Extra treatment

A week ago I had a CT and a bone scan, followed a couple of days later by the usual blood test. (I had to leave a gap between them because one of the scans involved being injected with a radioactive tracer dye. This dye can affect a blood test if the latter comes straight after.) This afternoon we saw Dr P to see what all these tests revealed.

The PSA has continued to creep up — only about 0.7 from the previous result, however. The scans revealed a few new spots, something of more consequence. Fortunately, however, these are all in bone, something that is greatly preferable to visceral metastases. (The phrase used in the findings of the scan was “mild progression of bony metastatic disease”.)

Dr P said he thought it was time for an additional treatment, enzalutamide. (The link points to a post in the Harvard Health blog which gives a bit of context about this type of drug.) I had heard of enzalutamide, and know a few guys who are on it. Dr P is confident I will tolerate this treatment well, and that he can get my PSA down to zero on it. (The last time he predicted this, it came about.)

Obviously having new spots isn’t ideal. However, Dr P emphasised that the new ones are minor, and that I’m not (as he put it) “lighting up like a Christmas tree” in the scans. We are both relieved to be moving to an additional treatment. I will continue with the Zolodex until further notice; the next implant for this will take place in 6 weeks. (I have actually been on Zolodex for almost three years, an unusually long time. Zolodex is an androgen deprivation treatment — see another link from the same source for more information.) I will see Dr P in a fortnight so he can see how I am going with the new drug. All going well, we will revert to our usual 6 weekly consult. Enzalutamide is on the PBS, so it should not cost much.

Pharmacists don’t tend to carry enzalutamide, so we had to order it, but it will be availabIe tomorrow. I will obviously just have to try it and see how I tolerate it.

Less good news

I have been procrastinating about writing this, so I am just going to get it over with. We saw Phillip P on Wednesday 9th (about 8 days after my appointment with Pat B). Unfortunately the “gains” that Pat reported, in terms of a reduction in PSA score, have entirely been lost. The score that we got from Phillip was 6.5, which is back to where it had been before the radiation treatment.

Phillip made several points about this. (Sorry, I have forgotten how to do numbered lists in this infuriating blog editor.) First, he found the increase “not upsetting”, and he hoped we were not perturbed by it. Second, he understood also that people made a fetish (my word) of the PSA score. However, the metric that he is focused on is the doubling rate, i.e. the time interval in which the PSA score doubles. A doubling rate of 6-8 weeks would cause him concern, but he feels I am a long way off that. Third, 90% of his consultation time is spent reassuring patients and their carers about PSA scores. So he gets that people find these increases worrying. (He was at pains not to ridicule or downplay our concern.) But he would like us to look, not just at the quantum of the score, but at its rate of progression. Fourth, he has many other treatments up his sleeve.

As to when it comes time for me to move to the next treatment, as he has said previously, Phillip wants to keep me on Zolodex for as long as possible. Let’s call the its successor “Treatment 2”. Say Treatment 2 has an estimated efficacy of a year. If I go onto it now, I will get a year out of it. If I go onto it in six months, I will get eighteen months out of it. So that is why he wants to defer Treatment 2, and its heirs and successors, for as long as possible. (Phillip has said to me before quite bluntly, that the fewer treatments I have, the better.) Treatment 2 will be deployed at a rapid rise in my PSA. But we ain’t there yet.

I was due for another Zolodex implant after the consult with Phillip, which I had without incident. I will go on having these every three months until I move to another treatment. I will continue seeing Phillip every 6 weeks, and having a CT whole body scan every three months. (The next one of these is booked in for 12 July.) So I remain under close surveillance.

It took us a while to digest this news. On hearing it, and the rest of that day, we both felt a bit stunned. What made me feel better, actually, was doing some German homework. Everyone deals with adversity in their own way, and this is mine. We both felt more positive the next day, having had some time to get a better grip on the situation.

