Henry 2012.

I forgot to mention that Henry emerged from hibernation at New Year. Whether he was hoping for a share of the remaining Christmas cake he didn’t say.

As soon as I noticed that he was awake he was transferred, complete with his customised winter residence, to my “den” where he will occupy half of my workspace for the next few months until the weather is warm enough for him to go out to the garden. Meanwhile, he has supplementary heat and light to ensure that he gets enough of each until nature takes over, not to mention a five-star room service.  The latter supplements my daily exercise by ensuring that I have two or three extra opportunities to climb the stairs daily to deliver Henry’s diet of miscellaneous vegetation.

The Patient’s Story, part 7

Today I had the privilege of being treated at the renowned Velindre Cancer Hospital in Cardiff. It was the next stage in the necessarily long-winded programme of treatment for my prostate cancer. The purpose of the appointment was to have tiny gold implants inserted in the prostate to act as markers, which will guide the radiotherapy machine when we get to that stage later.This was done by the same doctor who has been in charge of my treatment from the beginning at University Hospital, Cardiff and, as these are teaching hospitals, there were additional persons present. The idea of a student and other staff being present doesn’t bother me. It is important that they train on the “real thing” where possible and I am happy to contribute to that training.

It was an interesting experience, slightly uncomfortable but perfectly bearable. I won’t go into the gory detail except to say that the procedure was very similar to the prostate biopsy that I had some time ago, except that instead of taking tissue samples, the doctor was actually inserting (permanently) tiny bits of gold. So I guess that my scrap value is a bit higher today than it was yesterday, which can’t be bad.

To minimise the risk of infection following the biopsy, two antibiotics were supplied at my previous hospital visit. The same applied this time. Three tablets of each antibiotic were supplied complete with instructions. These must be taken exactly as instructed, that is, one of each two hours before the appointment, another one of each six hours after the appointment, and the last one of each the next morning. It is important to read the instructions on the packs and in the leaflets that come with these tablets because the timing of the doses are not the only details that the patient needs to know. For example, alcohol should be avoided while one of these antibiotics is being taken and, when taking the other, it is important to avoid milk, indigestion remedies and medicines containing iron or zinc. So, given that the third dose will be taken at breakfast time, breakfast cereal, porridge etc. with milk will be avoided together with milk in tea or coffee. Similarly, I will not start taking another daily tablet called Stronazon until the day after my third dose of antibiotics, because Stronazon contains three varieties of iron oxide.

I’ll bet that you never thought of rust (iron oxide) as an ingredient of medicine! I will tell you about Stronazon in Part 8.

After the treatment I was asked to remain in the hospital until I had passed water without problems and to have a blood pressure test. When I was ready, daughter Jennie kindly returned to take me home, saving me from the discomfort of two bus journeys and an extra hour of travelling each way.

The hormone injections (leuprorelin acetate) that I have been having at 28-day intervals will continue at least until some time in April, when I will be assessed following the radiotherapy which is expected to occupy most of March. The injections might continue for some months after April, depending on how I respond to the radiotherapy. The only obvious side effect has been hot flushes but I gather that they are nowhere near as uncomfortable as those suffered by pregnant women. Indeed, so far as I am cencerned, they can be a bonus on cold days!

The next appointment will be really interesting. This (as I understand it) is where I will take up my position on the radiotherapy machine and my treatment will be planned in detail, especially for me. I visualise that this will entail adjusting the machine to target, very accurately, the cancer cells in my prostate and retaining the settings for when the actual treatment takes place. It will mean that I will have to occupy exactly the same position on the machine every day of the treatment (five days per week for four weeks) and there is more…   …as I will attempt to describe in due course.

Retail suicide?

Yesterday presented my first opportunbity since Christmas to complete my younger grandson’s Christmas present, having forgotten a few minor items before the holiday. The said grandson shows some promise (and a lot of enthusiasm) as an artist but, like most nearly-eight-year-olds, he has been painting for a few years with the usual cheap and cheerful materials which are perfectly adequate for total beginners. However, I concluded a while ago that he deserved something better. So at Christmas, daughter Jennie and I set off for a large art and craft superstore on the outskirts of Newport which was expected to stock everything on my shopping list. To my surprise the shop did not have everything on my list but the missing items were few and easily obtained in Cardiff, or so I thought. Despite daughters anxiety to moderate my ambitions I managed to assemble a kit of paints, brushes, pencils and papers of the very brands that I would use, together with a carrying case for convenient storage.

