February is meant to be the shortest month of the year. But when you are in a sort of limbo brought on by inconclusive blood test results, it seems to drag on into 32, 33, maybe even 34 days. So you start to over-analyse stuff. For example, I just looked at what I wrote in the previous chapter about the side effects of Prostap, and noticed, for the first time, that it includes “joint pain”.
Those of you who read the “Interlude: let’s go to A&E for a change” chapter of my blog will recall that I twisted my knee playing football. Two months on, and after seeing sufficient healing to strap the old joint up and have three really very gentle work-outs on it, we are back not just to square one, but all the way back to square minus quite a few. I know I’m not as young as I was, but I’d have thought a tweaked anterior cruciate ligament, or possibly a tweaked medial collateral ligament, or possibly both (this being the best diagnosis that Dr. Wikipedia, the well-known knee consultant, could manage), would have sorted itself out after all that time.
So that’s two things I’m blaming on Prostap now: liver function and knee pain. The problem with the knee pain is that it is inhibiting my physical activity, and if I’m going to keep my body at some sort of half-decent level of fitness I need to be active. By the 14th of February there was no anonymous card through the post, never mind any news about any planned chemotherapy, and I was acutely aware that if chemo was going to be the next phase of treatment, by now I wasn’t as fit as I’d like to have been.
The reason for that worry, and for the month dragging so slowly, was Newton’s third law of motion: for every action, there is an equal and opposite reaction. As a schoolboy in Physics classes I liked to think that he discovered it just after he discovered gravity. I imagined that old Issac casually tossed the apple to Mrs Newton and said “Prithee wife, goeth forth and baketh unto us a pie.” At which point she threw it forcibly back at him and told him to goeth forth and baketh it where the sun don’t shine. And there you go, suddenly he realised that for every action…
Anyway, my slowly reducing PSA was, in my mind, dependent on the residual effectiveness of the course of (radical) radiotherapy. I know the oncologist says that the hormone injections and the suppressed testosterone are reducing it as well, but you can’t really “see” that. And the final session of (radical) radiotherapy was already three months in the past, so effectiveness was inevitably diminishing. That meant that its impact on the PSA must be diminishing. But I needed the PSA to keep dropping so that I could avoid (equally radical?) chemotherapy. And the reason that February had started to go so slowly was that my indicator of the radiotherapy’s effects was beginning to diminish (at last), and by now I was beginning to see less evidence of its watery effects in my bowel.
So to my problem with Newton’s third law of motion: for every action (less bowel irritation), there is an equal and opposite reaction (less PSA reduction). This may actually be total rubbish, but it seemed a logical outcome to me at the time. Applying Newton’s third law of motion to my own motions meant that I was worried that my PSA wasn’t going to be anywhere near where both the consultant/doctor and I wanted it to be by the time I saw her again on 11th March.
My little bits of anxiety weren’t helped by the postal system operated by the hospital. I received a letter on the 6th February confirming my appointment on 11th March, then on the following day there was another letter from them. I didn’t open it immediately, wondering what news it contained. Your first chemotherapy session is on…? Eventually I bit the bullet and opened it. It was confirmation of the cancellation of the oncology appointment I’d originally had booked for 25th February, and which had been replaced by the 11th March one. I knew that already.
So there I was, back to the limbo of the longest February ever. Then I very nearly ran out of Tamsulosin. That’s the drug that keeps Edmund Slackbladder under a bit of control. I ended up having to go to the pharmacy three times before the repeat prescription was there in full; on the second of those visits the pharmacist gave me three days’ worth to tide me over. By the third visit of course I was a regular, and highly valued, customer, so I took the opportunity to have a short consultation with the pharmacist about my knee pain.
She listened to my theory about the Prostap inhibiting the healing, but then pointed out that a side effect of “joint pain” didn’t mean just one joint. No, it would be all of your joints. To be honest, being older than I used to be, quite a few of my joints remind me of their existence through the medium of pain some days, but I got what she was saying. The knee pain was probably football’s fault, not the Prostap’s fault. She suggested that I modify my treatment regime, and alternately rub/spray hot and cold creams or aerosols to it. Oddly even after less than 24 hours of this, I felt some slight improvement.