It was obviously disappointing that the radiation treatment didn’t have more effect. However, Phillip has many arrows left in his quiver, and we are confident that he will deploy these as the situation dictates. I am still feeling fine, exercising, doing stuff on the home front, and all the other things I have been doing. So there are a lot of positives to focus on — take it from me, we are doing just that! To this end, I would also like to maintain the moratorium on questions. I say this for two reasons. One, I just don’t have any more information to add to what I have written above. Two, I don’t want to give the situation more mental space than it already occupies; we don’t want to delve into it further.

Marching on

I had my appointment with Dr P this morning. The PSA has gone up slightly again — to 4.8 from 3.7. However, the scans I had on Monday didn’t reveal any new activity. So I am still radiologically in remission. Dr P said there was a spot on my chest which was probably causing the increase in the PSA. (On the way home I checked the list of metastases, or “spots” in doctor-speak, that he gave me in February, 2019. This showed one on the sternum — this is probably the one he was referring to this morning.) Dr P referred me to a radiation oncologist for stereotactic treatment of that spot; I will be having this treatment starting on the 23rd.

(I had stereotactic radiation treatment a few years ago — after the operation and before the chemo/hormone treatment. So it is quite familiar. All these treatments are pretty refined, and fortunately don’t seem to cause me many side effects.)

Anyway, Dr P is not worried about the blood test and scan results — “not even close” were his exact words. I am certainly still feeling fine. The sleep continues to improve, and this always makes me feel better. I will continue with the exercise classes twice a week. (Ditto with the hormone treatment unless and until I need a different one.) I had another Zolodex implant after the appointment with Dr P. After that we had a coffee on Maling Road, and I went to the greengrocers.

The day went a bit pear-shaped after we got home, though. I should explain, for those who haven’t been to our place, we are in the rear unit of two. Another pair of units is directly to the north of us. As we approached our place, we saw a police car on the nature strip and a fire truck and an SES truck in the street. As we passed the units beside us, my beloved glanced up their driveway and exclaimed “Oh, my God!”. A car was sitting in their driveway at right angles to the boundary fence. When we got up to our driveway, the car belonging to the neighbour in the front unit was parked outside our garage. This was all highly unusual!

We asked one of the coppers what was going on. Apparently someone in one of the units to the north of us, while driving out of their garage, had lost control and gone through the boundary fence. This had flattened a section of the fence, and knocked a hole in the garage of the front unit on our side. (This was why the neighbour’s car was outside our garage.)

Our garage has a party wall with that of the front unit. The police and SES therefore asked to check inside our garage to see if it too was damaged. There was a small crack in our garage wall, but no other visible damage. As a precaution, though, the SES put a prop inside our garage to reinforce the roof where it joins our neighbour’s. The latter went to the trouble of tying up the prop to prevent it from falling onto our car, should the wall shift. (They were very concerned that they get this prop back — I assured them I would keep an eye on it. I reckon if the prop fell on the Camry, we would be up for a new car — they are hefty pieces of kit!) Our neighbour’s garage is quite badly damaged — one can see straight through the wall where the impact occurred. She will have to leave her car in the street for the time being. It was just lucky no-one was hurt.

Everyone was very calm and pleasant. One of the police helped me drag some stuff out of the garage to let the SES put the prop in. The police also helpfully supplied us with the contact details belonging to the driver of the car. Armed with this information we rang our insurance company and explained what had happened. They will be sending out someone to assess the damage to our wall in the next few days. No-one actually said “You can go on parking your car in the garage”, but we inferred that this was a fair thing to do while we are waiting for any remedial work that might be required. TBC!

Carry on in remission

We saw Dr P this morning. The news wasn’t great, on the face of it: the PSA is up from 2.3 to 3.7. However, Dr P continues to be happy with where I’m at. He referred to the scans I had had in December, which showed neither “clear evidence of bony metastatic disease”, nor indication of “local soft tissue recurrence”. He said while the PSA scores showed that there was something going on biologically, I was still in remission radiologically. He wants me to have scans now every three months, adding “I’m probably just being paranoid”. (He can be as paranoid as he likes as far as we’re concerned!) He doesn’t intend to change the treatment I’m on until something shows up on the scans.