So I set off on my first shopping trip of 2012 with the last of the morning commuters and the other early shoppers, on the half-hour bus journey. I should have known better. Don’t misunderstand me. I have grown to like Cardiff in the short time we have lived here but there are aspects of shopping here which, though doubtless experienced up and down the UK, simply shouldn’t happen in a place that is a capital city. Wales deserves better. Instead of wasting half a day walking from one end of the city centre to the other without finding everything that I wanted – and interrupting the bus journey home to try yet another shop – I should have gone online and bought the lot with half a dozen clicks on the computer. But I am old-fashioned in some respects and like to support local businesses first, where possible, before rushing to the internet, even when those “local” businesses are branches of national chains.  At least they contribute to the local economy by employing local people. This preference also harks back to my time in retailing and in running my own shop for a few years.

So what else was needed? Well, a decent soft eraser (rubber, not kneadable and certainly not plastic), a double sharpener catering for pencils of different thicknesses and with its own reservoir for waste shavings), and a tough  A3 clipboard. I have found the latter immensely useful as a light, portable worktop which needs little storage space when not in use.

As far as I know, Cardiff city centre has three quite substantial shops selling some combination of stationery and art and craft materials, with a further even larger specialist in art and crafts just a short bus ride away. The double sharpener was easy to find, the soft rubber was in one shop only and the A3 clipboard was not found at all. Later in the day I contacted a major business stationer with a branch in Newport, a few miles away, but apparently they didn’t stock A3 clipboards.

This is a very minor issue in the great scheme of things but I come across examples all too frequently. I had plenty of time on the bus returning home to wonder why retailers are so unimaginative in the extent of the products they sell. Why, for example, did the large branch of a national newsagents/stationers/booksellers devote a display unit some 8-9 feet wide by 5 feet high entirely to soft pencil cases, dozens of which were the same in size and style and differed only in colours – but no clipboards at all. Less than a quarter of that display space could have been used for A3, A4 and A5 clipboards in a variety of styles and materials. Why did one of the major art materials retailers have no identifiable soft rubber erasers, yet found ample space for numerous plastic erasers of various shapes and sizes?

And theres is no point in arguing that no-one makes A3 clipboards or that there is no demand for them. One of the most successful online businesses sells them – and in a variety of materials at that. It doesn’t surprise me that amazon.co.uk is such a success or that the “high street” is fast losing out to online shopping.

And (at last) a Happy New Year to you.

First, I wish you a Happy New Year. I would have done this about 100 hours earlier but my laptop was not cooperating.

I forget now exactly how the trouble started but by Christmas the laptop was becoming intolerably slow and unpredictable. For months I have been toying with the idea of a new computer in early 2012 but I simply don’t think that they are worth the hassle and the money. Why should I pay for a computer that, unavoidably, comes complete with a load of software that I don’t want? Take that software out, reduce the price accordingly and sell me a machine with a decent operating system and I will be happy. On second thoughts I won’t be entirely happy because, after just four years, I shouldn’t feel the need for a new machine at all.

As an alternative to a new laptop I have also been considering the feasability and likely effectiveness of clearing out the contents of the present one and starting again from scratch. By New Year I was sufficiently exasperated to give this a try and so, having copied my own files to a separate hard drive, I loaded the “Product Recovery Disc” (which came with the computer) and followed the on-screen instructions. It took most of an evening and I couldn’t begin to describe what was happening but I was left with a computer plus operating system and very little else. My spare time over the following day or two was spent reinstalling my favourite software packages. The result of all this is a noticeably quicker computer with around 24GB extra free space on the hard drive and all but one of  the original problems eliminated.

