On March 6, I sent Dr. Myers the following e-mail via the patient portal:
" I have two concerns which I believe warrant your attention. The first of these we have discussed on more than one occasion, but continues to evolve. My nipples remain quite sensitive and painful to pressure. A new, worrisome development (literally) consists of a checker-shaped and checker-sized disc beneath each nipple. Additionally there has been a modest growth of soft tissue on either side, more so on the left than the right. I doubt this condition is noticeable to others, but I need your help in determining when and if corrective action may be indicated.
The second concern involves my sexuality. Within the past four or five weeks there has been a dramatic reduction in my sexual potency. For perspective if asked to quantify the loss, I would place the figure between 35 and 45 percent.
My top priorities are to arrest the progression of my cancer and extend the quality of my life for as long as possible. My questions are as follows:
-- Is there a change in my protocol that will enable my wife and I to continue to "have our cake and eat it too?
--. At age 78 is it time for us to accept the status quo? Is it time to thank our lucky stars that we have had such "a good long run?"
Your assistance on these matters would be particularly appreciated.
Any additional comments or suggestions you care to offer would be most welcome."*
On March 16 Dr. Myers responded as follows:
"Reduce your dosage of Casodex from thrice weekly to twice a week. This change should help you with your quality of life."*
I would have preferred a more definitive answer. Rather than belabor the point, however, I chose to interpret Dr. Myers' response to mean that such a change may well (1) enable my wife and I to return to our customary level of cake eating activity, (2) suspend the progression of my cancer and (3) stifle any further breast development.
Accordingly I replied to his proposed treatment modification as shown below:
"I appreciate your responsiveness to these issues. I will make the change and monitor the results. Thanks again."*
***While most of the material in quotes is verbatim, I exercised my author's editorial prerogative here and there.