As Dr P pointed out, we have been coming to see him for three years now, something that surprised us. During this period I have had adjunct chemotherapy and hormone treatment — the latter of which is continuing — and spent two years in remission, i.e. with an undetectable PSA score. It was welcome news to me also that I remained in any kind of remission — I thought this had finished when my PSA score started climbing. Being in remission doesn’t change anything, of course, it just makes me feel that bit better. Physically I still feel fine, thanks to the exercise classes and lots of walking.

The last lot of scans was bulk billed, so the only drawback of having more is the time required. There is a gap of an hour or two between the two scans. By the time you arrive, get prepped, have scan #1, then wait until you can have scan #2, the day has a fair sized hole in it. Last time I came home for lunch during the gap. Next time, however, I will just walk up to Whitehorse Road, buy a sandwich, and go and sit in the park across the road from the hospital. If it is a hot day I will renew my community membership in the RSL and have lunch there — the food is pretty good, and they even have a senior special menu!

Post for 23 November 2020

I am pretty tired after an eventful morning, so I am just going to write the basics.

I saw Phillip P, my oncologist, this morning. The PSA has gone up slightly, now 1.4. (The previous reading was 0.5.) He said it is still very low, he is happy with how I am travelling at present, and that I shouldn’t worry. He is focused less on the quantum of the PSA than on the trajectory of the rise. A steep increase would be concerning, but a gentle increase like this is not. Nevertheless, he wrote me a referral for a couple of scans (CT and bone) to be conducted before our next appointment. These will reveal if there is any spread of the disease.

(After I came home from a walk this afternoon, I got a call from the scanning centre at Epworth Eastern. The scans are booked for 17 December. It is a convenient location in Box Hill, being where I go for the Zolodex implants. Speaking of which, the next consult with Dr P, and the next Zolodex, are booked in for 23rd of December. This is a bit better than the original appointment, which was scheduled for the 30th of that month. There are lots of places at which I would prefer to celebrate my birthday than a day oncology centre!)

Dr P was running quite behind, and I had a consult booked also later that morning with my GP. I did make the latter on time. Unfortunately, it was a bit jarring. After having discussed a few alternatives for sleeping tablets, he wrote me a couple of prescriptions for some new ones. I quizzed him to make sure I understood how I was to take them — alternating one with the other, or both at once — the latter was the case.

He then said I had had my fifteen minutes and I couldn’t have any more time. If I had further things on my list (which I did), I should have outlined them at the start. I did get one more prescription out of him, for the blood pressure medication. Anyway, I will be changing GPs. I get that medicos are stressed. They need to manage that stress, though, in ways that don’t involve taking it out on their patients.

Positive points to the day included sitting down in a cafe for a coffee after the GP consult — I needed a lift by then! Another was going to the local library, picking up my hold, and taking out a few other books as well. These were both things I had missed doing for most of this year (cafes and libraries having been closed in Melbourne). Op shops have re-opened as well, so things are really getting back to normal.

Last night I took out a monthly subscription to Netflix. This will allow us to watch some more episodes of Emily in Paris, previously mentioned, and a favourite of my beloved. We will also be able to bring ourselves up to date with The Crown. The Netflix Android app works well with the Chromecast, and we were able to switch on the closed captioning without difficulty. One can just renew the subscription monthly. Entertainment is welcome at present, particularly in the leadup to The Festering Season (as I grumpily think of it).

Snakes and ladders

Apologies in advance for any repetition of anything covered in previous posts, errors, or other solecisms. I have had rather a lot to arrange just lately. Please therefore take this as both an apologia and a disclaimer for this and all subsequent posts.

I had previously scheduled my next Zolodex implant for Monday 12th October. This date was made long before I knew I had to have the hernia operation (the latter scheduled for Friday 9th October). The hernia op can cause some bruising in the general area. So, on my oncologist’s advice, I rescheduled the Zolodex implant to be done before the operation. I had this implant yesterday, which was uneventful.

Generally, I see the oncologist (Dr P) on the same day on which I have the Zolodex implant. This time I had to have the implant before having gone over my most recent blood test results with Dr P. He will be ringing me some time today, however. I will put the results of that conversation in a separate post.

