TechnoMonk’s Musings

Please note:

This long essay (it’s at least four times optimum blog-post length) makes my personal case against the “medical establishment.” I do not take on the insurance companies here, though, but rather the doctors who provide front-line health care for us all.

Although I deal at length with the PSA blood test in the discussion below, I totally omit mention of the controversy currently raging about this procedure.

Caveat lector: this post would likely merit an “R” rating near the end...

I’m one of those old geezers for whom the TV commercials advertising such products as Flomax and Proscar are made: I have an enlarged prostate [benign prostatic hyperplasia (BPH)]. BPH is characterized by a number of urinary symptoms, one of the most obvious being the number of times I have to get up during the night to relieve myself. (For a list of other symptoms, click here.)

As I have monitored my condition over the last 12 years, with the assistance of various urologists in the cities I have lived, I have regularly (at least every six months) undergone the blood test for prostate specific antigen (PSA), the front-line screening protocol for prostate cancer. During this time, as my prostate has grown in size, my PSA has risen slowly, steadily, but not dangerously. I keep track of the results by means of an Excel spreadsheet and graph, and even furnish my doctors with a least-squares plot of these data at every appointment. At one point, back in late 2002, there was an unusual spike in the one of the readings, and I was advised to have a prostate biopsy. This procedure is a very invasive and uncomfortable one, but I went ahead, in early 2003, and did it anyway. After eight full days anxiously waiting, I finally was informed that the result was negative. Since that time I have simply continued to monitor the slow, steady, predictable rise of my PSA level.

Well: except that that all changed recently. In both January and March of this year, my PSA tests have yielded significantly higher readings – data that do not fit neatly within the paradigm of my least-squares analysis. After the January result, my urologist reacted as I did: one test alone means nothing. Let’s wait a bit (a few weeks) and do it over again.

And that’s what we did, though the second test in March indicated a slightly elevated level compared to the January number. It was at this point that he stated that it was time for concern and said, “you know where we go from here.” He meant a biopsy, of course, and I declined, indicating that I wanted to wait for one more blood (PSA) test before undergoing that procedure again.

However, he was very insistent that we do a biopsy, and I was just as opinionated that it was not yet time. I told him that I had one more hypothesis to test out before I would submit to the procedure. Simply put, my theory is: my PSA number is inflated due to a new dietary supplement I had started taking. Last October (over two months prior to the January blood test), I began a product called ArthroZyme, advertised as an anti-inflammatory agent, to see if it would help me out with the chronic muscle pain that has plagued me for the last few years. The active ingredient in this product is a proteolytic enzyme called serratiopeptidase. And, as it turns out, PSA itself is itself a proteolytic enzyme. I believe it is much more than coincidental that immediately after I began taking a proteolytic enzyme supplement I start testing differently for a specific proteolytic enzyme. I believe the two phenomena are connected and that this is the simplest possible, and most likely, explanation. I contend that this hypothesis is one that merits serious consideration, and that I should, therefore, simply stop taking the supplement and re-test.

As it turned out, I was only able to leave the urologist’s office in early April after hearing the strongest language he could muster that I was making a mistake and the he strongly recommended this test. NOW.

Of course, I don’t think I’m being at all unreasonable.

I’m the guy, after all, who was told, by TWO doctors, in no uncertain terms, one night in an emergency room, that he had bladder cancer. But I didn’t, as the cystoscopy (now there’s an invasive procedure), performed a couple of days later in a doctor’s office, conclusively demonstrated.

I’m the one who submitted to a biopsy back in 2003 on the basis of a PSA spike. And I didn’t have cancer, then, either.

I’m the one who has been totally discounted by my primary care physician, to the point of being told that my body aches and pains were “psychiatric” in origin and that the supplements I take (and rely on) couldn’t possibly be doing me any good.

And, I’m the person who was kept waiting for a half hour in a neurologist’s office after having experienced the intake nurse botch the explanation of my test results – only to finally talk to the doctor and learn that the (MRI) result in question was inconsequential.

In short, my trust of most medical professionals is exceptionally low, based on a history of negative experiences, how I’ve been treated by said “professionals,” and the inability of so-called “Western medicine” to get a cancer diagnosis right or to provide any kind of explanation for what’s going on with my chronic pain.

In the urologist’s office, I had to ultimately, assertively, take charge of the meeting and say, “look, this is how it’s going to be: I’m stopping the supplement and we’re going to re-test in a few weeks.” I took away with me a lab order for the blood test and an appointment card for early June.

THEN: last week I showed up for a previously-scheduled appointment with my primary care physician. After a very cursory greeting, he immediately launched into a lecture on how irresponsible he thought I was being by ignoring the urologist’s advice. In fact, he went directly to his computer screen and read to me, word-for-word, the report forwarded to him from my urologist. The write-up was clearly written to make certain that there was no doubt that I was ignoring sound medical advice, but the most irritating and distressing element of the exercise was that he read it to me with an intentional and highly-exaggerated condescending attitude. He was clearly trying to shame me into changing my mind by giving me the message of (a) how stupidly, (b) how crazy, or (c) how both, I was behaving.

