Staying in the lane

We saw Dr P on Monday (22 November). The PSA was 1.29, which he described as a “very minor increase” on the previous figure of 1.01. The good doctor added that

  • Enzalutamide is known to give such increases, so this one was “not unexpected”
  • the PSA could come down
  • he thought the PSA was “just grumbling along”.

Most importantly, I still feel fine. After the consultation I walked up to Epworth Eastern to have my Zolodex implant, which was delivered as usual.

The preceding week we had finally gotten away for our mini-break in Daylesford (two nights in a self-contained villa near the lake). We had booked this originally in August for September, I think, and it was deferred three times with various lockdowns. The holiday was lovely, but its conclusion was a tad stressful. On the morning of Friday 19th, while I was getting all our stuff together before checking out of the villa, I got an SMS alerting me that we had a message on our landline. (We seldom use this number, and consequently don’t often check the message bank attached to it.) I thought I could play back these messages remotely, and found out how to do so after a bit of Googling. The message directed me to call Epworth Eastern, where I was booked in to have the Zolodex the following Monday.

I rang the number that had been left on the message, and got through to the day oncology ward at Epworth Eastern. I had to have a Covid-19 test before I could have the implant on Monday. (They apologised for the short notice — apparently this is a new hospital policy.) I didn’t have to get the results back in order to have the implant — I just had to have had the test.

My beloved was taking the waters at the Hepburn Springs bath house at the time, and had the car. I tried to figure out what to do. Should I try to have the Covid test in Daylesford? Or should we cancel our lunch booking and drive straight back to Melbourne? I decided we should go to lunch as planned and drive straight home. I would then have a Covid test at a drive-in centre at Deakin University a short distance away. If I could get the result back in time, well and good; if not, it wouldn’t matter. This all worked out as anticipated. I had the test on Friday afternoon, and got the result the next morning via SMS — no Covid discovered. I just showed the SMS to the oncology centre when I booked in on Monday. (I also asked them to remove our landline number from their records.) It looks as if I will have to have this test at three monthly intervals, before every Zolodex implant, or before any other hospital admission. Touch wood there won’t be too many of the latter!

Level pegging

Updates to this post are minor, made only for clarity.

My beloved and I went to see Dr P on Wednesday, October 27th. The PSA is very slightly elevated — 1.01, up from 0.94 at the previous test. However, Dr P. said this is within the measurement error of the machine. So we weren’t to worry. He emphasised that he was still happy with where I was at. I am to see him next on 22 November, on which date I will also be having another Zolodex implant.

I am a bit late posting this because the consult came at mid-way of an extremely busy week. On Monday I parked the GT at the back of the IGA supermarket on Maling Road, Caterbury. I noticed a truck unloading in a right-of-way next to my parking space. I went to four places on Maling Road, at all of which I checked in, using the Service Victoria QR code reader and digital vax certificate. When I got back from the last stop (the IGA supermarket, as it happened), the truck had gone, but I noticed a bit of damage on the car bonnet and driver’s side guard. (There wasn’t a note on the car acknowledging responsibility.)

I whizzed back to the supermarket and asked if they had had a delivery that morning. (I’d chosen not to get a receipt for the items I’d bought, but, via the Service Victoria app, was able to show them that I had been in the store within the last half-hour.) They were very helpful and gave me a copy of the receipt that they had received from the delivery driver. The latter wasn’t an employee of IGA, but was working for a transport company. The invoice gave me his name and other useful information.

When I got home I wasn’t sure whether to call the transport company or my insurance company. I hadn’t seen how the damage occurred — I was only inferring that that it had been caused by the truck driver who’d made the delivery to IGA. So I rang my insurance company (Apia) and explained what had happened. They agreed that there was only circumstantial evidence that a third party was involved, charged me my excess (which I paid over the phone by credit card), and set an assessment and repair appointment in train.