This morning I also had a COVID19 test, now required in Victoria (and probably everywhere else) before any operation can be performed. The office of the surgeon who will be doing the hernia op (Mr B) requested that I have this test a couple of days beforehand, at the pathology office located at Knox Private Hospital. (This was to ensure that Mr B gets the results in good time before the operation on Friday.) We therefore headed out to Knox Private this morning, where I had the usual back-of-throat and nasal swabs. My eyes watered a bit, but otherwise it was not too bad. I have to stay in isolation until I get the results of this test. Unless the result comes back positive, everything is set for Friday.

One of the snakes referred to in the title to this post has been the health care card. I successfully applied for this card in July (uploading, in the process, a significant number of documents about our super and other assets). This card entitled me to various concessions, all of which I duly applied for — power and gas, water, car registration, and so on. A week or so ago, however, a couple of these organisations informed me that I no longer had a valid concession. On Monday I spent the best part of a day attempting to re-apply for the card, by uploading a different form and a lot of other scanned documents. I could upload the former, but not the latter: it just gave me an error message. (Later on I got a different message, to the effect that the site was down for maintenance.) Eventually I did what I had avoided doing until absolutely necessary, and rang them.

The person I eventually got to speak to confirmed that I had lost the concession. (She acknowledged I hadn’t been informed of this decision by the Illuminati bureaucracy; this omission was “unusual”.) I could make a fresh application: if that were successful, I would be sent a new card. I could then apply to have the date of the new card backdated to that of the original card. When this was done, I could apply retrospectively for the concessions that I had missed out on in the period between the expiry of the first and the beginning of the second cards.

Clear as mud? After I translated this out of bureaucratese, I looked again at the guidelines, and our finances. I can’t see how we can now satisfy the former. (I believe a recent change in our circumstances is why we got pushed off the concession. In the interests of privacy, I won’t go into more detail here.) So it’s back to being a self-funding retiree — for a while at least.

As oldies like me know, age pension eligibility depends on one’s birth year. Theoretically I become eligible for this entitlement at the very end of 2020. Meanwhile I could make an early application for the age pension. If this application is successful, the pension and the other entitlements will be ready to go from one second after midnight on the day on which I come of age. (Sorry to be a tad vague about this — privacy again.) Anyway, I will save this task for when I am recuperating from the operation. They can only say no!

On a lighter note, as the saying goes (and correct me if I misuse the expression) — if you like opera, here is a small diversion. The British Classic FM station is running a quiz about famous operas. The exercise is to match a set of emojis with an opera. No prizes — just a bit of fun. The spirit of competitiveness and one-upmanship is obviously just as strong among my faithful readership as elsewhere. So I will reveal the score I got in this quiz in the next post. Bragging rights are up for grabs, so have a go! This link should open in a new tab: opera quiz . (It isn’t over until you-know-what happens.)

More, but not in a bad way

Note to family members — this post doesn’t contain any information that wasn’t in my last email message.

We saw Dr P on Monday, to get the unwelcome news that the PSA was up at the last test. However, the current level is 0.3 — still obviously less than 1. When we found this out, we were somewhat daunted. Our feeling was “a rise is a rise”. The consult didn’t allow us time to process the information or ask what it meant. However, on the advice of Dr P’s PA, I sent him an email with some questions. He rang me back the same day and I learned a lot more about it. The new information:

