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Change in Medication

There is nothing permanent except change.

So far all had gone well. During his monthly follow-up on the atment strategy being followed by Arun, his oncologist had ed three parameters to judge the success of the treatment nd advancement of the disease, in order to decide when it cas time to change medication. The parameters were: rising trend of PSA, reappearance of symptoms and unequivocal increase in the number of lesions from radiology. Though radiology alone was the single-most important criteria-the appearance of even a single new lesion was enough to start a new drug-if any two of the three parameters were positive on two consecutive consultations, the decision for change was apparent. In early September 2011, Arun's PSA was rising and some pain began to appear off and on.

Casodex-the anti-androgen drug-was stopped and Ketoconazole and Prednisone were started. Ketoconazole would inhibit testicular and adrenal steroid production, while Prednisone was replacement therapy--replacing the essential corticoids depleted by Ketoconazole. These corticoids, normally produced by the adrenals, were necessary for maintaining life. The toxicity encountered by Arun was followed by minimal nausea-short-lived and vercome by frequent mouth-washing and sugar-free mint. These were oral medicines-easy to administer and carry on trips--and Arun was comfortable taking them.

Alternative Remedies

Arun was a great bel his childhood experie homeopath gave him un was a great believer in homeopathy, partly because of ood experiences with this form of medication. The copath gave him medication to boost his immune system. in homeopathy," he ultaneously with niscule doses that ects, or have any not revealed the mitted by law) but e first pregnancy op boy. There was

There is nothing specific for the cancer in homeopark said. Arun took the homeopathic pills simultaneo the other drugs. These pills were of such miniscule d. they were unlikely to produce any side-effects, or interplay with the other medications he was taking

In the third week of September, our second grand Seher, was born. As the radiologist had not reveal. gender of the child on ultrasound (not permitted by la had made similar pronouncements as for the first pre it was assumed that it would be another boy. The much excitement when a girl child was born instead. It the first girl to be born in Arun's family in three generatie Arun loved both his grandchildren dearly, but he always had a special bond with Arman. Possibly, it was because Arman was the first grandchild, but I suspect it was more because he looked just like Adil, our son, at that age. For Arun, it was like having his fully-grown son along with this child version of him, both at the same time.

At the beginning of December 2011, Arun had written about the progression of his disease and the fatigue he sometimes felt to his friend and cousin, George Verghese (known to us as Reji), a professor at MIT. Reji was very perceptive and connected Arun to Dr Paul Mathew, an oncologist in Boston with expertise in prostate cancer. Email communication with Paul was established. All details of previous treatment, blood tests and radiological investigations were sent. Dr Mathew had been greatly reassuring and had managed to placate Arun with the long list of alternative remedies available to him. Henceforth, an information regarding the progress of his disease and any regimen change were first vetted by Paul. He advised him on an exercise routine and a change in diet in order to ove the fatigue he had recently developed.

Regular physical activity may have a pro against cancer-tempering the adverse effects of the se effects of treatment. It is true that pati and radiation It improves mus quality of life. oxygen to the cells cancer. that patients experience fatigue during chemotherapy adiation therapy but exercise has the opposite effect. roves muscle power, cardio-respiratory function and of life. Improving the circulation provides more en to the cells which, in itself, is detrimental to the

Another Change In Medication 

After Christmas 2011, the monthly PSA had again started showing an upward trend. Though he had remained symptom-free, a CT scan showed a thickening of the bladder wall. The oncologist was of the opinion that the previous combination of drugs was no longer effective and replaced them with Honvan, another oral anti-androgen drug.

Honvan is a synthetic oestrogen that is converted to an active form in the body. It acts by lowering the levels of androgens, resulting in reduction of the size of the tumour. Arun continued to work and lead a normal life. He managed to visit his grandchildren as part of his daily routine, also meeting with friends and going on walks as before.

In the second week of January we went to Cochin for six days. Arun wanted his dose of Kerala food. For this, nothing was better than the food at The Grand Hotel, and we lunched there daily. The cuisine was authentic Syrian Christian-very fresh and quite delicious. In fact, the seafood comprised of that morning's catch. The fried prawns, meen pollichathu (fish in banana leaves), and coconut meat were the highlights. On the second day at lunch, as we awaited our food, a couple walked in. The man looked like a local, Woman was Caucasian, and with them was a little girl. They took the table adjacent to ours.

Suddenly, Arun got up from his chair and went up to ntly-arrived gentleman. I heard him say, 'Are you Paul Mathew?' Paul was completely blown away. Here n Kerala, on holiday from Boston with his family, he was in Kerala, on the recently arrived gentleman him. A month n his photograph d easily identified and an unknown person had recognized him. A earlier, while emailing him, Arun had seen his phor on the web. He never forgot a face and had easily id him. Paul proved to be a friend, an understanding caring oncologist, always factual, logical and down pushing us in the right direction. and down to earth.