After this I rang the transport company. They were unexpectedly sympathetic and said they would speak to the driver, and that someone would call me back. I didn’t have great hopes from this. However, I was pleasantly surprised to hear from the company the next day. They had indeed spoken to the driver, who said he hadn’t had any traffic accidents on his run. However, they had looked at footage from a video camera mounted on the back of the truck. This showed a pole, called a pogo stick, which the driver used in unloading the truck. The driver had leant the pogo stick against the truck, causing it to fall onto the bonnet of the GT as the truck reversed out of the right-of-way. So they acknowledged responsibility for the damage. (I thought this very decent of the company to put their hand up for this, and said so.)

To cut a long story short, after exchanging a few SMSs and emails, I received an indemnity form to fill in and send back. According to this the company said they would pay the amount of my insurance excess, if I, my heirs and descendants and so on, undertook to make no further claim on them in this matter. Rightio, I said, and filled it out and returned it to them forthwith. (What is this mysterious company’s name? I haven’t received the money yet, dear readers, so I am keeping schtum until I do. However, I expect the amount to be forthcoming.)

In the same week

  • I had two in-person exercise classes at the exercise physiology practice;
  • via Zoom, had a German lesson (for which I hadn’t done much hausaufgabe);
  • also by Zoom, had an appointment with my psychologist;
  • hooked up our barbecue (which had been sitting out in the garage for eighteen months or so after having been gifted to us by a former neighbour), in preparation for a Cup Day get-together with friends;
  • drove the GT out to Blackburn to the damage assessor/body shop place, where it resides until Friday (Apia shouted me an Uber back home); and
  • baked two sourdough loaves.

The loaves turned out well, the BBQ works fine (although I have to clean the grill plate soon), and I have been adapting well to only having one car between us. Actually, my beloved and I got by perfectly well with one car between us for twenty years. It is only in the last seven years that we have had a car each. As far as I am concerned, I would be happy to trade both the Toyotas in on an EV.

I can’t preview this post as I used to be able to, so I am just going to post it as is.

Down but not out

We went to see Dr P yesterday, and the news was good: the PSA was 0.94 at the last test. He said “I told you I’d get it down to zero”, and he has. As I understand it, anything under 1.0 is undetectable, so this is as close as makes no difference. (Or, as Dad would have said, 5/8 of SFA. That’s the expurgated version, anyway!) We walked away with a script for the next lot of Enzalutamide, a copy of the latest blood test results (“pristine”, according to the good Dr), a screed for the next blood test, and the receipt for the consult. After the Medicare rebate, this last was only a few dollars — 5/8 of you-know-what! Frequent illness points, or something.

I had been expecting the number to continue its downward progress, but still felt rather tired and drained afterwards. Had we been able to go out for a coffee we would have; as it was, we just had one at home, and watched “My Unorthodox Life” on Netflix. The show is about Julia Haart, who left an orthodox Jewish sect in New York and went on to make a major career for herself in the fashion industry. (There is a rather academic account of the show in The Conversation, which nevertheless covers most of the bases.) Whether you are into fashion or not, it is a lot of fun, and is beautifully shot in the Haart penthouse in Tribeca, her fashion company, and various other locations in Manhattan. In the last episode we watched, she, her husband and four kids also go to Paris for the fashion season. They hire a 13th century chateau as well (presumably close to Paris). You get the picture — they have plenty of dough — but this makes the show a great bit of escapism!

I had a small win also, closer to home. The study, where I spend a lot of time, had a picture which, for historical reasons, was situated oddly in the right hand corner of the rear wall. I wanted to move this picture to the middle of the wall, and hang my masters and long service award from RMIT on either side. The fact that all these are a different size — and that I didn’t have another hook the same as that which the picture was hanging on — made this a maƱana project. A catalyst that enabled me to Move Forward with it was reading an article in the New York Times about picture hanging. This article made a couple of helpful suggestion for hanging pictures of disparate size together:

  • give them a common top line, and
  • using painter’s tape (AKA masking tape) to show this line.

I had the further brainwave to use a blob of Blu-tak on the top of this line of masking tape to show the position of each hook. (Saves making pencil marks on the wall.) So the tape gives you the horizontal and the Blu-tak the vertical reference. Et voila!

