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!)

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