But sadly although it offered some relief, that didn’t provide a cure for the knee problem. As I was still enduring medically induced frustration throughout February, I decided to do an online GP consultation. That took me only so far before it threw me out and told me to go to A&E. Go directly to A&E, do not pass GP, do not collect a prescription. So I hobbled off to the Walk-In Centre and they very quickly told me that as it was an old injury I should see my GP. That’s the modern world as it should be, everything gets recycled, including our medical needs.
A telephone consultation with a GP ended up with him providing me with a voucher for an x-ray, which I collected and handed in on Friday 21st February. The radiographer said that the results would be through in five working days, at which point I should contact my GP for the result. Being sneaky, I asked the receptionist at the Health Centre on the 26th (immediately after I had been in and had my next sweaty Prostap injection), and she said that it was already on the system and there was a note saying there was no obvious damage. That would be no damage to the bones. It must be a soft tissue injury then. But I already knew that.
The surgery (sorry, they are officially known as a “Medical Group” nowadays) was closed for a half-day for training, so I had to wait until the next day to see what would happen next. Eventually I got another telephone consultation with another GP, and she told me to carry on rubbing/spraying whatever I found most effective, drop a few paracetamol as well if it helps, and in a couple of weeks I’ll have an appointment to be seen by a physiotherapist. Another couple of weeks of no progress then. For all I knew, I could be on chemotherapy by then.
Well, what a shock awaited me the following Monday morning, the 4th March. A letter from the Physiotherapy team invited me to ring them to book an appointment, an invitation that I promptly took up. They offered me a choice of venues, both acceptable. They had some spaces available in late May. That seems to be just a teensy little bit more than the fortnight away I had been expecting. No thanks. I figured that if the injury is bad enough to need physiotherapy treatment in late May, nearly three months away, then it probably needs treatment NOW, and I declined their offer.
So I went back to the GP Medical Group, and was eventually told that the only people who could refer me to a MRI or similar scan were the physiotherapists. Or I could go private, which would probably cost me about £1000 by the time I’d paid for the consultation, the MRI scan, and then the course of physiotherapy treatment; assuming it doesn’t need surgery. Or I could ask my oncologist to try to swing me a scan…
Anyway, our walking football team being part of the “In The Community” side of a professional football club does have some benefits. After I’d grumbled and moaned as I refereed another training session, Shaun the Community Manager, clearly fed up with my refereeing, spoke to the club physio. Almost magically he arranged for me to see him the very next day after the first team training session. At last someone was going to have a look at it, and it was someone with vast experience of treating this sort of injury. Now that the longest February in history was over, perhaps things had already started to come together a bit more serendipitously.
The session with the club physio went brilliantly. He had two third-year University Sports Science students there to be given some experience, and boy did the one called Tom get some experience out of me. The club physio has probably seen more knee injuries on footballers than anyone else within fifty miles of where I live, and is a renowned expert in the field. It turned out that I had returned from Swindon three months earlier with a Grade 2 Medial Collateral Ligament (MCL) injury – a partially torn knee ligament. I was kind of pleased with myself that that had been one of the conditions I had guessed at before.
So after being shown how to perform the massage technique, Tom and Cathy had a go at shifting the fluid off my knee and getting it up to the groin where the inguinal lymph glands are just hanging about waiting to drain off toxins. Apparently the technical term for this fluid on footballers’ MCLs is “shit”, as in “you need to push the shit up into the lymph glands”.
Then the physio told Tom to check for adhesions, which I believe are a sort of compensation injury caused by limping as the muscles overwork in one place to try to make up for the injury elsewhere. And Tom found a couple of them exactly where the physio said they’d be. Then of course, these adhesions needed breaking down. And that hurt. A lot. Some of this paragraph may be inaccurate, as I couldn’t hear what people were saying above my screams of agony. I know Cathy kept telling me to breathe, which was pointless advice, as how else was I able to scream the foul-mouthed tirade that the breaking down of adhesions brought on if I wasn’t breathing?
Anyway, suddenly March was moving far more successfully than February had (eventually) managed, and after just a couple of days I felt better about my knee, while still being very much acutely aware that it needed looking after. It should be healed in about six weeks as long as I maintain the regime and don’t do anything silly.
