Going down in style

We saw Dr P this afternoon. Cutting to the chase, the PSA has actually gone down down a titchy bit; the one from the previous consult 9.9, while today’s score was 9.7. A small decrease, but welcome after several consecutive rises. (I had gone there expecting to be told that everything had zoomed up, and I would need another round of chemo.) Dr P was very pleased, as (obviously) were we.

There was more good news. A couple of days before today’s consultation I had had my scheduled isotope bone scan and CT upper body scan. To quote from what that found, “avid foci in the lower thoracic region in the previous study have largely resolved with the activity at the L4 level not being substantially altered”. My inexpert translation: spots that were lighting up in the previous isotope scan didn’t light up this time; the exception was the one at the L4 vertebra, which is still lighting up. As before: no questions by request. If you want to read up on the isotope scan, have a look at Bone scan from the Mayo Clinic.

The only fly in the ointment is quite a decent bit of sciatic pain in the left thigh. This is exactly where it was when it first reared its head, less seriously, 5 or 6 weeks ago. (I had mentioned this to Dr P at our previous consultation, who said “Sounds like a touch of sciatica”.) At that time I was able to resolve it by stretching the thigh and running a spiky ball over the painful area. This afternoon those things, plus some escalating pain relief, made it go away for a bit. After this, however, it pulsed back to life, although less strongly than before. (Sitting for a while does seem to bring it on; apparently this is classically associated with the condition.) So maybe I need a steroid injection in the site. I will try a quad stretch, and/or running the spiky ball across the quad, when I have sent this off.

For now, as the man used to say, that’s your bloomin’ lot.

Still in single figures

Accentuating the positive here! The PSA at the consult yesterday was 9.9, up from 7.6 previously. I asked Dr P if he said he was still happy with how I was going. He said “Exceptionally happy!”. I looked great, etc., and was living with my disease (both comments from him). There was no need no change the treatment regimen. The next time I see him I will have had my three-monthly scan. (Dr P said he was being conservative with this timing; I said I never minded him erring on that side.) I am still feeling well, just a bit of discomfort along the left thigh, particularly after exercise class. Dr P thought this could be a touch of sciatica. This discomfort diminishes and ultimately disappears if I run a spiky ball along the area, and take some analgesics. (Apparently the standard treatments include massage and analgesics or a muscle relaxant.)

Although we were expecting a rise in the PSA, for some reason I found this particular one daunting. This was although I have tried to focus on the rate of increase, not the quantum. We will just have to see what the scan picks up. I don’t yet know exactly when the latter will occur, other than that it needs to be three days before my next appointment with Dr P on 28 September. The scan folk will be contacting me to set this up.

Steady as she goes

At our last appointment with Dr P on Wednesday, the PSA had continued to increase: 7.6, up from 6.9. The good news was that he thought this was (in my words) nothing to worry about; I have a cancer that is “grumbling along”. He declared himself “very happy” with how I was going, and that I looked very well — something in which he places a lot of store. He doesn’t think chemotherapy is required at this stage. I certainly have been feeling fine, apart from the odd arthritic twinge or muscular strain (no worse than usual in frequency or intensity). The hot flushes are continuing, but these seem the main side effects of my current treatment regimen.

I asked also about a Covid prophylactic called Evusheld. (This link points to a .pdf file.) Dr P said the treatment I was on wasn’t suppressing my immune system. I therefore wouldn’t be eligible for Evusheld, the supply of which is reserved for immunosuppressed or immunocompromised patients. (I’ve had my three jabs and booster anyway.)

This visit to Dr P coincided, as every third one does, with my having a new Zolodex implant. Dr P has new and very swish (but rather hot) rooms at Epworth Eastern. His new location is actually closer to the Epworth day oncology unit, where the Zolodex implants are done. The proximity will save me having to hot-foot it to day oncology on days when Dr P is running late. The implant went uneventfully, apart from some bleeding from the site. I have had this before; it was just a bit inconvenient this time because my T-shirt and top got some blood on them. The nurse put a new dressing and several layers of gauze on the site (abdomen, left hand side). Fortunately the bleeding came to a stop pretty soon, so I was able to go downstairs and pay the excess on our health insurance. Then I texted my beloved, who materialised in the RAV4 to whisk me away.

