The last of the cheMohicans

I am becoming a bit blase about the chemo sessions, I fear. My dedicated followers will know the last one of the six occurred yesterday. I was just poking around in the kitchen a short time ago, looking at the calendar, which had it listed for Boxing Day. My trusty Raymond Weil automatic watch, obtained through the combined generosity of RMIT and my beloved about four years ago, told me it was the 28th today. Other sources contradicted this, telling me that today is the 27th: ergo, I had had the chemo yesterday. (The date window in the Raymond, for some reason, only adjusts forwards. Rather than advance a whole month, it is easier to not wear it for a day, and let the date run down to the correct one. September, April, June and November are all easy months, as all that is required is a single advance. February, of course, requires two, but I can just about cope with that.)

If I was having trouble remembering when I actually had the chemo, you can infer it went without incident. The worst thing was the coffee they sweetly made me in the oncology unit — they are so nice, I feel a bit mean to complain! (I just had another one at home.) The PSA continues to edge south, being now <0.01 — truly undetectable. I am not having any side effects yet, apart from a bit of fluid retention around the ankles. We got some lovely presents the day before, including a bottle of Mumm — my favourite! And my beloved gave me a super photo of our wedding day (the silver anniversary of which having ticked over a few days before).

Today it was hot — about 37 — so we went to see a morning session of Collette at the Balwyn Cinema. It was enjoyable, if rather resembling a BBC three-part costume drama stitched into a feature film. I would say “Get it on video”, but I am showing my age there! Still, anything with Keira Knightley is generally worth watching. Domenic West was good as Collette’s husband, the frightful (and appropriately-named) Willy. Lunch followed at a local Italian place, which was reliable as always. Then home to sit in the air conditioning and watch Day 2 of the Boxing Day test.  Hope everyone’s Christmas-New Year break is slipping similarly under the radar!

What’s been and what’s to come

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.

Remission man

I saw Dr Parente this morning, and had chemo #4. All went well. The good news from the consult:

  1. PSA is now 0.01 (down from 0.03); and
  2. I am now, according to Dr P, in remission.

I am still not quite sure if it has quite sunk in. Of course, to put it bluntly, “remission” doesn’t equate to “cure”. Still, I would rather have this result than others! Staying on the ADT should mean that the remission continues as long as possible.

Yesterday I saw an exercise physiologist. This was as a result of a leaflet given to me at the previous chemo session. There is a push to make exercise much more of a front line treatment for prostate and other cancers. (I wrote about this previously .) So I now have an exercise physio specialising in such matters. What is the difference between an exercise physio and a regular physio? In this context, the former has a qualification in working with particular patients; in my case, obviously, those with prostate cancer. They have the skills to devise and implement an exercise program that will both be tailored for my individual capabilities — any physio does this — and not aggravate the bone mets. The latter is the secret sauce!

What’s so good about exercise, anyway? Apart from all its usual benefits, you mean, like improving sleep (for most of us, anyway), lowering blood cholesterol, stress and risk of heart attack and stroke, and enhancing bone density, cognitive function and general well being? All with next to no side effects, at generally a modest cost. (How much does it cost to go for a walk?) Yes, OK, but what does it do for cancer patients? Well, the more active blood circulation increases the exposure of the tumours to the nasty stuff in the chemotherapy compounds. So they get more of what they don’t like. Why don’t more GPs prescribe exercise, then? Well, for one thing, not many exercise themselves. Some of the issues are canvassed in this recent MJA article [NB: pdf.] As ever, your mileage with your particular GP may vary.

Warning: eyeglazing detail to follow. One can get onto an exercise physiologist via a Chronic Disease Management Plan . This gives five subsidised consults with a physio (any type), chiropractor, nutritionist, or other allied healthcare professional. You can see more than one of these, but you still only get five consults per calendar year. Your GP decides whether such a thing would be appropriate for you, what practitioner/s you should consult, etc. (guided in practice by your input). It is a bit of a bureaucratic echo chamber, and a well-kept secret, but nevertheless a good idea for fairly crook people. Once you jump through all the hoops, the subsidy is much better than you would get for getting those services through your private health fund.

