Sunday 27 December 2015

A Favourite Time of the Year


Dr. Hugh Tildesley

Merry Christmas and Happy New Year. This posting will be brief. Insomniacs consult the CPS for hypnotic of choice, reading my blog will be too brief to induce deep REM sleep…. sorry.

Status Update: Status quo, weight, appetite, blood count stable. Each meeting with poisons evokes subtle differences. This time the 5FU effect on digestion was more prolonged, thankfully, self-limited. December has been a busy month and I have had to manage rest more diligently, we are now almost backing to normal.

My next blood test is the first week of January, followed by poisons, then another CT; all on consecutive days. I will apply for a monthly parking pass!

Obama has a Port?
Through shaking elbows and avoiding coughers so far I have avoided any illness, a blessing.

I have to admit defeat; attacks on my port continue to be random, from unexpected sources and without warning. Is ISL behind them? I now just defend, as my risk evaluation for these attacks is useless. I just pretend I am an American, swearing allegiance with my palm over my port. (Wrong side I know, I know).



Before
Social: The out of town off spring landed Dec 21 for the tree decorations. Catherine on time from Edmonton, poor Hamish stuck on the tarmac at LAX for over 2 hours as they changed a tire. Flight north was into head winds and his landing had to be aborted! Thank God his AA pilot saw a plane on his runway, Hamish described G forces as the plane assumed a 45-degree pitch. The only decoration left for him was the Angel, in his case very poignant.
The process,missing Hamish




Angel and All

The next day was our annual open house. A gathering of friends, a wonderful time to catch up, my favourite fete of the year, made all the better with my brother in law Ted flying in. Theresa, initially a nanny for the kids, now part of the family also flew in for the party and Christmas. She and the kids did double duty as hosts as well as helping with the logistics of getting rentals to and fro, and just kept the food coming.



The gifts of wine and tequila were over the top; I won’t be shopping for libation in the near future.







 Drew Thompson has been a friend since Edmonton days, he is a renaissance man who is constantly learning. Cooking is just one of his passions, this tortiere tasted as good as it looks!


Tortiere Extraordinaire

From the left,Hamish,Ginn barely visible,Donovan,me,Deborah,Teresa,Catherine on Christmas eve




The traditions always joyous, Christmas eve service followed by good cheer and good company.

 







 Tesla Titillations: 
 In preparation for our open house Deborah and I needed to transport rentals. The suburban had been sitting and although started a few weeks ago, this time the battery was dead. I had forgotten about the issues with gas vehicles. The other car was on errands; all that was left was the Tesla. I of course called BCAA, problem solved, my daily schedule now dealing with a negative delta of 1.25 hours.

This led me to further research if I could jump the Suburban from the Tesla, answer not recommended. Believe it or not the Tesla does have a 12 volt battery under the nose cone, removing the nose cone can be done by sequential pushing until it pops or using a stiff credit card to get a finger hold so it can be pulled off. Once off, the red and black terminals are clearly visible. As mentioned jumping an Internal Combustion Engine (ICE), is not recommended. What you can do his hook up battery to battery and hopefully recharge enough to get the ICE to turn over, (let charge for at least 15 mines) remembering to disconnect from the Tesla, otherwise you may corrupt your internal computer operations!

Wearing the Gear
Believe it or not you sometimes need to jump a Tesla, same preparations to connect the cables, but do not start the ICE, battery to battery should suffice. Once the Tesla is operational, immediately get in touch with Tesla’s 24-hour service for further instructions.
I have driven over 4,000 KM in the last 5 months about twice the distance I usually drive (the Portland trip is the reason); there have been no issues whatsoever.

The touch screen is problematic if wearing gloves the touch screen does not respond, unless of course wearing gear which transmits heat from the index finger as the Tesla gloves I am modelling do. the hat is for those owners who are bald naturally or on chemo.