Everything else is going along absolutely as usual.

Nothing much to see

We went to see Dr P yesterday and the news was not as bad as we had expected. The magic PSA number is 6.8, not much of an increase on the previous one of 6.2, and certainly nowhere near doubling. So the rate of increase has obviously slowed. As well as the usual blood test, on the Monday of this week I had an all-body CT scan and a head and neck scan. (I generally have this combo every three months, so am well used to the rigmarole.) This showed one new spot, but also that an old one (on the L4 vertebra) had almost completely dissolved. So, in other words, a steady state. Dr P’s wrap-up was that the disease is stable and low volume. Chemo will not be required unless and until things go south; I am just going to continue on the existing regimen of a Zolodex implant every three months, and four enzalutamides a day. We were obviously relieved, and celebrated with a drink before dinner, which was Chinese takeaway — night off for the cook!

We have been watching Succession on Binge, which we have on a free three month trial. Good, but not as outstanding as Mare of Easttown, via the same source. I have embarked on a mini project I have thinking about for quite a while, digitising my German index cards to put onto my online vocabulary lists on dict.cc. I had hoped to use our new printer scanner for this, but while this scans the cards perfectly well, even after quite a few goes I can’t get it to save the scanned files in any editable format. (I am too cheap to pay for full-fat Adobe Acrobat, which would probably do this.) I have, however, found a workaround, involving scanning a batch of cards with Google Lens on my phone, then copying that text to the laptop. I then paste the text into a Google Sheet, massage it a bit, then upload it to dict.cc as a tab delimited file. Nerdy paradise!

Down a snake

I have been a bit remiss in writing up my consults with Dr P, having missed the previous one (11 May). However, as has been previously remarked, the trend (rather than the quantum) of the PSA results is what matters. Unfortunately, the trend is not my friend at present. The previous number was 3.9; the most recent one (from 8 June) was 6.2. This is not doubling, but more of an increase than anyone would like. So I will be having another round of chemo.

Before that I am booked in for another CT scan on Monday, 4 July. This will reveal any new developments. I will be seeing Dr P on Wednesday, 6 June, at which time he will fill me in on the CT scan results and arrangements for the chemo. This will be my second round of this treatment, one of the “cut, burn and poison” trilogy. Fortunately, I seem to tolerate all these pretty well. As with the previous round, the chemo will be administered at Epworth in Box Hill, pretty close by. I don’t at this stage know how long it will take, the frequency of the doses, etc. Stay tuned for details.

Fortunately as well, I am feeling fine. I put this down in large part to continuing to exercise, mostly in the mens’ oncology classes at my exercise physiology practice. (I will be informing them I will be going back onto chemo so they can adjust my program if necessary.) My walking has been curtailed quite a lot by soreness in the left ankle. This has been a problem for a long time, so I think this is just an overuse injury after a lot of walks during lockdown. Before I used to just strap it up, but now even this isn’t having any effect. So I will probably get an exercise bike for an aerobic workout (the ankle isn’t bothered by that movement).

I have been occupied recently with installing a new Denon receiver in the living room. The previous one, a Harman Kardon, worked perfectly well, but was just a bit unexciting. I was initially looking for another stereo receiver, but the home theatre-type ones were actually much more reasonably priced, as well as offering more functionality. I have the Denon hooked up for 5.1, (something that took most of a weekend), and it is definitely much more punchy. It bristles with useful features like internet radio, sound modes, and numerous digital as well as analog inputs, including one for the turntable. (The HK only had analog inputs). Staying home and watching movies or TV series is a good winter activity, but the receiver works equally well for music.

.

Mutatis mutandis

We had an appointment with Dr P on Wednesday. On that date the PSA was 3.6, an increase from the previous reading of 2.9. All the comments made in the post for the last appointment (“Onwards and upwards“) apply here as well. The only new information was his reply when I asked him at what PSA score he would change treatments. He said (words to this effect) when the current score has doubled relative to the previous one. I have an appointment with him every four weeks, so, obviously, the PSA would have to double over that period. At the last consult he did a quick calculation of the present doubling rate, but it is nowhere near what he would find alarming (my words, not his.)