Study

Of course I mucked it up slightly in the execution — measure once, cut twice, and all that. (Not saying where!) But eventually I think it was quite successful. Oddly, from this slight angle, there is a slight optical illusion that makes the large picture look a tad higher than the others. From where I am sitting it actually looks a bit lower. I can tell you they are the same distance apart, however they might look in the picture! Anyway, it is “rough enough for the bush”. More importantly, it has the elusive WAF (Wife Approval Factor). This is no small thing from someone I have been known to refer to affectionately as Der Fisch — as in, an eye like a dead fish! (This is meant to be complimentary: I can’t understand why it is not always so taken.)

International day of …

This morning I was vaguely encouraged, for no good reason, to read in The Age that 1 October is the International Day of Older Persons.

When I informed my beloved of this, she snorted and enquired as to why they didn’t just call it the International Day of Old People. This set me thinking about euphemisms and their continued popularity. Maybe we could have an International Day of Euphemisms. The difficulty is that these circumlocutions seem to be popular year-round.

Body parts seem to provide a rich source of euphemisms. I was reminded of an old one a few days ago, when my exercise physiologist asked me if I was feeling a stretch in the lower part of my back. Thinking of the antique phrase “lower back”, I asked if she meant my bottom. (She didn’t.) The backside is also referred to in polite circles as the BTM. (Modern American parlance refers to the “butt” — itself also a euphemism, and something that seems to have displaced “bum”.) The nether regions seem particularly to attract euphemisms, “down there” being a sort of catch-all phrase that springs to mind. When considering the business end of the BTM, the “Khyber Pass” (usually abbreviated to “the Khyber”) is one of a large group of euphemisms employing rhyming slang.

Everyone will have their favourite euphemism. The motoring industry has provided a few good ones. One from yesteryear, also qualifying as an oxymoron, was “compulsory option”. (This was a way of allowing a manufacturer to price a car under a particular price point, by “disallowing” a particular feature that purchasers had to pay for separately.) Others that come to mind: “budget” (poverty pack), “detuned” (gutless), “economy” (couldn’t pull the skin off a rice pudding), “family” (a boring barge), and “reliable” (whitegoods on wheels).

Euphemisms are a peculiar sub-branch of language because they are a way to refer to something without actually naming what you are referring to. I generally disapprove of euphemisms because I feel they blunt meaning — this being, obviously, their purpose in life. (At least the ones using rhyming slang are a bit witty.) When pondering this topic I thought “Wouldn’t it be great to compile a dictionary of slang?”. A quick Google search revealed that, as often, I am late to the party. Several quite august publishers such as university presses have brought out dictionaries of euphemisms. One example is R W Holder’s now rather venerable A dictionary of euphemisms, published by Oxford University Press. (No, I’m not going to give you publication dates — the thing has gone through more editions than I’ve had hot dinners.) There are numerous lists of euphemisms on the internet, too, of which this one at Lynn Schneider Books has some quite funny examples.

Slang seems to go the other way to euphemisms in finding a zingy and forceful way to refer to things. An earlier post in this august publication, Partridge in a pear tree, listed some of the slang expressions for the male generative organ. (Warning: adult content.)

The teabag challenge

I generally don’t include video or any other links in blog posts. However, I am making an exception with this clip because it is really fun — even if you’re not normally into this sort of thing! The Teabag Challenge is a 58 second video clip (.mp4) showing a rather nifty bit of heavy vehicle driving. (I think the truck featured is a B-double: maybe someone could confirm or correct this? You know who you are.)

Here is the link to a YouTube copy of the file. (It will open a 15 second ad at the beginning, but you can skip this.)

Scratchings

This is the first in an irregular series of stuff that has been disinterred from old notebooks; some quotations, some drafts of poems. All are posted as I found them.

Humankind, fleet of life like tree leaves, unsubstantial as shadows, weak creatures of clay, wingless, ephemeral, sorrow worn, and dreamlike.

(Aristophanes, quoted by Raymond Moody, Paranormal.)

