countdown

[apple and raspberry juice]
[if I can see through it, I can drink it]

I’m definitely counting down the hours. Tomorrow I am scheduled for a radical robotic prostatectomy at the Sydney Adventist Hospital. I stopped eating yesterday, and today I am allowed to drink – but only if it’s transparent. Apple and raspberry juice is OK, black coffee is OK too (yay!).

In two hours’ time, I start flushing my bowel. I will be glad when the surgery is over. Watch this space for a report.

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Requiem on hold

There was the faintest suggestion of a sprightly spring in my step this morning as I walked to work, listening to Fauré’s Requiem but not imagining my own eternal rest (well, not to the same extent as perhaps I would have done in recent weeks).  Yesterday I heard the news that technology had trumped technology and I have been booked in for possibly curative surgical removal of my cancerous prostate gland.

Two weeks ago a 99mTc bone scan  and CT scan were reported as showing:

The appearances of the T8 to T10 region, the 3rd rib anteriorly and the 10th rib posteriorly are all suspicious for bony metastases. While the linear appearance of T9/10 can be typically seen on a bone scan with a compression, given the underlying destructive CT changes, metastatic disease is favoured.

Yesterday the 68Ga Prostate Specific Membrane Antigen (PSMA) PET-CT scan reviewer concluded:

The prostate shows mild heterogeneous uptake, mainly on the right side….There is no definite evidence of extracapsular spread or involvement of the seminal vesicles…No PSMA avid metastases seen. The thoracic spinal and rib uptake described on the bone scan shows no increased activity. The appearance may be due to prior trauma.

 PET scan images 11 November 2016

As a result my prostate surgeon, the excellent Dr K, has booked me in to undergo a radical robotic prostatectomy at the Sydney Adventist Hospital, known as ‘The San’, on Tuesday 22 November. I’m not out of the woods yet, but I’m feeling distinctly more optimistic than I was last week.

The PET technology has superseded bone scan technology for detection of prostate cancer metastases. This kind of prostate-specific PET scan has only been available in Australia for less than a year. How would I have been treated in 2015, I wonder?

Posted in death, emotions, health, observations, technology | Tagged , , , , , , , ,

together

In August I developed a sore back while running to work. Over a few weeks it gradually got better and I started running to work again. After about a week of running the same thing happened again. Suspecting something significant I visited my GP. She did a bunch of tests and now I can summarise:

  • I probably fractured two or three thoracic vertebrae
  • I have osteoporosis in my spine
  • I’ve got coronary artery disease and have probably had a heart attack
  • I have prostate cancer, detected by:
    • high Prostate Specific Antigen levels in my blood
    • a specialised prostate MRI scan indicated likely cancer
    • a trans-perineal prostate biopsy found a “punchy” form of cancer
    • a bone scan and CT scan showed strong evidence that the thoracic vertebral fractures were in fact due to prostate metastases, and I have “advanced” prostate cancer

[minimal blood loss immediately after 29 needles were inserted through my perineum into my prostate]
[minimal blood loss immediately after 29 needles were inserted through my perineum into my prostate]

It hasn’t been too physically traumatic so far. The prostate biopsy was my first ever hospital admission & anaesthetic, so I was a little anxious about it beforehand. But it turned out to be not too painful, with little blood loss on the day and rosé-coloured urine for a week afterwards.

Despite the evidence collected so far, my urological surgeon, Dr Kris, is not quite totally convinced that the prostate cancer has developed beyond redemption. There’s one last test that can determine the state of the cancer and hence my likely future options. It’s 68Ga-PSMA (prostate specific membrane antigene) ligand positron emission tomography (PET). It’s expensive and not widely available, and so I’m travelling a long way and paying a lot of money to have one done the day after tomorrow. There’s an unlikely but important (to me) possibility that the bone & CT scan reports are wrong and in fact my prostate cancer is still confined to the gland itself, which would make it potentially treatable with surgical removal. On the other hand, if the PET scan confirms the current diagnosis of bony metastases, there’s very little that can be done, and certainly nothing that carries that hope of a cure. In that case Dr Kris will put away his gadget arms and refer me for palliative treatment.

I won’t get the PET scan results on Friday so I’ll inevitably spend the weekend contemplating the possible directions and duration of my future life. As I reflect, I will be very aware that my experience of the past few months has taught me how wonderful my family is and how lucky I have been to share my life with such loving and caring people. On Monday I should find out the PET scan results. In the short term that information is sure to have a big emotional impact on us all. But we will move on from there, and I am confident we’ll face this uncertain future together and make the best of my (indeed our) remaining life time, whatever that turns out to be.