  1. the increase I had had was not a rise in clinical terms.
  2. He would be worried about an increase of a much bigger trajectory, e.g. if it was
    measured in whole numbers (integers), and doubling in 4 weeks. So, for example, if I had a PSA of 5.0 and it went up to 10.0.
  3. Increases in fractions of 1.0 aren’t really accurate anyway. (This information is given in a disclaimer on  printout from the path company — a copy of which Phillip gave me on the day.) So, while one may worry about going from 0.09 to 0.3 — an increase of 0.21, which is more than double the first score — it’s a mistake to read too much into that increase. At that quantum it’s not really meaningful.
  4. He doesn’t look at the number itself, but at the velocity of the increase. (This goes back to #2 above.) A steep increase is most undesirable. But if it just grumbles away, as he put it, and increases gradually, that’s not alarming. Scores can move around, particularly under 1.0.
  5. One of the things he teaches his students is not just to look at the PSA, but look at the whole person. Do they feel (and look) well and healthy? On that basis, I am doing very well.
  6. One of the questions I had sent him was whether I would need to move to another treatment (e.g. another round of chemo). He doesn’t think that will be necessary for some time (see below). The longer we can delay my moving to a second-line treatment, the longer I’ll live!
  7. These are the answers he gave me to the questions I had sent him:
    Does he believe the cancer is progressing? No.
    Is he worried at the last increase? No.
    Is he expecting that I may need to move to a different treatment? Possibly, around the end of this year.
  8. He reminded me the treatment I am having presently (androgen deprivation) is Plan A. It has an expected maximum life of about 24 months. (I started it around Christmas, 2018. I can’t recall exactly, as it started as adjunct treatment with the chemo. The latter definitely finished on Boxing Day, 2018 — that I do remember!) Beyond Plan A, however, he has Plans B, C, D and E.

So the whole exercise was quite reassuring. He hadn’t realised we were worried — to be fair, we were wearing masks, which may have made it more difficult to read our expressions. Anyway, I will be talking to him in about 5 weeks, after the next blood test.

There is a lot of ambiguity around PSA. As I commented before, people look for certainty, and want a simple test to see whether they are doing OK or not. There is a temptation to simplify:  low PSA is good, high PSA is bad. As you can see above, it is a lot more nuanced than that. Dr P thinks PSA is a really useful way to see whether someone who has been pronounced cancer-free has suddenly relapsed. It is a less useful measure for someone like me in whom the disease is continuing.

However, I think medicos are partly responsible for this fetishising of the score. For the first half dozen or so consults this year, Phillip was very enthusiastic about my having PSA that was undetectable. He seemed different in the last consult, and I read a fair amount into him being much less effusive than usual. I can see I drew the wrong inferences, but then, I’m not an oncologist.

I believe situations like this arise because experts find it really difficult to remember what life was like before they became experts. Their knowledge gives them an incredibly rich context in which to interpret things. Can they meaningfully ask themselves the question “How would I interpret this if I didn’t know what I know?”. It’s an almost impossible task. Also, people join the dots in an attempt to find a “take-out” message.

My take-out from this? If in doubt, ask questions. There’s no statute of limitations — you can ask questions that occur to you after the consult. (My beloved prodded me to do this, and it was the right thing to do.)

The (provisional) new normal

First the news — we saw Dr P this morning, and the PSA remains undetectable. (This has been the score the last few times (with minor variations in 100ths of a per cent). Today’s consult was followed by a Zolodex appointment; the latter was scheduled half an hour afterwards. Dr P was running a tad behind, so after the consult I legged it off to the oncology unit at Epworth Box Hill for the implant. That was delivered uneventfully. (I had had a little bleeding from the previous one, which was unusual. There were no problems today, though. The implant is only about the size of a grain of rice, so it is not a big thing to put in.)  

After that we had a coffee — takeaway of course — drunk back in the car. Then we headed off to Mitcham, where my beloved wanted to check the size of a pair of shoes she had bought on Thursday. It was good that she did, as she ended up getting a half size bigger than those she had been sold previously. Finalising the transaction took some doing — there were complications. She had purchased two pairs on Thursday, one of which she took with her, the second to be mailed to us later. Much checking was required to distinguish the pair being returned from the pair being sent! (We will have to return this pair to the store for a refund — whenever they arrive.) We had gotten a discount on the price of the pair she had bought on Thursday, and this was duly applied also to the pair bought this morning. Of course the sales assistant we had today was not the one who had done the transaction last Thursday. Etcetera. Anyway, after trying on several further pairs, the slightly-too-small ones were “swapped out” (as people like to say) for the correctly sized pair. We thankfully headed for home after our voyage around the ‘burbs of outer eastern Melbourne. When large areas of the globe were still undiscovered, early cartographers used to write in the blank spaces — here there be dragons!  