There is fortunately no other news. The RAV4 is still great to drive, with just a few quirks emerging in its operations. It has a powered tailgate, which can be operated from the key fob, from a button on the dashboard, or a hidden switch on the tailgate. (It is accompanied in all these instances case by warning beeps like a truck reversing). The tailgate can only be operated from the key fob or the tailgate button, however, when the car doors are unlocked. Another owner pointed out that the doors can’t be locked before the tailgate has finished closing — a process that takes maybe ten seconds. So if you go food shopping while it’s raining, you return to the car with the bags, unlock the doors, open the tailgate, load up, then wait in the rain until the tailgate has closed before you can lock the car. (This assumes you have to go somewhere else before driving off.) Of course, if you park underground, there is no problem!

At least the tailgate doesn’t have that opening technology whereby you stand on one foot and swing the other one underneath the rear bumper. (I’m not making this up! It’s quite common on Euro SUVs, I think.) This calls for good balance if you are burdened with shopping bags. I’ve witnessed people in this situation swinging a foot underneath the back of their cars, fail to do it correctly, and have to have several goes at it, becoming more peeved each time. The wonders of proximity keys!

There were a few other minor things we found mildly annoying about the car. Once it has reached 20 kilometres an hour, the doors automatically lock. One unexpected disadvantage of this is, if the car is in Park with the engine running, and someone in the front or rear passenger seats wants to get out, the driver has to unlock the doors. My beloved became quite irritated when I had to release her from durance vile. (I spent about half an hour reading the manual before I could reverse this setting. Now, when I put it in Park, the front passenger door unlocks.) At the free 1,000 kilometre service we also got the dealer to switch off the speed limit warnings, which were becoming quite irritating. We kept the warnings about red light camera intersections, though! These are but minor foibles in a car that goes about its business in a quiet and calming manner.

Splitting hairs

I was a cataloguer for over 25 years. This means I am a serial quibbler, arguer of the toss, and professional pedant about stylistic and linguistic matters. Thus I enjoyed David Astle’s piece in this morning’s Age, ‘A beginner’s guide to redundant acronyms‘. Covid-inspired expressions such as “RAT test” and “face masks” (as opposed to those worn on the knee) are called out. Astle also lists common tautologies such as “clenched fist”, “minor quibble”, “past experience” and “end result”.

Pedants will all have their lists of personal irritants. Mine includes

  • local residents (as in, “local residents expressed concern about the spate of accidents at the intersection”). If those interviewed were not locals, i.e. living near the intersection, they wouldn’t have been interviewed. Hence “local” is redundant.
  • band together, join together, etc.
  • sleeveless vest
  • unfairly maligned (it’s difficult to malign someone fairly)
  • reverting back
  • ISBN number (a favourite among librarians who have forgotten that ISBN stands for International Standard Book Number)
  • very unique (qualifying an absolute)
  • very adjacent (ditto; restricted in practice to cricket commentators believing that a batter was out leg before wicket; possibly ironic by now)
  • predicting the future (what else?); and
  • long standing (or established) traditions — is there another kind?

I am a bit exercised about “small select group”. The notion of a large select group seems counterintuitive, but not impossible. Therefore I will give it the benefit of the doubt.

This is not a redundancy exactly, but has anyone noticed the increasing incidence of sentences beginning with “So”? (For example, “So, at the beginning of last century … .”) I suspect this is an Americanism. So, I’ll leave it there!

Onwards and upwards

We saw Dr Parente on Wednesday. The PSA is continuing its gentle rise: 2.9 at the last test a week before the consult, up from 2.5 previously. Dr P continued to emphasise the trajectory of the increase over the quantum of the score; the former remains low. This time he also made the following points:

  • If I were not taking Enzalutamide, the increases would be much steeper. Therefore (my words not his) it’s doing its job in damping things down.
  • I asked if I needed another scan, but he doesn’t think I need one.
  • At this rate, my doubling rate (i.e. the period of time in which the PSA score would double) is about four months. He said he would only start worrying if the doubling rate got to about four weeks.

