Loss of confidence

By nature, I normally combine brutal confidence with a sunny disposition and a relatively good perception of my strengths and faults. As the French say, I’m comfortable in my skin. (Though they generally say it in French)

Recently that confidence seems to have taken a hit and initially I blamed the Unwelcome Guest.

When people learn you’ve got cancer, they immediately think you’re going to die and even if you’re not headed straight to the departure lounge, they tend to assume you spend all your time thinking about your mortality or lack of it.

Cancer changes people’s perception. Someone once said we all carry three words in our head to describe people we know. Whatever those three words are when people think of me, I’m pretty sure one of them is now cancer. I suspect this leads some to think I’m diminished in some way and unlikely to perform my job as effectively or be a generally high-functioning member of society. Cancer also coshes humour, stuffs it in a burlap sack and throws it overboard.

I’ve been too blessed in my life ever to be a victim and I’ll be damned if cancer is going to make me one now, but dealing with cancer is odd for those who’ve contracted it and for those who come into contact with it who are mostly thinking, thank God it’s not me. Cancer can be like water on limestone, a slow drip-drip of confidence erosion.

Part of my job is to get on my hind legs and talk to groups of people who then benefit from my enormous wisdom. Lucky sods. Unlike Mrs Preen who hates giving talks, I quite like it. If you haven’t already guessed, I’m a bit of a show-off.

Part of my cancer treatment is getting quarterly hormone shots which gives me a small insight as to what menopausal women have to endure. In short, I get hot flushes, flashes and sweats. A week or so after my first shot I was at a meeting at the Natural History Museum when suddenly, out of nowhere, I’m in a muck sweat. High temperatures seem to trigger these events and the summer is definitely worse but whatever the ambient temperature, I start leaking at least five times a day.

This is uncomfortable, unpleasant, but as I’ve said elsewhere if this is what it takes to boot out the Unwelcome Guest then so be it. No sweat you might say, but it’s not so great when it happens when giving a presentation to clients. Suddenly I’m melting in front of their eyes and I can see it’s as uncomfortable for them as it is for me. They’re thinking Jim’s either as nervous as a first date or having a heart attack, whatever their thoughts, dripping sweat from the eyebrows is not a great look.

On a more banal level, I’m also a bit Mutt & Jeff – too much loud rock & roll from a young age is the culprit there. Being hard of hearing also tends to sap one’s confidence, as if you don’t catch what people say, you just appear thick.

Don’t get me wrong this loss of confidence is by no means terminal and most days I’m just as arrogant, self-assured and opinionated as ever, but it does tend to gnaw.

As much as I’d like to blame the Unwelcome Guest for this intermittent confidence outage it might be as much about old age as cancer. I hit 65 this year, which in a peculiar way I’m quite looking forward to. My last socially significant birthday was 21 and that’s 44 years ago. Here comes retirement age, though I have absolutely no intention of retiring as I’ve always associated retirement with death. My Dad retired at 60 and was dead in eighteen months.

I may not be able to run as fast as I could, getting up from kneeling down requires a herculean effort and my prostate is shot, but I’m taking comfort in the words of PJ O’ Rourke: ‘Age and guile beat youth, innocence, and a bad haircut.’

Unwelcome Guest in arse kicking sensation

The Brexit box-set psychodrama seems to be reaching the season finale, but let’s forget about that and concentrate on good news. I am now officially the James Bond of prostate cancer – my PSA level is 0.07.

Yesterday’s appointment with the oncologist, following two months of radiotherapy and a year on hormone therapy, revealed my PSA level to be ‘virtually undetectable’. Take that Unwelcome Guest, you now almost don’t exist.

To complete the Unwelcome Guest arse-booting contest my PSA level needs to be 0.03 or lower. Then it is undetectable and, for a while at least, I join the NED club. (No evidence of disease)

Now I know the Guest might already be planning a come-back tour but right now the NHS seems to have bested the little bastard. So first a big PHEW from me and then a huge thank you to all the wonderful urologists, oncologists, radiotherapists, GPs and nurses who have nursed me through this horrible twelve months. Without exception they have been splendid, caring and often funny. Who can forget the time I told a doctor that cancer had come as a shock as both my parents had died from heart disease, only for him to reply: ‘Don’t worry Jim, you’re still way more likely to die from a heart attack’. Such comfort.

So what now? I still have two years of unlovely hormone therapy to endure. I’m aware that some find this therapy truly horrible, and while I’m not crazy about it, if this is what it takes to be rid of the Guest then I’m in. I’ll see the oncologist every four months and hopefully my PSA level will decline still further. If it were to rise above two, that would be a cause for concern and would require further treatment.

I’m aware this game isn’t over, but neither is it game over. With one bound Jim was free to fight another day. I’m seriously considering having a couple of light ales this evening.

Prostate Cancer UK

Anybody reading this blog in the UK who has prostate cancer will almost certainly know about Prostate Cancer UK. This is their mission statement:

‘Prostate Cancer UK has a simple ambition – to stop men dying from prostate cancer. Through shifting the science over the next 10 years to focus on radical improvements in diagnosis, treatment, prevention, and support, we will stop prostate cancer being a killer.’

I’ve just been doing some copy editing for their website, which is an excellent resource that answers many of the questions both sufferers and their families may have about this pernicious disease. You can get your Man of Men charity pin from them too. Check out the website, if you haven’t already, and support a worthy cause.

Injecting a note of caution

Those reading this blog who have prostate cancer and are on hormone therapy will know that the spring-loaded needle that drives the hormone implant into the luckless victim’s abdomen can sting a little. My last injection was administered by a doctor with the skill set of a porcupine in a hurry. In our house he’s now known as the South Lambeth Road Slasher (SLRS). For him it’s not so much an injection; more a drive-by shooting.

