Green(house) fingers

I may have mentioned previously that I look after the garden of a disabled neighbour. During the foul weather of the past few weeks I have turned my attention to the small (8 feet by 6) greenhouse, which has been unused for some years.

Despite limited previous experience of vegetable growing, and none at all of greenhouse growing, I thought it might be fun to “have a go”. Admittedly I have spent a few pounds on trays, pots, plants, seeds and compost but so far it has been an enjoyable experience. I am attempting to grow tomatoes, peppers, onions, carrots and radishes. Repotting plants from the local garden centre and sowing seeds and then seeing the plants thriving and the seedlings appearing is immensely satisfying. I have even started a few plants (peppers actually, since you ask) on my windowsill indoors and they have since been re-potted and moved to the greenhouse.

It remains to be seen how successful the greenhouse will be on two levels: Will the novelty wear off in a month or two so that the daily attention needed starts to be neglected and, if not, will I actually grow a worthwhile amount of vegetables?  At least I will not be able to blame the weather for any failures.

When clutter becomes baggage

Now that day to day life has returned to something like normal, after weeks of disruption by medical appointments, I feel ready at last to tackle a vital task which has waited far too long, namely “decluttering”. Our small modern house is just about as delightful as small modern houses can be but it is too small to allow the luxury of an ever-growing collection of books and other goods with which we fill our lives these days.

From time to time, during the few years that we have been here, I have sat and looked around me wondering what I could get rid of to create some space. Once in a while a few books will find their way to the Oxfam shop in the city centre and other items will be moved to the garage, where clutter is marginally less offensive, mainly because it is out of sight. It is difficult. It is even difficult to define the difficulty. Some books and other “things” have been part of my immediate, personal environment for decades. It sounds ridiculous but they seem to be part of my very identity. And then there is the nostalgia. Moreover, many are irreplaceable (despite Ebay) yet of no actual monetary value. Sometimes, when feeling ruthless, I resolve to clear the decks, get rid, make some space, reorganise, make a fresh start. But you know how it is. The very week after you get rid of something, all of a sudden you need it and nothing else will do.

To some extent it is a matter of recognising that the world has moved on and a new mindset is required. No longer is it essential to house a large reference library (most of my books are non-fiction) when a few clicks on laptop, tablet or phone will call up whatever information is needed from the Internet. No longer do I need to keep fat files of sheet music when sheet music is readily available online, much of it free and even accompanied by tolerable midi files which can be played as an aid to rehearsal. And no longer do I need to keep a garage full of tools and equipment “just in case” when a few acres of B&Q store, less than a ten minute drive away, stands ready to supply my needs in the unlikely event – made more unlikely by the fact that from now on someone else will be paid to “sort” the kind of problems that I might have tackled as a matter of course a few years ago.

This time it will be different. There is no space to spare. Something has to go. In fact a lot of things have to go. It is time to recognise that much of the cosy collection of clutter has now become baggage and an obstacle, psychological as well as actual, to moving on.

I will keep my collection of essential books and tools and painting equipment and this and that – and how will I decide what is “essential”? Simple. If it has not been read, or used in the past two years and/or is unlikely to be read or used before the end of this year, out it must go.

The Patient’s Story, Part 10.

My four weeks of radiotherapy finished today and I have been almost completely free of any side effects. My biggest problem has been tiredness. This was already a side effect of the monthly Prostap injections (which continue) before it was increased by the radiotherapy. It was also a consequence of reduced and disturbed sleep caused by the need to get up several times each night to visit the bathroom. Fortunately I am able to cope by having a nap from time to time during the daylight hours.

As you may have gathered, from earlier parts of this series of posts, I have been fascinated by all aspects of my treatment and especially by the amazing technology that has been brought to bear. Well, Velindre Cancer Centre in Cardiff (the proud capital of Wales, UK, for the benefit of overseas readers who may not know) kept the biggest treat until last. Its brand name is Elekta Synergy and it is a linear accelerator, usually abbreviated to Linac.

