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Difficult Decisions in Uncharted Waters

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Difficult Decisions in Uncharted Waters

Difficult Decisions in Uncharted Waters

Difficult Decisions in Uncharted Waters

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  • <iframe src="https://www.npr.org/player/embed/11146099/13810442" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

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The following essay is from the NPR My Cancer weekly podcast:

If it weren't for bad luck, I'd have no luck at all. That saying has been attributed to a long list of people. I'd like to paraphrase it, and say, "If it weren't for bad choices, I'd have no choices at all." That's the situation I find myself in now, trying to decide what to do about the tumors on my spine. When I first found out about them two weeks ago, I wasn't particularly worried. I thought I'd just have radiation again, and that would be it. Compared to chemo, the radiation I had wasn't bad at all. Except it's never that easy.

Your spine can only take so much radiation. And it turns out I've had about three-quarters of the safe dosage. That doesn't leave much room for more. If I went ahead with it, my spinal cord could be damaged. All sorts of bad things could happen. So that's not much of a choice.

I could try chemo. But the drugs available to me would make me very sick. And there would only be about a twenty-five percent chance or less that they would be effective. And this is where it gets good. "Effective" means about another four or five months. So that's not much of a choice either.

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We could watch and do nothing for a while. One of the tumors, the largest, would most likely cause the vertebrae to crack or collapse within months, rather than years. In that case, I can have surgery. In an extreme case, they would replace it with synthetic vertebrae. And while having a bionic spine may have been great on television, it doesn't sound like much fun. The risks of that surgery are very high as well. So that choice? Well, there's starting to be a pattern.

The best possibility may be a new type of very precise radiation, designed for just my type of situation. But it's still radiation. I don't know if it will be too much radiation. Killing the tumors, but causing all sorts of sensory or motor problems, wouldn't be much of a victory.

I'm in this dilemma because my case is not quite normal. We've been able to kill, or just about kill, the tumors in my body. Normally, spine tumors aren't a huge problem because patients that get them usually have so many other problems that the spine tumors are a secondary concern. That's not the case for me.

So once again I find myself in uncharted territory. I'm going to have to pick one of these options. I'm going to have to make a choice. "None of the above" isn't on the list.

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