As if to prove that March was a turning point, I had a blood test on the 7th. I got to the hospital at ten past eight in the morning, walked into phlebotomy, pulled ticket number 4 out of the dispenser, looked at the counter on the wall, and saw that it was showing number 4. And number four wasn’t “next”, but was actually “now”. I didn’t even get to sit down. The phlebotomist got stuck in to the back of my hand immediately, and before I knew it I was on my way. Note to self: I must get a lottery ticket this week.
So to the appointed day, March 11th. We got there a little early, so went and had a cuppa and a sandwich for a late lunch. Then we went to reception to book in in good time, and as always they gave me a random computer-generated 3-character code. When this code beeps up on a screen it means that it’s time to go to the sub-waiting area. Codes that I’ve had in the past include a XCN, a GTZ, and a BNQ. This time, much to most people’s amusement, they gave me a FCK. I was going to say “nice to know that occasionally they do give one”, but that wouldn’t be fair.
So once the FCK came up, off to the sub-wait area where I was weighed and blood pressured. Both were a little high. After the drag of the longest February ever, where I was relatively inactive and wishing the days away, I had of course been eating a bit more than usual, and all of my good intentions of losing weight had gone up in smoke. This new reading of 92.5kg meant that the 2.1kg I’d lost when I was last weighed had more than been made up for. The blood pressure wasn’t good at 159/90, but they didn’t seem worried about it.
So to the regular Stampede Trial questionnaire. Written at the top, along with my anonymised details, was the time frame, showing that this was week 36 since I signed up for the research programme; it seems like longer. It started with a lot of questions about recent activity and sleep, so I scored myself quite low on those, and made notes alongside the tick boxes about the knee injury. Before I could finish the questions, I was summoned to see the Oncologist.
She started with some general questions about how I’d been lately, so of course I gave her the saga of my knee, trying to impress her with my newly-acquired “grade 2 MCL” jargon. She seemed genuinely shocked and concerned at the waiting time the GP had offered me before treatment. Next she asked about the sweats, and I explained that they seem to be wetter than they used to be, but shorter in duration. The acupuncture is ongoing, designed to help with both the sweats and overall energy levels.
I also told her that my bowels were still a bit leaky, just a kind of clear mucus, and that my “proper” bowel movements were quite normal. She used the phrase “proctitis inflammation” which she linked to the radiotherapy, so I was left thinking that maybe Newton’s third law of motion wasn’t quite as rigid in biology as it appears to be in physics. But I dropped out of biology at school, so I wouldn’t know!
As you can imagine once I got home, Dr. Wikipedia came out to play on “proctitis inflammation”. What I found was quite reassuring. “Proctitis caused by radiation therapy. … If you have mild symptoms, such as occasional bleeding or tenesmus, your proctitis may heal without treatment.” Well, I don’t have any bleeding, and once Doc Wiki had explained tenesmus to me (look it up), I established that I don’t have that either. And as both of those symptoms are “mild”, what I have must be “less than mild” symptoms, whatever that would be: “bland symptoms”, I suppose.
Then we got down to the nitty gritty, and she told me that my PSA was down again, this time from 3.0 to 1.8. Still going in the right direction. Although I was happy to hear the “one point” bit of the number, I was disappointed that it was still only just below two, and my immediate resignation to expecting the chemotherapy referral led me to say that it wasn’t as low as both of us would like. But she was more positive than that. She said that she had spoken with colleagues (again) about my case, and that as long as the PSA was continuing to drop there was no evidence that chemotherapy would be needed. Although I wasn’t meeting the statistical norms that the published research showed, I was showing improvement. I repeated my previous comment that all statistical populations have outliers, so I guess I must be one.
What this meant was that there was no plan to enrol me on a course of chemotherapy. She will monitor my PSA, testosterone etc., and only if the PSA rises will she refer me for anything else. First she would want another PET/CT scan to see if there was any sign of cancer outside the prostate, as well as the level of activity within it. The option of chemotherapy remains available at a later date if needed. Meanwhile she wanted to see me again just before my next Prostap jab, which is scheduled for 21st May. So we agreed on 20th May, and she gave me a bloods form for a fasting test to be done shortly before that date.
I came away feeling extremely relieved. Of course I don’t want chemotherapy. Who would? But I had genuinely been expecting it, and was prepared to say not just “yes”, but also “how soon can we start?” if she had told me that it needed doing. So far then, the month of March, compared to February, is going so much better.
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