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).

Rest & recovery

When I started writing this post, I was trying to remember when I had had the hernia operation. According to an email message in my inbox, this took place on 9 October. I came home the following day. By now I am therefore well past the four week mark in my recovery. According to what the nurse told me, I have a couple of weeks to go.

The wound site was never really painful, and over the last few weeks has become gradually much less sensitive. It was always a bit worse in the evenings, when I generally felt more crummy. Now I am only conscious of the wound if I do something it doesn’t like. Yesterday was one of those days.

Sweeping the courtyard was one of the jobs I had been putting off. This procrastination isn’t unusual for me, but in this case I was conscious of all the bending down this job would involve. (Bending from the waist is better for me at the moment, as it puts less strain on the wound site.) By now, though, I thought that I could probably handle a little task like this. Sweeping the courtyard always makes it look neater and more inviting. Afterwards, I pictured myself sitting out there in the shade of the umbrella, enjoying my handiwork.

This was pretty much how it transpired. The sweeping, picking up all the debris into the big garden bag, putting some of that into the compost, and the rest into the green waste bin, all took about an hour. Along the way I re-fixed some shade cloth I have rigged up over the daphne in the front garden. I interspersed these with hanging out a couple of loads of washing, including the towels. (All these little tasks took me over my step target for the day, without having gone past the mailbox.)

I did notice the hernia wound after a while. It wasn’t painful exactly — just enough for me to think, okay, that’s about as much as I can manage right now. But I enjoyed being outside, getting things looking a bit better, and having a closer look at the garden.

The main problem I’ve had over the last few weeks has been my sleep. I think this has to do, at least in part, with my not being able to exercise as much as before the operation. (I did resume a modified exercise class just last week.) Consequently I have been getting, on average, an hour and ten minutes less sleep than I was having before the operation. I have also been waking several times a night, and getting up in search of something that will knock me out for a while. So the sleep has been both shorter and more fragmented.

The other reason is to do with my sleep medication (Stilnox), to which I have been gradually becoming habituated over the years. I really need a new one. Whatever I take, however, has to not interfere with the Zolodex — while I remain on that treatment. I will be seeing Dr P on Monday week to discuss all this, together with my most recent blood test.

I have had insomnia for about 25 years now. Over this time I tried most of the sleep treatments around. None delivered a cure, so I just learned to live with it. The last four weeks has been an extremely sustained patch of sleep deprivation, however, and I have been finding it pretty tough. I hope that gradually getting back to my full exercise program will help.

I am also going to investigate contactless shopping for groceries. In this scenario, I drive to the supermarket, open the boot of the GT, and send a text to the effect of “I’m here”. Someone will put the bags into the boot of my car, I drive home, and at this point my beloved will bring the bags inside. This way I will get a mini-outing, and she will have the chance to catch up on her work a tad. From each according to his ability, to each according to her need.

We did some old-style shopping over the weekend. Our dishwasher packed it in last week. (I think the noisy, thrashy thing is about 20 years old.) I read lots of reviews, and measured the recess in which it sits under the kitchen bench several times. Yesterday we headed to one of the nearby big box stores to kick some tyres. Did we want a two or a five year warranty? Would a cutlery drawer be a good thing, or would we make do with a basket? All the alternatives were worked through, and we chose a German make with which to replace the tired old Dishlex. The credit card was unfurled to good effect, and the new dishwasher — a Siemens — is being delivered on Friday.

In the meantime, my beloved and I have had some slightly nostalgic times handwashing our dishes, and drying them with a tea towel. I seem to remember Mum and Dad having sotto voce arguments while doing this. Like them, we have fallen into gender roles — my beloved washing, me drying up. We haven’t had any arguments so far, though, even when I queried her practice of putting the cutlery into the sink first. I will remain a cutlery-last man to the end of my days! (I hope this preference will soon revert to being a theoretical one.)

Mr B sees it through

[Apologies — I have corrected the first sentence to remove various solecisms. Some changes further down are too trivial to mention. So no need to read further if you’ve already read it.]

Yesterday I went with my beloved to see Michael B, the surgeon who carried out the hernia operation . This follow-up consult was one week after the operation had been carried out. Mr B pronounced himself satisfied with how everything was looking. My main question was “When I can go back to exercise classes?”. He thought another couple of weeks’ recuperation should do it .

Just before Michael came in, the nurse removed the dressing that had been put on the wound after the operation. This dressing was transparent, allowing any bleeding or anything else undesirable to be identified. According to the notes with which we were supplied on discharge, this dressing could be left in place, absent any leaking, oozing, or other indications of the wound not healing. We had seen no reason to change it, however. (Several spare dressings had been included in the sample bag I took home on discharge.)

