Tag: cancer

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…

Cancer Diagnoses – Dead People – Seeing – David Bowie Dream 29-04-2025

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Here is this morning’s dream.

The flavour of this dream in entirely UK and specifically England. I am in a small featureless room with D whom I used to know. He is taciturn and concerned. There is a heavy leaden vibe. I know that in the last few days he has received an advanced cancer diagnosis and he has yet come to terms with it. It is in a sense tearing him up and bringing up inner conflicts long avoided. We are in his parents’ house. I leave the room and go for a loud and long “dad piss” in the toilet next door. On the way out I bump into D’s long dead father. He tells me that D is in in denial and would like to express himself but is having trouble pissing, metaphorically speaking.

I go back into the room and already I can see that a part of D is in the in-between and that his time before passing over is not all that long. I say to him in the dream that I am not surprised to see him there given what has occurred in dreaming recently. I know that his Soul is being subjugated by his stubborn personality. There is a part of him which seeks to speak to me and it is not his personality. The inner conflict is making him grey and dank. There is nothing I can do. I know that post death I will get a visit. By then it will be late.

The scene changes to some kind of work’s social event. I am talking with two early middle aged English women, who are expensively dressed. One has a grey bob and the other has longer dyed orange hair. They are both “crystal feeler” new age types and speak posh and clipped. There is some kind of new age book launch going on. The woman with the longer hair asks me if I can “see”. I say to her that I certainly could in the past but that I have not done this for a long time because it tends to freak out any person being seen. They are both excited.

The grey bob asks me if I could “see” her. I warn her that if I Iook she may not like what I see and that she might not like the experience. Intrigued she asks me to go ahead. I stand close to her around one foot away and look into her eyes and more diffusely with unfocused eyes. I see first her form and then her thoughts. Beyond that I can see her Soul. I say to her that she finds me attractive. She comments that such a comment is no big deal nor seeing. I can tell that she is sexually aroused and defiant, refusing to believe that she is being seen. I ask her if she would like a tissue to wipe the moisture from her vulva which I know she has emitted. She turns bright red and moves away aware that she has been fully transparent to me. I know that it is this sensation of transparency which makes people anxious and antagonistic.

The scene changes and we are upstairs in a plush London hotel not too far away from Covent Garden. There is some kind of training or healing event going on with facilitators and a finger buffet. The guests are all very well-heeled except me. There are a few Richmond type women who have “beautiful” homes. There is one woman in peach who is talking to the facilitator stood up in plenary. She says that she is fearful because she has just had a cancer diagnosis and does not know what to do with the rest of her life. I walk over to her and hug her in my arms. She starts to cry.

Later an older woman is talking to the facilitator. She too has a recent diagnosis. I hug her also. She is the mother of the younger woman. In contrast she has accepted her fate and is worried that her daughter is not being real. She asks me how come I am calm. I explain that in our house we have a lot of experience of cancer diagnoses. She asks me if I can help her daughter.

The next to speak is David Bowie. He is taller than in “real” life and dressed in an immaculate pastel blue suit with bleach dyed blond hair. He looks as he did forty plus year ago. He too is diagnosed and I similarly hug him. He towers over me. We both know he is dead. It is our shared joke. I suggest that we all go to a nightclub to dance. Everyone thinks this is a good idea.

Bowie and I are in a bright red low long American style convertible with white walled tyres. He is driving the right hand drive car. The cream leather upholstery is immaculate. He does a handbrake turn into a parking spot on a cobbled square. We get out and head toward the night club. Outside on the pavement are many Bowie statutes representing his various on-stage incarnations. He is very laconic and holds back.

The others all go into the night club. I then marshal them back out onto the square where Bowie is doing a medley of his hits. We start to conga with Bowie at the head and the daughter from before behind him. Behind her the mother and then me. The bouncers from the night club join in. The sense is of a warm summer dawn around 5 AM.

The dream ends.

