Maybe if I write this down I can get it off my mind for a while.

One of the peculiar things about CLL – which is what people call Chronic Lymphocytic Leukemia if they can’t spell lymphocytic – is that you can be in Stage 4 and not get all exercised about the need to start treatment.

Because it’s not a curable disease the treatment just reduces the symptoms. And since I don’t have many symptoms, there’s no rush. After looking at the bone marrow biopsy, my doctor declared I’m fairly healthy for a guy with stage four cancer.

That’s a bit like saying Russell Crowe sings okay for an actor. Except he doesn’t. Even for an actor. So just forget this whole paragraph. I just wanted to throw it in.

We walked into my last appointment expecting to hear that I had to start treatment right away and then trying to choose among the various tried and true treatments and the clinical trial protocols that are out there. I don’t mind saying I was pretty depressed about it. It had been five years since we last went through this. And even though it wasn’t hard to do and I had no evil side effects and didn’t even lose the hair in my ears, I was not looking forward to doing it again. Who wants to hang out every few days with folks in recliner chairs, wrapped in blankets and tubes in their arms?  No one wants to be reminded that they have an incurable disease. Not that I need any reminding. I get up every day and look at the fat guy in the mirror and tell him he has cancer.

And then my doctor said it. He didn’t think we had to take an aggressive stance. My marrow is doing okay, as marrow goes, and we can wait awhile. We walked out feeling pretty good.  Relieved. Until the second thoughts started setting in. Maybe I should be treating this stuff. Maybe I shouldn’t wait. Maybe it will be better to get started and get it over with. After all it’s stage four.

So there we are. There’s no reason to treat it right now. But there’s no reason not to.

I did what you would do in this situation. Made a list.

And that’s where I’m at.  Or, so as not to end a sentence in a preposition, that’s where at I am.

First, I’ve got great faith in my doctor. He is the top of the line in CLL treatment and research. Tell another CLL patient anywhere in the world that you see Tom Kipps and they will ask if they can just stand in your presence for a while and breathe the same air.

And it’s true there is some stuff going on right now that seems exciting, if this is the sort of thing that excites you. Not that it’s a cure, but that it might put off another round of treatment for a fairly long time.

It’s not necessarily fun stuff. A drug that has finished clinical trial and has been flagged by the FDA for fast-track approval should be available early next year. It’s called Ibrutinib, apparently because all the decent names for drugs were already taken.

So that’s a possibility.  It will be a legal drug and as Nancy Reagan taught us, legal drugs are so much better than those naughty illegal drugs.

(Stock tip: Google Ibrutinib and most of the first page of results is about the money the company will make. So that should make me feel good about it.  I mean, has Jim Cramer ever been wrong?)

It does have some side effects and it’s brand new – you might even say it’s newer than brand new – so who knows what it means in the long-term or how long the long-term will be.

Then there’s another drug that my doctor is high on – figuratively speaking. Maybe I should say “he’s enthused about”. It’s called ABT-199, further proving that all the good drug names have been taken. It is doing really, really well in trials, except for the handful of patients who died. I guess it is the real life example of the adage that “what doesn’t kill you makes you stronger.”

They’re pretty sure they’ve got that part under control, because dying is not really the goal and besides, it is really bad PR to have patients die on you.

So that’s the long version. The next appointment is in January and I’ll be ready for treatment then, whether he is or not. It’s just too much psychic energy to have to think about it all the time.