Month: October 2018

Radio Days (11): My side-effects have side-effects

Posted in Cancer, NHS, Prostate Cancer, St Thomas' Hospital1 Comment

Most days the dog and I trot round to Kennington Park. It’s particularly beautiful at the moment with the leaves on the London Planes turning to shades of gold and brown. Rusty, being gold-leaf coloured, disappears as if she’s wearing camouflage.

I remember taking this walk just over a year ago, not long after the mutt came from Battersea to share our life. It was a scary time, I’d just been diagnosed with prostate cancer and I had no idea what the future held. I wasn’t even sure I had a future.

Things have changed for the better and I have every reason to believe Bucket and I will be taking the same stroll next year. But I know from interaction with others that the early days, just after diagnosis are tricky. My life felt out of control; slipping from my grip.

I’m currently having two day’s grace from Radiotherapy while the doo-dat is jacked up and serviced. I want it over but can’t deny it’s quite pleasant to get some time off.

I’ve had 26 rides in the doughnut of doom and have a further 13 to complete the course. I asked Aaron, one of the radiographers, how many patients he treats in a day and he told me it’s between thirty and forty. That’s a lot of prostates getting clobbered by just one machine.

Sorry to bang on about the side-effects of radiotherapy yet again, but something needs to be made clear. I was warned that about a month in many people feel overcome with tiredness and fatigue. I’m feeling a little tired myself for the simple reason that I’m now getting up to pee four times a night. I’m wearing out the Axminster on the way to the bathroom. I’d assumed fatigue would be a direct product of the treatment rather than a side-effect of the side-effects. Breaking News: Man feels sleepy because he’s not sleeping very well.

I’m now scanning the internet to find side-effect free medication that’ll stop me talking about sodding side-effects.

Moving right along, I want to introduce you to a new member of the early morning cancer crew, another of us lads (Lads! Who are we kidding?) who sit waiting for our doughnut appointment. I’m calling him Stringbean and I thought to shake things up, I’d tell his story in the style of Damon Runyon.

Such a guy as wears shorts

So it’s round 9 bells and we’re all sitting in the paddock, waiting for one of the radio jockeys to come in saying, quite formal: ‘Please start drinking Mr Preen’ on account of we need to get outside of a jug of water to fill our bladders, so the ray guns are hitting their target. And there are the usual jokes like ‘I’m having a little whiskey with my water today’, which aren’t funny but hey some of us like a little whiskey now we have cancer an’ all.

We are a gabby bunch talking of this and that with someone crying the blues about Radiotherapy, Hormone-therapy Tomotherapy and Brachytherapy until most of us are wondering if there’s some kind of therapy that’ll put a sock in his mouth.

Just then a new guy busts in. So of course we give him the big hello, nice to see you, haven’t seen you before and so on. He’s a tall string bean of a guy, maybe seventy with white hair and not so remarkable except he’s wearing shorts, a t-shirt and trainers. We’re all thinking, who is this wingnut wearing beach clothes in the middle of autumn? Of course, being English we stay shtum and Stringbean sits down and we lapse into silence and wait our turn on the doughnut.

Next day we’re there shooting the breeze when in comes Stringbean once again sporting the shorts, t-shirt and trainers rig. This is too much for me so I’m saying: What’s with this garb? Are you jogging here? No Stringbean says, I’m coming from Bromley and taking a train and a bus. And I say you must be some kind of chump, it’s freezing out there.

What you say is true, he says, but a story goes with it. Well of course we all love a story and are all ears, even those of us who don’t hear so good no more.

Stringbean starts and it sounds like he’s crying the blues along with Mr Therapy. I’m working hard all my life, he says, and sometimes I’m on Easy Street and have plenty of scratch and other times no scratch at all, maybe not even two bobs to rub together. One time a dame gives me the run-out powder and I’m sad as all get out.

