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title: Betting against the future
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image: 
    feature: header_dice.png
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I am tired of medical decisions with a trade-off. On a regular basis I am presented with decisions that have deferred negative consequences in order to fix something in the present. The two examples that spring to mind are the BK virus nephropathy and hip replacement surgery.

On the first, when they initially detected that I had BK virus, the choice I was given was between staying on my immunosuppressive drugs with almost certain kidney destruction or coming off them and letting the rheumatoid arthritis go wild, but hoping the virus was cleared. I took the second option and lost the bet. The kidneys were destroyed anyway... _BUT_ the rheumatoid arthritis, in that period, also destroyed my hip joint, to the point where I can no longer walk on my right leg. 

So now I am faced with another, second dilemma. My hip is destroyed and I can't walk. It is "worthy of a replacement" in the consultant's words. BUT: hip replacements only last 10-20 years, with revisions. My life expectancy on dialysis is roughly the same period, but the choice, again, I must make will probably lead me to a situation where, if I am still going in 20 years, I have a non-functioning hip again -- and this time, it's permanent.

Lots of these medical situations involve making decisions that have bad tradeoffs in the future. And the fact that patients have to make them defers any consequential blame to them, also. If/when my hip does finally fail, I will ultimately have nobody to blame but myself. I _chose_ to have the hip operation, after all, even if my only choice was between the operation and constant ongoing gruelling pain in the present. I don't have a great record of betting against the future, although every decision I made at every point felt right at the time and the only option I could take. 

Time for another roll of the dice.