Mini-break

We just had a couple of days catching up with family in Ocean Grove and Barwon Heads. We stayed with one of the sisters in law, and caught up with all the other family members whom we hadn’t seen for a while. (Last Christmas I had not long had my operation, so we dipped out for that reason.) This was a very cruisy visit. The thought crossed both our minds to go down in the new TTM, a,k.a. Testosterone Machine. (The second “T” makes it scan better, don’t you think? Actually, what about Testosterone Transplant and Orgone Machine, a.k.a TTOM?)

We decided against this for several reasons. First, we are still waiting on the full size spare. (More on this later.) OK, there is an inflation kit, but I didn’t feel like getting to grips with that beside the Geelong Road on Cup Weekend. Second, I was very tired, and thought I might fall asleep at the wheel. My beloved can drive it, but is less familiar with it than I am. Third, although we have added it to our Linkt account, we have as yet no clip in which to attach the new e-tag. The tag itself is still sitting in the old clip behind the mirror of the Fairmont, whence I just have not had time to remove it. Fourth, in all the documents I had been given for the car, there was no phone number for the roadside assist service that comes with the extended warranty.

This was something I had to follow up. While going through the car manuals, receipts and so on, I had noticed that the roadside assist phone number was missing. I wanted to check on the full size spare as well, so called the dealer. The salesman from whom we had bought the car was away sick. I there fore explained it all to a fairly gormless sounding person, who coughed into the phone without saying “excuse me”. (He did say “Sorry about that” when I remonstrated with him.) He passed me over to a more senior salesman who had been present for the purchase of the car. Obviously no explanation had been given of the reason for my call, as I had to explain it all over again. Had we been given a little warranty booklet? We had been, but I had forgotten it in all the excitement, and no-one had mentioned it to me. This booklet contained the magic phone number.

We were going away on the Saturday. I was coincidentally picking up the Camry from a service the day before — not at the Toyota dealer, but nearby — so decided I would drop in to pick up this booklet while I was out. I saw the business manager, who searched on their database. No, I wasn’t on there. I began to wish I’d brought all the paperwork with me so he could get the details from there. He did eventually find the transaction. I got a copy of the booklet, into which he clipped a small printed notice with the roadside assist details. We agreed I would take the booklet home, he would raise a receipt which he would then scan and email me. I would print this receipt out at home; I would then stick it inside the booklet with the little piece of double-sided tape provided for that purpose. Clip the printed notice over the receipt, and I would be in business. All this he and I duly did. So now I have the phone number and the roadside assist dudes have verification that I am the authorised owner. (Note to self — remove previous car from RACV roadside assist.)

It is not all fiddly details and things falling through the cracks. Alert readers — I’m sure you’ve both had your coffee — will recall I purchased a two year warranty. There was an additional statutory warranty of three months. Rather than give us a combined warranty of two years and three months, the dealership gave us one for three years, at no extra cost. The reason? They can only provide warranty cover for two or three years, not 2.25 years. So rather than round us down to two years, they rounded us up to three.

The spare wheel? Thanks for asking. The senior salesman said “I’ll have to order that for you”. In other words, no-one had done anything about it. I just hope it will be available for Christmas, probably to be held down on the coast again, in about seven weeks. You’re welcome!

A day in the country

A couple of years ago, I finally subscribed to the Melbourne community radio station 3MBS-FM. Because I did this during their annual radiothon, my subscription was entered in their prize draw. Renewing my sub this year, I won 6th prize in the draw, which was a weekend hire of a car from Toorak Mercedes.

(If you think this is a plug for 3MBS, you might be right. As Bill McLaughlan, presenter of Exploring Music says, if you’ve been thinking about subscribing, don’t feel guilty – do something! You do get a lot for your $30. And from their monthly online guide, one can actually see what programs are being broadcast. (Luddites can get this guide in hard copy, for no extra charge.) Planning one’s listening is practically impossible with ABC Classic FM, despite all the time and, presumably, money lavished on the recent upgrade to their web site. Don’t live in Melbourne? Support your local community radio station.)

Getting back to the prize, a Benz is a nice piece of metal to punt around for a day and generally put on airs. This is particularly so, given that our cars are 14 and 22 years old. My beloved and I were originally going to have a weekend in Daylesford, or somewhere like that, in July. This was pretty close to the date of her work moving to Port Melbourne and all the stress associated with that process. (Former colleagues relocated to Bundoora can sympathise!) So we decided to defer the country excursion for a bit until she was more used to getting herself to Port Melbourne and back.

