Required fields are marked *, PHONE 310-827-7707 Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Second opinions offer different things in different circumstances, Dr. Matasar says. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. Good Luck and God Bless everyone. Masks are required inside all of our care facilities. The total number of cores with carcinoma is 3 T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Your email address will not be published. A second opinion is part of the education process that is critical for many cancer patients. The people were great. Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. A new study by researchers at the Johns Hopkins University has found that . Now the oncologist wants to perform a PSMA Pet Scan. They agreed with the PI-RADS 4. Accessibility Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. The percentage of Gleason grade 4 and/or 5 is 5 % Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Expert review of your case by a Cleveland Clinic specialist. Over kill and redundancy I know, but it's my money, my prerogative. My urologist suggested a couple more PSA tests followed by an MRI. Please enable it to take advantage of the complete set of features! I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). * Location: Left, anterior, base to apex, transition zone I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach.
Stanford Medicine Online Second Opinion Program Dr. Nour is 100% sure that nothing has spread. desired outcome. Using the Bullet Volume gives you gland of 25.55. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. poorly defined margins and intermediate to low T2. Dr. Jonathan Epstein of Johns Hopkins University Hospital. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? The review process normally takes several days, after which we will send your slides and other materials are returned. See this image and copyright information in PMC.
Natural history of progression after PSA elevation following radical My thoughts focus on the fact that I have a disabled son who needs my care. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) And again, most of you tell me time is on my side, so I am comforted in hearing that. Discover what's to love about Charm City for yourself. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? Request an Appointment 410-955-6100 Anyone else encounter something like this? Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 1: Prostate, right lateral apex An accurate diagnosis is essential to ensure the most effective treatment. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. I'm turning 58 in one week.
Second opinion Johns Hopkins? - Prostate cancer The linear amount of tissue with carcinoma is 23 mm No definitive evidence of distant metastatic disease is seen." Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. When I was diagnosed I really thought that I will live only 2 years. However, there are also many more options for treatment and these options are more complicated than in the past. I retested in January 2019 and scored 4.20. 8. Secondary Gleason grade: 4 * Location: Right, anterior, apex, peripheral zone Thanks, -------------------------------------------------------- Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, Schaufeld Program for Prostate Cancer in Black Men, Read about the latest prostate cancer discoveries by our world-renowned researchers, Learn more about prostate cancer in our health library, Watch: What to expect during your post-surgery hospital stay. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. Reasons for obtaining a second opinion from urologists. My experience at Johns Hopkins was awesome. Diffusely decreased * PIRADS v2 Score: 3 In fact, additional biopsies revealed no additional cancer. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. World J Urol. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Watch: Are supplements good for prostate health? The percentage of tissue with carcinoma is 70% Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." Benign prostatic tissue Not all cancers are the same and not all treatment plans are absolutely clear. This teamwork ensures the best possible patient outcomes.
Getting A Second Opinion On Your Pathology Report - Cancer ABCs * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Do any of you have an opinion or actual experience with any of the three listed below? Any input on this would really be appreciated. We will give that a shot and see how it turns out. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. He was right. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. It took me awhile but minutes ago received my second opinion from Johns Hopkins. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. ---------------------------------------------------- Then about a month later I started 28 fractions of Proton Radiation.It was painless. B. Prostate, right mid, core biopsy: It is still important to do your own research. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. Following the advice of all on here, I need a team of doctors to manage my care. Just had my appointment today and they are pleased with the results, so far. A biopsy was performed on 2/26. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. So, I believe I made the right choice. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. I guess TWO national centers of excellence are better than one? I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. I am unfortunately "officially" joining the club after getting my biopsy results today. I just turned 71 in February. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Careers. What are you doing about it? Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? Fear motivates you to want to treat this as soon as possible. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Anyone with insight into this and advice? It can be caused by many factors, including infection and inflammation. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Even at the age of 48, he thought I would be a good candidate for AS. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . Suspicion for malignancy left anterior base-to-apex transition zone; Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 2. There are lots of lessons learned on the forum. Reinterpretation of imaging scans and lab tests. Dont Miss: Bladder Control After Prostate Surgery. I wish the VA would be more informative about this disease they owe it to our veterans. Patients may experience a fever or chills as a result of the infection. They hesitated calling it a TARGET LESION, but scored it PIRADS 4.
Johns Hopkins Prostate Cancer Second Opinion Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Obtaining a second opinion in Pathology can in a small percent of cases lead to a complete change in diagnosis in a wide range of conditions including non-cancerous growths, inflammatory disorders, infections, and cancer. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. Second opinions offer different things in different circumstances, Dr. Matasar says. I have been drinking out of an information fire hose. After a little experimenting I have been able to achieve a partial erection. Patients may experience a fever or chills as a result of the infection. What are your opinions of what that is, and where to get it? Overall my PSA is between 4 and 10. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Recently diagnosed a Gleason 3 + 3. Benign Processes: It would be more convenient to use Mayo but I want the best practitioner regardless. Maybe lycopene and pomegranate have helped. In severe cases, a catheter may be required to relieve the symptoms. It was easy.
Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Oncologist. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Need guidance choosing from multiple treatment options. MRI RE-READ #2 (VERY VERY well respected radiologist): The study was published online Nov. 7 in the journal Cancer. FOIA I appreciate any comments or insight that anyone wants to share. Jonathan Epstein, M.D. They did 9 patients in Phase I and there have been 12 so far in Phase II. 2. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. You feel healthy, you arent in pain, you But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. -------------------------------------------------------- We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment .
Masks are required inside all of our care facilities. Am I wrong? A blocked urethra can also damage the kidneys. Benign Processes: Caused me to bleed heavily. I had a very bad experience with an incompetent nurse that did a catheter change. The urologist offered surgery and radiation as options on 3/10 when we met. Younger men also sought the 'best' doctor. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. doi: 10.1002/cncr.30412. One to a 3+4=7 and the other to a 3+3=6. I am 65 and in excellent general health. 4. Does this also include HIFU, Cryoablation?
Prostate Cancer: Symptoms, Causes & Treatment - Cleveland Clinic FAX 310-574-4002 1. Do I need a third opinion? Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. Their opinions are widely held to be definitive. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. It is OK to be overwhelmed with info. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. I could not get a definitive answer from them on how much, how many cells, or any information. Men need to be educated on all treatment options to protect themselves from a biased industry. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. A week later had catheter removed and had no bladder leakage problems. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. 180 days after treatment PSA was .50. doi: 10.1002/cncr.30412. A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. This may include imaging, blood tests, prior treatment, and pathology reports. information. Prostate cancer is the second-most diagnosed cancer in American men. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. First let me just say what so many others have previously stated, the thought of going on this journey alone is frightening, I cant imagine traveling this road alone. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Your doctor is not sure what is wrong with you. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. We are vaccinating all eligible patients. During puberty, the body produces semen in a large number of cases, including enlarged prostate. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. Over 80,000 specimen cases are seen at Johns Hopkins each year. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Thanks for considering.
Biopsy Results: What Do They Mean? - Prostate Cancer Foundation -------------------------------------------------------- Youve just been diagnosed with prostate cancer. 3. 3 months has passed, and its time for a PSA and a plan to have an MRI. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Benign prostatic tissue Had a little complication a day after release, excessive blood/clots in urine. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. That is literally the first time I heard that term other than seeing it in my pathology report. Im currently 67 years old. Time moves fast when dealing with cancer, but Doctors dont. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. I have developed an "abscess" on my prostate. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Dr. Erick Walser at University of Texas Medical Center. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures. Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. Call us with any questions: 410-955-2405, ext. Assessment categories for this lesion: While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. Two weeks later I meet with my Johns Hopkins Dr. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. If pain is present, a digital rectal examination will reveal hard areas. Primary Gleason grade: 3 My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. IMPRESSION: This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed.
A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. So off I went to see a community urologist who performed a needle biopsy in his office. Surabhi Dangi-Garimella, PhD. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. Slightly In the United States, prostate cancer is among the most common cancers found in men. And should I treat prostatitis before FLA? Prostatic Adenocarcinoma Please don't hesitate to make any observations or ask questions. Enter the last name, specialty or keyword for your search below. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. D. Prostate, left base, core biopsy: Masks are required inside all of our care facilities. SMIL radiologist reported nothing found. Methods: Most reputable HMOs can, however, deliver state of the art treatment for most cancers. What have your doctors told you? Be well. 9. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. And just this week, 1 YEAR post treatment, it is .46. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion.
Second Opinion Pathology | MD Anderson Cancer Center Masks are required inside all of our care facilities. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. 2. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. Johns Hopkins second opinion - nothing found. Day 7 after surgery I took my last pain pill. Thank you for your understanding and cooperation. 6. You're also at greater risk of prostate cancer forming before age 50. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? He recommended waiting and watching at that time due to the lower PSA reading. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. This is often the case when the primary physician advises an expensive treatment. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Bethesda, MD 20894, Web Policies A total of 2386 men responded to the survey (adjusted response rate, 51.1%). Adenocarcinoma: Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Specimens Submitted: I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. There are so many different departments at Hopkins that I don't know the optimal department to contact. This is a PI-RADS 5 lesion in You may also complete an online appointment request form and we'll respond to schedule an appointment. By Dec 2019, my PSA reached 4.13. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? After applying exclusion criteria, the final analytic cohort included 2365 respondents. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news.