“Interesting,” I said. And then I showed him the latest PSA graph, the supplement bottle containing the proteolytic enzyme I had stopped taking, and offered my explanation. I indicated to him that I was merely applying the well-known principle of Occam’s Razor: “The simplest explanation for a phenomenon is most likely the correct explanation.”

To which he, again, with an air of annoying superiority, replied, “that would be fine, except that what you offer is NOT an explanation at all, and you’re taking unnecessary chances with your life.”

I had experienced this kind of situation with him before, of course. The first true break in our relationship came about when he labeled my physical symptoms as likely “psychiatric” in nature. During the appointment at which that language was used, I let it go; I confronted him on his condescending behavior the next time I saw him, however. And he apologized at that time.

He apparently really doesn’t get it, though. Now the same kind of attitude was being exhibited over my PSA result. I sat silent for a half minute or so, took a deep breath, and then said,

“Look, I really don’t think this relationship is working out. I have much different expectations of physician behavior than you have been able to provide. Some of the qualities I expect from you are clear communication, respect, decency, dignity, honesty, and support. I resent your snobbish, superior, condescending attitude and your assumption that you know what’s “right” for me. Let me tell you, I’ve spent a lifetime becoming an expert not only on my body, but on knowing my inner self...and believe me, the numbers you have cataloged away in your little computer there are not me. I know me. You don’t. Not at all. And, you’re apparently exceptionally reluctant to allow me the freedom to make decisions about this body myself. I think it’s best to part ways, and I’m wondering if there’s any physician you know of that would be open-minded enough to take on a patient who knows what self-care is and is seeking a doctor who will serve as a consultant to that self-care.”

And I wasn’t done yet...

“Look” (I said yet again; I was repeating myself), “I’ve got the lab order for the PSA test right here in this folder. And I’ve got my next appointment with the urologist scheduled. I’ve got time scheduled away from work in June for a trip, but the plans are soft. I can easily change them and stay here and be available for a biopsy. I’m testing a hypothesis. A reasonable one, I think, but I know I could be wrong. I’ve got the plans all laid out. I’m taking care of myself. What the fuck is your problem?!”

This guy, taken in tandem with the urologist a couple of weeks earlier, had obviously struck a nerve with me: pushed my buttons big time. I immediately started reflecting on all the pre-med students I had competed with in math and science classes in college – along with my complete and utter disdain for them at the time. They were all about their course grades and med-school admission. They were exceptionally good memorizers of content, but, generally speaking, amazingly poor critical thinkers. They always got A’s, but I always got a higher A, especially in those courses that really meant something: organic chemistry, physical chemistry, etc. I pretty much kicked their collective butts. Pre-med? HA!

During my time in my primary care doc’s office, I became angry, resentful, (defensive, of course), and as assertive as I’d ever had to be in that kind of environment. I was appalled that I hadn’t changed doctors when he had labeled me a nut case the year before.

He ultimately apologized. Again. He said that he did listen to me and support me. And he said that he really didn’t know of anyone that practiced medicine any differently than he did...that everyone he knew was as skeptical of dietary supplements as he was, and suspicious of patients who experimented with unproven “natural” substances who sometimes ascribed to them “magical properties.”

I left the appointment by reiterating that I had a plan, that I was sticking to it, and that, despite his insinuations, I was neither stupid nor crazy. I said, simply, I knew how to take care of myself, and I was doing just that.

Now: could I be wrong about all this? Could I be merely delaying the inevitable cancer diagnosis by insisting on testing my theory? Might I simply be afraid of undergoing a painful, invasive procedure? Might I be terrified that I really do have prostate cancer?

The answers to the above: YES, of course. To any or all of them. But, it seems to me that I have a legitimate theory, one that I’m entitled to test out. The blood will be drawn next week and we’ll soon see if the PSA level drops. Or not.

Could I die? Well, yes. We’re all going to die, right? Have I put my life at risk by testing out a reasonable hypothesis? I rather doubt it, but, as I remind the doctors, it is my life to risk. In the matter of my body, I get to choose. Pure and simple, I get the final word here. It’s my body. It’s my choice.

Dear Doctor: If you are unable to partner with your patients in their care, then you have little business doing your business. Go be an auto mechanic, where the computer diagnostics these days are amazing, and quite often accurate, I’m told. Or, at least, do something else. And, for sure, if you can’t treat me with any more dignity, respect, or support than you’ve been able to muster so far: please go fuck yourself.

Soundtrack Suggestion

I told the witch doctor I was in love with you
I told the witch doctor I was in love with you
And then the witch doctor, he told me what to do
He said that ....

Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang...
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang

(“Witch Doctor” – David Seville)