Down, down

We went to see Dr P today, and the news continued to be good: the PSA is now 1.07, down from 3.2. The good doctor is confident he can get it below zero. I know I’m not supposed to be focusing too much on the PSA. But Dr P has led with it the last couple of consults. Maybe he does this because he knows we get concerned about it if it rises. Also, let’s face it, medicos, like everyone else, like to focus on good news — something with which to cheer the patients up. Whichever it is, I’ll take it anyway! So the Enzalutamide continues be successful, while at the same time not incurring any very objectionable side effects. (The exception to this is hot flushes, which are definitely on the increase. I don’t mind these, however, because I feel them to be a sign that the medication is doing what it’s supposed to do, i.e. starving the cancer of androgen.)

While I was just having the Zolodex, I used to see Dr P every six weeks. Now that I am having the Enzalutamide to my regimen, I need to see him every four weeks. This is to do with the Enza being dispensed in batches of 112 — a strange number, on the face of it. However, the logic is: I take four of these a day. Each lot of 112 therefore cunningly lasts me 28 days. (Trust me on this.) Dr P wants to see me after each batch, therefore every four weeks. I continue to have a Zolodex implant every 12 weeks. Each of these will now occur following every third consult with Dr P (instead of every second consult, as has been the case until now). Alles klar? I get most of the charge for each consult back from Medicare anyway, so having them more frequently is not a financial impost.

Coincidentally, today was also a Zolodex day. I was actually a bit early for this appointment. The nurse who was supposed to administer it was busy, so one of her colleagues took over. There was a slight confusion initially, on my part, over terminology. Zolodex had always been referred to previously as an implant; it is about the size of a grain of rice, and is placed just under the skin of the abdomen with a fair size syringe. This afternoon, though, the nurse asked something to the effect of “Which side would you like your injection on”? When I heard the word “injection” I automatically thought it would be something going into the vein at the wrist, so started rolling up my sleeve. Then I remembered it was an implant, and said this to the nurse. She said “Oh, I’ll go and get the box” (again, words to this effect), and went to fetch the relevant documentation.

At this point I should explain that each Zolodex implant goes into a different side of the abdomen to the previous one. Whichever side is used each time goes into the clinical record. Nursing staff avoid putting the implant into the same side twice in a row to reduce bruising, I think. However, I wasn’t worried about getting the wrong stuff — each dose is checked by another nurse before it is administered. (I know because, as always, they did this in front of me.) The patient is always asked their name and date of birth as well, to make sure the correct medication goes into the correct person. There was just a moment of being at cross purposes because the nurse said “injection”, not “implant”, sending me momentarily off down the wrong rabbit hole. We had a joke about how she was just seeing if I was paying attention (like Captain Mainwaring in Dad’s Army.) For chemo patients and those having CRT scans, an injection means a cannula in the wrist. (Yeah, OK, I suppose technically an implant is a type of injection. Please don’t correct me if I’m wrong about this! When I hear the word “culture” I reach for my Browning!)

Better news

We went along to see Dr P this afternoon to check how the Enzalutamide is going. He had some encouraging results from my last blood test. After two weeks the PSA has gone down from 7.2 to 3.2, a drop of 55% by my arithmetic. This has been accompanied by absolutely zero side effects. (I was supplied with a fancy little diary in which to record does times, dates, and side effects. After the first one, I had nothing to record.)

I will have my next Zolodex as scheduled on 1 September. Fingers crossed we can get away for a two-night break in a week or so (within Victoria, obvs). The arrangements are all made, but all of course is contingent on no more mystery cases, or people not being stupid. As I saw in an article somewhere or other — it is all down to the single males. (Apparently this is the the group most likely to party, not observe social distancing regulations, and thus be COVID spreaders.)

To be watchful of single males is also a maxim that everyone who learns German comes across early on. The masculine singular form of articles in the more exotic German cases (accusative, dative and genitive) do tend to be the most at variance with the plain old nominative forms. Crazily, this complexity is a reassuring thing into which to immerse myself. I’ve never been a crossword person — they just don’t grab me — but I imagine the feeling of finding the answers to a puzzle is similar.

Extra treatment

A week ago I had a CT and a bone scan, followed a couple of days later by the usual blood test. (I had to leave a gap between them because one of the scans involved being injected with a radioactive tracer dye. This dye can affect a blood test if the latter comes straight after.) This afternoon we saw Dr P to see what all these tests revealed.