Over the weekend I caught up with an old friend, with whom I had shared another takeaway coffee and a wander around the local park. He is working at a university library. All Australian unis depend on foreign students to remain solvent; with COVID19, a smaller number of these folk is expected to enrol in 2021. I think many people in the university sector are waiting to see what their jobs will look like when this happens. My friend is no exception. We swapped health updates as well while working our way around Wattle Park. 

A lot of people seem to be in this very provisional space at present. Whether we go up a ladder or down a snake seems to be one set of numbers away. The best to be hoped for is to keep plodding along, and staying off the radar. Is it a life stage thing? Was life always like this, or has it become more so recently?  

I wore a pink shirt this morning to give myself a bit of a lift, and, I hoped, to cast a healthy glow. I am developing a shirt colour theory of history. Garibaldi’s volunteers wore red shirts (the “Camicie Rosse“). So did the illegally-employed minions working for Victorian Labor Government MPs. These minions were paid out of public funds despite doing electorate work — quite naughty of their employers. (See the ABC News story for those who, like me, had forgotten about this rather sordid tale.) The fascists wore black shirts, Hitler’s Storm Troopers wore brown ones.  Conservative pollies — male ones, at least — seem to favour white shirts. Incidentally — hold the presses — I realise I have hardly worn my white shirts since leaving the paid workforce. So colour does stand for something. But what? 

Step up the pressure

As part of my exercise physiologist’s surveillance, I get a three-monthly checkup with her. This is just to see how things are going, how I’m travelling with the exercise classes, and run some basic tests. Because this was a Zoom appointment, the usual testing of things like blood pressure and weight had to be outsourced. (I managed to measure my waist circumference; that was nothing to write home about, so I’ll suppress that for now!) Accordingly I went to a local pharmacy to have a BP check.

As part of my exercise physiologist’s surveillance, I get a three-monthly checkup with her. This is just to see how things are going, how I’m travelling with the exercise classes, and run some basic tests. Because this was a Zoom appointment, the usual testing of things like blood pressure and weight had to be outsourced. (I managed to measure my waist circumference; that was nothing to write home about, so I’ll suppress that for now!) Accordingly I went to a local pharmacy to have a BP check. 

The value of this was born out when, surprisingly, the numbers came in a bit on the high side: 145/102. I say “surprisingly” because to date, my BP has been on the low side of normal. When I relayed this score to Lauren, the EP, she suggested I have a retest somewhere that used an arm cuff machine. (The pharmacy used a wrist cuff, which apparently aren’t as accurate.) If the retest was still around the same numbers, I should go see my GP. 

I decided to cut to the chase, and saw the good doctor last Thursday. (He hadn’t tested my BP for a while, having assumed that these things were being done as part of my oncologist’s checks. However, the latter hadn’t been doing it either! So it had fallen through the cracks a bit. To be fair, however, it hadn’t been problematic before.) The GP’s test came back with a similar number, so further investigation was required. He ordered several blood tests were to see if any minerals and so on are deficient. He also wanted me to get a portable testing machine for 24 hours. (These are available through Dorevitch Pathology, and probably elsewhere.)  

I went to get this fitted this morning. The main unit is pretty small, about the size of an old-fashioned digital camera. This is worn around the waist, and is connected to an arm cuff by a rubber cord. The actual measuring is pretty strong. I’ve never been squeezed by a python, but I imagine it feels a bit like this. (The measurement only lasts 10 seconds or so.)  

I am to press a button on the main unit when I go to bed, and again when I get up. Until the bedtime button press, it will measure my BP every half hour. When you tell it you are in bed, it only measures you every hour. (I imagine this will wake me up!) After I get up and do the morning button press, it will revert to a test every half hour. I am to go in tomorrow morning to hand it back. At the end of this week or early next, I will see my GP and get the results of all this measuring. TBC! 

Meantime I have been having fun with my German lessons. I realised I love the pedantry of it all, and the fact that there is a right and wrong answer. When I was learning a few years ago, I kept all my books and index cards; blue cards for verbs, yellow for everything else. When I restarted a few weeks ago, I wrote out some more of these. 