The picture below, taken with the kind permission of the radiographers at Velindre, shows “Linac 3″ on which I received my treatment. In simple layman’s terms the basic function of a Linac is to fire high-powered and very accurately focussed X-ray beams at cancer cells within the patient’s body, thus damaging those cells irreparably while minimising damage to healthy cells nearby which, unlike cancer cells, are capable of recovering from such damage.

The “bed” is capable of multiple adjustments, up, down and sideways (among others) and to achieve the essential accuracy the patient is moved by the radiographers to exactly the same position on the bed for each treatment, with feet touching and remaining in contact with the red footrest and the blue headrest adjusted to suit. Positioning is aided by tiny permanent marks made on the patient at the planning meeting which can then be used in conjunction with green “gridlines” projected by lights in the cross-shaped apertures in the ceiling and side walls of the treatment room.

With the bed raised and the patient in position, and remaining perfectly still for the few minutes of the treatment, the radiographers depart to their workstation outside the radiation-proof treatment room, where the treatment procedure is controlled on monitors and keyboards. From the patient’s point of view it is painless and relatively quiet. The Linac hums as it revolves (note the circular “mounting” on the wall) around the bed, hisses slightly as it focusses and then buzzes as the treatment is being applied. To get an idea of how the Elekta Synergy LINAC can be moved in relation to the patient on the bed, have a look at this YouTube video, which lasts about 4 minutes 50seconds. It provides a summary of the whole external beam radiotherapy treatment but the part showing the LINAC in action starts at about 3 minutes 16 seconds. For a more detailed explanation of the internal workings of the LINAC try this video. Do have a look at these videos as they will help you to make sense of my brief explanation.

Radiotherapy usually lasts between four and seven weeks and takes place daily except on weekends and Bank Holidays. I had twenty treatments (four weeks), each consisting of several beams from above and both sides and also a scan (also on the Linac) every few days, presumably so that the radiographers could assess progress.

I must give enormous credit to the radiographers. They worked in pairs and I don’t think I saw the same pair two days in succession but it didn’t matter. They were all brilliant without exception. They couldn’t have done more to make me feel at ease.

It is extraordinary how lucky I have been.  First, my prostate cancer was discovered only because Granny-Anne prompted me to go and get the general check-up that I had been merely thinking about for some time. Secondly it was discovered before it was sufficiently advanced to cause very much alarm. Thirdly, we had moved only just over three years earlier to Cardiff, the home of a major centre of excellence where cancer research and treatment are concerned, namely Velindre Cancer Centre. We had lived around 90 miles away previously but now we are about 20 minutes drive from the hospital. Finally, the various procedures involved in my treatment would have cost a fortune had I been required to pay for them, not to mention the advanced nature of many of those procedures and of the equipment used. The cost of a Linac alone, together with its ancillary equipment and special accomodation wouldn’t leave a great deal of change out of two-and-a-half to three million pounds. Yet it was all used on me for free, thanks to our great National Health Service. What a shame that both the present and previous governments have set in motion the destruction of the NHS as we have known it these past 60+ years.

There will be nothing to report now until I see my doctor at Velindre in mid June to find out how successful the treatment has been and for how much longer I will be having the Prostap injections.

The fun begins

Nine months, almost to the day, after the routine general check-up that alerted my family doctor to the possibility of prostate cancer, the real treatment started this week. Granny-Anne and I have been pinned down for all these months by the avalanche of appointments for scans, blood tests, biopsys, injections, eye tests and laser treatment, supplemented more recently by investigations into possible diabetes and those mysterious chest pains, plus visits to the dentist (for a check-up, with treatment later) and optician (for new glasses). I am also a part-time carer for a disabled friend in the almost complete absence of any predictable help from the normal sources following her three months in hospital last year, I have been her regular shopper and have provided her transport (including wheelchair) for appointments at her doctor’s surgery and at no fewer than three local hospitals. Fortunately, she is now getting more attention from the medics and more support generally, but why not 3-4 months earlier?