Posted in death, depression, emotions, family, health, injuries, observations, pessimism, running, technology | Tagged , , , , , , , ,

art imitates my life

I don’t know what haruspicy* means, but this is the story of my life at the moment:

Lerner, Ben (2014) 10:02, London, Granta, p. 206

Lerner, Ben (2014) 10:02, London, Granta, p. 206

A doctor discovers accidentally that the main character in poet Ben Lerner’s novel 10:02 has an unusual condition of his aortic root, which means he is at risk of a sudden dissection – a fatal tearing of the aorta.

I really don’t understand much of this book (all the poetry references are completely lost on me), and so I suspect I’m missing out on some significant aspects of the novel, but on my simple level it’s a story of a man whose life is changed by acquiring knowledge about the possible (maybe even likely?) mechanism by which he could die – and the fact that the death could occur any time from now on but there’s very little he can do to prevent it. As also in my case, the condition was not associated with any symptoms and without its accidental discovery, he could have gone on with life quite happily. Is it better to be ignorant, or to have the knowledge of your life-threatening condition but not be able to prevent the forewarned event?

I think my G.P. feels a little uncomfortable that she has, by testing for conditions for which I was not reporting any symptoms, inadvertently placed me in this conundrum. Of course, you can argue that anyone of my age (three decades older than Lerner’s protagonist), is at risk of sudden death from some hitherto unknown disease. But there is something different about having that additional knowledge. There’s also the question that Lerner alludes to in the passage above: once you discover a life-or-death health issue, how much time and money do you spend trying to define the parameters of the threat? And Lerner seems to be also exploring the issue of how this knowledge might change our behaviour. In his case, his character considers his proclivity to procreate, but in my case I wonder about what impact my death would have on the family I would leave behind. I have new impetus to clean out the shed, arrange for someone to manage my blogs/emails/etc, and most importantly, sort out my mother’s remaining life.

* OK, I did look it up – I now know what haruspicy means.

Posted in books, death, depression, emotions, friends, health, injuries, pessimism | Tagged , , , , ,

all over

I’ve been running as long as I can remember. I remember being the boys captain of our school athletic team that travelled to a small country town (Dorrigo) for an inter-school competition when I was aged 8 or 9. We didn’t do very well against those sons and daughters of dairy farmers, and I haven’t subsequently achieved any remarkable results in competitions either.

It now appears to me that my running life is over. As you can see on this graph, I’ve had three attempts to start running again in the past few months after a hamstring tendon injury forced me to take about 9 months off.

[my running distances from 01 July 2015 to 06 October 2016]

[my running distances from 01 July 2015 to 06 October 2016]

Each of those three attempts to start running again has ended in exactly the same way – with a fracture of one of my osteoporotic vertebrae. I can’t go on doing that.

So my running life appears likely to be over. The only consolation is that my cancer or ischaemic heart disease may intervene to keep the remaining sedentary years to a minimum.

Posted in annoyances, death, depression, emotions, health, injuries, pessimism, running | 1 Comment

A warning from the widowmaker?

I’ve had a heart attack, a myocardial infarction (MI). So says a cardiologist, anyway. It could be due to a blockage in the left anterior descending (LAD) branch of my left coronary artery, which the angiogram found to be 30% – 50% obstructed. This branch of the coronary artery system is known as the widowmaker because of its proclivity to obstruction and the likely outcome of a significant blockage.

[my heart - the Left Anterior Descending artery]

CT scan of my heart arteries – the Left Anterior Descending artery

Perhaps this is a warning of bigger things to come. I suppose the cardiologist is correct about the MI- he’s basing this call on the fact that I had high levels of troponin in my blood, a substance which is released from damaged heart muscle. My symptoms aren’t a good guide as I have pain in the chest region from two likely osteoporotic fractures in the thoracic spine and yet another broken rib (right anterior rib 4?). Further, an ECG and stress-echo test were both fairly normal. On the other hand, two investigations ordered by the cardiologist, coronary artery calcium scoring and coronary artery angiogram, did show plenty of cause for concern (report page 1, report page 2) and tend to support his diagnosis (and also suggests that I have a ‘hole in the heart’ – patent foramen ovale). Regardless of whether an MI has already occurred, I’ve now started on medication I’ll take for the rest of my life – however short that period may be:

  • aspirin
  • rosuvastatin
  • atenolol

And don’t do any activities you’re not used to“, advised the cardiologist. I didn’t find this or any of his advice very useful, nor do I think he did a very thorough job of investigating my particular case. He didn’t measure fasting cholesterol levels, and didn’t really listen to me describe my symptoms; he just wanted to hear me say “chest pain“.  He seemed determined to go through a standard investigative routine (and in the process keeping his own stress-echo lab staff employed), leading almost inevitably to the three drug treatment he ended up prescribing. The total bill for the cardiologist’s consultations and investigations was $1700! If I’d asked my GP to prescribe a treatment, with no more information than the troponin result she had already discovered, I reckon she would have come up with almost exactly the same regimen, at zero cost to me.