Cometh the hour, cometh the vehicle, in the shape of a GLC 350 SUV with only 7,000 kilometres on the clock. (We had expressed interest in borrowing a GLA or C class. This being near the end of the month, however, there weren’t many sedans in stock, so we got upsized into the GLC.) The logistics of picking it up were not straightforward. I had originally thought we would get to Toorak by public transport. Given that this involved getting to Riversdale station, a train from there to Burnley, then another to Heyington, and a hike up the hill to Toorak Village, we opted to drive there, then proceed by convoy home. So guess who got to drive it back to beautiful downtown Burwood?

A sales “executive” showed us the ropes beforehand. It has proximity unlocking. This means it detects when someone approaches it with the key. To open the door, just press a button in the door handle, then pull the handle back towards you. Inside, you can leave the key in your pocket, or put it in one of the cup holders. Seats, steering wheel, and external mirrors have power settings that can be saved individually. Gear selection is done by way of a lever mounted on the steering column, like a turn indicator. (Yes, that’s the one on the left hand side, like all Euro cars.) Want to open the tailgate? Wave one foot under the rear bumper bar; then step back. The tailgate majestically rises. Same procedure to close it.

The Benz is chockers with this kind of electronic gadgetry. Seatbelts tension themselves across your chest as you draw out from the kerb. If you are changing lanes, and someone is approaching on that side, it shows a red triangle in the mirror and beeps. Draw in to park it, and the passenger side external mirror angles down so you can see how close you are to the kerb. When driving up our driveway, lined with rather overgrown plants, beeping begins to sound. Squeezing it into our garage, past the less ancient car, the front camera automatically switches on.  This screen gives you red and yellow lines (with more beeping) as you approach obstacles like other cars and walls. Lights and wipers switch on automatically. You get the picture.

We just drove it up to the Dandenongs and back. On the road it gets along very well. There is plenty of mumbo on tap, albeit with a long travel accelerator pedal, but the turbo diesel is quiet. Even on the Comfort setting, the ride is not plush, something for which the run flat tyres are probably responsible. You feel the road surface, lane markers, driveways, and so on. However, the seats are great, controls are beautifully laid out, and it is generally easy to punt along. It isn’t actually bigger than either of our existing cars; the SUV packaging just makes it feel bigger, on account of its being higher. Could I get used to it? Certainly! You would probably walk away from most prangs. We don’t have 80 large to splash on a vehicle, though.

We had lunch in Maling Road, after which my beloved proceeded to have a mani and pedi. I made myself useful by buying some meat and vegetables for tomorrow (being Grand Final day public holiday), then having an iced coffee sitting on the pavement. Did I mention it was a sunny day? 24 degrees! On our way back to the Benz, my beloved saw a dress in a little shop. Trying it on was facilitated by my taking her top off for her in the change room (so as not to muck up the newly done nails), buttoning and unbuttoning the dress. The dress having gotten a guernsey, as it were, the process happened in reverse. Being a Thursday, it was not too busy anywhere. And we got home in time to miss the school pick-up imbroglio. Each of us had something on order for home delivery; both parcels arrived. The day would not have been improved if my beloved’s ticket had won the lottery.

Sunday miscellany

A cure for insomnia? That seems something we are as likely to see as as a perpetual motion machine. Nevertheless, this article from The Guardian has definite cred. (Apologies, as ever, for cross posting.) Merely by taking people’s insomnia seriously, Dr Selsick of the Insomnia Clinic in Bloomsbury is doing a great service. The method seems to work, too, in the experience of the article’s author. The good doctor is also refreshingly non-doctrinaire about sleeping tablets. No-one regards them as ideal, but, as he points out, sleep deprivation carries risk as well.  (I have tried the sleep medication mentioned in the article, Belsomra. It does something, just not quite enough.)

I am going OK with the aftermath of the chemotherapy. Thursday and Friday were pretty normal days. Yesterday and today I have noticed more symptoms, mostly a bit of discomfort in the legs and ankles. These symptoms are not new, but have become more noticeable over the last couple of days. So far a combo of paracetamol and a little Endone is making it tolerable. (Thanks, Jane, for putting me onto that.) I found a good booklet on cancer pain and medications online from the Cancer Council, updated, as it happens, this month. The booklet discusses various aspects of pain, medications, and pain management in a useful way. Of course what I am experiencing is not cancer pain, more a side effect of the chemo.

