Tag: breast cancer

What is on the Dance Card?

~ quantumdreamer ~ Leave a comment

Next week returns us both to the medical merry-go-round. The wife is getting the results of her post breast cancer full genetic work up and I am having a preoperative stress echocardiogram because there was an anomaly with the ST section in my ECG trace. This could be due to ischemia or larger than usual size and ageing. When you look in Pandora’s box you never know what you will find. Our understanding of where we stand could change. The results for me might influence the go/no go for the hip replacement surgery. There may/may not be something wrong with my ticker.

In about a month’s time I have a full blood work up at which I will finally find out my blood group. I will get to meet the anaesthetist, the physio and a dietician. The latter no doubt will imply that I am a fat bastard. Explaining to French people that you do not eat vast amounts of charcuterie, cheese, fish and shellfish is not facile. They do not get it. The don’t do, vindaloo. They will want me to lose weight. I am currently a nice round 100kg. When I bust my hip I dropped below 85kg.

The notion of downscaling house is still on the cards and chronic. We need to do it. What we don’t know is how crippled I will be post operation(s). This feeds into the bungalow or single floor flat versus house decision. Currently single floor is favourite.

After watching the NF/BNP march in London yesterday I wonder why did Blair Peach die. Maybe it is time to reboot the anti nazi league.

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Come back to blighty.. really ….. hmmnnn…

So far I have written up 77 dreams this year. There are others I can’t be arsed with. The dream length of late is heading past 1000 words. Why I am dreaming about AI I do not know. I do not use it nor know anything about it. I hate prompts to use bloody copilot.

I also have had numerous pseudo-technical or pseudo-scientific dreams. I do not mix in the kind of circles where I might discuss these nor chase them up. I don’t have to write research grant proposals or come up with ideas. The only person outside medical and this house I speak with is the ex-farmer who helps out in the garden. He does not care about quantum.

There are also Tibetan and Toltec dreaming themes. Again I do not move in circles where these might be in any way applicable. There is a part of me which mildly dreads going to bed. It means an hour in the morning typing up dreams.

The basic notion is visit UK see how it feels. Get bionic hip fitted – recover over winter. Maybe put house on market. Decide UK or France. Move. Or wait, get second bionic hip fitted, recover, put house on market, move. I looked at property in Erice Sicily yesterday.

Our right to remain expires end of March 2026. Probably there is no problem with renewal. Depending on the vagaries of French politics we could be much less welcome. The decision for the second hip is timed for around spring 2026. We too could become unwelcome immigrants.

All this flag waving marching creates fear and uncertainty. Seig heil…

There are a lot of things in the garden that I am going to have to let slip. Maybe in January I might be able to turn my hand to them.

I have a couple more months of increasingly painful / useless right hip on the cards. I need to only stand for an hour or so a day which limits what is possible. I can still do brief DIY painting and cooking and using the strimmer.

We will have a little more info by next Saturday…

So what is the Plan?

~ quantumdreamer ~ Leave a comment

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No specific dreams overnight. I have started painting the end of the room near the log burner. The winter wood situation is now ready and good to go until February. There are a few items left on the checklist.

It seems to me that as I enter my 62nd  year tonight around midnight there is not a lot of change foreseen.

There are a number of medical things upcoming. The wife may / may not stop the lenalidomide maintenance therapy for her multiple myeloma and will soon get back the post breast cancer genetic screening tests. The treatment of myeloma is evolving and the epidemiology complicated by diverse treatment protocols and disease presentation. It seems that the better the initial depth of success with first line treatment the greater the disease free longevity. Studies on stopping lenalidomide maintenance are sparse and of low number participation. Drawing reliable conclusions is tricky. In France they tend to stick to agreed {collective} protocols so we will soon find out if that has changed since the last visit to the haematologist.

It seems to me that a fair proportion of the tests that I have undergone will be let slip “laisser-tomber”. I have a repeat prostate specific antigen test upcoming. Any increase in  number will trigger another MRI and possible biopsy. I need a dental infection all clear before the scheduled hip operation. In the pipeline is a cardio ECG stress test. Assuming all is OK I should sliced and drilled in autumn with round two pencilled in for spring next year. After that I will complete my job application at the Bolshoi. I may start treatment for osteoporosis. The French budget deficit is big maybe they need to spend less on some aspects of healthcare. I will have to do physiotherapy.