The cardiologist wants to see me again in 3 months’ time. Right now I’m thinking I’d rather spend his consultation fee on something useful instead.

Anyway, the SAH CT scan has provided enough evidence to convincingly support the argument that all is not well with my heart. I will heed the warning and will consume these three medications, hoping they will do more good than harm. And I’ll make sure I’m carrying a phone all the time, ready to dial the emergency ambulance if the widowmaker  decides to step up the attack to the next level.

Posted in death, emotions, health, observations, pessimism, technology | Tagged , , , , , | 1 Comment

Partnership

I haven’t run much for quite a while. From September 2015 to July 2016 I was constrained by a hamstring tendon over-use injury. And when I tried starting running again I sustained two thoracic vertebral fractures, due to osteoporosis in my spine. That abruptly ended my return to running.

Last Sunday, however, I took time out from my normal early morning routine of coffee drinking and novel reading to attend the Blackmore’s Half Marathon – as a spectator. I was not permitted to drink coffee anyway, as I was preparing for this coronary artery angiogram and Coronary Artery Calcium Scoring at the Sydney Adventist Hospital (run by vegetarians!) because a cardiologist believes I have serious Ischaemic Heart Disease.

The main reason I attended the Blackmore’s Half Marathon was to cheer on my daughter, daiskmeliadorn. Under rain-threatening, cloudy grey dawn skies I set myself up at a location where I was sure I would see her. I stood at a point about 8 km into the route where the field would be somewhat thinned out compared with the start, and where the race course narrowed to just a single road lane as they ran across a pedestrian crossing. I had my supporter’s sign with me.

[Waiting at the 8 km point, Blackmore's Half Marathon]
[Waiting for the runners at the 8 km point, Blackmore’s Half Marathon]

It wasn’t too long before the leading runner came through, with his pursuers not too far behind.

[Leading runner, Japanese teenager Kei Katanishi, goes through the 8 km point of the Blackmore's Half Marathon]
[Leading runner and eventual winner, Japanese teenager Kei Katanishi, goes through the 8 km point of the Blackmore’s Half Marathon]

I had a good idea when daiskmeliadorn was expecting to go through, and I watched and waited. The numbers increased and soon they were running through thick and fast.

[Lots of runners go through the 8 km point of the Blackmore's Half Marathon]
[Lots of runners go through the 8 km point]

I watched, and watched….but eventually the numbers declined, leaving only their characteristic detritus behind, along with one disappointed father.

[runners' detritus]
[runners’ detritus]

Fortunately, just across the other side of road, the runners looped back on their way towards the finish, making that point the 19 km marker of the 21.1 km race. So I moved myself and my sign over to where there was already a trickle of runners passing through.

[19 km marker]
[I move across to the 19 km marker]

Not a great deal of time passed until I saw her running towards me. Yay! Oh joy!!

I waved and reached for my camera – but by the time I figured out that I didn’t have the camera switched on, she was running past, looking cool as a cucumber. She ran off down the road and I got this parting shot of her disappearing down the road towards the Sydney Harbour Bridge.

[daiskmeliadorn!]
[daiskmeliadorn! That’s her with dreadlocks, wearing a white and red Sydney Frontrunners shirt, next to the guy with the blue top]

I checked my watch. Although I didn’t know exactly what time the race started, it looked like she was perhaps headed for a good time, close to her previous best of 01:47:20, set in the May 2016 SMH Half Marathon. I packed up my sign, collected my umbrella – thankful that it wasn’t needed – and took my coffee-deprived body back towards the train station to go home. About 15 minutes later, on my walk to the station, a message from Sam flashed up on my phone: daiskmeliadorn had finished! Time: about 1 hour 43!!! What a performance. How proud I was to see how daiskmeliadorn had worked so hard and trained conscientiously and was rewarded with a great personal best time.

[daiskmeliadorn and partner after Blackmore's Half Marathon 2016]
[Sydney Frontrunner, daiskmeliadorn, and her partner, Sam.
Photo credit:
Picture taken by a friend of daiskmeliadorn]

That achievement is nothing, however, in the overall scheme of things, by comparison with what you and I can see in the picture above. As I commented after the SMH Half Marathon, these two people have a wonderful partnership in which they provide magnificent mutual support and rejoice in each other’s successes.

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