The Minnesota "Legionnaire"

gunfighter
New Member

Posts: 8

The Minnesota "Legionnaire" Apr 10, 2014 13:18:33 GMT -8

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Post by gunfighter on Apr 10, 2014 13:18:33 GMT -8

"Timothy J Wilt, M.D., is the recipient of the 2014 VA Under Secretary's Award for Outstanding Achievement in Health Services Research which looks at the quality of care and how it is delivered. He is a staff physician at the Minneapolis VA and also is a professor at the UM Medical School. Dr Wilt's work has led to the development of national practice guidelines to implement high-value, cost conscious healthcare particularly in the area of screening." April 2014

The lengthy article goes on to describe his PIVOT trial and his diagnostic research in COPD, Hepatitis B infections, to name a pertinent few diseases. The man has devoted his life to medicine and I can only applaud his devotion. Some members of this forum will have interaction with this professional so his contributions should be recognized and appreciated.

To Summarize: Tony, KC, Jerry L, et al.,
I will never be at the "either and" stage regarding prostate cancer screening and Dr Wilt was a member of the "Task Force". A few days ago I forwarded Tony the latest (August) guidelines for the VA clinicians to utilize regarding prostate cancer screening and my reply to the Chief Consultant for Preventive Medicine, VHA National Center for Health Promotion and Disease Prevention (NCP). In my letter I commended this Doctor for publishing a document that makes "no recommends for or against screening for prostate cancer with psa" for high risk men in contravention of the task force's recommendations; to be honest I was thinking primarily about Viet Vets so I had a bias. I would hate to be an African American Vietnam Vet. Tony is absolutely correct in his "silo" analogy. Doctors at the Portland VA are recommending more screening while mine is recommending none or minimal. Since the VA is a bureaucracy, I can only assume that each "silo" will receive gold stars depending on how much screening is reduced--lol. Have a great day!
Bill

KC
Veteran Member

Posts: 10,133

The Minnesota "Legionnaire" May 8, 2014 9:24:05 GMT -8

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Post by KC on May 8, 2014 9:24:05 GMT -8

“Prostate cancer in Vietnam veterans who were exposed to Agent Orange is considered a service-connected condition by the Veterans Health Administration.”

No uncertain or “either and” phrases in this clear and unambiguous statement.

Unfortunately, I’ve observed that some men who served in Vietnam and were later diagnosed with prostate cancer have been unaware of this important statement, unaware that exposure to Agent Orange is a risk factor for PC, and unaware of the additional benefits to which they are entitled.

Any vets who served with boots-on-the-ground in Vietnam are and can produce (i) a doctor’s report certifying that he has PC, and (ii) his DD214 discharge papers should immediately meet with his local VSO (Veterans Service Officer) to initiate the Form 21-256 “Veteran’s Application for Compensation and/or Pension.” Benefits (which are completely independent of PC treatment or non-treatment) will typically begin accruing the month after submission, even if there is a subsequent request for a Form 21-4138 “Statement in Support of Claim.” Also, note that your VSO can help find an online version of DD214 if yours has been misplaced or lost.

Help spread the word to Vietnam-era vets!

By the way, Dr. Timothy J. Wilt was one of 14 physicians who co-authored the paper which included the important statement quoted in italics above, and one of only two paper co-authors affiliated with VA facilities; he is with the Minneapolis Veterans Affairs Medical Center.

KC’s PC Case History: HERE

gunfighter
New Member

Posts: 8

The Minnesota "Legionnaire" May 11, 2014 11:24:47 GMT -8

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Post by gunfighter on May 11, 2014 11:24:47 GMT -8

KC,
I realize that Dr. Timothy Wilt has devoted a large part of his life to research. etc. and his contributions are recognized. I believe that one of our members has stated that when discussing PCa with his patients, Dr Wilt recommends that the patient not have a screening test. I don't know how this impacts "informed decision making"?
Bill

KC
Veteran Member

Posts: 10,133

The Minnesota "Legionnaire" May 12, 2014 12:59:39 GMT -8

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Post by KC on May 12, 2014 12:59:39 GMT -8

May 11, 2014 11:24:47 GMT -8 gunfighter said:

I don't know how this impacts "informed decision making"?

How should the physician impact the informed decision-making process?

My opinion is that the physician should inform the patient about any high risk categories which may apply (Agent Orange exposure, African-American, first relative of victim, etc) which might make PSA testing more beneficial. He/she should discuss possible outcomes of the PSA test; specifically that a high test result does not necessarily mean cancer, and that a low value does not necessarily mean no cancer. He/she should inform him that if his PSA test is high, a biopsy may be in order but that biopsies themselves are not risk free. He/she should inform the patient that the harder one looks for prostate cancer, the more likely one is to find it, and that most prostate cancers are in fact indolent. He/she should informed the patient of both the potential benefits and potential harms of treatment. Armed with this type of information, patients should be able to make an informed decision.

Even after all this discussion, what I've read about "informed decision making" is that a number of patients will still say, "so what should I do, doc?" From what I've read of Dr Wilt's focus on high-value care (good net benefit relative to expenditure), someone in the low-risk category would not be recommended for testing, and certainly not for annual screening. This does not seem out of the mainstream — very few (if any) physicians follow the formerly accepted mantra of "test everyone every year."

Last Edit: May 12, 2014 13:14:55 GMT -8 by KC

KC’s PC Case History: HERE

Post by gunfighter on Apr 10, 2014 13:18:33 GMT -8

Post by KC on May 8, 2014 9:24:05 GMT -8

Post by gunfighter on May 11, 2014 11:24:47 GMT -8

Post by KC on May 12, 2014 12:59:39 GMT -8

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