We could get a nationalist anti-immigration government which will cast a cloud over our right to stay in Brittany. We could be booted out if they raise the financial threshold for residency.

Being positive we might hope for no recurrence of myeloma symptoms and some enhanced mobility for me for summer ’26. We do need to downsize house. The window of opportunity is before the second hip operation or after it. We have a short visit to blighty booked during which we wish to find out how the UK now feels. From the news here and on UK TV it looks to have gone somewhat down the shitter since we left. We need to see for ourselves. The expectation is that it will be cramped and expensive. The wife managed to grow cavolo nero so we sourced one of the things we missed.  At £4 a coffee for an Americano it could be painful.

Irrespective of the dream content which tends towards the highfalutin, life here will probably carry on much as normal. The lack of mobility will increase over the next few months. The circles I move in are very unlikely to change. I will not be at the fromagerie meeting with big cheeses any time soon. Some people my age are still pursuing high-octane careers and being all stressed out and busy. I have been “retired” for five years and am miles from the greasy pole hamster wheel. It was another world.

Unless anyone is reading the blog in a surreptitious manner, what I type here is read by only a small handful of individuals. If people are snooping and want to get in contact, how might they broach the subject? People do not often think things through.

Of late we have watched a number of Netflix series and in all of these smartphones and social media play a significant part in the plot, the so-called story line. It is another alien world to me. Weird to see text messages as part of a film plot!! We look at a ‘phone on a bigger screen. Seems a bit desperate. And they say Fentanyl is bad.

I guess I have reached the part of life when I have turned into my father, at odds with the current version of modern life. Maybe I’ll start harping after Bing Crosby next. I already think people need to shave and get a haircut…pull their trousers up.

The plan then is to increasingly turn to DIY as the autumn rains arrive. Our pampas grass has just grown fluffy bits, as usual in time for the Atlantic winds to blow in from the wet West. There are some more jobs in the garden but soon the bulk growing will slow.

We have to navigate the medical merry-go-round and that is about all on the dance card so to speak. Aside from the blighty trip it is unlikely we will leave our prefecture.

The plan is not overly complicated…

140 keV Gamma “Ray” Bone Scans…

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My rate of emission of 140 keV photons is now down to lower levels, five radioactive half lives after injection. The concentration has been reduced by biological elution and the radioactivity by decay. It was interesting to read how few suppliers there were for 99mTc. Yesterday, she only injected a few millilitres of tracer.

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I have been reading up and watching videos on the interpretation of bone scans, I can probably note metastatic lesions, depletion in tracer localisation due to prothesis, fractures (old and new), areas of bone formation and depletion. It might be interesting to see what my damaged cervical spine looks like and if my “broken” ribs from rugby can be seen.  Osteophytes are evident on my thoracic spine and near my Titanium pin. The Diffuse Idiopathic Skeletal hyperostosis (DISH) is probably still growing and could localise tracer. {I had a full body scan.} This, if seen, can be cross referenced with an upcoming CT scan.

There could be plenty in my scans for a nuclear medicine professional to discuss with her younger colleagues.

I meet some of the diagnostic criteria for polycythaemia (probably secondary). If it is the malignant form this may interfere with bone cycling in the marrow and could appear in the scintigraphy. There are a few suggestions in the literature to use nuclear medicine to detect this. But it is not common practice.

I guess the single-photon emission computed tomographic (SPECT) images might show something like this below. My hip arthritis is much worse than in the X-ray or CT images below. It does not look like a whole lot of extra knowledge comes from the SPECT data for the hip.

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Dunn’s view of (A) right and (B) left hips of a 48-year-old male patient presenting with left hip pain only. Single-photon emission computed tomographic images shown in (C) anterior and (D) posterior coronal views display more uptake (black arrow) along the superolateral aspect of the acetabular roof on the symptomatic left hip compared with the asymptomatic right hip (white arrow).

Clin Orthop Relat Res. 2008 Dec 17;467(3):676–681

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What might however be interesting is what tips up in the rest of the body scan. The pain in my lower and mid lumbar spine has been explained in different ways by different doctors.  There might be clues as to what is going on.

I guess what I do not want to see is evidence for primary bone cancer or metastatic disease. The main diagnostic differentiation of the latter is a disordered or “random” appearance of tracer localisation. Metastatic disease is incurable and often terminal.

I have joked that I could re-train as a radiographer or a nuclear medicine operator. But you know what they say about old dogs.