I didn’t write much before about the actual process of receiving the treatment. Being the first time, it took a bit longer, there being more to explain. The nurse was very thorough in doing this and walking me through the side effects that I may or may not experience. After putting in a cannula, they started with an anti-nausea drug, then put another drip in for the chemo (a drug called Docetaxel). Putting in the Docetaxel takes about 1.5 hours. I also got an implant just under the skin of the stomach; this lasts for three months. The implant is about the size of a grain of rice. I haven’t had any problems with wounds where the cannula or the implant went in.

On Wednesday night, my face felt a bit hot, and my cheeks were a a little red. I just put some face cream on from the sample bag of products donated by the hospital pharmacy. (Marketing, of course, but the products themselves all seem good.) There was quite a number of mouth care products: moisturising toothpaste, mouthwash, and gel. The nurse also suggested I could make a mouthwash from a salt or baking powder solution.

The chemo goes on a three week cycle.  I am to have six cycles, so five to go. (I should be finished in early January, 2019.) I will probably feel pretty ordinary in the middle week of the three as the red and white blood cells drop. As these recover in the following week, I should feel better. I have to have a blood test at the beginning of each chemo week. If all is well here, and I don’t have a temperature, I should be good to go. I still have about half the ADT tablets to take, but I should have finished those by the time the next chemo rolls around.

Energy matters

Of course Father’s Day is a commercialised rort and an excuse for selling more stuff. Nonetheless, siblings, and anyone without a dad handy, will probably be feeling a pang today. I still have one of Dad’s old shirts, and his dressing gown. More practically  I have been honouring our Dad in a practical way, by doing a spreadsheet about energy use.

(To bring non-family members up to speed, our Dad, David, was an engineer. Toward the end of his career, he developed a particular interest in energy conservation. Unfortunately, as in other things, he was ahead of his time. In the eighties, most people thought fossil fuel energy was cheap, and would last forever. Peak oil and global warming were unheard of out here.)

Dad therefore would have been totally across my spreadsheet, which bears the catchy title “Cooling & heating costs with split system versus separate evaporative cooling + gas ducted heating” (Aron, 2018, unpublished.) You may not find this magnum opus in a bookshop near you, if there still is one. So I can upload it to Google Drive, if anyone is interested. (No? Fair enough.)

I will prevail on your patience with a précis. We have to replace our 15 year old evaporative cooler with a newer system. This has opened a bit of a Pandora’s box. Should we replace it with another evaporative system? Or go reverse cycle ducted? This would use more power, but wouldn’t use any extra water. What are the comparative costs of these systems?

This begs another interesting question. How much water do evaporative systems use, anyway? The answers are complicated. Modern evaporative coolers recycle their water. They can’t do this indefinitely, however, as the salts in the water become concentrated. This shortens the life of the cooling pads. The point at which a cooler will dump its water varies between brands, the salinity of the water, etc., and is just about impossible to find out. Different manufacturers’ web sites mostly say: it depends.

I consulted Dr Google on this matter and found two figures for water consumption of evaporative coolers: 58.6  and 113 litres per hour. The first is contained in a paper written under the auspices of the Federal Government’s Water Efficiency Labelling and Standards Scheme. (The link points to the .pdf format.) The second is derived from post to the Whirlpool discussion list. I included both figures in my spreadsheet, as Scenarios 1 and 2. (As you do.)

How much energy do different types of coolers and heaters use? This is much easier to find out. Sustainability Victoria has useful summaries for cooling and heating .

Those still awake will be on the edge of their seats, I know, so here is the executive summary of what I found:

  1. Reverse cycle would be cheaper for us, by between $239-$891 dollars per year.
  2. Reverse cycle systems are more expensive to purchase than evaporative. What would the payback period be? I did two calculations; one guesstimated the extra cost of a ducted system at $4,000, the second at $8,000. Accounting for multiple variables, the payback period varies from 4 to 33 years!

Anyway, we have pretty much decided to go with another evaporative unit. This is for non-financial reasons. My beloved has sinus problems, and the extra humidity of the evaporative is better for her. We can also use our existing ceiling ducts. Refrigerant system ducts are smaller, so we would have to have some new holes cut in our ceilings, and the old ducts covered over.

This is what we were leaning toward in the first place, but we now know why this is the right answer – for us. I hope Dad would approve.