Doctor’s orders

I went to my scheduled appointment with Phillip Parente this morning. The news was all good as far as the tests went; the PSA was 0.02, still undetectable. Phillip pointed out that, until recently, the test only went to one place after the decimal point. So, my inference from this is: while it was up by 0.01, that’s not worth worrying about.

The bad news: as a cancer patient, I am in a high risk category for the novel coronavirus. So I have to self-isolate for a few weeks. For details of what to do and not to do, he referred me to my GP and the Commonwealth Department of Health COVID-19 isolation statement.)

This affects my beloved too. (There is obviously not much point in my being self isolated and her not.) So she will be working from home: fortunately she brought her laptop home a few days ago. Neither of us will be going to exercise class, coffee with friends, book group, concerts (probably cancelled anyway), movies, or any of the social things we used to do. I will also be avoiding  catching up with my friend, a fellow prostate cancer patient, who is also writing a memoir. At least we can exchange drafts by email.  

Shopping is out too! We picked up a few things on our way home this morning. Our greengrocer, fortunately, does home deliveries. I can just text him what we need & pay over the phone. I have been doing little shops over the last few days, so we are fairly well stocked for the essentials. I even managed to get a four pack of loo paper! The bottom line (sorry about that): neither of us is displaying symptoms, we are pretty well prepped for a few weeks chez nous. The Guardian article “Never read Middlemarch or listened to Wagner’s Ring Cycle? Now’s your chance” fits our circumstances pretty well.  We have a courtyard in which to sit, and a park at the end of the street to walk down to. As the poet proclaimed (cliché alert):

A Book of Verses underneath the Bough,
A Jug of Wine, a Loaf of Bread–and Thou
Beside me singing in the Wilderness–
Oh, Wilderness were Paradise enow!

(The Rubayait, by Omar Khayam. But you knew that! The Wikipedia article about the Fitzgerald rendition — of which the above is Quatrain XII — is most interesting.)

Apocalypse already?

Like most of the world, I have been watching and reading the coronavirus news with mounting alarm. Obviously, any new virus which is capable of causing fatalities is frightful. One to which there is as yet no vaccine (it being a new strain) is worse. And one which has the potential to initiate a global recession is worse still. All this is known. The cherry on top is the the uncertainty in figuring out just how bad things might get. Epidemiologists and other experts are either being properly cautious in their forecasts, or predicting that (as I saw over the weekend) coronavirus will be like the common cold; everyone will catch it at some point, but not everyone will be symptomatic, and only a few of those will progress to the full-blown disease. (There is a good article which I stumbled on, 12 myths about the coronavirus, that contains some good information in an accessible form.)

Like everyone, the unfolding news about the coronavirus affects me in a particular way. Before all this happened, my beloved was planning to going to Paris towards the end of March. I was to accompany her, and we would go somewhere in  Europe afterwards. But where? We were attracted by the idea of a cruise: just making one booking, and only unpacking once. None was available, though, it being just too early in the year. As time progressed, it became less likely that she would get to attend the meeting anyway: it was a long way to go for one-and-a-half days. The year was starting to look a bit crowded already, weirdly, with other things we had planned. So 2021 began to look like the earliest I could contemplate another overseas trip. Then the coronavirus news started trickling in, making what seemed only probable into a near certainty.

Given that (to put it bluntly) I may not get many more opportunities, an overseas trip is fairly high on the bucket list. So anything that defers it is unwelcome; the more so if the period of deferral is as indefinite as this. No-one seems to have the definitive formula for how people can minimise their chances of infection. For me, however, one precaution stands out: stay out of situations in which you are in forced proximity with a lot of people. An international flight and a cruise seem therefore like exactly the things to avoid.

Being a cancer patient by itself doesn’t mean you have to avoid all risk of infection. (An exception is people who are actually undergoing chemotherapy, who are encouraged to avoid opportunistic infections.) And I feel generally very well. Having had chemo and radiation treatment, though, does undermine one’s immune system. Consequently, I make sure to have a flu shot — all the more given the coronavirus infection peak may coincide with the flu season. So, while you can’t avoid risk altogether, you can sensibly minimise it. This means taking precautions that people who aren’t cancer patients may not bother to take.