It is weird, I feel very up in the air, with little or no idea if/when I will get to see the data. Something which could change the direction of life is hanging ill-defined in the aether. I am in a kind of limbo.

I wonder if people who prescribe scans have ever had to wait and hang like this…

Maybe it should be a compulsory part of training…

Bioethics, Genetic Testing and Notification

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This morning, just for a change, we went to another hospital for a genetics follow up to the wife’s breast cancer. In France they are very keen on prophylactic measures and like to test things in a lab wherever possible. The wife’s blood is going to be screened for genetic predisposition to breast and ovarian cancer. The results will have implications for her and her siblings, including the men. In French law the geneticist or the wife herself MUST inform her brother if the tests suggest that he too might have a predisposition for cancer. This true for if he lived in France not sure if it extends legally to the UK. The form letter on the government site, for the geneticist to fill in, does not really hide the identity of the provider of genetic material very well. Today she advised against sending this. It was better to pass on the tidings of joy personally.

« Décret n° 2013-527 du 20 juin 2013 relatif aux conditions de mise en œuvre de l’information de la parentèle dans le cadre d’un examen des caractéristiques génétiques à finalité médicale.

Notice : la loi no 2011-814 du 7 juillet 2011 relative à la bioéthique a modifié le dispositif d’information de la parentèle dans le cadre d’un examen des caractéristiques génétiques introduit par la loi no 2004-800 du 6 août 2004 relative à la bioéthique. La personne concernée est informée, avant la réalisation de l’examen de ses caractéristiques génétiques, de l’obligation qui pèse sur elle, au cas où une anomalie génétique grave serait diagnostiquée, d’informer les membres de sa famille potentiellement concernés dès lors que des mesures de prévention ou de soins peuvent leur être proposées. »

The gastroenterologist following my colon cancer has been very pushy about me notifying blood relatives because there is some genetic component to colon cancer.

I have already tested for HBA B27 which was negative therefore there are no requirements for notification. There are no possible interventions foreseen.

I am considering HFE and JAK poly screening, the latter of which costs ~€1500. The HFE if positive would indicate hereditary Haemochromatosis which can have interventions. The JAK poly screening for predisposition to malignancies, would if positive, require notification. There would under law be an obligation to inform.

This explains why the GP isn’t overly keen. There is a possible can of worms attached.

The documentation for the test today has inherent in it an authorisation to share genetic test results with relatives if relevant to their healthcare.

Given the price of the test, I am likely to need a specialist to write the JAK screening prescription. They may well want a “who do you think you are” family tree.

You learn something every day…and given the French love of protocol this is non-negotiable.

There are often implications we do not consider…and only find subsequently.

Once you have had test results you cannot un-have them or un-see them…

Hmnn…

Away From the Highfalutin

~ quantumdreamer ~ Leave a comment

Irrespective of anything fancy, life goes on much as normal here. Yesterday I went to see the arse doctor and today we went to see the boob doctor. I was being followed up for post operative colon cancer and the wife for post-op breast cancer. In July I have an appointment for a colonoscopy and in August one for the higher PSA level and a prostate follow up.

I was thinking of a tune but I could not quite put a finger on it so to speak

“Bum-titty-bum-bum…”

Once I have seen the chimney sweep, and after my joyous interaction with industrial grade laxative, if all is well and supercalifragilisticexpialidocious, there is no more programmed chimney sweeping for five years.

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My next GP appointment is, barring any health change, due in October. I have a rheumatology appointment next week, which should provide some clarity. The issue of two {three} major operations on my hips will be on hold over the summer.

We view a house for sale later this week which will make the downsizing real. A brief visit to Jersey will advise if we can hack being surrounded by anglophones.

At the moment aside from the wife, I speak briefly with the guy who cuts the grass every few weeks, 4-6 times per year with the GP and with the physiotherapist every three weeks or so. That is the full extent of my external “social” interaction. I speak with nobody on the ‘phone or internet and am not in any email dialogue. People might find that extent of social interaction difficult to believe. But it is true.

It is possible that we may downsize this year. The tax return has been sent off.

Shortly I have 75kg of dry bentonite in the garage. The pond has a slow leak and I am going to attempt to plug that a little with clay. Then before we have any drought warning I will refill the pond from the river.

The contrast between the day to day life and what happens in the dreaming is marked.

My “diabetic” socks from China have just arrived without any tariff notice or to pay.

There are two decisions pending patent and blog…what to do…

Life goes on pretty much as normal…nothing fancy…