I understand Dr P’s reasons (which he has previously explained) for wanting to get the most out of this treatment regimen before switching to another one, giving me another line of chemo, etc. Everything else is still the same, i.e. I’m feeling fine, keeping up the exercise, staying busy, and am not too worried about developments. I continue to see Dr P every four weeks. I start to get a bit anxious around the three week mark, peaking when I have the blood test about a week before the consult. After this, however, I tend to relax and think, well, I’ve done everything I can, we’ll see what he says. The effect of the anti-depressant and CBT combo helps to keep this anxiety manageable, as do the two exercise classes a week.

This week I also had my biennial consultation with my psychiatrist, Dr T. I need to touch base with him periodically so that he can renew the authority for my dexamphetamine prescription. (This last is very helpful for my ADHD.) Dr T said he had a friend with prostate cancer, who was controlling it entirely with diet and exercise. I just said “Good for him”. It’s interesting how many people know PC patients who are using complementary treatments, and who implicitly recommend these treatments to me. (Apart from medical professionals, no-one has ever recommended surgery, chemo or radiation.) I have had the odd comment here and there about the importance of maintaining a positive attitude, and so on.

I think these comments all come from a good place. People want to pass something onto me that they think could be helpful. I’ve no doubt that complementary therapies can be efficacious with less aggressive cancers. (Of course spontaneous remission can occur at any time.) No-one has explicitly recommended complementary therapies to me, but if they were to, I would ask them for a citation to a gold standard, double blind study, published in a high impact, peer reviewed journal. Evidence for these treatments, however, tends to be anecdotal, and involves only a single subject. The cases mentioned also seem unrepresentative, in that only the success stories are reported. No-one would boast about having abandoned their conventional treatment for complementary therapies, only to find their symptoms recurring; returning to their oncologist, they find that their cancer has become too advanced for any further medical intervention. Statistically, of course, such outcomes must occur. Complementary medicine researchers are attempting to build up a research base of properly conducted studies of these therapies. Meanwhile, I will stick to the treatment I am receiving, unless and until I have a reason to change it.

In more cheerful news, we got our new vehicle a fortnight or so ago, a Toyota RAV 4 hybrid Edge. It glides along in a beguiling way. I have clocked up about 270 kilometres in it, mostly just doing trips to the shops and exercise class. The needle in the fuel gauge is still showing 3/4 full. I gave it its first wash this morning; it was pretty clean, just rather dusty. It is noticeably higher than the Camry: I had to stand on a little step to wash the roof. Of course it towers over the GT (which has become my beloved’s car). I drove behind a GT the other day, and could see right over its roof. The extra ride height on the RAV is handy for getting in and out, although I think the GT kept me somewhat flexible. The former is the sixth Toyota that we have owned, jointly and severally.

Poco a poco

We saw Dr P on Monday, and the PSA is now measuring 2.1. I was a little unsettled at this continuing trend upwards. Dr P has been saying things like “the cancer is just grumbling along”, “scores go up and down”, and “at this rate it’ll take forever to get to 2”. I pointed out that the scores had only been moving in one direction, and I was now at 2. He said, again, that the significant thing was the rate of increase, which remains small. (He is always careful, however, not to minimise or brush aside my concerns.) he pointed out also that there is a number of treatments I can have after this one has outlived its usefulness.

One of these, about which I had heard, is lutetium . Apparently this is several thousand dollars each dose. There is another new treatment, which has only just become free, and is something for which I may be eligible. (It sounded something like alaporip.) It is only suitable for patients with a DNA target, in the same way that many breast cancer patients have the BRCA 1 and 2 genes. He asked if I would like to participate in a genetic analysis to see if I have the DNA target (to which I said “Yes”). I didn’t have to give any new samples; they will examine the pathology samples from my operation in 2017. The analysis will take a couple of months to complete. Given that my father had cancer, I think it is likely that mine has a hereditary component. Anyway, we will see how that turns out. I’m still feeling fine, and am somewhat heartened by the number of options that exist in this obviously very dynamic field of medicine. For a bit of light relief, we are off to see House of Gucci. (I saw Belfast last weekend, which I enjoyed.)

