Chemotherapy

Down a snake

by feurmann

I have been a bit remiss in writing up my consults with Dr P, having missed the previous one (11 May). However, as has been previously remarked, the trend (rather than the quantum) of the PSA results is what matters. Unfortunately, the trend is not my friend at present. The previous number was 3.9; the most recent one (from 8 June) was 6.2. This is not doubling, but more of an increase than anyone would like. So I will be having another round of chemo.

Before that I am booked in for another CT scan on Monday, 4 July. This will reveal any new developments. I will be seeing Dr P on Wednesday, 6 June, at which time he will fill me in on the CT scan results and arrangements for the chemo. This will be my second round of this treatment, one of the “cut, burn and poison” trilogy. Fortunately, I seem to tolerate all these pretty well. As with the previous round, the chemo will be administered at Epworth in Box Hill, pretty close by. I don’t at this stage know how long it will take, the frequency of the doses, etc. Stay tuned for details.

Fortunately as well, I am feeling fine. I put this down in large part to continuing to exercise, mostly in the mens’ oncology classes at my exercise physiology practice. (I will be informing them I will be going back onto chemo so they can adjust my program if necessary.) My walking has been curtailed quite a lot by soreness in the left ankle. This has been a problem for a long time, so I think this is just an overuse injury after a lot of walks during lockdown. Before I used to just strap it up, but now even this isn’t having any effect. So I will probably get an exercise bike for an aerobic workout (the ankle isn’t bothered by that movement).

I have been occupied recently with installing a new Denon receiver in the living room. The previous one, a Harman Kardon, worked perfectly well, but was just a bit unexciting. I was initially looking for another stereo receiver, but the home theatre-type ones were actually much more reasonably priced, as well as offering more functionality. I have the Denon hooked up for 5.1, (something that took most of a weekend), and it is definitely much more punchy. It bristles with useful features like internet radio, sound modes, and numerous digital as well as analog inputs, including one for the turntable. (The HK only had analog inputs). Staying home and watching movies or TV series is a good winter activity, but the receiver works equally well for music.

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Sir’s undetectable

by feurmann

There was a line of wigs or hairpieces widely advertised in the media of the 1960s or 70s as “Sir’s Undetectable”. I am hoping that someone of my vintage, or thereabouts, can confirm (or otherwise) that I am spelling “Sir’s” correctly with the apostrophe after the “r”. These products were legendary in our family as “Sir’s detectable“!

Dr Google can only turn up a Yellow Pages advertisement for “Sir’s For Men Wigs & Hairpieces” in Baulkham Hills, Sydney, which assures us that this is “A Name You Have Relied On For Three Generations”. My curiosity being aroused, I turned to Trove, where I performed the following search . This only found results from advertising in the Canberra Times from 1980 onwards. These advertisers of this era were unsurprisingly unsure about whether to spell their product “Sir’s”, “Sirs” or even “Sirs’ “, resorting to all three spellings in the 19 ads retrieved. That apostrophe was indeed a pesky piece of punctuation! Is there a grammarian in the house?

There is indeed method behind all this tonsorial nostalgia. My last PSA result repeated the previous one, I think it was, as 0.01. Apparently this amounts to  being undetectable. (I had been hoping for the “bagel score” of 0.0, but I guess the .01 part is a courtesy amount, rather as people refer to retired military or politicians by a courtesy title.) Anyway, I remain happily in remission. The last chemotherapy session went well, as all the previous ones had. Only one to go, on Boxing Day! (I will be seeing the good Dr P on Christmas Eve to get the go-ahead for this final infusion.)

I am still enjoying punting the little Toyota around. The previous weekend I had the chance to stretch its legs a bit on a run down to Cranbourne. This was the first time I had had it on a freeway. It felt very stable and solid, and there was no problem keeping up with the other traffic. It isn’t the best car for an interstate cruiser, being a bit noisy on coarse-chip road surfaces. But it was definitely fun. I think what is enjoyable about it is not just the attributes of the car itself, but the fact that I bought such a wildly unsuitable and midlife-crisis advertising vehicle in so insouciant a fashion!

