Of course Father’s Day is a commercialised rort and an excuse for selling more stuff. Nonetheless, siblings, and anyone without a dad handy, will probably be feeling a pang today. I still have one of Dad’s old shirts, and his dressing gown. More practically  I have been honouring our Dad in a practical way, by doing a spreadsheet about energy use.

(To bring non-family members up to speed, our Dad, David, was an engineer. Toward the end of his career, he developed a particular interest in energy conservation. Unfortunately, as in other things, he was ahead of his time. In the eighties, most people thought fossil fuel energy was cheap, and would last forever. Peak oil and global warming were unheard of out here.)

Dad therefore would have been totally across my spreadsheet, which bears the catchy title “Cooling & heating costs with split system versus separate evaporative cooling + gas ducted heating” (Aron, 2018, unpublished.) You may not find this magnum opus in a bookshop near you, if there still is one. So I can upload it to Google Drive, if anyone is interested. (No? Fair enough.)

I will prevail on your patience with a précis. We have to replace our 15 year old evaporative cooler with a newer system. This has opened a bit of a Pandora’s box. Should we replace it with another evaporative system? Or go reverse cycle ducted? This would use more power, but wouldn’t use any extra water. What are the comparative costs of these systems?

This begs another interesting question. How much water do evaporative systems use, anyway? The answers are complicated. Modern evaporative coolers recycle their water. They can’t do this indefinitely, however, as the salts in the water become concentrated. This shortens the life of the cooling pads. The point at which a cooler will dump its water varies between brands, the salinity of the water, etc., and is just about impossible to find out. Different manufacturers’ web sites mostly say: it depends.

I consulted Dr Google on this matter and found two figures for water consumption of evaporative coolers: 58.6  and 113 litres per hour. The first is contained in a paper written under the auspices of the Federal Government’s Water Efficiency Labelling and Standards Scheme. (The link points to the .pdf format.) The second is derived from post to the Whirlpool discussion list. I included both figures in my spreadsheet, as Scenarios 1 and 2. (As you do.)

How much energy do different types of coolers and heaters use? This is much easier to find out. Sustainability Victoria has useful summaries for cooling and heating .

Those still awake will be on the edge of their seats, I know, so here is the executive summary of what I found:

1. Reverse cycle would be cheaper for us, by between $239-$891 dollars per year.
2. Reverse cycle systems are more expensive to purchase than evaporative. What would the payback period be? I did two calculations; one guesstimated the extra cost of a ducted system at $4,000, the second at $8,000. Accounting for multiple variables, the payback period varies from 4 to 33 years!

Anyway, we have pretty much decided to go with another evaporative unit. This is for non-financial reasons. My beloved has sinus problems, and the extra humidity of the evaporative is better for her. We can also use our existing ceiling ducts. Refrigerant system ducts are smaller, so we would have to have some new holes cut in our ceilings, and the old ducts covered over.

This is what we were leaning toward in the first place, but we now know why this is the right answer – for us. I hope Dad would approve.

Well, I had my appointment with Dr Phillip Parente this afternoon. (He is a medical oncologist, and adjunct clinical associate professor and acting director of cancer services, Eastern Health.) We were both impressed by Phillip. He is very concerned to explain treatment options and considerations clearly so that patients understand the issues. He even drew me a sort of ideas map, explaining that his handwriting is better than that of most doctors (it is). Phillip struck us also as energetic, positive, evidence-based, and fully seized of the need to get a move on. I said that I wanted the most aggressive treatment that he would advise, and this is exactly what he wants too.

He needs to find out whether my condition is low or high volume. The latter is three or four bone spots, or any visceral disease (for example, in the liver or another organ). If this is the case, he will recommend hormone treatment plus chemotherapy. Adjunct therapies like this have significantly extended efficacy over a single treatment. So I won’t need to come back so often to repeat or have it changed over to another drug. (As he put it, I have a lot of tricks in my bag.) It is difficult to say how long the effectiveness of a treatment will be, as individuals respond differently. He thinks that, with my (relative – my word) youth and fitness, I will be able to handle the side effects easily. Low volume disease – the former possibility – can be addressed by hormone treatment alone.