My system is: when I look something up in the dictionary, I put in a little coloured marker. I go through the dictionary periodically and write up an index card for each word I have marked. I use blue cards for verbs and yellow (or white) cards for everything else. Irregular verbs are marked with an orange dot at the top right. Some cards are general, like the alphabet, numbers 1-20, and so on. But mostly each word gets its own card. The German goes on top with the translation below; this is reversed on the other side.  

My teacher Jörg and I also had an enjoyable exchange about index cards. He uses them too, and has four boxes, as follows: 

  1. current cards; 
  1. words he doesn’t remember at the first test; 
  1. words that he does remember;  
  1. words that he has learned.  

(I guess that, when a word goes into box #4, it would get a final test, which would pick up anything that had dropped out of memory.) I thought this was a great system, and bought another card box and some more packets of cards at the newsagent. I have one card in my box #4: kugelschreiber (pen). As I have one of those classy multicoloured pens, I made up a sentence to describe my pen:

Mein kugelschreiber hat vier Farben: schwartz, blau, grün, und rot. 

Next I will tackle Die Katze saß auf der Matte. 

 

Isolation day 30 (I think)

Ah, ’tis a bit hard for the old noggin when I skip a day’s posting. But that number seems right. Gosh — more than 4 weeks in isolation! The only people I have interacted with during that period in RL are my beloved and the assistant who took my blood sample on Monday. But everyone is staying calm and keeping isolated. The trend in new cases in Victoria is obviously encouraging.

Some of the following is shamelessly repurposed from an email — I hope the recipient will indulge me.

  • Cutting to the chase — I spoke to my oncologist, Dr P, a few hours ago. All good! The PSA is still 0.02, the same score as the previous test. (Earlier ones had been 0.01 for quite a while, so I asked if this new score was anything to worry about. He said it was within measurement error, and still undetectable.)
  • I hadn’t expect to see Dr P until Monday. When I saw him last, he said our next appointment would be a teleconsultation. So I rang the practice this morning to confirm this. When I got through, his extremely switched-on assistant said “Oh, Guy! I saw your bloods come in — I’ll just ring Phillip and see if he can talk to you now”. I said “Fine” (grabbing my notebook, and wrestling the pen out of its little loop). Anyway, Dr P and I had a teleconsult then and there, over in about 1 minute. (This was a win-win; I got my results a few days early, he now has one less phone call to make over the weekend.)
  • He then put me back to the assistant, with whom I made the next 2 appointments  — these could be 3D, or teleconsults: TBC. His PA is really very efficient — a shout-out to these super-organised folk everywhere for how they keep all of us punters turning up on the right dates. It’s not just a matter of making appointments, but co-ordinating the latter with treatments as well. (This is the sort of job of which I would make a total dog’s breakfast.)
  • My next Zolodex implant is still taking place next week in the day oncology unit at Epworth East. (I don’t think they have worked out a way to do these by a teleconsult yet!) My appointment time has been put back, doubtless to allow better separation between patients. The Zolodex usually follows every second consult with Dr P — assuming the blood test gives the right result. The actual implantation only takes a minute, and that will be it for another 12 weeks.
  • I had a pretty poor night’s sleep again last night — awake before 5.00. (I did have a doze in the study before taking my beloved in her coffee.) She and I managed to get out for a longish walk this morning, which was great. There was a light drizzle, but then the sun came out. I have done nearly 7,000 steps, just over 5 km.
  • To celebrate the good news, my beloved and I had fish and chips for lunch. Very nice — I am feeling slightly liverish and absolutely stuffed.
  • My shirts arrived from HBs. They are lovely. One is a bit big — although they are both the same size — but that is a risk associated with ordering online. (I did look at the size guides, but they weren’t a lot of help.) I could possibly exchange it for the next size down, but that would be a hassle to have to post it back — even if such exchanges are still done. They are the kinds of shirts one layers up, however, so being a bit over size is fine. I will probably wear the bigger one over a light jumper or long sleeved t-shirt, etc., like the mysterious “shacket”.