A Four Cancer Couple – No News Yet

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The probability of two people, a couple, being diagnosed and treated for four cancers {two each} by the age of sixty and currently still alive is not high. Especially given one of those cancers is a rare incurable one. So, when I say that we are more experienced with cancer than average, I am not lying nor bragging. It is possible that we might add a fifth cancer to the list soon. There is no news yet on the lung CT scans. As a precaution I have entered the Euromillions draw for tonight.

I do not want a full house or a royal flush.

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I can generally stave off conclusion longer than most and am not overly prone to catastrophising. Being in a vacuum is not entirely to my liking. I can wait until a week Friday when we have a scheduled GP appointment. One of my “coping” mechanisms is investigation and learning. I read around the subject as preparation and will go to the length consistent with my academic background in a prior incarnation {this life}. One can add two and two and come up with three, but I have not. I am as ever curious. I have learned a fair bit, enough to worry a doctor.

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In the social security office today, the woman asked me if I had a smartphone. I said yes but that I do not use it. I said that I was a little Jurassic. She suggested downloading an “application”, whatever one of those is, to apply for a new social security card. I have found a new Crusade. That is to demand ways of doing things which do not use satanic smartphones or demonic applications. That way I will not be subject to Trumpian tariffs on semiconductors.

I have been thinking about getting a dumb-phone as a protest.

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The French administration system even frustrates the French. They could save shit loads of money and significantly reduce the budget deficit by getting doggy-boy Musk to slash and burn. However, the unemployment levels would soar. The national mental heath and blood pressure levels would ameliorate.

I / we are in a bit of a limbo, which is an odd state for spring.

I speculated that this year would be a minus nine, lack of completion, year. The various wars are no where near resolution and will drag on for months despite the show-boating efforts of the orange very stable genius.

Our limbo is a comfortable one. So far there are no cluster bombs falling on Brittany.

There is food and water and heating.

Thanks to the four cancer status our pharmacy is well stocked.

Hmnn…

A New Phase?

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My previous passport was set to expire in March 2015 so I applied for a new one in September 2014. The following year I joined the big C club and was operated on 2nd July at full moon. The cancer was diagnosed pT3N0M0 with around 40 clear lymph nodes. They caught it just in time as at T3 it had broken through the colon wall. That passport kicked off a new phase of my life. I had colon cancer and bought myself T-shirts with a large semicolon on. I no longer had a full colon. I did not get any chemotherapy. I was now very expensive to insure in terms of life cover. Key man insurance was in the 50 grand sterling range. I did not want to continue tutoring high school science.

I have just applied for a new passport. The passport office have told me that it is printed and on its way. A passport is an identity document. My identity has been renewed. I hope this one is not a harbinger of doom. We have seen too many hospitals these last few years.

I have had a feeling these last few weeks that I am waiting for something and that something new is on its way.

Suddenly two things went our way. I caught the stray Tom and he is back now neutered looking at me through the window to see if there are any more bits of food. The vet thinks he may have feline FIV. And the volet company can fix our volets before Christmas!!

I am a bit sad in that my new passport will not be an EU one…

It is a full moon today…

Hmnn

Travelling With a 511 keV Gamma Emitter Tomorrow

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We are a four cancer household of two. I have had stage 3 colon cancer and a couple of basal cell carcinomas. The wife has recently had a lumpectomy for breast cancer, stage 1, followed by 15 sessions of radiotherapy. Tomorrow, she has a Positron Emission Tomography {PET} scan to check on the state of play with her multiple myeloma, it will be an 18F – FDG PET scan. The [18F] fluorodeoxyglucose shows sites of hypermetabolism associated with regular cancer or myeloma. It decays by positron emission, an up quark changes to a down quark.

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The annihilation of the emitted positron causes two ~511 keV gamma “rays” emitted at exactly 180 degrees to each other to conserve momentum. The half-life of 18F is around 110 minutes. The drive back from the centre of nuclear medicine is half an hour, we have a smallish Peugeot 207 and it takes place at less than one half life after injection.

