Wednesday, December 3, 2008

A Definitive Diagnosis

As expected the urologist biopsied my prostate within an hour of my arrival. "Let's get to it," he said, "this will be quick and easy". From start to finish the procedure took about 30 minutes. In terms of discomfort it registered 3.5 on a pain scale ranging in level from 1 to 10.

A week later I received a call from Dr. Ezee's office. A member of his staff informed me the biopsy revealed one or more "anomalies" . "Is it cancer", I wanted to know? "I am sorry", she replied, "I am not authorized to disclose such matters over the phone. Dr. Ezee intends to discuss the results with you personally. We have arranged for you to meet with him on Friday, October 31, 2008". This conversation occurred on October 14 which meant a two and one half week delay before I would officially learn the outcome of my biopsy. " Under the circumstances that seems like an awfully long time to wait," I responded. "I am truly sorry", she replied "October 31 is the earliest possible date Dr. Ezee can see you". It seemed apparent that neither of us could do anything more; so we ended our discussion.

Upon reflection a two and one half week delay seemed wholly unreasonable and totally unacceptable. How to proceed became the question of the day. Should I contact Dr. Ezee directly, and plead my case, or should I contact my primary care physician and ask him to intervene? Neither of these options appealed to me .Remembering that Dr. Ezee practised in a clinic with several other urologists, I called his office later that same day and asked to speak to his nurse. I posed the following question: "Is there any chance that one of the other practitioners could see me sooner by working me into his/her schedule?" She agreed to investigate this possibility and get back to me. A few hours later she returned my call. Dr. Ezee arranged to see me the following Monday. My followup appointment would be in two and a half days rather than two and a half weeks.

"First the good news Mr. Oberlin" Dr. Ezee began, "only two of the twelve samples we took detected cancer. With a Gleason score of seven your results could have been far worse. Your cancer is only moderately aggressive, and I can almost guarantee you, it has not metastasized. I recommend robotic surgery. Unlike most other treatment modalities, adverse side effects show up immediately and most are reversible". "What kind of side effects can I expect", I wanted to know. "Roughly 50% of radical prostatectomy patients became impotent," he said. "Nearly all such patients experience a degree of incontinence, but typically this condition is temporary. Longer term incontinence can be ameliorated in a variety of ways." " What about impotence", I wondered, "can this be corrected with medication?" "In most cases no", he responded. Changing the direction of our conversation Dr. Ezee offered the following option. "If you prefer I can implant your prostate with radioactive seeds." "Seeds are easy", he added ."Whichever option you choose we can get this done in a matter of weeks. How would you like to proceed?" "Before deciding I would like to mull it over for a few days," I replied. Before we concluded I asked him what he thought of proton therapy. Dr. Ezee shook his head, with genuine concern, "once you injure your colon," he said, "it is extremely difficult to repair." On this relatively uneasy note, I thanked Dr. Ezee for his time and professional consideration.

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