Still, I am trying to make it as practical as possible. I had the full size spare wheel fitted and the steering wheel re-covered at the dealer’s (these things having being folded into the purchase agreement). I also had a sunvisor and the reversing camera replaced, both under warranty. It remains a delightful car in being easy to manoeuvre around shopping centre carparks, small enough to fit in most car spaces, and very sporty in which to whip around corners. I am also getting the hang of various features like the ability to retract the side mirrors at the press of a button.

On one of these shopping expeditions, I left it in a brand-new supermarket carpark, and returned to find dark red fluid leaking from underneath its nose (or so I thought). On checking the service record, I found that the last service had occurred about nine months ago. This being, oddly, the service interval for this vehicle, I took it to my local garage for a workshop once-over. They replaced all the fluids, and declared that no leaks could be found. The previous owner having been pretty spotty with the servicing, I know it has been brought up to where it should be.

What’s been and what’s to come

by feurmann

Before the main part of the post, there is a small addition to the Resources page in the form of the NCI Dictionary of Cancer Terms .

We are now just a few weeks from Christmas. Those who know me will know this is my favourite time of year! (Not.) Still, it brings us to a sort-of review time for 2018.

The last twelve months has been one of numerous changes, and some milestones. I bought a new car, and we replaced some big-ticket things like the ducted cooling and the bed. The Blu-Ray recorder, and some electrical equipment, was also replaced. For the first time ever, my beloved moved to part-time employment. Most importantly, we are to celebrate our twenty-fifth wedding anniversary at the end of this year.

It has also been a huge twelve months or so health-wise. My treatment summary from November 2017 to now is the story of my cancer:

  • radical open prostatectomy
  • subsequent treatment with a physiologist specialising in continence
  • referred to a radiation oncologist, with whom I
    • had radiation therapy, with moderate success
  • then referred to a medical oncologist, with whom I
    • had androgen deprivation treatment and chemotherapy.

Of course the last of these is ongoing. However, being in remission is a great result for the treatments I have received under the care of Dr Parente and the staff of the oncology ward in Epworth Eastern. My GP has been terrific as well — someone I have been seeing for many years. Modern cancer treatment of course relies on adjunct modalities, and I feel my exercise physiologist (a recent referral) will become someone else I rely on.

My progress through these treatments has been one from specific to general, i.e. from treatments focusing on individual mets, to ones that are treating the whole body. This has been driven by the failure of the specific treatments to keep pace with the growth in the tumours.  I believe the progression in the treatments is also from ones with lower potential side effects to those with more potential side effects, but more efficacy. (Time, as ever, will tell.)

The chemotherapy  has been less of a big deal than I expected. I have dropped some social engagements in order to lessen the risk of opportunistic infection — something my immune system is less able to handle than usual. However, I haven’t wanted to become a recluse. So new year resolutions include doing a better job of keeping up with people, both individually and through groups like the local Cancer Survivors.

The chemotherapy is adjunct with androgen deprivation therapy. Their combination gives apparently an increase in efficacy of 10% in absolute terms, over either treatment singly. I started with the ADT some weeks before the beginning of the chemo, and I will continue with that as long as I remain in remission.

(On the subject of keeping up with people, we have been having a lovely time just recently having an old friend to stay for a couple of nights. She came down from Sydney for Die Meistersinger at the opera, which we all saw last night. Amazing! The second act was quite the most spectacular I have ever seen live. The orchestra played every bit as well as the Gewandhaus, whom we heard in the Leipzig Ring, and everyone acquitted themselves extremely well in the principal roles, especially Michael Kupfer-Radecky, the third singer to be engaged as Hans Sachs. And Warwick Fyfe as Beckmesser! Is there a better anywhere? Anyway, I hope that 2019 includes more Wagner as well as more socialising. Wagner’s beautiful libretto also gave me the latest candidate for my memoir title: How spring has to be.)