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According to what I have read in the scarce literature, this car journey gives me an exposure of ~0.4% of the annual average exposure to radiation.

Perhaps there is a need for more research on what happens when a patient leaves the nuclear medicine centre? There are health and safety assessments for the healthcare practitioners, what about the carers? This is the third journey like this for me. There will be more.

We have an appointment with the radio-oncology specialist and the haematologist week beginning 2nd December.  We will know a little more about what our immediate future holds by the end of that week….

The Waking Dream

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On the 7th of July I had a passive nocturnal dream in which an unknown cat cuddled up to my thigh. On the 8th of July a new stray cat appeared through the fence and he has been with us on and off since. I have named him Gandalf because he is grey and white. {Viz Lord of the Rings}

We have posted news of his arrival to various pet lost and found channels.

A while back a woman from a local hamlet knocked on our door asking if we had seen her cat. The local knowledge says that all stray cats end up here. We have had quite a few. The local knowledge is good.

Another uncanny dream prediction has pointed at something unexpected which thematically may be true. I could realistically accidentally bump into the person in question now. It has gone from highly improbable to possible. I will be in the ‘hood tomorrow at a nodal place, a hospital, where people often meet. I will be only 17km away from where they live.

Our local internet and phone provider had an incident around easter and for two months we had no ‘phone signal nor internet. Neither did we have any external appointments, we were cut off from the world, more than usual.

I saw this as a sign to look into our/my connections. We changed internet and ‘phone provider, I reached out to the world via LinkedIn and this blog. It has been very interesting for me who has accepted my invitations and who has visited my profile following on from me visiting theirs. Take up is not good.

Let’s say there has not been a rush to connect with me in public. My leper’s bell seems to be working, though not all hear its dulcet tones.

Maybe the universe, the dream, is telling me to do another disappearing act?

The “connections” theme was perhaps a red herring.

We have one chronic problem that sooner or later needs to be solved. I have osteoarthritis in my hips and lower back. It is there in my cervical spine. I have disc herniation which causes symptoms c5c6 and c7 in my left and right fingers. The nerves are impinged upon.

It is unwise for me to do heavy labour; we have 0.8 hectare of garden.

One solution to the problem is for me to get an income stream of around 500-1000€ a month. I could then pay someone to do the heavy work.

We are on a very tight budget and live well below minimum wage levels of income.

It is not a big ask, a few hundred euros a month, but that would suffice.

The idea of scientific English editing looks to be a no-go. The market is crowded and the price per word low. The work is perhaps drying up due to AI.

The purpose behind the LinkedIn account was to try to get this off the ground.

The alternative is to downsize houses.

It costs roughly 50 grand in fees to move house here. The housing market is severely constipated.

Having an offer made on this house would be a real problem because they are not used to chain sales and they have some quaint customs about signing. There is little we would like to move into, especially at that level of cost.

Move somewhere you don’t like and spend 50 grand….does not sound ideal or appetizing.

I have had numerous dreams pointing at doorways, gates and the deep unknown. So far not a lot has materialised.

We are in the time of year where the crop ripens and heads towards harvest later in summer or early autumn. Whatever it is I have sown, I will reap.

The firewood store is full. I have just power washed the propane tank, if we get it filled, we are good until end of January 2025.

The wife had a breast lump biopsy taken and sent off on Friday. I am due an MRI scan of my prostate tomorrow morning, because my Prostate Specific Antigen {PSA} test was elevated.

If there are any lesions in the prostate I will have a prostate biopsy on my dance card in the near future.

A further episode of medical-merry-go-round might be incoming. This could be bilateral.

The USA is now further destabilized. Adamant hot heads and automatic weapons are not a good mix.

How did an “advanced” country get to a geriatric presidency race?

I could finish my work up of dreams and then repurpose this blog.

I could leave social media.

To try to write another hobby-vanity patent would cost around £500 to get to the stage of grant. I have proved I can do it once; not sure I need to do it again.

There is no real incentive.

Things could change PDQ over the next few weeks or they will stay roughly the same.

We shall see…