The Arts Report: Concussion
A family tradition is the Boxing Day movie, this year it was Concussion. Will Smith is exceptional, maybe an Academy nominee but not a winner. The story is well known, the first part of the movie highly effective, and then the writing loses focus and in the end they do not go for the NFL’s jugular (and by the way the NHL, college football, junior hockey, boxing, ultimate fighting etc. are equally culpable). For those who have not followed this story it is compelling and I am so glad my kids were swimmers, soccer players and field hockey players, and that I was never concussed.



Open Heart Open Mind, Clara Hughes

Although I am only ½ way through this book it is powerful. She is frank, and her story is powerful. She mentions her considerable athletic accomplishments almost in passing, focusing on her family, interpersonal and emotional issues. Having been to numerous Olympic, and Paralympic trials I have seen other iterations of her all controlling coach, and athlete dependency on some highly dysfunctional people in positions of power. I highly recommend this book.




 Happy New Year, may 2016 bring you happiness, and good health.

Until next time…..

Sunday 20 December 2015

Made it to Christmas: Major Goal


Dr. Hugh Tildesley
Status Update: Status quo, weight, appetite, blood count stable. This week’s tumour marker consistent with other values, no significant change. Another infusion of the poisons completed on Monday, each session is unique, no untoward effects, the usual “ High” with dexamethasone thus I store up a bunch of tasks to complete the first 24 hours after therapy.

I just finished a 4.5 km walk with Deborah and Ginn in 1 hr. 25 mins, energy level is about 90-95%.
 
I have not worn support stockings for 10 days and I think my feet are adapting. The residual swelling from my blood clots in the spring is almost completely resolved; there is no impediment for walking at a normal pace

I must be careful this time of the year, crowded spaces, with easy spread of infection, so I pick my spots. I also have to say no to some invitations to manage my rest, this can be challenging.


Tesla Titillations: Still no snow so no report yet on the car’s performance. Predictably battery consumption is temperature dependent but no real surprises.

BC Hydro bill came this week, compared to last year I am up 5kW.h. Some variables not stated on the bill such as ambient temperatures etc. It is fair to say this year was warmer thus power consumption for the house is down.

 

The Arts Report: Two Poles, by Terry Fallis.A fun read, totally entertaining and a nice escape.You will also note it is blog based.




Rantage: The long awaited report from Mr Plecas was released regarding Children’s Services in BC.Twenty years ago this man was the senior bureaucrat who laid the foundation for the current service model within this ministry. His report has the gall to criticize the Childrens’ advocate Mary Ellen Turpel-Lafont, claiming her oversight is over zealous and the position should be fazed out.

One question? If she was not calling the social workers to task who would be?

The native leaders lined up in support of her as she was attacked by Plecas. But hold on! The majority of children in care are aboriginal ( 60%), extreme over representation based on population. These same leaders attacked Turpel-Lafont 2 years ago when she could find little trace that federal money to be directed by the bands to child welfare was actually being done.

When Mr. Plecas was chosen to do his review those of us with memories of over 20 years knew full well there was an unavoidable conflict of interest. His bias has shown through as bright as the star of David.

The native stance shows a new found mainstream  political sophistication, hypocrisy.

The tragedy; the child victims.


Some local photos to calm the spirits:

Cranes next to RBC on Dunbar







Until next time……..

Saturday 12 December 2015

More on the Glucose/Cancer Hypothesis




Dr. Hugh Tildesley
Status Update: Status quo, weight, appetite, blood count stable. Still await this week’s tumour marker. Another infusion of the poisons on Monday, it is frightening that I am getting used to this.

A positive meeting with Dr. Renouf, for the first time he told me not to worry about the tumour marker unless there is a large a quick upward trend. This is helpful information and reflects how long I have been on the treatment. Early on I am sure he was worried he would see a steady if not quick rise. This not being the case, I think the marker is a reflection of tumour activity and tumour mass. A downward trend is therefore where we want to go.

Skip this part if you are intimidated by bio-talk.

He also has discussed the glucose hypothesis regarding glucose levels and tumour growth. Interestingly a recent paper in Science( December 11, 2015) in part summarizes the theory we are writing up, and  importantly links the KRAS mutation (which most pancreatic patients have), with activation of the GLUT 1 transporter which facilitates glucose uptake, the hooker being that the usual on/off mechanisms are not operational therefore to “starve” the cell requires inhibiting the intracellular use of glucose. I previously have mentioned 3-Bromopyruvate as 1 agent; further research suggests some technical issues getting the compound to the tumour. (Please see post # 20 “Is Science 100 years old Important?”)