Before yesterday’s consult, I had imagined the dressing being ripped off in enthusiastic Nurse Ratched style, perhaps preceded by a bracing “This won’t hurt a bit!”. However, it was just gently peeled off, with zero discomfort. I was lying on an examination couch, with my shirt and jacket pulled up a bit, so I couldn’t see exactly what the nurse was doing. On our way out my beloved and I asked ourselves “Did she put another one on?”. I checked when we got home — she hadn’t. But the wound still seems dry, and neither tender nor inflamed .

A few stitches are holding the edges of the wound together. These stitches will just dissolve by themselves, so there is nothing further to be removed. Because I seem to be healing well, a second consult date wasn’t set. Of course I can ring and report any problems or complications that might ensue. Based on how things have gone so far, however, I am not expecting any.

Hospital admissions are bit more protracted, in Victoria at least, because of a compulsory temperature check, a digital form to be filled out on one’s phone, and other CoVID19 business at the point of entry. Even with these extra steps, we were in and out in less than half an hour. This period is the maximum for which Knox Private Hospital provides free parking: after this, their meter is on. Anyway, we must just have snuck under the wire — yay!

Yesterday’s visit featured another freebie: there was no charge for yesterday’s consult. I am not expecting any other charge to be forthcoming. Before we booked in for the procedure, I had requested a financial quote from the practice. According to this, Mr B’s, the assisting surgeon’s, and the anaesthetist’s fees were all to be sent direct to our health insurance fund. This seems to have happened exactly as promised. So, apart from a few dollars for some anti-inflammatories and analgesics with which I was supplied on discharge, the procedure cost has cost nothing.

We won’t (fingers crossed) have to pay anything for the costs for my overnight hospital stay, either. The hospital cover of our health insurance features a $500 excess. The hospital cover year runs from May to April. (Just to make things difficult, the extras cover corresponds to the financial year.) From May to April, the first two hospital admissions for either of us cost $250 a throw. Any subsequent admissions in that period come after the excess has been paid, and are therefore not charged.

This operation was preceded by a couple of hospital admissions during this period, each for a Zoladex implant (albeit this is only a day procedure). The lady at the cashier’s at Knox Private, by whom I was interviewed at admission and at discharge, did try to charge me $250 both times. She readily demurred when I pointed out I had already had two hospital admissions since May. No, I’m not having anything else done, even for free! I do believe in being careful what you wish for.

Hernia op all done

Many of you will have found out, directly or indirectly, that my hernia operation went successfully yesterday.

I didn’t get much sleep last night. The wound made it difficult to push myself up the bed far enough so that my feet weren’t pressing against the end of the bed. Fortunately it was possible to raise the middle of the bed independently of the top section. This raised my knees a bit, which took a lot of pressure off the feet. By the time I fiddled around with this, however, I had woken up, so I had to go through all the business of sitting up again. Laughing was the worst thing for the wound — I had to press on the wound site to avoid straining it too much. (Of course, trying not to laugh at something that is bloody funny is next to impossible.)

I felt a lot better after breakfast this morning, and was able to get up, shower, and dress myself independently. (These always seem like major achievements after surgery!) Kudos to the nursing staff at Knox Private Hospital, who were kind and attentive. I was sent home with painkillers and anti-inflammatories, and strict instructions not to lift anything much, or strain the site in general. Today when I stand up, the wound is a bit painful. When sitting I can still feel it, but there is only a mild discomfort.

Fortunately I had taken in a few things with which entertain myself. Among these was Night letters, by Robert Dessaix. I hadn’t read this since it came out in 1996. It had a lot of extra resonances for me this time through. I gather it was written after his diagnosis as HIV positive. (Fortunately his Wikipedia entry only has a birthdate after his name, so I gather he is still with us.) Dessaix vividly describes how receiving a diagnosis of a serious medical condition throws one’s values and plans into disarray.

One of the nurses was interested in it. I tried to explain that the book purports to be a series of letters written by a character strongly resembling Robert Dessaix, who is travelling through Italy and Switzerland after receiving a life-changing diagnosis. Night letters is both an epistolary novel and a memoir, and a great example of both genres. It has some playful mock-academic apparatus in the form of a “translator’s” foreword, and three lots of end-notes. If this all sounds bit drearily post-modern, have no fear — the narrative pulse beats strongly throughout.

My tablet is running out of charge, so I am going to press “Publish”.