However, this so-called “Product Recovery Disc”  has not entirely lived up to its grand title. There are two new problems, and a couple of mysterious pop-up messages that I have never seen before. The problem that has not gone away is that it it necessary only to hover over a link briefly to activate it, whereas activation should require a definite button click. I can find nothing in the Control Panel to change this. The new problems are that the touchpad lights up unexpectedly – I don’t remember the last time it did this and had forgotten that it was able to do so – and I seem to have lost all references to Bluetooth from the laptop (and that was definitely in the Control Panel prior to the “Recovery”). Apart from the loss of Bluetooth (which I was about to start using to connect the laptop to another gadget – about which I will tell you another time) everything seems to be working.

The mystery messages? One refers to a failure to make a Windows connection – which I cannot describe further as I don’t understand it. The second message (which has appeared a couple of times at the bottom right of the Desktop tells me that this is not a genuine version of Windows! How come? The original was bought pre-installed in the new laptop. Clearly, the new messages must have something to do with the “Product Recovery Disc”. I am beginning to detect the odour of a rodent!

Save a life – yours

It is amazing how unhealthy one can be without realising it. As my long-suffering regular readers will know, I am now about halfway through my treatment for prostate cancer. There was no instant diagnosis for this, despite the seriousness of the condition as, reportedly, the second biggest killer of men in the UK (after heart disease). The diagnosis was suspected following a blood test and confirmed much later after a scan and a biopsy. Even more amazing was the complete absence of any symptoms of which I was aware. It is that fact that makes prostate cancer such a dangerous disease – combined with the fact that it can affect men of any age and needs to be discovered early to be sure of bringing it under control before it spreads to other organs.

So if this post has one key message for men (it doesn’t apply to women as they have no prostate gland) it is get a check-up by your family doctor and make it an annual fixture.

All I would add to that is that you have nothing to fear. Yes, I would have been anxious about the prospect of a simple injection not that long ago but not any more. In recent months I have experienced a catalogue of medical and surgical procedures (as described in my recent series of posts entitled “The Patient’s Story”) including several injections and at least three blood tests, approaching each one with curiosity rather than fear and I would have no qualms about doing them all over again. So get yourself along to your GP and get checked. You might well save a life – YOURS.