So, seeing our opportunity, Granny-Anne and I set off for a few days away in Devon last week, and very pleasant it was too. We stayed at the Manor House Hotel near Okehampton. This is one of a pair of “sport and leisure” hotels on an estate of several hundred acres and it certainly lived up to the description. There are excellent facilities for guests to participate in dozens (no exaggeration) of sports and craft activities at little or no cost, the accomodation was adequate and comfortable and the food was very good indeed. We are hardly “sporty” people but we wanted to stay somewhere where there would be things to do, regardless of the weather. As it turned out the weather was bright (even sunny) and dry almost all of the time but there was a cold wind. So we found lots of indoor activities and, afterwards, I wished that I had had time to try more of them. I managed to fit in sessions of rifle and pistol shooting and proved to be pretty useful at both. I also tried three other activities about which I have wondered often but never attempted. One of these was archery. What fun! The arms aren’t as strong as they were but, even so, I might start looking for a local club.

The second activity was falconry. This was very interesting. The falconer had four birds tethered to their perches. One of them was just being trained to get used to being near people but took no active part in the proceedings. The other three birds (two falcons and a large owl, all of them American with names that I had never heard before and thus forgot almost instantly) were used for demonstrations in which a dozen or so guests queued up to take turns. The birds flew to each of us in turn as we held out an arm wearing a big gauntlet on which a small piece of meat had been placed. The birds were well trained but still kept tethered on a long cord so that they would not be tempted to fly away to the nearest tall trees, in which the local feathered population were letting it be known that they were not happy about these fierce intruders.

Thirdly, several varieties of bowls were available so, having no previous experience whatsoever, I settled for a short session of indoor bowls coaching. I found it a challenge but would like to do more. Indeed it was unexpectedly stimulating to try the new activities (the rifle shooting being the only one of which I have previous experience).

The Morris Traveller managed the trip to Devon and back with considerable aplomb and returned us to Cardiff in time for my birthday celebration lunch, kindly hosted by my lovely Daughter Jennie and her family at their impressive new house. It was a glorious, sunny day unspoilt by any wind at all, cold or otherwise, so we lunched outside and thoroughly enjoyed it.

Actually, we had not been the first house guests in the new home. That honour had fallen to Henry (our tortoise) who had stayed there the previous week while we were away. Henry is still brought indoors overnight but now spends several hours daily in our garden, not going very far but eating vast amounts of mixed greens etc. including lettuce, red cabbage, sliced carrot, sliced apple and the occasional grape or strawberry. There cannot be much wrong with an animal that eats with such consistent enthusiasm.

So this week it was back to the real world and I have had three radiotherapy sessions already. It is too early yet to offer any new information about the experience but it is quite boring really. The radiographers move me into exactly the right position on the linear accelerator and then I have to lie perfectly still until the procedure finishes. The machine is very accurate and fires strong Xrays at the prostate cancer cells from various angles causing damage from which they cannot recover. If healthy cells are damaged the difference is that they ARE able to recover. Everything that has happened to me so far has been a preparation, albeit an essential preparation, for this radiotherapy, which is why I refer to it as the “real treatment”. There is a bit of preparation to be done each day before I set out for the hospital but that is straightforward enough and, as always, ample instructions are supplied. The radiotherapy itself lasts only a few minutes and is totally painless. There are recognised side effects which may or may not occur. I am feeling quite tired already as a result of the Prostap injections and of the totally disrupted sleep of the past several months and tiredness is listed as a side effect of the radiotherapy as well. So you may see my next post or three tailing off…..into…..a bunch of disjointed…..mutterings…..(then again, would you notice any difference!)…..or I might just…..drift off into…..ZZZZZZZZZZzzzzzzzzzzzz

