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”.

Isolation day 28

  • I have an appointment with my oncologist, Dr P. in a week’s time. Yesterday I was feeling quite anxious ahead of this appointment, and was quite tense and emotional. This anxiety always seems to dissipate when I have the blood test that precedes the appointment.
  • So I was quite happy to set out early this morning to have my blood test. There was only one patient in the queue ahead of me; he was wearing a mask. I always find there is something soothing, somehow, about the ritual of having a blood sample taken. It could be partly the contact with the pathology assistants, who are always pleasant and matter-of fact. (We all know our roles in this drama and what is expected of us.) I had drunk a couple of glasses of water before I left, and one of assistants exclaimed approvingly: “Look at your lovely plump vein”.
  • After I got home, we went out for the morning to get out of the way for our cleaning lady. We had had quite a bit of rain overnight, and some of this was still around when we set off. My beloved had the idea of driving to a large park, Summerhill Park, in Glen Iris and going for an hour’s walk. This would take us past a nice cafe where we could get a takeaway coffee. There is a covered area in the park opposite the cafe, with several tables and benches; we planned to have our coffees there if the rain persisted. (There was quite a queue at the cafe, however, so we decided to have one at our next stop, in Camberwell Junction.) There was quite a number of people walking along the path in Summerhill Park, and the one it connects to further to the west, Ferndale Park. Many were out with kids in prams, dogs, or both. It was a friendly atmosphere; people seemed a bit more aware of social distancing than in Wattle Park, our usual hangout.
  • My beloved then drove to Camberwell Junction, where we stopped for a coffee. The cafe is on a walkway between the car park and Burke Road; there are several seats along this walkway, and we sat on one of those. It was a little bit breezy, but we were equipped for a cool day. The coffee was very good — my first for the day. After that my beloved headed off to the supermarket for some groceries, while I sat in the car, read my emails, made some phone calls, and listened to the radio for a while.
  • We got home with the groceries, whereupon my beloved headed off to her workstation for a while. I made us some lunch and we watched an episode of Deutschland 86. I hadn’t liked this series quite as much as its predecessor (Deutschland 83) at first, but I am enjoying it now. The second series is set supposedly in South Africa, Angola and Namibia, as well as in Germany. The photography of all these places is beautiful, and exploits the contrasts between the harsh light of the African countries and the dull, rather drained look of Germany.
  • My beloved returned to work for an hour or two. (She had received a call from a colleague just before lunch, which made me realise she is part of the “always available” workforce.) I downloaded an app from Telstra which allowed me to draw a map of our wifi coverage. This map, and a couple of different tests of our upload and download speeds, confirmed my impressions of the still fairly new NBN service. In a place the size of ours, our (basic) plan allows us to watch streaming video in high definition and browse the internet, with only occasional dropouts. Given that there is one more person using the wifi, for four or five hours a day longer than before the isolation began, this is a pretty fair result.

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.