My situation is fortunate in several ways. Being retired, I no longer have to undertake the daily commute on increasingly crowded trains or trams. Because my main income source is an indexed super pension, I am rendered fairly immune from the effects of an economic downturn. If I want to take a less risky trip, there are plenty of places to go in Australia with my beloved. (She is the one who will really need the holiday.) Many people would gladly swap their existential anxieties in the face of the coronavirus for my concerns. Saying this doesn’t make the latter go away — it just puts them in a context. 

On this note, some of you will have seen the article which fortuitously appeared in The Guardian this morning “Young and forever sick“. This piece gives an account of some young people’s experiences with a chronic (and acute) medical condition. The focus is on the concept of mortality salience — how a serious illness can change your view of the world. I have written about this before, so won’t repeat myself other than to say that I think this is an important discussion to have. Olivia Gee’s experience of serious illnesses in her twenties adds a layer to this already gnarly topic. Getting a life-changing diagnosis when you can reasonably expect to have most of your life in front of you would be tough indeed. (To say that it is tough at any life stage is not to negate her experience.) Medicos and mere mortals alike need to remember that their patients still have things that they want to achieve. This existential shopping list will be different for everyone.

Needles, active and stationary

I wonder when “moving the needle” started creeping into our discourse? I would have said some time last year. Wiktionary, however, has a quote from the august Time magazine, dating from 2002.

I had a blood test in late January before seeing Phillip Parente earlier this week. The results of the latter appointment: the PSA is still undetectable. So I was glad not to have moved that needle. Everything else is good, and Dr P commented also on how well I was looking. After every other specialist appointment, all being well, I get a new another Zolodex implant. This had been scheduled in half an hour after seeing Dr P, so I duly walked up the hill and presented at the Epworth Eastern oncology ward.

The cheery nurse (they all are) checked with a colleague that I was to get the right stuff, and with me that I was the correct body. Then, having prepped the site, the needle was wielded and the new dose swiftly implanted. I thought of quoting from the Scottish play

If it were done when ’tis done, then ’twere well
It were done quickly

but didn’t want to attract any bad luck to the enterprise! But I do find, with this particular procedure, the sooner, the better. Because the Zolodex is about the size of a rice grain, a decent size needle is needed to shove it in. The nurse confirmed that this was “pretty much” the biggest syringe they had. I joked that, should they run short, they could go and borrow one from a horse vet. She agreed — they are doubtless used to patients’ black humour. The implants are put in each time on the alternate side of the abdomen. Strangely, I find an implant put into the right hand side less bruising than one on the left. I had an impressive bruise from the last one, which took quite a while to fade. I must ask next time whether implanting it into muscle is more difficult than into fat. (I hope I have a bit more of the former after three months of exercise classes, due to finish this week.)

Each time I am to see Dr P, I get a bit of testing anxiety. I usually sleep fairly well the night before, figuring that I have done what I can to maintain myself in a well state. This time, following the appointment, I had a very poor night’s sleep. Fortunately I didn’t have exercise class to get to, so could just plod around, go and get some groceries, do a bit of feeding and pruning in the courtyard, and other anodyne activities.

I also spent much of the day reading A life of my own, by Claire Tomalin (the link in the title points to my local library record). This had been recommended by a friend who is also writing a memoir. (He and I are a kind of mutual admiration society). I liked it a lot too — it is certainly very readable, and I finished it in a day. Her resilience in the face of the dreadful things that happened to her is impressive, and she writes about them in an unadorned and straightforward way. For me, however, there was an indefinable something missing from it. She is candid, but not really self-disclosing. Maybe there is a British reserve in her temperament and upbringing that inhibited her from really exploring the darkest places. There is a lot about what she did, and she was very busy, researching and  writing biographies, being literary editor of several major newspapers, and looking after her family. Work was possibly her therapy, and she obviously had too much going on to drop her bundle, even if she had felt like it. I am glad to have read it — books that don’t quite hit the mark are often more instructive than the ten out of ten ones — those books that are like discovering a new planet.

New normal

Well, we saw Dr Parente this morning, and the news continues to be good. Everything is looking fine on the blood test; the PSA continues to be undetectable. Dr P was saying that everything was totally normal, then corrected himself. An undetectable PSA score is not normal. However, I’m happy to be an outlier — some might say, a freak — in this context!