The Patient’s Story, part 6

I visited the hospital on November 29th as part of the arrangements for my radiotherapy treatment. Having spent November waiting in vain for a new appointment with the Ophthalmology Department I took the opportunity to visit the department and was given the ‘phone number of the coordinator who actually books the appointments for my consultant. I was not able to see that person face to face and by the time I arrived home, a few minutes after 4pm, she had left for the day and I was told to phone again two days later when  she would be back. This I did. There was not even a hint of an apology for cancelling my last appointment (due, apparently, to staff illness), nor for failing during the whole of November to notify me of a new appointment. I was told that the laser surgery by my consultant took place once per fortnight and that the next available appointment would be on December 13th. In my experience, the normal procedure has been for the hospital to notify the patient of their next appointment automatically, rather than wait for the patient to phone up and ask for an appointment. So it seems clear to me that I had been overlooked and that it might well have been possible to have had my treatment two, or even four weeks earlier. It was also clear that had I not taken the initiative, I would be waiting still. As I said, there was no apology but just a grudging agreement, expressed in a patronising fashion, to give me an appointment.
In the meantime, as a holding exercise, I have been expected to take these miserable Pilocarpine eye drops, thrice daily in each eye and to put up with the side effects of headaches, nausea and general discomfort ever since September 15th, the first date on which the treatment was supposed to have taken place. I have used three 10ml bottles of Pilocarpine drops  – I had hoped that the first one would have been more than enough! For the first 3-4 weeks the worst side effect was a sharp headache for about 25-30 minutes after I applied the drops. From the second month the headaches were in decline and ceased completely to be replaced by nausea, usually in the first hour of each day. I began referring to this as “morning sickness” and assumed that the cause was the hormone injections. But nausea is not a recognised side effect of my hormone injections whereas it is with the eye drops. To cure each attack of nausea, Granny-Anne prescribed a couple of ginger biscuits – and it worked. It also gave me an excuse to eat ginger biscuits!
The fiasco over ophthalmology appointments caused me to reflect on my impressions of the University Hospital at Cardiff and to feel genuine disappointment that the reputation of the hospital can be so undermined by the poor organisation and attitude experienced in one department (probably all due to one or two inept people), yet enormously enhanced by the enthusiasm, efficiency and great atmosphere that I have encountered on every visit to another, namely Urology (specifically Clinic 18), where they deal with prostate cancer patients.
Anyway, the appointment took place today (December 13th) and, surprise, surprise, it was not cancelled but just the best part of an hour late. As I was unaware of the precise effect of the treatment, my super daughter Jennie drove me to and from the hospital, taking an extremely heavy hail storm in her stride on the way there and a total log-jam of traffic within the hospital grounds on arrival, which meant that I was having my treatment by the time she was able to park the car around an hour later.
And I must mention that I did switch my mobile phone off before entering the hospital, forgetting that the alarm works even when the phone is switched off. So, inevitably, the alarm sounded loud and clear at 3.30pm, just before the laser treatment was about to start. It was embarrassing but at least I was able to tell the doctor that its purpose was to remind me to take my eye drops. He didn’t seem to mind.
The laser treatment was another high-tech procedure which, as anticipated, proved interesting and it all started with a short reading test and a further Pilocarpine drop in each eye. After a wait (I wish I had taken a good book to read) I was summoned by the doctor for the fun to begin. The objective was to use laser surgery to enlarge the drainage channels in each eye so that the pressure of the fluid in  each eye would not build up excessively, which could lead to Glaucoma and blindness. More eye drops were administered before the surgery to act as an anaesthetic, numbing each eye but not affecting the vision.
Apparently “laser” is an acronym for “light amplification by stimulated emission of radiation”, whatever that means! To begin it is much like an ordinary eye test – chin on chin rest, forehead against support, look up, look straight ahead, look down, hold it just like that – with a little extra explanation. Then the laser equipment was wheeled into place and the procedure repeated. This time the laser treatment was applied in very short (fraction of a second) but repeated bursts. As this was happening there was a very colourful firework display in the eye being treated, together with an ache in the eye and a fascinating sound. If you have ever poked yourself in the eye with a blunt object you will know about that ache. The doctor started with the power turned up and the ache was sharp but tolerable, but it could be turned down a bit to become just dull enough to be ignored. The sound fascinated me because it was like the sizzle that I associate with an electric welder (or, for non-welders among my readers, the sound of bacon frying – but, please, no jokes about the nature of the bacon in this instance!). Meanwhile, as the right eye was being treated, I was required to look downwards and to the left and to keep still. The latter was remarkably difficult in a darkened room with nothing on which to focus. After finishing with the right eye the doctor asked whether I wanted him to continue with the left one, or do that on another day. I was happy for him to continue and finish the job.
Apart from during the treatment my sight was unaffected and  the only after-effect was a slight soreness in the eyes similar to that produced by tired, dry eyes when staying up far too late in the night. More drops were put in my eyes and I went home equipped with yet another bottle of drops to be used for just two weeks.
I will be returning to the hospital in eight weeks time for a check-up and then back to the optician at Boots the Chemists  for some new glasses.

The patient’s story, part 5

At the end of “part 4″ I had started the leuprorelin acetate injections. These are a type of hormone treatment which is intended to inhibit the production of testosterone, the male hormone on which the prostate cancer cells “feed”, thus preventing them from growing. I have now had three of those injections at 28 day intervals and there are three more to come, by which time I will have been prepared for radiotherapy. The latter is due to start in the second half of February and will take place on five days per week for four weeks.
This is now the plan, according to my hospital doctor today. He seemed pleased with my progress  I noted that the PSA reading from a recent blood test was well down on what it had been previously and his estimate of the duration of the radiotherapy had reduced from six weeks (at my last assessment) to four weeks today. At our last meeting  I volunteered to be considered for a clinical trial which was due to start soon but was told that my case was not bad enough to qualify. That sounded like good news to me.
So far I have experienced only one of the side effects attributable (according to the literature) to leuprorelin acetate – hot flushes. These are no problem. I just peel off the outer layer of whatever I am wearing at the time, usually a jacket or cardigan, and make my small contribution to global warming. Come to think of it, it has been an unusually mild November. Well, I do get very warm but I don’t think they can blame it all on me!

