This past week was one of decisions of some gravity.  I received my latest PSA test and had my quarterly checkup.  Both were, by most measures, unremarkable, but laden with consideration, considerations which could define the progression, or suspension, of my disease.  The gravity of the day weighed unusually heavy upon me, but as with most things of this ilk, did not consume me.  However, in the end it was time to put down my bet, to place my chip on one square, and only one for that was choice afforded me.  The analogy comes from a time from the past when in Las Vegas for a trade show where I intently studied the roulette wheel.

The week began as normal my usual work week and considerations of things to come.  On Monday I recognized both my PSA and quarterly checkup were scheduled for the same morning, often meaning the numbers upon which all decisions are made these days, would not be available.  I took action, arranging to have the blood drawn on Wednesday, moving it up and thus insuring availability of the numbers.  The results were in Wednesday afternoon, PSA of 0.3.

Entering into the hormone ablation therapy my PSA was 271 upon which we devised the plan of going off the therapy if, or when, my PSA went to single digits.  With the last appointment we saw my PSA drop to 0.6, well below the target, both remarkable and highly unexpected.  I was now faced with the decision of whether to continue on the therapy or discontinue the treatment.  Before doing so I began some research and the first place I turned was Ron, my Hopkins doctor.

In reaching out to Ron I recognized him as somewhat conventional in his approach, more often adhering to the ‘standard of care’ than most.  However, I’ve also had time to develop a bit more than the standard relationship with Ron, I feel he now sees me, and my perspectives, more clearly.  His response, while not recommended, if followed closely, going of the treatment was a reasonable approach.  His response was, for me, by most measures unexpected.  It was also reassuring since very little data on intermittent use of hormone ablation exists, most of it resides within the minds of practitioners such as Ron, and of Paul.

When the day came to meet with Paul, I was introduced to his resident, a guy named Allen.  Paul opened the discussion by offering Allen a synopsis of my condition and noting my unconventional approaches to treatment.  He continued with some of the particulars and then began my usual physical exam.  Paul’s next comment was to say it was time for another shot, to which I responded, we were supposed to discuss that today.  It was clear this was not a conversation for which Paul prepared.  His body language immediately turned defensive, arms crossed leaning slightly back, he asked what I was thinking.  I presented my rationale, that of keeping the disease off-balance, of not allowing it time to adapt to our game plan.  Clearly, Paul was not convinced, Allen listened intently and watched.

We continued the conversation with Paul making a very salient point, that being my PSA while down, had not bottomed yet.  His point being to continue the treatment until my PSA no longer dropped.  I acknowledge his as being a very important point, but countered with a question.  The question being, what do we do if I have bottomed out, remain on the treatment and my PSA rises, I asked what that would mean.  His sense was it is likely that in that scenario I am already refractory.  I pointed out to him the oft mentioned statistic that the one very consistent known is that once refractory, the vast majority of those so afflicted die, Paul hedged on that but in the end I know this is one thing to which he had always held fast, his words did not resonate with me.

The conversation then turned to having a plan, something Paul had not recognized as being in place going into this therapy.  I pointed out that we had indeed established a plan based on the premise of going off the treatment when my PSA went below 10.  In pointing this out I added it is very likely I would not have stopped with a PSA simply falling below 10, especially had it not bottomed out.  The conversation turned as did Paul’s body language.  The wheels were turning and it was apparent he no longer viewed my rationale as being unreasonable, but instead, rather logical.

Getting back to my time in Las Vegas and study of the roulette wheel, when, on three separate occasions I saw someone win with seventeen black.  Some readers will also recall that in the movie “Last Holiday” which is about a woman who, presumed to have a fatal disease likely to kill her in weeks, won with three consecutive bets on seventeen black.  In that story, the main character placed a bet on seventeen black on three separate spins of the wheel.  Other readers will recognize seventeen black is almost on the geometric center of the board.  In the end, I chose to not continue the therapy.  In the end, I put my chip on seventeen black.

Happy reading, happy thoughts and happy trails.

As always, feel free to comment or you may email me at lifeabstractions@gmail.com

ciao

Lifesabstractions

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