The paper focuses on how oxidized Vitamin C is transported into the cell, via GLUT 1, intracellularly it is reduced to Vitamin C, which is toxic and leads to metabolic disruption and ultimately cell death. Bottom line is that we are now discussing metabolic inhibitors rather than cellular poisons. The study in the journal Science was in mice, but provides a mechanism of action. Phase 1 and 2 studies are now underway (early clinical studies in humans)

Those in my age group will remember Linus Pauling and his claims late in his career about Vitamin C and it’s cancer-healing effects. The studies were done with oral vitamin C; this was before the recognition of cancer markers such as KRAS. It will likely turn out his intuition was right but Vit C must be high and thus delivered IV.

Here is our working hypothesis:

Pancreatic Cancer------KRAS Mutations
                                                 
                                                 
                                                 

                                    Glut 1……….up regulated

                                    

                                    Increased Glucose uptake
                                   
                                   
                                    Accelerated Tumour growth



Vitamin C Effect          KRAS Mutations
   In Cancer                                            
                                                                                             
Vitamin C is
Oxidized to DHA
(Dehydroascorbate)   Glut 1……….up regulated…..
                                                
Glut 1-DHA (DHA competes with glucose and is transported intracellularly
                                      


In the cell:

  DHA.............Vitamin C

                                                
Increased intracellular Vitamin C levels

          
Metabolic disruption
(Inhibition of glycolysis)

          

Loss of pyruvate production

        
    Cell Death


This is exciting news as intuitively infusions of Vitamin C are much more palatable than selective infusions of bromopyruvate through the arterial feeders of a tumour.

Tesla Titillations: No real cold or snowy weather, so I await to see how the car operates in true winter conditions. For now no new surprises.
One of my patients took delivery of a model S 95. A great celebration of their 35th anniversary.

 

 

The Arts Report: 

Henry Kaplan and the Story of Hodgkin's Disease

Written by a renowned Stanford oncologist, Charlotte Jacobs, it is a story beautifully told, with personal successes of the man, his role in making Stanford Medical School world renowned, ultimate jealousy and betrayal by peers. His focus and dedication to his profession, developing Stanford, and his innate ability to solve complex medical problems is truly inspirational. It also showed little known facts about his humanitarian efforts and tireless work with Amnesty International.

Three books on the shelf ready to be devoured and of course the Christmas film season looks very rich, an expanded report next time.

Christmas Aberrations: Over the years I have reassured my kids that there is no such thing as a functional family, we are all dysfunctional at some levels, and in my ultra sensitive way reassured them to “ get over it”, the corollary was also that it would all come out in their therapy in their 40’s.

The artificial tree

A few years ago we decided that an artificial facsimile could replace the classic Christmas tree. This was satisfactory at a bunch of levels: cost, ease of decorating, cleanliness.

Then the rule of unintended consequences kicked in! Catherine and Hamish had no problem. Surprisingly the effort over 25 years of picking out a tree, loading it on the suburban, trying to get it upright, the theatre of Deborah asking why we didn’t get a smaller tree really did not seem to be missed. The other night Donovan was adamant as to how much he missed the “real tree”, the reason: there was no smell from the new tree. We never considered it. For a sighted person it would be a kin being told that the pine smell from the corner of the living room emanating from a small urn, was the tree, of course no lights or decorations would be visible. I think we would feel cheated. Fortunately we now have pine scenting, Donovan is in part placated.

Rantage:It’s been a while, but it is time. Vancouver has many with driving challenges; however there can be no excuse for not knowing or following the rules of the road. This week on my our way home from the cancer agency we witnessed 2 near accidents, both involved drivers going through stop signs from side streets onto major roads. These folks did not even look! More galling when lights are flashed, or a horn honked, there is indigninty, anger and single finger salutes. Stop with the roadside suspensions, police get out there and censor these idiots!!

