There is a bit to catch people up on, so I will just put it all in point form. (I have condensed a lot of medical appointments and put things out of strict chronological order. Trust me on this.)

First, the Merkel carcinoma.

• About a fortnight ago I had an operation to remove a growth on my upper left eyelid. This was picked up in my annual eye check at OPSM, who referred me to a local opthalmologist. He (Dr L) removed the growth and sent it to be biopsied as normal.
• This turned out to be a somewhat unusual cancer called a Merkel carcinoma. Merkel is a quite aggressive cancer, which can spread widely under the skin. Like other aggressive cancers, it can infect the lymph nodes. On the positive side, it responds well to radiation treatment. Dr L referred me to the Peter MacCallum Cancer Centre for further treatment.
• My beloved and I spent a couple of days there last week. In these appointments I had a PET scan, then met a radiation oncologist and a couple of plastic surgeons. (The PET scan showed that the Merkel had not spread to the lymph nodes in other parts of my body.)
• The radiation oncologist was there to talk me through what radiation treatment would look like. In short:
  • I will be having 30 sessions of radiation over six weeks.
  • Before this starts, I will need to be “marked up” by having a lead shield custom made for the contours of my old dial. This will ensure that only the appropriate areas are irradiated.
  • To the same end, a little metal disc like a contact lens will be placed over the cornea of the left eye, underneath the upper lid.
  • Fortunately, each session of RT will only take 15 minutes or so.
  • The markup session was yesterday. The team working on me took great pains to shape the lead shield to fit me closely. I had some numbing eye drops applied before they put the metal shield in place over the cornea. The discomfort of this was not nearly as bad as I had thought.
  • Apparently I can expect some redness and soreness of the upper lid as the treatment progresses. I will also lose the left eyebrow. (This is OK; the one I can raise is the right one!)
• The plastic surgeons were there to talk me through a procedure called a sentinel lymph node biopsy, for which I am booked in on Monday.
  • This is mostly a diagnostic procedure which will reveal whether the Merkel has spread to any of the lymph nodes in the head or neck. It does so by injecting a couple of radioactive dyes at the area where the original surgery was performed.
  • The procedure does not do anything to “cure” the cancer: it merely shows to which lymph nodes it might have spread. This is an important thing, however, because the radiation folk will need this information to proceed to treat any affected lymph nodes. (As I think of it: they can’t shoot at what they can’t see!)
  • SLNB also has the benefit of allowing any cancerous areas to be detected while they are still small. Removal of small cancers is easier than if they have been allowed to grow (and spread).
  • I asked the radiation oncologist why I was having the markup session yesterday and the SLNB on Monday. Shouldn’t they be in the other way around? She said that normally this would be the case. In my case, however, they were regarding the treatment of the lesion on my upper left eyelid, and treatment of any affected lymph nodes, as separate procedures. The markup was only applying to the former.
• The Peter Mac’s location in the Melbourne CBD makes getting to all these appointments a bit of a bore. (It does have a Box Hill campus, but they can’t provide the treatment I will require.) Driving oneself is not recommended because of the effect on the vision of the numbing eye drops which the radiation sessions require. Fortunately, however, my beloved is stalwartly driving me to them all. She will pack her laptop and work away on the free Peter Mac wifi.
• Apart from its location, I am greatly fortunate in having been referred to the Peter Mac, unusually (and fortunately) a public institution. Consequently all this treatment and surgery is not going to cost us a cent. The staff there are quite wonderful: it has pretty good coffee too! Out taxes at work.

OK, onto the prostate cancer.

• The PSA has gone up to 33, but only by one. I am counting this as a win! (A bit like the England cricket team feeling as if they won the first Ashes test.)
• Dr P had been told all about the Merkel. He is happy to hold off on any change to treatment for me (i.e. chemo) until after the radiation. (Not that I seem to need that — see below). This avoids the WICOS problem that I read about in one of Atul Gawande’s books. This initialism stands for “Who’s in charge of the ship?”: a question that can arise when a patient is being treated by several specialists.
• Incidentally, Dr P said he has one of the biggest Merkel practices in Melbourne. So when I have worked through the treatment at Peter Mac, I could come to him for that as well (if I wanted to). However, he is going away for five weeks, and we need to get onto the Merkel PDQ. So we decided to stick with Peter Mac.
• Later that day I had a Zolodex implant, which went well.
• Goddam it, I’ve forgotten how to mark the following up as a paragraph! This new WordPress editor gives me the Jimmies. You’ll just have to work it out.

• In the morning before I saw Dr P, I saw a gastroenterologist to whom he had referred me, Dr B.
• In a phone consult I had explained I was suffering from shortness of breath and dizziness on getting up. He asked me to measure my blood pressure sitting down, then standing up.
• Before the in-person consult, I had been increasing my consumption of iron rich foods as much as possible: two eggs for breakfast, meat sandwich for lunch, and so on. I had also doubled my iron supplement to two Ferrograd-C tablets per day — although only after the blood test which he had ordered for me. (The extra dietary iron may not fix the deficiency, but I figured it couldn’t hurt.)
• I gave him a couple of sitting-to-standing readings in our in-person consult. These revealed quite a drop between the two states — hence the dizziness. (He wasn’t interested in the BP after I had been standing for ten minutes or so.) Normally the body compensates for the change in states; however,for some reason this wasn’t happening in my case.
• In the consult Dr B said my iron level was “OK at present”. (Maybe the eggs and meat had been doing something after all!) He thought the Ferrograd-C contained too much iron for the body to assimilate, and suggested I drop the dosage to one every other day.
• Fortunately, he didn’t suggest a colonoscopy! (I had had three “scopes” about five years ago, when the low iron was first picked up.) He did suggest that I have a heart ultrasound in case there had been any partial heart failure. After all the dust clears from the Merkel, I will investigate this.
• I am generally feeling better and getting less puffed after walking up an incline. So I am planning to continue with the iron-rich diet.
• That’s your blooming lot! Comments not questions, please.