So, how high should PSA be? According to Medline Plus, a score of 2.5 is considered normal for males 50 or younger. This will rise gradually from that age onwards. But in the context of prostate cancer, it is not so much the quantum of the score as its trajectory that counts. If your PSA takes a sudden jump, that is what gets everyone suddenly very concerned. As the Medline article says, prostate cancer can’t be diagnosed from a PSA test alone — that needs a biopsy. The test just raises a red flag.

The reliability or otherwise of the PSA test for mass screening test is extremely controversial, as it should be. But for individuals, there doesn’t seem to be another test that is as good. My impression is that males are under-tested, insofar as we tend to be at the GP’s office less often than females. So when a man in his fifties or older finally gets around to going to the doctor, the GP may order PSA to be tested as a just-in-case.

My message to male readers? It ain’t rocket science — get it checked out! Early detection still gives the best prospects. Men may feel reluctant to open that door; I certainly did. But just because you need to pee more often, it could just be benign prostatic hyperplasia. Treatments for this condition cover a spectrum of “let’s just keep an eye on it” to something more elaborate. That is a judgement that obviously needs to be made by a specialist. On the other hand, and not wanting to be alarmist, but you could have no symptoms and have something going on that needs to be nipped in the bud. (This was my experience.)

If you see a specialist, and want to get some more information before you commit yourself, get along to a prostate cancer survivor’s group, or join one of the discussion lists. You don’t need to have had an operation to join a group or a web site. But if you want to talk to those who have had surgery, radiation, chemo, or whatever else, this is a great opportunity. The Prostate Cancer Foundation of Australia is a good place to start.

Nothing to see here …

The main news, and you will forgive me if I repeat myself, is the PSA is still undetectable.

Getting the all-clear from the good Dr P always gives me a bit of a boost. Before we saw him I had made an appointment for the following day (i.e. today) for an induction from the volunteer co-ordinator at the Melbourne Museum. (I will be working there on a project to make digital scans of archival scientific documents, and add metadata to records linked to those digital images.)  Being involved in this enterprise will be a good thing, because manageable. I will be there only a morning a week, breathing those cataloguing muscles back into life after five years of inactivity. I made notes on the train on my way in about how much I am really appreciating Melbourne this winter — the grey days, the European lanes in the CBD, the lovely gardens and Victorian buildings through and past which I walk on my way to the Museum. 

The morning went the deceptive way of days when everything seems to just fit in. I left the GT in a side street and walked back to the station. The train before mine stopped the traffic at the level crossing on Riversdale Road in nice time for me to cross, touch on with my Myki, and get the all-important coffee. I had allowed half an hour to get from Parliament station to the Museum, plenty of time to walk along Spring Street, past the Royal College of Surgeons, through the Carlton Gardens, and, with a slight detour, past the Exhibition Building. (In the course of my Museum induction, I learn that this huge structure, the best preserved of the Victorian era exhibition buildings, is technically part of its 15 million item collection.) 

Of course, when things seem to be going just right, some sand gets thrown in the gears. I had planned to do the food shopping on the way home. In my haste to leave early in order to get the coffee, I had forgotten to bring both the cool brick for the little esky in the car boot, and (disastrously) the shopping list. Rather than have to go home then go out again, I reconstructed the extensive list of comestibles as best I could on my homeward journey from the Museum. I decided to go to the supermarket, then the butcher, so that the meat wouldn’t be sitting in the esky sans cool brick. Of course I promptly forgot about this, arriving at the butcher first. Curses! Should I backtrack to the supermarket? No, I’ll just get the meat, then whiz through the grocery shopping so the meat doesn’t go off. (With ambient temperatures of about 12 degrees, this was never likely, but it is one of the things I am most neurotic about.) Of course, not having a proper list, many things remained annoyingly needing to be purchased in a second excursion tomorrow.