Until next time…….

 


Saturday 5 December 2015

The Solstice Approaches


Dr. Hugh Tildesley
Status Update: Latest infusion of poison complete. Blood work all in order; bone marrow effects (hemoglobin, white count) remain minimal. Tumour marker is the lowest since July. It is not clear how much the marker means, importantly I continue to feel well, the need for naps much less, weight stable.


Tesla Titillations: Voluntary recall for seat belt check unexpected, bottom line there was 1 minor defect found in 3,000 cars. The issue not of significant danger, air bags require adequate redundancy. This must be compared as to what stimulates a recall in the US market; deaths, usually noted by families of customers not by the manufacturers.

There was an interesting phenomenon while on autopilot this week. The Tesla “sees” the car in front, on this one occasion the front car pulled a left and Tesla followed! I did not wait for the hoped correction. Keep both hands on the wheel, especially in 2-lane traffic!

Arvida
The Arts Report: Just finished another Giller Finalist: Arvida. As a Quebecer I am somewhat familiar with this Alcan built company town. I grew up in a small town, Rosemere, so am familiar with the intimacies of living in a close community. The stories are a mixed bag some of beauty and interest, others fragmented, all unique. One has to lend a little slack as they are translated. Bottom line 15 Dogs was a worthy winner of the prize.




Typical Radar Image for Vancouver
Benign Radar Image in LA
Looking Forward: Thank goodness for mild temperatures but the rain is a little discouraging. Plans are to chase the sun, early January back to LA, close to Deb’s family, the beach, and a retreat from the pummeling Vancouver rains.












The Pope after another Vatican Transfer


Another California golf boondoggle is planned as the Pope’s guest in Palm desert in early February (as he redistributes the wealth of the Vatican to infidels such as me).



Later in the month we return to Tofino for storm watching



The winter solstice is my Prozac, 2 weeks away!

 
Deborah is pragmatically transforming the house into one of Christmas celebration, I love the traditions and think the off spring appreciate returning to their childhood memories.



The Five o’clock club: I have mentioned this group of Point Grey Members who attempt to keep the food and beverage budget balanced. I have taken my kids to this gathering and all have commented on the level of wit and irreverence of the group. For me, it is a wonderful escape and a suitable denouement to the day. The cast of characters is led by a most colorful Scot, Bob Duncan; a successful TV producer and failed comedian. A shout out to him as he won the reservoir quiz, this was a bet within the group as to what the Vancouver reservoir level would be in November in response to the water restrictions in the summer. The entry fee was $10.00, payout $60.00. The hope was that someone would have read my suggestion of reading:” How not to be Wrong”, the power of mathematical thinking. Duncan won! True to his complete integration to Canadian society he bought his fellow contestants a libation. (except me as I was already at quota, still waiting).

Why did I report on this, well under duress, Bob has been quoted: “ I do not read your frigging blog, the only things I read is what I write or what is written about me!”

I will do anything for yet another page view.

Professional Development: Vancouver hosted the International Diabetes Federation meetings this past week. The convention center was a source of great pride!

Our group had 2 posters, always nice to have our scientific work displayed, as well our GAP students now have a publication to strengthen their CV’s.


 


Not worthy of a rant , but the meeting had some challenges with organization, prompt communication of program content and talks of mixed quality.The hassle is that one never can predict until you are in the meeting!

Until next time……

Saturday 28 November 2015

A Magical Time of the Year


Dr. Hugh Tildesley
 


We are less than 1 month from Christmas…



Unbelievable!

Status Update: Blood work ok, my 12th course of poisons is in a few days. My oncologists are pleased with my progress, however as we go longer with this treatment,they become visibly concerned about me developing the neuropathy associated with Oxaliplatin. It usually shows up after 8 cycles, it looks like I may be playing with fire here, however, the incidence is around 10%, is reversible with time, and can be effectively treated with a number of agents. I will press on.