Mini-snake

I heard from Dr P. The PSA score in the most recent blood test is 0.5. Previously, it was 0.3. According to him, this increase is nothing to worry about. (I was told that at least twice.) He won’t be concerned until it gets “into double figures”. (I clarified this — yes, he did mean 10.) So he doesn’t propose any change in the treatment unless and until that happens.

You’re doubtless (both of you) dying to know what I scored in the opera quiz. Well, I got 10/11. Just saying. There were 6 Wagner operas that I can remember — assuming you count the Ring Cycle as 4, which makes sense. I am still poring over the comment received re a hypothetical quiz for classic novels. Ahh — a rural romance/epic of some kind? Middlemarch? The Chronicles of Barsetshire? You got me!

I’ve got a classic movie for you: (T.N.T()–‚úĻ

And another classic novel (trick question alert): ūüĒé‚ĆõÔłŹ¬†

Of course, we know no-one says “Over and out” when terminating a radio conversation. So I am just going to say “Over”. See the Prof. Paul Brians’ explanation, should one be required. (Warning — this web site is a paradise for pedants! His entry for “I/me/myself” is a classic. He missed out on “sanction”, though, which I will leave for someone else to disentangle. I found a typo in a heading, though, which I will leave for fellow pedants to rootle out.)

Didn’t see that coming!

Note to siblings: I have already alerted you to the main matter of this post.

This Friday, 8 October, I am booked in to have an operation to fix an inguinial hernia. This is quite unrelated to the cancer. I’m not sure how I developed the hernia — possibly through lifting weights that were a bit heavy for me. The weakness in the abdominal wall might have been there for quite a while. Anyway, it’s something that has gradually developed until the time has rolled around to do something about it. It is good to get it dealt with before it develops into something more serious, i.e. incarceration or strangulation, as set out in this Healthline article.

Naturally I checked with my oncologist before booking the surgery. He strongly encouraged me to have it. He said (words to this effect) “You’re very fit, you’ll breeze through it”. Having the hernia fixed will allow me to continue exercising, something of great importance to cancer patients (as for everyone). I sought a few other opinions as well, about the surgeon, and the technique he proposes to use. All these came back favourably as well. So I am as confident as I can be that the outcome will be positive.

After the open radical prostatectomy, this should be much less of a production. Having had the former operation unfortunately rules out keyhole surgery in this case. Hernias are still much easier to get at than prostates, lymph nodes, etc. I am scheduled to have the operation on Friday morning, and be in hospital overnight. I will have to take my music player in! I will also take in something a bit lighter to read than what I chose for the prostatectomy — G√∂del, Escher, Bach, by Douglas Hofstedter. (It’s not every book that gets its own Wikipedia entry. Who was I trying to impress? Needless to say, three years later, including six months in lockdown, I still haven’t read it.)

Another unexpected development has occurred, this one associated with my foray into the German language. My patient and good-humoured teacher J√∂rg told me on Friday that he now has a full-time job, starting in the middle of the month. He and I will finish up the two lessons remaining in the current block of ten. After that I will have to either find another teacher, or join a class. I am leaning towards the latter of these options, if I can find a class that is at about my level, and at a convenient time. (I was planning to have a break for a week or so in any case with the operation.) Of course I am happy for J√∂rg that he has a better position. I have come to look forward to the lessons, though, and it is a little sad that they will not be continuing after the next couple. We have developed something of a rapport, even after I corrected one of his corrections — something he took in good spirit! (As Mime says to Siegfried, in the opera of that name, “den Lehrer sein Knabe lehrt” — literally, “the teacher learns from the lad”.)

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?¬†

Back to the OK Corral

I just heard from Phillip Parente — all good. I am to see him next on 20 July. On that date I am also scheduled to have my next Zolodex implant, with the usual provisos. On 20 July I will be seeing Phillip face to face; the appointment in the Epworth day oncology unit which is scheduled 30 minutes later. One day they some clever person will work out a way to deliver drug implants via the internet. Until then I have to schlep over there in person for one of the super oncology nurses to do the business.