That day I am to have two cooks, the first to make a banana bread for morning tea. One of our neighbours is moving to the inner city; she and her daughter have been clearing the ancestral home. I offered to bring them around coffee and a snack to sustain them in this enterprise. Fortunately, they have no dietary issues for me to consider. (I wouldn’t mind if they did, it just makes things a tad more complex.) Unfortunately, I am not sure that I have enough sugar — this being one of the things left off my reconstructed list. If I don’t, I am going to have to improvise by making up the shortfall with a few spoons of jam. (I have done this once before — one just has to take a guess at quantities — but it worked surprisingly well.) The second cook is dinner for us and our niece. I have all the ingredients for the main course, but not the dessert. So I will have to head out after morning tea and get the things I left off the list. You’ll be sick of hearing about this list! I’m sick of thinking about it! My usual scattiness is being given a turbo boost by the stress of measurement anxiety — bringing me back to the start of this rather ratty blog post.

Still, compared to what they could be, the little niggles and irrits I am having a whinge about here are great problems to have. I do know this. Thank you, universe! You feel you can’t make things too easy for me — in case I get too complacent? Fair enough. You the man.

Anticipation is half the pleasure

My beloved and I just saw Dr Parente for my regular 6 weekly check-in. Executive summary: the PSA is still undetectable.

Getting the news was almost comically protracted this morning. First there were no parking spots in the car parks at the practice.  So my beloved had to drop me off and go and hunt for a spot outside. She found one, but didn’t have many coins to put into the meter. (Some meters accept credit card, but not those in the City of Whitehorse.)  When I went in, the waiting room was almost empty.  This made the lack of parking somewhat peculiar. There are, admittedly, other doctors’ practices in the building; it is unusual, though, that none of the cars in the carparks should belong to Dr Parente’s patients.

Because of my beloved not having many coins, we didn’t have long to go on the meter. This wouldn’t have mattered had Dr P been on time, but — doubtless for excellent reasons — he was running late. We were chatting to the other patient in the waiting room when I arrived — his chauffeur had had to drop him off, too. And he had an appointment booked at the same time as me! Who would get to go in first? He did, of course. The time ticked away on the waiting room clock.

My turn came. Dr P had to connect his laptop to the practice’s wifi (or something). It was slow to load up with the results of the blood test I’d had on Monday. At least your name’s not in red, he said encouragingly, peering at his screen. Still, the news, when we finally got it, was good. McFate had obviously read the famous advice to writers: make ’em laugh — make ’em cry — make ’em wait.

(PS: I had always thought this advice to have been the work of Wilkie Collins. When checking this, I found that it is now attributed to Charles Reade. Warning — this link points to a Guardian article.)

You are what you eat

This is a minor rewrite of a previous post, published under the title ‘The more things change’. 

First, the breaking non-news. I saw Dr Parente (oncologist) yesterday, and the PSA is still undetectable. So everything is the same as last time. The next appointment, in May, will be a Zolodex one. This means, after seeing Dr P, I get a new implant up in the oncology ward. (I say “up” because it is on the 4th floor of Epworth Eastern. If your station overlooks a window, there are soothing views over the nearby park. I always take my noise cancelling headphones, and usually listen to ABC Classic.)

My beloved has just returned from Paris. She had a week there, mainly for work, but added a couple of days to the end of the trip. I was to go with her initially, but we decided against this. Having flown business class on our last trip, it is pretty well impossible to go back to economy. (I would have needed to keep my feet up in any case, for the lymphedema.) We would therefore have been up for another BC ticket and extra accommodation costs. We looked at tacking on a river cruise or something similar to the end of the week. At that time of year, however, there is nothing much available — it’s just too cold.  I had Dr P’s appointment to go to as well — these things can usually be changed — but I wasn’t sure that I wanted to. So I was baching for the week.

It was a strange time. We hadn’t been away from each other for that long for twenty-five years. So I decided I needed things to do. Fortunately there was no shortage of projects. We had a big sheet of plywood sitting down in the garage, about 1.2 metres square. With the help of a neighbour, I cut a roughly triangular piece out of it. This I used as a floor  underneath the vertical garden. The latter is in a corner of the courtyard which faces west and north. Being on casters, is obviously meant to go on a smooth surface, not resting on the ground as I had it. Having the plywood underneath it means I can now move it around to follow the sun, which is now much lower in the sky, and shining more on the northern wall.