Tesla Titillations: Each week there are subtle changes to the car. Autopilot continues to improve. It operates best when the sensors are seeing 2 lane lines. It will operate following 1 lane line, unfortunately it is usually the lane separating you from oncoming traffic, and the car hugs that line and it can be quite unnerving and lead to knuckle whitening of any passengers who notice. My advice is only use autopilot with dual line input, the car stays perfectly centered and collective anxieties abate.
With 2 lane lines the car remains perfectly centered









One of my patients recently ordered a Model S 90,a top of the line model. I am going add this as one of the options on my prescription pad. 


The Arts report: The Secret of Golf: The story of Tom Watson and Jack Nicklaus. Most golf fans know most of these stories but there were some nuances I had not appreciated. Firstly it appears Watson practiced more than Woods. Secondly he was an alcoholic and has fortunately stayed off the booze. Watson was instrumental in helping David Feherty get and stay sober.

As a coach for Donovan I always worried about the line between coaching and sabotaging a father son relationship.

Watson’s father was a prick, rarely giving positive feedback, commenting that every good shot was “lucky”. On the other hand Nicklaus’ father was as equally a good golfer as Watson senior and played frequently with Jack. The bets between them were always good-natured, such as a car or a house (this was when Jack was a teen!). They both knew the bets would never be paid but it taught competiveness. They usually walked off the course laughing.

Quite a contrast, but they both sought and achieved excellence.

Who can forget the Open in 2009, the 59-year-old Watson was 1 putt away from victory. Somehow the broadcast patched Nicklaus in by phone, his emotion and genuine cheering for Tom was palpable. The book tells us that Jack watched the complete broadcast, absolutely fixated. Generally, he never watches golf!

More touching was his support of Watson’s decision to putt from the fringe rather than chip on the 18 th hole that led to a bogey, his playoff with Stewart Cink which he lost. Watson finally accepted that it was the right play and his disappointment dissipated.

After reading this book I shot my best round in weeks , I focused on inner calm and focus.



15 Dogs: This year’s deserving winner of the Giller Prize. A great read and will leave you talking to your dog and expecting a conversation!






Celtic Lightning: compared to his previous book, “ How the Scots Invented Canada”, a huge disappointment. It became obvious that he had won a grant for the book and it is just not up to snuff. Read his previous book for a more comprehensive and organized look at our history and heritage.






Adele 25: a great album worth it.






The bucket list: get music throughout the house and be able to have different tunes play in different rooms.

Done: I purchased a sonos connect and 2 wireless speakers. I have hard wired speakers in Deborah’s study, the kitchen, the living room, and the patio. The wireless speakers can be moved but are now in the bedroom and my study. I can control the system with my iPhone. I have spotify integrated, thus music choices are endless, of course all my digitalized music is also on the iphone thus options are expanded.

A simplified diagram of the components
The E connect, this accepts input from your home network and some direct hardwire connections eg your CD player
The back view showing wired access
Great quality speakers that only need to be plugged in and get be moved where you want them.




































Sorry to be so crass and materialistic …. But as Kurt Vonnegut wrote in Slaughterhouse-Five….

“ and so it goes”




Social: We approach the holiday season and the exchange of good wishes and good cheer. There is also the reality of crowded rooms and the pesky winter viruses. I must therefore pick and choose venues with caution and as many of you know I no longer shake hands but rather rub elbows. Also, my white count recovers about a week after the poisons ,thus I time my attendance at gatherings accordingly. 

We recently had our staff Christmas lunch at C Prime, at the Century Plaza hotel, I have of course seen this hotel change over the last 30 years, I highly recommend the restaurant, comfortable ambience and very reasonably priced. 


The Team: from L to R, Helen,Augustine,Patricia,Christina,Dr.P,HT,Adam,Dan,Jessica,Betty



On December 8, I have my last official task as a member of the Point Grey Board as I open the AGM, this will end 8 years on the board, a highly satisfying activity. I will miss it.

We host our sometimes annual Open House on December 22, Hamish and Catherine return on the 21st, they are invaluable in helping Deborah bring it all together.

Christmas will bring Uncle Ted and Teresa as visitors; the Christmas dinner will be extra raucous.

Until next time…