Deja vu all over again

We saw Dr P last Monday. The PSA is continuing to creep up: 1.63 is the current score. Context is, as ever, important. At 4 weekly intervals, the last 3 readings were 1.29, 1.44, and 1.63. So the increases are less than 0.2 each time. Dr P said he was “pretty happy” with me, and that’s good enough for me! I still feel fine: the sleep is pretty good, a key component in well-being for me.

Things automotive have been the flavour of the last couple of weeks. Some of you will know that I gave the GT a scrape on the passenger side of the front bumper bar a few weeks ago. I had that fixed last week (coincidentally, the day before taking it in for a service). The guy in the paint shop recognised it as a 2014 model, and said his wife had just sold hers recently. He added that a local second-hand dealer was selling a 2015 GT for about $7,000 more than I paid for mine.

OK, I thought, and checked it out. What he said was spot on. I can’t give a link to that sale, however, as it appears the car has sold, even at that crazy price. As the paint shop guy said — demand for these cars has taken off. While looking through the site, I went down a bit of a rabbit hole. The dealer also had a 2016 Mercedes C180 coupe, with pretty low mileage, at a reduced price. I have always had a fantasy about owning a Benz, so I took it for a spin.

Despite having only a 1.6 litre 4 cylinder engine, it drove very well. The cosmetic condition was pretty good, with just a few minor scratches, which partly explained the reasonable asking price — pretty much in the middle of the Red Book indicated range. The car appears to have had all its required services. (I emphasise this because Benz service histories are now, apparently, entirely digital. So no more logbooks in the glovebox to check.) The salesman gave me a list of dates and kilometres he had obtained by ringing the dealerships at which the car had been serviced, and everything seemed to check out.

Anyway, I researched this and similar models for sale in Melbourne. C class Benzes are actually quite numerous, being Mercedes’ best seller in Australia. So there was a number of other examples for sale in a similar price range. Sense prevailed, however, when it occurred to me that a Benz that I could afford wasn’t one that I ought to be thinking about buying. Mercedes reliability has been extremely variable for the last several years. Fantasies are one thing, but the reality of buying a seven year old Euro car stuffed to the gills with expensive high tech gadgets was likely to be a lot less fun. I could have bought an extended warranty from the dealer, but I felt it was better to avoid trouble. The GT has had absolutely zip go wrong with it in the three years in which I’ve owned it — and it’s fun to drive. As the paint shop guy said — you can’t go wrong with Toyota.

Strange things are happening in the car market. I’m very glad that we paid a deposit in November for a Toyota RAV4 hybrid. At that time we were quoted a waiting period of 3 to 4 months. Had we gone for a Cruiser, which is the model underneath ours, we would have had a 10 month wait. Someone ordering a RAV4 now is being quoted delivery around Easter, 2023. Toyota has paused production at several of its Japanese factories. The one which produces RAV4s has, at this stage, only been paused for a couple of days. All these delays will obviously push out wait times, already pretty decent.

What’s going on here? Household savings have jumped under lockdown. One of the few things that people could spend their spare cash on was a new car in which to go travelling around their state (whenever they could actually do this). The crazy wait times for new cars have pushed up the prices of second hand ones. Specifically too, the RAV4 is a car that is in high demand. The reasons for this are apparent to everyone who takes one for a drive. It is just the right size — less hulking than a Land Cruiser, less poky than a C-HR. Its being available in a hybrid makes it even more attractive.

Apparently, also, there is a world-wide shortage of semiconductors, of which modern cars have an increasing number. Intel is building a couple of new factories to supply this demand, but they will take a couple of years to come on stream. Meanwhile, most semiconductors are manufactured in PRC. Someone posting to a discussion list muttered darkly that MG, now under Chinese ownership, doesn’t seem to be affected by this shortage. Conspiracy theorists take note –today your garage, tomorrow the world!