I need to do more to keep the remaining grey matter active next year, too. I think 2018 was the year of Karl Ove Knausgaard. (I have the final volume of his autobiographical novel sequence to finish off.) I feel that enrolling in a course would keep me at something better than if I were just doing it under my own steam. Some candidates include a couple of online masters programs in creative writing. Doing the internet course Modern Poetry over the last few weeks was great as well; it is very well-supported. Hearing the beautiful German in the Wagner last night, however, and even understanding bits of it, put this further up the batting order as something I could re-engage with.

I would also like to read through In Search of Lost Time again, with a group. Ever thought about it? Or even just wanted to see what the fuss is about? (For example, Maugham regarding it the greatest novel of the twentieth century.) I will do it via Skype, if required. So come on, all you wavering Proustians! Carpe the diem, grasp the literary nettle, and let’s get down to it. I can issue a portentous promise — your lives won’t be the same.

Less is more

by feurmann

Chemo session #2 today; all seemed to go well. The infusion was, as usual, preceded by a consult with Dr Parente. He was encouraging, as usual, and today had something more to be encouraging about: the PSA is down to 0.18. (It had been 2.0 previously.) So the ADT has done what it was supposed to do. I am not really having persistent side effects. The worst — and it is not bad — is an itchy and rough patch on the back of my hands, over the knuckles. I am putting a medicated cream on those, which calms them down.

I asked Dr P a couple of questions:

  1. Question: does the fact that the new metastases are in different places mean that the radiation therapy was successful in treating the old mets? Answer: yes.
  2. Question: will the dosage and/or concentration of Docetaxel (the chemo medication) increase over the six sessions? Answer: no. I am scheduled to have the maximum dosage, and this will be the same each time. If I experience worse side effects, the dosage can be reduced. The Docetaxel itself passes out of the system in 12-24 hours. Its effects on the tumours, however, continue for about three weeks. (He put this particularly carefully, not saying “get rid of” or anything like that.)

We had a gap in between the consult and the chemo, the latter being at 12 noon, so were able to go to the cafe in Epworth Eastern (just up the road from Dr P’s practice). We both had a coffee, my beloved the rest of her breakfast, and I had a toasted sandwich. Ambrosial!

Upstairs in the day oncology unit, it seemed like a full house. I got a little more information today from the nurse driving the drip. The sensation of heat around the face I had experienced during the last cycle was due to the anti-nausea drug wearing off; this is a steroid medication.  The powers that be are also pushing exercise for cancer patients. (I had heard a lot about this during the Peter Mac information session a few months ago.)  Fatigue is one of the most widely experienced side effects of chemotherapy, and exercise can, paradoxically, help reduce this. I got a leaflet about a subsidised exercise program, designed specifically for cancer patients. This is doubly apposite for me, as I have my gym membership on hold while completing the chemo, so I will be investigating this.

I was pretty tired when I got home, so had a crash for an hour or so. Still feeling fine. There is enough of last night’s meal left over for dinner for my beloved tonight. I will have cheese on toast, or possibly a jaffle, with my two allowed standard drinks. You beauty! There is more excitement coming up during the rest of the month, with a heater service, installation of the new coolers, a memoir writing class, and a get-together with some other Melbourne ModPo folk. Like, in RL! I tell you, Melbourne in spring is not for the faint-hearted.

Alert readers, and this is both of you, will notice some minor changes in the blog. I have gotten off my duff and created some new categories, and applied them to some posts. The categories themselves have been shuffled up the batting order in the sidebar, so they now sit under the “Follow blog via email” link. You may still have to scroll down to see the categories, but they are there. More to follow. No, I’m not using Library of Congress Subject Headings. I may make an exception for “Anecdotes, facetiae, satire, etc.”. (I’m not making this up, you know! Technically, this was not a full heading, but a standard subdivision. It was replaced in recent years by the much more prim “Humor”: see example.) Will I be going back and applying categories retrospectively? What do you think I am, a librarian or something?

