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Q: I read your article, A New Step Forward For Early Detection of Bladder Cancer, online at buzzle.com. In the article you stated that you charge $250 for a UroVysion test. I just received a bill of $1178 for a UroVysion test. Am I being ripped off? The test will be paid for by me, not by insurance. Thank you. Ken M.
A: Hi Ken, The Urovysion test does run about $1000. I had negotiated a price of $250 for cash patients at the time of the article. This was about 3 years ago as I recall and I saw no reason why that should have changed. However, it must have been part of an aggressive promotion since they are no longer offering it to my patients at the $250 price as a screening test and your bill is about standard. For this reason, it is being used much less frequently as a screening test by my patients. I do believe you should call the lab and attempt a significant discount, however. That will often work when they know you are paying cash and they probably have a discounted rate they offer insurrance companies for the test. (It is used to follow existing bladder cancer patients and has some insurance company coverage, I believe in those cases.)
Q: Enjoyed your Univera talk in Portland last week. Chunking through your book. Interesting read... Curious - what assessment are you using to gauge the effectiveness of Rthymatix and RegeniFREE in the study you mentioned? Thanks...Jerry
A: Hi Jerry, In the study I am measuring some lesser known labs. They are Lp-PLA2, a marker of inflammation that is more specific for arterial wall inflammation than is CRP. I am also the measuring HDL subset known as HDL-2b. This is thought to be a measure of HDL (the "good cholesterol")function in the reverse transport of lipids back to the liver for re-use. Thanks!
Q: I was diagnosed with Fibromyalgia when I was 23, I am now 30, I have been a patient of Dr. Palmer\'s in Redmond Oregon, and I have no intense complaint. He is a caring and compliant doctor. However, I would really like to not be in pain, and not take so many pills. What is your base treatment for people with Fibromyalgia? Thank you Kelley
A: Hi Kelley, Fibromyalgia still has us all stumped. It is a very complicated disorder of pain “processing” by the nerves, the spinal chord and the brain and it has probably been around under different names (like Epstein Barr, Neurasthenia, and others) for centuries. Unfortunately, there is no one “base” treatment I use for my patients. In general we achieve some degree of improvement with the various treatment we try but not dramatic cures. My own strategy is to first look for any and all other treatable disorders such as thyroid and other hormone problems, vitamin or mineral deficiency, diabetes, food allergies, obesity, etc. I correct whatever is correctable. I also immediately evaluate for psychological stressors such as depression, bipolar disorder, ADHD in a person struggling with employment, etc. This is because our modern society brings so many high-pressure forces to bear on the average person that being psychologically out of kilter is very common and seems to increase the likelihood of Fibromyalgia. This stage may involve medications like antidepressants or stimulants to treat these problems, with the hope that quality of life will get better and perhaps the pain itself will improve a bit as well. My first approach to treating the condition itself is to manage expectations. Complete pain relief is something we are not (yet) able to achieve. Sometimes a patient does really well and seems to get mostly better, but that is very rare. With that in mind, I try to develop the understanding in the patient’s mind that they, not medication or the doctors, will mostly determine the quality of life they live. They must understand that they have an uphill task in getting through many days, but that they need to rise to the occasion willingly as much as possible. This involves mild daily exercise – even when fatigued, an ideal body weight and the elimination of the garbage food so many of us eat. Many don’t pull it off. They become “professional patients” and their disorder truly defines who they are. I am not being judgmental because I have lots of these patients and I know how tough this damn thing is. I have simply found that those who adopt as upbeat an attitude about life as possible are the ones who do the best, whether on medications or not. Last are the drugs specifically for Fibromyalgia pain like Lyrica-with its side effects and weight gain, Cymbalta-also an antidepressant, and Savella-also tough to take for some. These medications often help but the side effects can be significant and the benefits are sometimes “underwhelming.” Many patients wind up on narcotics and sometimes these provide much needed relief, however, more often than not, the relief is short-lived, requiring the patient to use ever-higher doses and eventually getting to a place where they hurt just as much, but are now physically dependent on the narcotic drug. Often their pain experience is worse overall on these medications. Naturally, I wish I had more and better news, but this is how I see the management of Fibromyalgia at the moment. There are a lot of so-called “cures” and I am open to anything from guaifenesin to acupuncture, but I have not found anything that works much better or in a greater percentage of patients than what I’ve outlined. Attitude and motivation are everything. Best regards, John
Q: Dr. Corso - The telephone number listed in the link to contact you is not in service. I'd like to interview you for a project I'm working on.
A: Sorry about the phone number update. The correct new number is 541 410-4303. The web site should be corrected soon.
Q: Dr Corso: I'm reading your book presently. Excellent! It's interesting that I always told my friends that I didn't want to die of a disease that could be detected on time. And then I find your book! My question: I'm, no doubt, a hypochondriac. A few years ago, fearing ca of pancreas (a friend younger than me had died of it) I had done, on my own, an abdominal scan, which was negative. Do you recommend I have another scan of the abdomen or do you think that it's not a good idea to get all that radiation (vs the benefits)? Can a ca of pancreas actually be detected early? After all, at some point we do have to die, don't we? (I'm 73 yr old) Thank you, Alfredo Santesteban, M.D. F.A.A.P.
A: Hello Dr. Santesteban. Thanks for the question. I do not believe there is any evidence that routine serial screening for pancreatic cancer, or even earlier detection, outweighs the risk of both the radiation and the fallout from false positive results (more radiation, probing with sharp objects, etc.) Unfortunately, this one is still too rare to make routine screening more useful than it is dangerous. For those who really feel anxiety about NOT looking, I would only look with non-ionizing image modalities like ultrasound or MRI. And then I would be VERY conservative about the results should something “equivocal” be found. (Please see Chapter 11 in my book called “Health Screening – Consider the Risks” for a discussion on how to keep screening in its place.) Of course, the hope and expectation is that we will eventually be able to come up with a better screening test or at least be able to select those people most at risk, who would therefore actually benefit from CT-guided pancreatic screening.