And all us greybeards are going: tell me about it, been there done that, because we’re thinking we are great sages about life and very likely had the same ups and downs ourselves. Though of course young people are claiming we know nothing at all and maybe not even that much, which is very fair because that’s how we think about them.

Stringbean continues: A couple of years ago I retire from my job in the government department and by now I have a few bobs to my name, a little pension income every month and life is very sweet. And one day I’m waking up and not running for the 6.15 train when suddenly it hits me: I’m on holiday for the rest of my life! And now I’m such a guy as wears holiday clothes 24/7.

Well this sounds fine to one and all except we live in England where the temperature is lower than a limbo dancer and he’ll be lucky not to get chilblains to go along with his prostate cancer, but of course we keep that to ourselves.

Hormone Therapy: Is there a good side-effect?

Posted in Cancer, NHS, Prostate Cancer, St Thomas' Hospital3 Comments

I’ve been undergoing hormone therapy for nearly a year and have just had another injection or implant. These last three months and stop hormone testosterone from reaching the prostate cancer cells. Unfortunately cancer relishes and grows on a diet of testosterone.

In previous blogs I’ve talked about the various downsides to this form of therapy, particularly the unpleasant side-effects. In a moment I want to talk about the possibility of an unexpected upside. But first let’s look at the sharp end of this treatment; specifically a bloody great needle.

A little prick

Those of a squeamish nature may want to look away now. The injection is delivered by a spring-loaded needle that shoots a slow release capsule into one’s abdomen. I’m not queasy about jabs but I tend not to look too closely as this medieval instrument of torture.

If the medical practitioner delivering the shot is skilful, it’s a moment of mild pain. If the skill level is one notch down, it does hurt a bit. If the doctor, and I use the term advisedly, has the chops of a butcher then the pain level is not inconsiderable.

My first injection was at Guy’s Cancer Clinic where a supremely skilled nurse popped it in, no problem. The nurse at my GP’s surgery is a little hit and miss and last time there was a fair bit of bruising. This time I was told a nurse was not available and a doctor was going to do the honours. Everyone knows doctors are useless at delivering jabs as they do it so infrequently and it’s a job best left to nurses who do it all the time. So I want to tell you that on this occasion I couldn’t have been more wrong, and the doctor delivered the injection in a professional pain free manner. I want to tell you that, but I can’t. For the first time I actually shouted out in agony. I can’t imagine what the other patients thought was going on.

Prostate cancer is tracked in various ways but the most common and widely used method is a PSA test that measures the total amount of prostate specific antigen (PSA) in your blood. It’s normal for a man to have a small amount of PSA, but a raised PSA level might indicate that further investigation is needed. When I was first diagnosed my PSA level was 5.03, which is relatively low and might not even indicate cancer. However, a physical examination and biopsy showed the Unwelcome Guest had set up shop.

Just a month after having my fist hormone injection my PSA was down to 2.61 and then six months later it was down further still to 0.8. So clearly the therapy is working and there is every expectation that when I have another PSA test in January of next year it will be even lower.

Last Friday Mrs Preen and I attended a radiotherapy treatment review session with Jenna the Urology Advanced Practitioner who we’ve met before. As ever she is excellent and a credit to the NHS. The bad news is she’s leaving to go work with one of the radiotherapy manufacturers, where I’m sure she’ll do a great job, get paid far more, but will be a great loss to our care service.

I have an appointment with my oncologist – still one of my least favourite sentences in the English language – in January. I asked whether, along with the PSA test, I’d have another MRI scan to take a closer look at the Unwelcome Guest, but Jenna said I won’t because there will be nothing to see, the cancer will have gone. I’m fully aware the Guest can make an unwelcome return, but I hadn’t appreciated that once the radiotherapy is complete, the current incumbent will have been booted out.

The docs then monitor my condition using a PSA test every three months until June and then every six months after that. If subsequent tests produce a similar result to that taken in January, then all is well. If the PSA level starts to rise, then that is a cause for concern.