Fine so far

by feurmann

This is somewhat of a place-holder message. The good news: PSA is down to 2.0, down from about 8. (This is the first time it’s headed south this year, I think.) This is the ADT treatment doing its thing. I’m generally feeling fine after the first chemo this afternoon. I have just slightly sore muscles, a bit like having been to the gym. Also subtly out of it; not unusually, though! Other than these hard to pin down symptoms, pretty good.

[This par was pasted in from an email, so may look a bit squashed up.) The chemo goes in three week cycles for prostate cancer. (Lucky breast cancer patients get it every week.) Apparently one can feel pretty ordinary in the middle week. This is because one’s red and white blood cell count are then at their lowest. That is also the week in which one is most vulnerable to infection. (The immune system is compromised by the chemo, so colds, flu etc. are something to avoid more than usually. I asked about going to meetings in that week, and the nurse said, if you know that the people you’re meeting aren’t sick, go ahead.
Anyway, I have lots of information to process. Will be in touch as I digest it all.

Dr Parente mk. II

by feurmann

At the risk of repeating myself, there was good and not so good news from the appointment with Dr Parente today.

(Briefly to recap: the PSA had risen in spite of the radiation treatment. So there was obviously something going on with the cancer. The purpose of the scan I had last week was to reveal what this was and where it was.)

The first piece of good news – and it is a big one – is that there are no metastases in the organs. The ones he mentioned, the lungs and liver, are clear. (I had heard that mets in the latter organ are particularly undesirable.)

The second is something I have thought of, not something mentioned by Dr P, so all the necessary caveats apply. However, the mets that were there in the last scan, in the left hip and left femur, aren’t there any more. So it would appear that the radiation treatment was successful in getting rid of those mets (or spots, as they refer to them).

The less good news is that there are five new spots, all in bone:

  • sternum
  • rib (right hand side)
  • lower thoracic spine
  • L4 vertebra
  • left sacrum (AKA the tailbone).

(I am inferring that these are all still small. I base this on the facts that they weren’t there at the last scan, and I don’t have any symptoms or pain.)

The PSA has risen a bit more at 8.6, further evidence that things are progressing in an undesirable direction.

So I am starting on conjunct hormone therapy and chemotherapy. The last time I saw him, Dr P did mention a couple of trials that strongly support this combo: STAMPEDE and CHAARTERED . So his view, which we share, is: what are we waiting for? Obviously we have to fire the big gun, as he put it. He rang the hospital pharmacy (Epworth Eastern is literally just up the road) to see if they had a box of Casodex. They did, he wrote me a script, and I have had my first one. I will be taking one of these each day for 28 days. This medication can affect the liver, so I am avoiding alcohol for the duration. (Just when I could have murdered a drink, too!)

In a fortnight I start the chemo part of the treatment:

  1. Zoladex; one injection every 3 months, and
  2. Taxetere (Docetaxel), once every 21 days, for six cycles (i.e. an 18 week course).

I have to have a blood test, and see Dr P, before each chemo session. The consult with him ended quite late, so his practice couldn’t contact the chemo people to make the first appointment. They will do this tomorrow, however, and let me know.

It is all a bit daunting, and a lot of information to process. We both found the consult fairly stressful for these reasons. However, he seems very positive. He feels that, at my age, and with my (relative) fitness, I will get through the chemo easily. Maybe this geeing-up is what oncologists do. However, I am grateful for it, for both our sakes. From here, I am just strapped in for the ride.

I just want things to be as normal, and mundane, as possible. We are taking some quotes for a new cooling system. I went to the Deakin open day yesterday, to investigate doing a course next year. I am going to a session in October about how to write a (non-boring) family history or memoir. I want to go on socialising, listening to music, fiddling around in the garden, and everything I am doing now. Obviously we will have to see how far this is possible.