This project actually took up quite a bit of time. First I had to measure up the corner. When I had a triangular bit of plywood, I removed the vertical garden and other things, then put the plywood in the corner to see if it fitted. It did — after I dug up a bunch of the native grass that is planted in the corner. (I will tell you what I did with that in a second.) The plywood has battens along two sides, so it is not lying flat on the ground. I decided I would paint it, however, to protect it just a bit from the rather boggy conditions in the corner. So I spread the tarp out on the driveway, and rustled up a miscellany of bits of cardboard packing and other things to rest it on. I had about ten litres of paint left over from painting the fence, so after pulling it out of the corner, I slapped a bit of that paint on both sides. The next day, I put it back in the corner, and arranged the vertical garden and another pot, into which I put the clump of grass which I had dug up before.

Sorted! Well, almost. The pot that holds the grass clump is slightly too small for it. (It isn’t a proper pot, but an old rubbish bucket that I have repurposed by drilling some drain holes in the bottom.) I have an old recycling bin which is a lot bigger, and is already equipped with drain holes. When I dragged this out, however, I realised it was about double the capacity of the present pot, and I didn’t have nearly enough soil or potting mix to fill it. When I shopped yesterday I bought a bag of potting mix. I expect therefore to have the grass in its new home as soon as I can get to it today.

Another little bit that needed fixing was the irrigation to the vertical garden. This is now a metre or so further away from the tap. I therefore had to cut a longer piece of hose to go on using the irrigation. When I move the vertical garden back in its original position, I will have to fit the shorter piece of hose to keep it connected to the tap. To do this easily, I will have to get some more of the click fittings — the bits that accept the male click-in portion.  Another trip to Bunnings! (Not that I mind — there is a coffee cart at the Chadstone store that sells the most insanely delicious Nutella doughnuts — giving my wanderings around its endless aisles a turbo boost.)

I have had very little success germinating seeds in the spot I originally set up for this purpose. So I am trying a new, shadier location, and giving it some more protection from slugs this time. They will have to be like Siegfried and pierce the ring of fire! In this new spot I put out dwarf beans and some more parsley and chives. The first of these have sprouted extremely vigorously — I will probably have to thin them out. So I have planted them out into the top layer of the vertical garden, where they get maximum sun, and have a trellis behind on which to grow.

The other seeds are not doing anything yet. To the ranks of these recalcitrants I added some baby beet seeds, having first soaked these in water for a couple of hours. When are you supposed to water seeds, by the way — as soon as you put them in, or after a week or so? The back of the packet doesn’t say anything about this. With the beets, however, I reasoned that, as they had been soaked in water, they wouldn’t mind a bit more straightaway. Incidentally, my helpful neighbour showed me a good way of labelling seeds or seedlings. This requires a packet of paddle-pop sticks (available from the $2 shop), on one of which one writes the name of the seed with a permanent marker. 

Another thing I did a fair bit of during this week was cooking. I did acquire a Sunbeam Nutri Oven for $20 in very good condition from the local op shop. Whenever I mention this device to anyone, they look puzzled, and I end up trying to describe it. A picture is worth a thousand words, however, so I am pasting in a picture below.

Nutri oven

The big ugly-looking unit on top contains the heating element. The vertical slots conceal a fan which circulates air around the food. Yes, folks, this is the predecessor to the air fryer we see advertised on late night TV. The Nutri Oven is a lot better, however, because it has a much larger capacity. Using the extension ring (not shown), you can cook a whole roast. Why bother when I have a perfectly good wall oven? The weather is chilly now, but after the hottest March on record, I was interested in something that wouldn’t heat up the whole kitchen. There is actually very little this thing can’t do! I have roasted, grilled, sauteed (sort of), and baked in it, all very successfully. You can do steaming as well, after a fashion — results with fish fillets and potatoes wrapped in foil are very good. I have also baked about half a dozen cakes and three loaves of bread. Being able to bake bread is particularly good for my beloved, who has to avoid bread containing any preservatives. (These don’t have to be listed on the packaging if they constitute less than a  certain percentage of the food.) She can now have a toasted egg sandwich, with Nuttelex, iceberg lettuce and salt. Raymond Blanc, eat your heart out!