Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the day “November 7, 2012”

Making Right Sized Decisions Ain’t Always Easy

Sitting down with my urologist after hearing the diagnosis of adenocarcinoma of the prostate to discuss the options for additional screening and possible courses of treatment, one of the things he advised was to change my eating habits; “Eat healthy,” he observed.  That was about two weeks ago, maybe three, and I have yet to change my diet.  While I know that it is best to eat more veggies, less red meat and so on, I am having trouble making the commitment to doing so.

So what is up with that?  Here I am, making arguments for the ethical relationship with the other and I am avoiding the ethical relationship with myself.  So here is what I have decided to do…and it won’t be easy.  I decided to limit my consumption of red meat and eggs to once a week.  I figured I would start with a basic commitment rather than make an entire plunge into something I am pretty sure I won’t be able to maintain.  It would make my wife quite happy if I added fish to my diet, but I can’t stand the stench in the house after most fish is cooked so that is hardly a legitimate option unless I add fish while eating out.  In place of the protein from the red meat and eggs, I can easily substitute dairy protein in the form of cheese, yogurt and milk.  In addition, the vegetarian staple of beans and rice along with the addition of tofu in stir fried veggies seems to be a reasonable option as well.

The plan is to follow this plan of eating for the next month while committing to blog about how I am holding out.  About four weeks from today I will have my surgery which may screw up my plans a bit but who is to say.  In the long run, I am certain that this change in lifestyle will be good for me and for my family as well, if I can maintain it.

All that being said, as I write this I am cooking a mushroom barley soup with lima beans and lentils.  Now there is a marrow bone with a bit of red meat attached and two short ribs for flavor, but the meat per serving will be less than one ounce.  The soup along with a small salad should prove to be a hearty fall meal, one that fits within the bounds of this new approach to eating a bit more healthy.

Here’s the thing, I am looking to focus on eating healthier in order to positively effect the outcome of my prostate cancer.  At the same time, I know I have absolutely no control over the outcome in any real way and that if I thought I did I would be ready to become obsessive over the outcome itself rather than to focus on the moment that surrounds the actions I take in this very moment.  For me this is less about results than it is about acting appropriately, of becoming present for myself in order to be more present for others; it is an ethical responsibility that I cannot pass off to any other person; there are no substitutes.  So here I go, ready to jump off the cliff and see just what might happen if I stay focused on this moment, the one that will never be repeated, never be reenacted.  It is in this very moment that I make a decision to act or not act, to do what is next before me or to shirk.  It is a choice, an ethical choice that I am placing at my own doorstep.  Only time will tell how successful this will be.

Something About Statistics and Cancer

English: A photo of Stephen Jay Gould, by Kath...

English: A photo of Stephen Jay Gould, by Kathy Chapman online. (Photo credit: Wikipedia)

I am something of a statistician, having endured five semesters of post graduate statistics and research methodology classes while working on my doctorate.  As part of that education I read an article by Stephen J. Gould discussing mortality statistics and cancer survival.  Wikipedia summarizes the contents and force of that article as follows:

In July 1982, Gould was diagnosed with peritoneal mesothelioma, a deadly form of cancer affecting the abdominal lining and frequently found in people who have been exposed to asbestos. After a difficult two-year recovery, Gould published a column for Discover magazine, entitled, “The Median Isn’t the Message”, which discusses his reaction to discovering that mesothelioma patients had a median lifespan of only eight months after diagnosis. He then describes the true significance behind this number, and his relief upon realizing that statistical averages are just useful abstractions, and do not encompass the full range of variation.

The median is the halfway point, which means that 50% of patients will die before eight months, but the other half will live longer, potentially much longer. He then needed to determine where his personal characteristics placed him within this range. Considering that the cancer was detected early, the fact he was young, optimistic, and had the best treatments available, Gould figured that he should be in the favorable half of the upper statistical range. After an experimental treatment of radiation, chemotherapy, and surgery, Gould made a full recovery, and his column became a source of comfort for many cancer patients.

The whole point of Gould’s position is that the median, which in the case of cancer is highly skewed to the left due to the fact that many cancers are not discovered early making the overall statistic biased toward terminal patients discovered in the late stages of the cancer, as the proper statistic, rather than the mean or average, is a very powerful statistic.  Mortality statistics begin with the day of diagnosis, not the time of the onset of disease.  So my diagnosis places me in Stage 1, while that could have been, and may still be, Stage 4, depending on the presence of cancer cells outside of my prostate.  If, in fact, I am truly in Stage 1 then my chances for survival of this particular cancer are far greater than if I fall into Stage 4.  Because mortality statistically begins at the time of diagnosis, there is a significant bias toward the later stages of cancer where treatment is often unsuccessful.

Taken in total as I look at the mortality statistics and my own adenocarcinoma of the prostate, I can take some comfort in the fact that the cancer was discovered quite early and I am relatively healthy for a 69 year old male.  With the sole exception of some significant osteoarthritis and well controlled atrial fibrillation, my health is quite good.  The fact that scans do not indicate any metastasis is also a good sign; the fact that the CAT scan is inconclusive around the groin area muddies those waters a bit but a resection of the lymph nodes around my prostate will either rule out or confirm a metastatic migration of the cancer. Only time will tell if the Stage P1c is a correct stage diagnosis.

As things stand at this very moment, I have a very good statistical probability for long term survival.  In probabilities, however, it is black letter that if something can happen it will.  As an example of probability I can relate the time there were ten people left in a poker tournament at Caesar’s Palace and the last nine players would get paid.  I had three nines after the flop with two in the hole at a table of 5 players.  I went all in, expecting to collect the chips in the pot without opposition.  Everyone folded except one player who had three-3s.  I was a 99% favorite to win that pot and double up almost assuring that I would be in the final nine.  My opponent had only one card in the deck, the final 3, to win the hand unless I got the final 9.  The very next card to come on the turn was that 3, the 1% possibility happened and I lost the hand and was knocked out of the tournament.  Probability is good when it is in your favor but it is never a sure thing.

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