The Patient’s Story, part 9

I am hoping that two or three more posts will conclude my cancer saga. It is not a subject that I want to write about. It hardly makes for an attractive blog. However, as I have explained previously, I am keen to encourage other men to take more interest in their health (even when all seems well) and to get themselves checked at suitable intervals by their general practitioner. There is nothing rare about the incidence of prostate cancer (among others) and there are no obvious symptoms either. My Father used to say that there are two sorts of drivers in London, the quick and the dead (obviously this was decades ago before traffic congestion became the norm). It’s a bit like that with many cancers including prostate. Catch it early and it can be sorted. The alternative doesn’t bear thinking about.

There have been two further appointments with my family doctor since the ECG test. At the first of these I forgot to ask her about the results of the test (absent minded or what?) but they were normal. Those mild but mysterious chest pains are still there and I conclude that they are caused by the Prostap injections that I am having every 28 days.

A  high cholesterol level and rising blood pressure are the current diversions and this is disappointing because I have been trying to eat a more healthy diet since last July and (with some success) to lose a bit of weight. The doctor has now prescribed pills for both problems and further tests will take place in a couple of weeks.

Meanwhile, I will be microwaved shortly, that is, the radiotherapy will start on March 26th and continue – five days per week, excluding bank holidays – for at least 4-5 weeks. I will be describing this experience in the next post.

The Patient’s Story, part 8

The next step in my prostate cancer treatment took place today. This was the “planning meeting”, in which (after a quick scan) small, permanent dots were marked on my skin on both hips and in the centre between them to guide the machine that will be used in a few weeks for the radiotherapy treatment. The point of all this is to target the cancer cells in the prostate very accurately so as to minimise, or avoid completely, any damage to good cells. This calls for great accuracy in focussing the radiation. I was very carefully positioned on the bed of the scanner before all this started and the challenge will be to return to that position, exactly, at each radiotherapy session.

There is little use in being in exactly the same position for the radiotherapy, day after day for several weeks, if the prostate gland is being moved around depending on whether bladder and rectum are full or empty. The clever people who design these treatments think of everything and have decided that the best combination is for the patient to have a full bladder and an empty rectum. So there is a bit of preparation to be done involving the timely use of an enema to ensure the empty rectum and sufficient drinking in the hour before the appointment to ensure the full bladder. Ample instructions were provided and it is all a lot easier than it seems at first.

Soon I will receive a letter giving details of the radiotherapy appointments and I know already that they are expected to start on March 26th and to continue for four weeks and possibly a little longer depending on progress.

At my last appointment at Velindre Cancer Centre back in January, my doctor prescribed Stronazon capsules in the hope that they would reduce the frequency of my visits to the bathroom at night, thereby helping me to get more sleep. This problem is a recognised side effect of the hormone treatment. I tried the Stronazon for eight consecutive days but it made no difference. This was a few weeks ago and I don’t know whether the Stronazon has a delayed action but, recently, my sleep has had (on average) fewer interruptions.

I then stopped taking the capsules, not because they seemed to have no effect but because I started to have some mysterious chest pains. There were no other symptoms, just mild chest pains and at first I wondered whether the Stronazon capsules were to blame. In retrospect I don’t think they were. The chest pains were coincidental – but also worrying. The conventional advice is that chest pains justify calling an ambulance. But the pains didn’t follow any physical exertion, there were no other symptoms and, in fact, I felt fine. The odd thing was that they tended to be there when I woke up in the morning and then wore off after I had been up and moving about for a while.

So I consulted my family doctor, who examined me carefully and concluded that I was still alive but ordered an ECG by way of confirmation. We also talked about diabetes. I am still trying to lose a bit more weight and she kindly ordered more blood tests (sugar and cholesterol in particular) so that we can see what progress I am making thanks to my slightly revised diet. As I have not received any urgent phone call from the surgery, I am assuming that the ECG results were unremarkable. We will discuss the blood tests at my next appointment in ten days time.

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.

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!