 or so. Now the Associated Press in today's Gazette has revealed to us old guys who are finally persuaded to get regular PSA tests done, that we shouldn't do that at any age. What is going on here? First of all, many of us don't trust the AP so maybe this would be a good time for Dr Muskett, or perhaps one of his friends of the urologic persuasion, to reassure us.

This would be a delicate operation because there are a fair number of older and some relatively young men who have had radical prostatectomies based in part on PSA levels. Telling their cousins and friends that they don't need to be screened risks the wrath of those who have had the operation, especially if they have had complications such as impotence and incontinence. And for those who like to have complete explanations for drastic changes in tactics or strategy, there are problems when we have to admit that some of the things we call cancer won't kill you if left alone, that even a normal PSA doesn't guarantee that you are free of prostate cancer, and that even our best surgeons are sometimes wondering what to do. This will not be good for the doctor-patient relationship.

I just asked Johns Hopkins to send me a free special report on my prostate biopsy. More on that later.

Perusing the Papers

As usual these mornings at the beginning of my eighth decade, along with taking my coffee and toast, I peruse the Billings Gazette and the Wall Street Journal, looking for articles to entertain or educate me. Oddly enough, in today's Gazette I found a serious column by the usually humorous Dr Alan Muskett, and conversely, a funny article in the Wall Street Journal, a normally strait-laced paper of record these days now that the New York Times and Washington Post have relinquished that title.

Dr Muskett writes about excuses in the fashion of Lord Chesterfield's Advice to his son, on men and manners: or, A new system of education. In which the principles of politeness,the art of acquiring a knowledge of the world, with every instruction necessary to form a man of honour, virtue, taste, and fashion are laid down in a plain, easy, familiar manner . . . but better and more succinctly. 


He is honest enough and without any noticeable irony to write this sentence: "I've had the privilege of reaching deep into the earth and snatching people out of the grave." And then he goes on to admit to mistakes and losses that might pull an ordinary man deep into a grave of self-pity but a really good surgeon will "give that loss a place in your life that is tolerable . . . to learn, to get better . . . to remember . . .[he] must remember." This is very good stuff. I hope he is saving these little essays to put them into a book one of these days.


And then I turned to the Sports section of the Wall Street Journal, yes there is at least a Sports page if not as much as a whole section. It is usually on the back page of the Personal Journal. I tried to capture part of it on camera, see above and below, but it is worth going over the whole thing by yourself. 

Probably some lawyer wrote a warning about the danger of concussions "following helmet to helmet contact and/or contact with the ground, object or another player." This is supposed to be posted in a prominent place in the locker rooms of National Football League teams. I hope Brett Favre reads it before he makes up his mind to return for another season. Anyway, Matthew Futterman thought it would be helpful to have warning signs for other sports. Here is another one to the right.


By the way, there is an interesting obituary in today's Gazette too. A guy by the name of Reber, born in 1919, what a life. He was born at just the right time. I wished I could have had a beer or two with him.

After A Little Poking Dr Muskett Rises Again

Today's Billings Gazette, perhaps to balance the usual crap from the Associated Press (AP), publishes some wise observations from Billings' own cardiac-turned-plastic surgeon, Dr Alan Muskett. Employing his usual acerbic but gently ironic wit on his and his friends practice of surgery he tells us, perhaps sub-consciously, a good deal of what our surgical friends are thinking about as they take care of the witless ones among us.

Physicians, especially surgeons—I hope that the surgeons will not object to being included in the larger category of physicians—have long taken care of people that don't pay them, perhaps balancing this with a slightly larger bill to those who can pay; and then more recently they accept the government's stingy reward of quite a bit less than the going rate for surgical care for us old geezers, without charging more to those who can pay—most of them even take the laughable amount that Medicaid offers. But in telling us what they are thinking while taking call for drunks and other less than sterling citizens, I suspect that Dr Muskett is asking us to read between the lines. There may be a line between the lines that we are getting closer to than we care to admit, especially when our DC lords and masters get done reforming the practice of medicine.
Paging Dr John Galt.

In any event, any column by Dr Muskett is always a good read. He entertains us, he instructs us and he warns us of our many follies.