Living with the Morris Traveller

I have owned the Morris 1000 Traveller for almost nine weeks. It was not love at first sight. Prior to taking delivery of the car I had not driven for about eighteen months and before that I had owned a succession of larger vehicles with bigger engines to match, which had a much heavier and more substantial “feel” about them from the driver’s point of view. At first the Traveller felt rather flimsy by comparison. The front doors closed with a rather “tinny” slam rather than a more refined click and engine noise levels in the car were relatively loud. These are not criticisms of the Traveller though, as most small cars of the ’50s and ’60s were exactly the same, if not worse, and it is worth remembering than the Morris Minor was designed in the 1940s. The problem was that I needed to become accustomed to the car.

Having concluded, most reluctantly, that I needed to own a car again I decided on my budget and I did consider a few modern cars. Nothing interested me enough to catch my attention for more than a few minutes and I was haunted by the long-held belief that most affordable modern cars are doomed to last only a few years thanks to built-in obsolescence, an early decline in spares availability and an inadequate supply of restoration skills and facilities in the average local garage. So my best bet was a well catered-for classic car which would be affordable and user-friendly to a DiY oriented owner, so that I would have the choice of taking it to a specialist or doing work myself when it becomes necessary.
The Traveller fulfilled all of these requirements. It helped that Charles Ware’s Morris Minor Centre at Bristol, arguably the leading specialist in these cars, is only about an hour from here by car or public transport.. Secondly, I needed the ability to carry larger loads than would fit in a saloon car and, thirdly, if I bought a good enough example to start with, it should be that much easier to preserve its condition during my ownership and thus avoid significant (or perhaps any) depreciation.

To my surprise, I felt a marked lack of excitement on taking delivery of the car.  I gave it a cursory inspection and put it away in the garage, from which it emerged every few days for short shopping trips.
After a while it began to grow on me. I had to admit that it always starts without delay and has no difficulty in keeping up with the modern traffic. It is very easy to drive and to park, being relatively compact and quite nippy. It is also very comfortable, especially since I acquired a couple of special cushions for the front seats  so that the passenger and I could enjoy a slightly higher viewpooint on the scene around us. The front seats shown in the picture below are from a modern Mini and form part of the upgrade to the “Series 3″ models now being built to special order at the aforementioned Morris Minor Centre. The Traveller puts smiles on other drivers faces and has started more conversations with total strangers on our local supermarket car park than I have experienced in years! How could it not grow on me?

After a month or so it became dusty and was treated to a wash and polish, by hand. I am sure that the woodwork had been more than adequately treated at Bristol but, a few days later when the car had dried thoroughly, I decided to add a further coat of Rustins Danish Oil. Apparently, varnish dries hard and eventually cracks as a result of temperature variations and general weathering. The cracks not only allow water to gain access to the wood but actually retain it while it helps to promote rot in the wood. Danish Oil, I understand, remains flexible enough to avoid cracking. However, it does need further applications twice a year, each consisting of several coats applied by brush. I was keen to ensure that there were no potential water traps along the inner edge of the wood or in the joints, So I took my time to apply a coating of oil to all the wood, not wiping it on with a rag, but applying it generously with a half-inch oil painters brush which, as you would expect, did rather a good job!
Whenever I have acquired a “new” car, even decades ago when I knew even less about cars than I do now, I have always been keen to inspect the beast from end to end, checking on oil and water and hydraulic fluid levels, and on the wear in brake shoes and pads, among other checks. It is a familiarisation exercise as much as anything else. I also make a point of obtaining and carrying the tools and spare parts that are most likely to be needed. It’s called “be prepared” and it’s ever so good for the peace of mind.

Before I forget…

…The appointment for the laser surgery on my eyes was cancelled for the second time (due to unforeseen circumstances), by letter from the hospital over a week ago. The same letter told me that another letter would be sent to me in due course. I am waiting still. I fail to understand why a new appointment couldn’t have been given in the same cancellation letter.
So today I ‘phoned the appointments section at the hospital to find out how long it would be until I had another appointment. I was told that they couldn’t help me but that I would have to speak directly to the Eye Casualty Department. Then they put me through to the wrong department where I was given another ‘phone number to ring, only to discover a few minutes later that this, too, was the wrong number.
Sometimes I am heard to exclaim that incompetence is becoming the UK’s national hobby. Certainly there is a lot of it about.