I have another two years of hormone therapy in front of me and sure wouldn’t mind having my sentence reduced. Gabbing with one of the cancer crew in the waiting room, one of my fellow sufferers said some recent research indicated that 18 months hormone therapy might be sufficient. I put this to Jenna, who merely said I should ask the oncologist in January, but this got me thinking.

An unexpected upside?

Regular readers of the blog will know that despite having cancer I feel remarkably spry and chipper; I’m not depressed or downhearted. Some comment on how ‘brave’ I am and wonder how I continue to be so upbeat. Trust me I’m not brave and neither am I putting on a brave face. Most of the time I really do feel happy. If I didn’t I’d say so.

Here’s another thing: Whenever food is served in our house, Mrs Preen and the daughter laugh at me as I’m always the first to say how delicious it tastes. For the absence of doubt, we are both good cooks.

At the back end of last year when this whole cancer farrago kicked off and it was decided that instead of having my prostate removed I should go down the hormone and radiotherapy route the oncologist outlined its pros and cons and talked about the possible side-effects. She then made a throwaway remark, claiming one of her patients had once told her he’d never felt better than while on hormone therapy. At which I remember thinking at the time: yeah right pull the other one. Typical doc just trying to gee me up and make me feel better.

So here’s the inevitable question: Is the reason I’m feeling happy and content and food tastes so good a completely unexpected side-effect of hormone therapy? Am I enjoying some form of chemically induced euphoria which will come crashing down once the therapy finishes?

 

Radio Days (10): Half-time

Posted in Cancer, NHS, Prostate Cancer, St Thomas' Hospital4 Comments

Tomorrow the seasaw tips and I start on the second half of my radiotherapy treatment. Just 19 fractions to go and then the doughnut and I part company.

Many of my prostate pals have already done their time: Bassie and Chas have gone, and John has one session left. Unfortunately their places are quickly taken as prostate cancer seems all the rage these days.

The many new faces include Sir Alan, a transatlantic sailor and board-level businessman. He’s now in his 80s but sailed to the Caribbean and back when he was 65 and was messing about on his boat in the Solent last weekend.

As you can see from the picture I finally got one of the doughnut jockeys to take a snap of my insides. These are the screens they look at while I’m being nuked.

They take pictures of a series of slices through the abdomen. The white sections on either side are my hip bones and the central section is my prostate and bladder. I think the red circle indicates the prostate and the flattened orange circle is a lymph node. This has to be zapped as the cancer has set up camp there.

Lymph nodes and lymph vessels form a superhighway that allow fluids to be transported around the body. Unfortunately cancer likes to hitch a ride on this highway and uses it to spread, hence the need to take out this particular node.

Personally I don’t think I’ve ever looked lovelier than in the picture below, but the prostate shows clearly in blue. Just above that keen sailors will have spotted three tabs marked Pitch, Roll and Yaw, all rated at zero. So clearly the radio-waves I was surfacing barely ruffled the surface.

Prostate Cancer

If anyone has anything to add and can decode these pictures better than I, then please do so.

Cancer communication

Sometimes people talk about cancer in unhelpful ways. In newspapers a celebrity is said to be ‘battling cancer’ and if they die they’ll have ‘lost the fight’.

At times it’s suggested cancer can be beaten if only people try hard enough. I know why newspapers do this because it plays to the emotions, but it in no way reflects what it’s like to be a cancer sufferer. When people succumb to the disease, suggesting they’ve lost a fight or didn’t try hard enough to overcome it is odious.

My approach is to treat cancer with the contempt it deserves. I cycle to my hospital appointments and go to the gym twice a week ostensibly to keep healthy, but actually it’s my way of saying you’re not going to stop me living my life buster. Or else I just laugh at it and hope it feels ashamed of itself.

Of course I’m aware it may be the Unwelcome Guest who has the last laugh, but when a person dies, the cancer goes too. Deeply unsatisfactory for the host and presumably the Guest.