So what happens next? I need another blood test, which I had on the way home. I also need another PSMA PET scan, this one at Epworth Box Hill. Phillip’s practice initially made an appointment for me on Friday afternoon. The scan folk, however, have a cancellation for tomorrow afternoon, so I will be going in then. (I have had one of these scans before, and compared to an MRI, they are a walk in the park. I don’t have to fast – although I do need to be hydrated – I can drive myself there and back, and it the scan is done in a large, open space.) After the scan, I will be seeing Phillip on Monday, when he will discuss what is the most appropriate treatment, and (I hope) start it then.

Watch this space.

Apologies everyone. I published this yesterday, but as a page, not a post. So no-one saw it.

I saw Pat Bowden, the radiation oncologist, this morning. The news was, as has been previously, neither the best nor the worst. The takeout: I have to have androgen deprivation therapy (ADT).

In more detail:

1. the last PSA test was 7.2, more than double the one previous to that, which was 3.4. So just over double in three months means it is obviously heading in the wrong direction.
2. I will be referred to one of two medical oncologists for the ADT. (Pat thinks they are equally good and experienced with prostate cancer. So it will be whichever of them is available first.)
3. ADT has been around for about forty years, so is a well established treatment.
4. ADT works by depriving the cancer of androgen, which is what feeds it. It is basically chemical castration.
5. ADT is known to have side effects, so I may experience one or more of these:
   1. hot sweats
   2. weight gain (most patients gain 2-3 kilos)
   3. aches and pains
   4. feeling weaker and less energetic
   5. decline in mood
6. It is delivered in the specialist’s rooms by means of an implant. The implant lasts three months.
7. ADT gives a median control time of four years until the next treatment. I asked what “control time” meant. It means the cancer being under control, i.e. not changing; see Managing cancer . So with four years being the median, this is the middle value in the range from shortest to longest control time. (Apologies if I have committed a statistical indignity here.)
8. Should it become uncontrolled, other treatments will be embarked on. As well as the existing treatment options, I could possibly participate in a trial of one or another emerging treatments, should they be suitable.
9. Cancers which are new to ADT are referred to as “castration naive” (or variations on that). They can then become “castration resistant”, “ADT refractory”, or other jargon that refers to the ADT becoming ineffective.
10. I was under the impression that this progression (from naive to resistant) was inevitable. However, only a small percentage of castration naive cancers become castration resistant.
11. New treatments are being developed all the time. As well as this, combinations of existing treatments are being tried very actively, to see if they work better together than singly. One that is potentially relevant for me is ADT in combination with a drug called abiraterone. (Pat, unsurprisingly, knew about this, and had had dinner with the author. See Osterwell, 2017 . You may be asked to register with the site. If so, I can send you a scan of the paper.) This combo has been found to give an absolute (not relative) increase in control of 8% over ADT by itself.
12. Pat was pretty positive about ADT and my cancer, saying (words to this effect) “It’ll stop it”. In my experience, specialists are not usually so forthright. (You will note he did not use the “C” word. I will settle for stopping it, though!)
13. I asked Pat what were the three things he would like me to take from the consult. His reply:
    1. We can control cancer for many years;
    2. ADT comes with side effects; and
    3. the treatment paradigm is very dynamic. So there will be new treatments available in a few years not currently available.

I will be going for the most aggressive option that the specialist recommends. Pat’s rooms are going to call both oncologists and see who is available first; I should hear from them in a few days. I still feel fine and intend to go on exercising, socialising, and all the other things I get up to. As my beloved correctly pointed out, it would be advantageous for me to lose a few kilos before starting the treatment, in case it does cause weigh gain. I will give it a go! Generally, I feel slightly daunted, but relieved, oddly, that I have a clear treatment path to follow.