Two Bags, for now

 Nov. 23, 2011

Two Bags, for now

I lied in that last post…no CT scan.   But I do now have two plastic bags.  I have had no CT scan since September.  I did have a “loopogram” on Nov. 10…if you are interested in more info on that test see http://www.unc.org/publications/1/UNC_Pipeline_2001FINAL.pdf

Since the loopogram showed that the right ureter looked like a string—BAD! while  left ureter was like a small pipe ( the diameter of a sink faucet feed pipe about ¼ inch)—GOOD!.  My new urologist suggested that an interventional radiologist do a “minor procedure” of placing a stent through my right flank into the kidney and ureter…the stent has a have a plastic collar where the blockage was.  Along with the stent, I now have a drain tube coming out the right flank and attached to the new and second bag.   And for now, I am now emptying each of the bags  when it filled with a cup or two of urine (and for the first several days some  blood for added color). 

 In contrast to the first procedure where the drain tube remained in place 4 days (See earlier post “two additional guides”) this one is to remain for 6 to 8 weeks. (If I can stand it.)

Oh yes, I am very pleased to report that my new PCP  (Dr. Kelly Scott) and I  seem to have a good understanding of each other and my overriding desire to maintain quality of life as long as feasible.

 (Sidebar: For anyone over 60 I highly recommend the recently published book “Rethinking Aging; Growing Old and Living Well in an over treated Society” by Nortin M. Hadler, MD.   I like it because the author provides empirical evidence that medical interventions for us “old farts” often result in lower quality of life AND  much more pain and suffering. 

“Everyone who is sixty already has significant atherosclerosis.  By seventy it is impressive. Most who are sixty are harboring cancer, and nearly all who are seventy are harboring cancer.  Nearly all who die in their ninth decade do so with many potentially lethal diseases, not from most of those diseases. It makes no sense to cure the diseases one will die with in the ninth decade and little sense to cure the diseases that one will die from in the ninth decade if another is to take its place in short order.”  (Page 175)

I remain adamant: no chemo and no major interventions. 

Do I get another CT scan?  How long do  I keep the new drain tube and the second bag? 

New Guides and More

I believe I am still out of cancerstan.  

This Thursday I get another CT Scan of the abdomen. 

However, recent conversations with my guides have brought to light irreconcilable differences (ID). 

Those ID result from my desire to avoid additional major medical interventions.  

As a result of the conversations:

I have decided to replace my urologist;

 and

my Primary Care Physician (PCP) guide has asked me to find a new PCP guide.  

It feels a lot like a divorce. Sad yet necessary.  

Sidebar:

Quote from my PCP's letter of Oct. 31

"The physician/patient relationship is one that depends on mutual trust.  Because that no long exists in our relationship, I think you 'd be better served by finding another physician where you can establish the relationship you deserve..."

I will see the former this Friday and the new PCP Monday Nov. 13. 

Based on their interpretations and advice, Mary Ann and I hope to decide on dates for the European trip. 

Sidebar:

I have three reasons to be skeptical of and likely to reject major medical interventions:

1.     I am old.  I was born in 1934 and one of these days I am going to die…I do not want major medical interventions, 

        which could result in 2 or 3 months of recovery or major side effects effecting quality of life.  Further more, I do not want to be kept alive in order to have a higher probability of dying from Alzheimer’s or a stroke…   

       both of which would result in being dependent and costly.

2.     Taxpayers have already spent over $40,000 on my care.  

       Major operations cost over $15k and chemo costs $2k to $10 per shot. I am not worth another $20k in medical treatment.   I and my fellow “old farts” are hogging Medicare and medicaid funds.     

      Too many children and young adults are unable to obtain the medical care they need partially because of the public policy    of taking care of the elderly first.  In my view at age 77, I am not worth as much as a younger person. 

3.     Major medical interventions often decrease the quality of life…more years of low quality life, makes no sense to me. 

Some History

As you know by now, I have chosen to forgo some recommended treatments.

My case has been written up in an electronic newsletter, "The Lund Report".  

you can google 

http://www.lundreport.org/

then search for "quality of life"

alternatively you might load onto your browser  the long URL below

 for the direct link

http://www.lundreport.org/resource/cancer_patient_believes_quality_of_life_should_come_before_treatment