The PSA has continued to creep up — only about 0.7 from the previous result, however. The scans revealed a few new spots, something of more consequence. Fortunately, however, these are all in bone, something that is greatly preferable to visceral metastases. (The phrase used in the findings of the scan was “mild progression of bony metastatic disease”.)

Dr P said he thought it was time for an additional treatment, enzalutamide. (The link points to a post in the Harvard Health blog which gives a bit of context about this type of drug.) I had heard of enzalutamide, and know a few guys who are on it. Dr P is confident I will tolerate this treatment well, and that he can get my PSA down to zero on it. (The last time he predicted this, it came about.)

Obviously having new spots isn’t ideal. However, Dr P emphasised that the new ones are minor, and that I’m not (as he put it) “lighting up like a Christmas tree” in the scans. We are both relieved to be moving to an additional treatment. I will continue with the Zolodex until further notice; the next implant for this will take place in 6 weeks. (I have actually been on Zolodex for almost three years, an unusually long time. Zolodex is an androgen deprivation treatment — see another link from the same source for more information.) I will see Dr P in a fortnight so he can see how I am going with the new drug. All going well, we will revert to our usual 6 weekly consult. Enzalutamide is on the PBS, so it should not cost much.

Pharmacists don’t tend to carry enzalutamide, so we had to order it, but it will be availabIe tomorrow. I will obviously just have to try it and see how I tolerate it.

Less good news

I have been procrastinating about writing this, so I am just going to get it over with. We saw Phillip P on Wednesday 9th (about 8 days after my appointment with Pat B). Unfortunately the “gains” that Pat reported, in terms of a reduction in PSA score, have entirely been lost. The score that we got from Phillip was 6.5, which is back to where it had been before the radiation treatment.

Phillip made several points about this. (Sorry, I have forgotten how to do numbered lists in this infuriating blog editor.) First, he found the increase “not upsetting”, and he hoped we were not perturbed by it. Second, he understood also that people made a fetish (my word) of the PSA score. However, the metric that he is focused on is the doubling rate, i.e. the time interval in which the PSA score doubles. A doubling rate of 6-8 weeks would cause him concern, but he feels I am a long way off that. Third, 90% of his consultation time is spent reassuring patients and their carers about PSA scores. So he gets that people find these increases worrying. (He was at pains not to ridicule or downplay our concern.) But he would like us to look, not just at the quantum of the score, but at its rate of progression. Fourth, he has many other treatments up his sleeve.

As to when it comes time for me to move to the next treatment, as he has said previously, Phillip wants to keep me on Zolodex for as long as possible. Let’s call the its successor “Treatment 2”. Say Treatment 2 has an estimated efficacy of a year. If I go onto it now, I will get a year out of it. If I go onto it in six months, I will get eighteen months out of it. So that is why he wants to defer Treatment 2, and its heirs and successors, for as long as possible. (Phillip has said to me before quite bluntly, that the fewer treatments I have, the better.) Treatment 2 will be deployed at a rapid rise in my PSA. But we ain’t there yet.

I was due for another Zolodex implant after the consult with Phillip, which I had without incident. I will go on having these every three months until I move to another treatment. I will continue seeing Phillip every 6 weeks, and having a CT whole body scan every three months. (The next one of these is booked in for 12 July.) So I remain under close surveillance.

It took us a while to digest this news. On hearing it, and the rest of that day, we both felt a bit stunned. What made me feel better, actually, was doing some German homework. Everyone deals with adversity in their own way, and this is mine. We both felt more positive the next day, having had some time to get a better grip on the situation.

It was obviously disappointing that the radiation treatment didn’t have more effect. However, Phillip has many arrows left in his quiver, and we are confident that he will deploy these as the situation dictates. I am still feeling fine, exercising, doing stuff on the home front, and all the other things I have been doing. So there are a lot of positives to focus on — take it from me, we are doing just that! To this end, I would also like to maintain the moratorium on questions. I say this for two reasons. One, I just don’t have any more information to add to what I have written above. Two, I don’t want to give the situation more mental space than it already occupies; we don’t want to delve into it further.