I have had three Zoom meetings this week, two for the exercise class, one for German. The latter is something I have just resumed doing after a break of several years. However much I doubted that I would ever get back to Austria or Germany, I kept all my books, dictionaries, and the other language learning clutter. Without any concrete purpose to turn over the language engine again, though, things stayed in a state of equilibrium. One day a few weeks ago, though, I started going a bit stir crazy with the isolation, and realised that I needed a project. I had had a fair bit of Zoom experience by then, as well. This led to one of those rare lightbulb moments in which I wondered if I could use that platform for language learning. Not only could I do that: my former language school wasn’t doing classes any other way. So I made contact, explained my purpose, and had my first lesson with J√∂rg. Alles gut!¬†

I have fond memories of making my way into Melbourne when I was doing German face to face in 2015 and 2016. I would drive to Riversdale station and catch the train to Parliament. From there I would cross Spring Street and walk through East Melbourne, past the lowering bluestone bulk of St Patrick’s Cathedral. The language school was in an old terrace house on Victoria Street. I began in a small class, which would make its way up the narrow, creaky stairs. When I got back from the trip, the class was half way¬†through its new term. The only way I could try to catch up was by seeing a teacher one on one. When I got the cancer diagnosis, language learning seemed like the least important thing to do.¬†¬†

I’m glad I didn’t let it go, though. German now seems like a vast jigsaw puzzle, complex, but less impenetrable than it did the first time. With my dictionaries, web sites, index cards, and¬†multi-coloured¬†pens (handy for learning genders), I feel better prepared for this second campaign. The break has given me time to ponder the intricacies of this knotty language, and a couple of countries to relate it to. For the first time in my life, I am learning grammar. (It would have been¬†get this under my belt at school, but besser¬†sp√§t¬†als¬†nie, as punctual Germans would say.)¬†

Scoreless draw

My beloved and I went along for my final appointment with Dr Parente for the year. All was as if had been the other times — PSA undetectable — everything good. Of course, this is something we never get tired of hearing! Herself and I had a celebratory coffee in Hawthorn before went to my exercise class.

The week before each appointment, I have a blood test, leaving enough time for the lab work to be done and delivered to Dr P. Around then, I start getting testing anxiety; I am more irritable, although I try not to be, and my sleep is worse. On the morning of the appointment, I feel quite neutral — there is almost a relief that it is here.¬† On the morning of the appointment, we drive to Box Hill, hoping to get a spot in the practice’s car park. This is quite contested. To keep non-patients out, the practice has had to hand out passes each day to display on the top of their vehicle’s dashboard. If there is a spot, my beloved parks the car while I nick in to grab a pass. I bring this back to her and retrieve my backpack. Necessary things contained therein are my notebook, and a book to read. If I don’t have the notebook, I just don’t remember anything much of what is said in the appointment. I just sit and read my book until my name is called.¬†

We have found morning appointments are best; I am usually a bit more alert, and there is less chance of the good doctor running behind. Dr P goes through the results from the blood test. This is usually straightforward; everything is over in about five minutes.  It is strange how, after I get this news, I feel a bit scatty and distracted. I never expect the results to be the same as they were last time, even when they have been good all year, or remember how I feel from one time to the next. We have gone through this cycle eight times this year. In saying this, I am very conscious that everything is the best that it can be.

Every other time I see Dr P, all being well, I have another Zolodex. (This is the estrogen treatment that is keeping the cancer quiet. It is delivered in the form of an implant about the size of a grain of rice.) I just walk up the street from the practice to the Epworth Box Hill oncology ward. One of the nurses there checks the dose, and what side it went in on last time. Then they swab the other side of my tummy, and shove it in. This is one of the situations where being a bit rounded is actually quite a good thing! One of the nurses said that they have to hunt around on really lean patients to find enough fat into which to put the implant. Even with my moderate spare tyre, the injection still leaves a fair size bruise.

Dr P told me to keep up the exercise, which I intend to do. I am about half way through the three months of exercise classes I am doing for the university study; three classes a week for the next six weeks, with a break for Christmas. The classes are all supervised by PhD students in exercise physiology. They are lovely young folk, radiating fitness and endorphins, who implacably raise the bar on us old roosters. The aerobic session I do first has gotten longer, and now features high intensity interval training. (This is where you go flat out for a minute, then ease back to the original speed. I do this three or four times, then have a cool-down.) In the resistance training part, the weights have gotten heavier, and the number of sets has gone from two to three. I am feeling better for it all, and even putting on some muscle.  On Sunday, two days after my last class, I felt restless, and found it hard to concentrate. I think I am getting hooked on this exercise caper!

I have been pondering what to do¬†around the end of January, after the study finishes.¬† I don’t think I will do three sessions a week on my own dime; two, however, is quite a possibility. Meanwhile, Christmas looms into view again. I had the end-of-year party for the Museum last week. This week there is the party for the physio practice I was going to before starting the university program. The same day there is a coffee morning for former RMIT people; everyone kindly rearranged this from its usual day to accommodate my exercise class. This week we will also be getting a visit from an air-conditioning installer, fortunately the day before a heatwave. We will have gone from fifteen to thirty-eight in the same week, an impressive range even for Melbourne.¬†

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.