Ten-four, good buddy

We shuffled along to our monthly consult with Dr P to get some better news. The PSA has gone down from 12 to 10.4. Everything else in the last blood test is looking good as well (liver and kidney function and so forth). Dr P repeated the usual flattery about how well I look, which I must say, went down well. But it was the headline number which was reassuring; not so much the quantum, but its welcome southwards direction for a change. Of course it will continue to move around, and doubtless give us concern again. But for now, we’ll take it.

Things elsewhere are improving as well. After our recent excursion to the Blue Mountains, my beloved came down with a nasty cough, which morphed first into a virulent cold, then sinusitis, complete with throbbing pain in the top right hand teeth. Her face also became swollen on that side of her face in a fashion she found most unbecoming. A phone consult with a GP (not her regular one) produced a prescription, delivered via SMS, for an antibiotic. This had some effect, but not as quickly as we had hoped. So we were able to get in to see her regular GP in person, who gave her a stronger antibiotic script (Augmentin). She supplied a script also for a super-duper analgesic with a decent whack of codeine. A few days of this combo have pretty much eliminated the swelling and tooth pain. The patient has also progressed from foods like soup, yoghurt, and mashed banana and mango, to more solid fare.

While this was going on the GT also to be dropped off for a service (booked weeks ago), and I had an appointment with my GP to renew my mental health plan. In one of the better kept secrets of public medicine, one can receive (on the say-so of one’s GP) six subsidised sessions with a psychologist. This can be extended if desired by a further four. This initial lot of 10 sessions can itself be extended, again under the aegis of the GP, by a further 10. These, in combination with an antidepressant, have been brilliant. For anyone feeling worried or distressed (and there is a lot of worrisome news around), I recommend asking your doctor about this. I was lucky to find a psychologist pretty quickly – they are usually snowed under. Another positive also is the number of people who are being open about their mental health struggles, and who are encouraging open discussion of these issues, which may lead to people seeking help.

With the unusually vile weather in Melbourne, and my beloved being laid up, we have been cocooning and watching the Kingsman movies (pure spectacle), and one for Agatha Christie fans, See How They Run. There are some good series on Disney as well; Andor, which is a kind of Star Wars prequel, and The Offer, a series about the making of The Godfather. All replete with A-list talent and excellent production values. This morning I also finished vol. 2 of ‘In search of lost time‘: In the shadow of young girls in flower. (Other translations give the series title as ‘Remembrance of things past‘, and the volume as In a budding grove. The former title is a bit more accurate; Proust aficionados just call the cycle ISOLT. ) November 2022 being the centenary of Proust’s death, there is a lot about him in the press. In the case of both the primary and the secondary materials, there’s a lot of it about. (Thanks to everyone who has sent me messages about these pieces.) There is a great article by Helen Elliott about this centenary, and Proust in general, in The Monthly . Unless you are a subscriber, you will have to give them your email address. Live dangerously and just do it. Neither care nor responsibility!

12 is the new 10

At our last consult with Dr P, there was an unwelcome turnaround: the PSA had gone up to 12 (from the previous score of 9.7). This was a bit disappointing in that we had hoped to continue the previous slight downward trend. Putting it in context, however, as Dr P is always doing, he said the cancer is grumbling along, but the medications are doing their job and keeping the rises small. I had had the CT scans only a month ago, and the results of those had been good. He actually apologised for being a touch paranoid in having me do the scans every 3 months. I said he could be as paranoid as he liked. He said I looked great and he was sure I was enjoying a good quality of life. I’ll take his word for the former, but the latter is certainly true; I am feeling fine and being very well looked after.

Straight after the consult I went to the day oncology ward and had the Zolodex implant. This was uneventful except for a small bleed from the implant site in the abdomen. (I think I caused this by bending over to pick up the cover from something on the tray of sandwiches I had been brought by a volunteer.) Anyway, no matter: I have had this before. The nurse just put a new and bigger dressing on it, from which there have been no further bleeds.

The day after I felt vaguely unwell — nothing specific — we both always have a bit of measurement anxiety before each consult. It was a rotten day, with steady rain, so I cancelled exercise class and had a day at home, spent largely on the couch, apart from attending to a loaf of bread. The latter was successful, and the day proved very therapeutic.

We have a break from the rain today (although showers are forecast), and tomorrow is Cup Day. Because of this my Tuesday exercise class will be cancelled. So I don’t miss out on two classes in a row, my beloved has made a one-off appointment with an exercise physiologist for us both; exercise is a vital part of our maintaining ourselves in a well space. I am pushing ahead also with Proust, as per the following quote:

“We do not receive wisdom, we must discover it for ourselves, after a journey through the wilderness that no one else can take for us, that no one can spare us, for our wisdom is the point of view from which we come at last to regard the world.”

Marcel Proust, In the shadow of young girls in flower (In Search of Lost Time, vol. 2), p. 482. Translated by C K Scott Moncrieff, edited and annotated by William C Carter. Yale UP, 2015.

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.

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!

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.

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!

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!

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.)