With my next injection due, I called the GP’s surgery to book an appointment with the nurse rather than a doctor and told them to make sure the Zoladex implant needle was in stock. Turning up two days later I tapped my details into the computer on the reception desk and guess who I was down to see? Yes of course, the Slasher himself.

I gently suggested to the lady on the desk that I didn’t want to waste the doctor’s time and would be very happy to see a nurse; only to be told that there was no nurse on duty. Finally, I had to admit that I didn’t have full confidence in the SLRS and asked if I could have an appointment with someone else on Monday or Tuesday. This didn’t prove possible at which point the lady on the desk volunteered to come in and hold my hand.

After agonising over the potential agony, I agreed to let the Slasher do his dirty work and waited for him to come and call me through. When he appeared, I gave a big wink to the ladies on the desk, all three were now in on it, and they burst into laughter. Hearing this the doctor said ‘I guess everyone’s so happy because it’s Friday’ which made everyone laugh some more.

This is where the story doesn’t build to a jabbing climax as It soon became apparent the pharmacy hadn’t delivered the hormone bazooka and I was able to escape unharmed from the clutches of the evil genius.

Unfortunately, I’ve just checked my voicemail and I’m now booked to see the Slasher on Tuesday. Will I escape unharmed, will I bottle out, will some kindly nurse come to my rescue and will this story ever get to the point? Stay tuned.

Slasher update

Pitching up at my GP’s surgery on Tuesday at 10.30, I tap my details into the reception desk computer and am rewarded with great news. The Slasher has been left on the bench and I’m seeing Nurse Angela for my hormone injection.

A shout of joy (mine) wakes up a couple of the older patients who are asleep in the waiting room’s heat. They look vaguely irritated, wonder what’s going on, but are soon back catching flies. So, it’s big news, the Slasher is side-lined.

Nurse Angela has been at the surgery for years and while she’s never skewered me with a Zoladex shot before, I’m mightily relieved it’s her doing the skewering and not you-know-who.

Because it’s a fairly serious procedure and being the professional she is, Angela wants a doctor in the room. A young medic enters, and I suppose out of professional courtesy she asks the doctor if he wants to give the injection. As you can imagine I’m having none of it and make it very clear if anyone’s going to ram a needle into Jim’s abdomen on the 15th January 2019 then that rammer is Angela.

The doctor steps back and Angela asks me how long I think she’s been giving injections. I hazard a guess and say two weeks. She laughs and says actually it’s 45 years.

The needle is unleashed, explodes into my belly with almost no pain whatsoever. My next shot is 9th April. I’ll be booking Angela early to avoid disappointment.

Practise Nurse

Having read the original article, Marnie, a practise nurse, got in touch. She has some interesting insights:

‘Although this injection (Zoladex) is fairly standard, originally nurses were not allowed to do it, only a doctor and back then they used to use a local anaesthetic. Over time nurses became deemed competent to do it, so that job is generally handed down. Research also shows that the local anaesthetic causes more problems than it solves so we stopped using it quite some time ago.

As with any task we do, we get better the more we do it, even in a very large surgery there may only be 2-3 patients on it at any one time so our skills can get a little ‘rusty’.

Because of this it is often left to one person only for these appointments, so they can keep their skills polished up. The drawback is, this treatment should not be delayed and if a (member of) staff is off sick, or (has) left, someone else should take over to make sure it is given on time. A new nurse or locum may not yet be trained to do it, so it is down to ‘slasher’ as a temporary solution.

I give my patients the choice of standing/sitting/laying down when they have it, sometimes a different position may help reduce the pain. I have even over the years had the odd patient who learned to do it themselves, rare but if you are brave enough!!’

This reminded me that the very first hormone injection I had was at Guy’s Cancer Centre where the nurse gave me a pain free shot standing up. I’ve suggested this to other nurses and doctors who’ve looked at me like I was mad.

Unfortunately, Marnie is also a cancer patient and is waiting on scans to see if her treatment has worked. Thanks for getting in touch Marnie and I sure hope it has.


Stats Angst

I think I have Stats Angst. Given that I’m almost entirely innumerate this is hardly surprising; it took me three attempts to pass maths ‘O’ Level. Show me a spreadsheet of numbers and initially I panic and then my brain fogs up as the figures swirl in front of my eyes. Me and numbers, we don’t get along.

But the Stats Angst I’m talking about here is a little different and of course cancer related. Eagle eyed readers of this blog will know that I’ve been on hormone therapy for over a year and have completed a two-month course of radiotherapy.

My cancer or hopefully lack of it will be monitored in the coming months by a simple PSA blood test. The last reading taken in June came in quite low at 0.8. I’m due for the next test in a couple of weeks prior to seeing my oncologist. Obviously, I’m hoping the number is even lower as this figure becomes the benchmark in my efforts to boot out the Unwelcome Guest. Despite being told it’s unlikely, I’m now scared the damn thing will have gone up rather than down. Hence the angst.

When having a consultation with the oncologist, I never quite know how to pitch the words I choose. Inevitably, given my condition, treatment and side effects there’s a fair bit of urological chat. So, what do I say? If I talk about excreta or faeces, I sound like a first-year medical student. If I talk about poo, I sound blushingly coy, in effect using baby talk. If I talk about shit, I sound like an oik. Cancer, it’s not just your health you have to worry about, it’s your vocabulary too.

The oncologist should be able to tell me how the Unwelcome Guest and I are getting along and what my prognosis looks like. Of course, I’m hoping she’ll say the Unwelcome Guest looks like he’s had seven shades of shit kicked out of him. Or words to that effect.