The patient’s story, part 4.

Now that the prostate cancer had been confirmed, together with its extent within the prostate gland, I still felt confident that it could be controlled, if not eliminated. The key question now was had it started to spread? Fortunately this form of cancer is a slow developer. Many men of my age can live with it for years, eventually dying of something entirely different. Not that I have any intention of dying of anything at all for long time yet, you understand.
Well, the team at University Hospital, Cardiff were still unsure as to whether the cancer had begun to spread and they were taking no chances. So my next little adventure would be a bone scan. For this, the patient is injected with a small amount of a radioactive isotope which is circulated in the bloodstream and tends to congregate where there is any activity happening in the bones, indicating damage. Here it acts as a marker which can be detected by the scanner. At least that is roughly how I understand it.
It all sounds very dramatic. One is conducted to the scanner room, where outdoor clothing is removed, All metal objects are removed such as belts (buckles), watches, mobile phone, keys, cash etc. and put safely to one side. Then it is on to the familiar narrow table again and get comfortable so as to remain perfectly still for the scan. This time it is a well-mannered scanner that is very quiet but the patient is inserted fully into the tunnel for an almost full-length scan. From time to time I heard the voice of the radiologist explaining what was about to happen. The scan was no problem, quite relaxing in fact. However, I was, in effect, radioactive. I had wondered about this for a while in the weeks before the scan. What would it mean? Would I set off security alarms, get tracked down by the Bomb Squad or even glow in the dark? No, nothing so exciting but my presence presented a very slight risk to pregnant women and young children and I was advised to stay away from these people for 18 hours after the scan.
The next step was to await the deliberations of a multi-disciplinary panel of medics who would consider all the results and help me to choose suitable treatment. I must say that the idea that I would be able to express a preference regarding treatment was new to me. I come from a generation in which the doctors were the professionals with the training, expertise and experience and it was they who made decisions. Unhappy patients may well have sought second opinions but on the whole they were in no position to make key decisions and neither did they want “choice”. How on earth are lay people supposed to choose between hospitals, between consultants to take charge of their treatment or between the treatments themselves?
Well, I have read the literature and listened intently when options have been explained to me. So when I was given an appointment to discuss treatments I was ready. The doctor started by inviting me to express my thoughts on the matter. I do not like the idea of surgery (complete removal of the prostate in this instance) unless truly unavoidable. The disadvantages seemed to me to outweigh the benefits given the stage of my cancer, the biggest risk being some internal infection which itself could prove very difficult. Implanting anything into the prostate to kill off the cancer cells was eliminated on technical grounds, the prostate having enlarged somewhat already. On the other hand to adopt a watching brief, which would involve periodic blood tests to check on the far from convincing PSA level, with perhaps further scans if the PSA looked suspicious, seemed to me too passive an approach during which the cancer might start to spread unnoticed between the tests. The bone scan had not shown anything suspicious so I suggested that a combination of hormone treatment and radiotherapy might fit the bill.
I was rather pleased that the doctor agreed, saying that my chosen approach was what the panel had also concluded. So the treatment started. First there was a daily anti-androgen tablet for 28 days, whose purpose was to stop the male hormone testosterone from reaching the prostate cancer cells (the cancer cells “feed” on the testosterone) so the cancer cells are unable to grow. My tablet were Bicalutamide but there are others. After these tablets had been taken for a couple of weeks a course of hormone injections (Leuprorelin acetate) was started. These were to be administered at 28-day intervals and the duration of this treatment remains to be decided, depending on results. Six injections seems the likely course at the moment. The purpose of these injections is to inhibit the production of testosterone and also shrink the prostate gland so that the radiotherapy will have a smaller target area. The patient is advised to read the leaflets that come with the various treatments. It is worth noting the potential side effects (none in my case to date) but not to be alarmed by them. They do not necessarily happen.  Yet to come are a further meeting with the doctor to assess progress, a CT scan as part of the preparations for the radiotherapy, and the radiotherapy itself, which is likely to start early in 2012. More about this in due course.