- 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.
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!
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.
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.
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.
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.)
We saw Dr Parente yesterday morning. The PSA is still undetectable, and I remain in remission. After receiving this good news, we went to the oncology unit, where I had another Zolodex implanted. (You will remember that this is the hormone treatment — androgen deprivation — that is aiming to starve the cancers of what they feed on.) The implants are about the size of a grain of rice and last about 3 months. They just go in in the abdominal fat, of which there is still plenty, even after the gastro! There is very little discomfort. I booked in the next appointments with Dr P & the oncology unit, for the next implant.
My beloved is going to Paris in early April for a few days. She will be representing her work at an international transport meeting. We thought of me going as well, and tacking a cruise or other expedition onto the end of her work commitments. However, there is bugger-all happening in that line at that time of year (too cold, I suspect). So I am going to hold the fort. Of course this depends on nothing going awry in the meantime, but (touch wood) all seems to be quite stable. I have been going to an exercise class for oncology patients run by Lauren, the exercise physio, and this is pretty good! I will be going back to the gym soon as well (I stopped for a few weeks with the gastro).
My lovely old Luxman pre-amp has spat the dummy again and is only working on one channel. This is a real bore as I have to disconnect everything, pull it out, and run it over to the valve amp guru in Glen Waverley. He will have it for however long he needs to ponder its mysteries — could be weeks. (His workshop is like an Aladdin’s cave of amplifiers, many much more expensive than mine. So he knows whereof he speaks.) This is not my first pilgrimage there, however, and to be honest I am a bit over the vintage gear. Maybe I should sell it on Gumtree and get a nice, soulless, reliable, solid state integrated amp!