The Last Week of April

Dr. Hugh Tildesley

Just finished a smooth 18 holes, 41/41 for 82. Butler and I smoked the Pope (Brian McGuire) and Russell. (Dr. Jim) We had a net 65 they were even par at 72. Plus Butler birdied the 18 th for the automatic extra $5.00.

Me and the Pope, note his winning grin

These matches are not without theatre. On 14 Russell and I were the same distance from the hole, I volunteered “ good for good”, meaning we both conceded our puts. Before the Pope could interject the deal was done, unfortunately it was not totally equitable as my put was for par, his for bogey. The Pope was duly irritated. Before he  earned his papal nick name he was known as “bitchy competitive”, shortened of course to BC. Fortunately the concession made no difference, we relented to his continuous sighing and gave him a 6 footer to tie!

So very therapeutic. irrelevant in the greater scheme of things.

A huge issue for me to walk 5 miles irrespective of the score. I treasure the time I spend with these guys, I think they know it.

A typical Bandon View

Butler and I were scheduled to leave on April 27^th to Bandon Dunes. It is the annual Amateurgolf.com 2 man best ball. It would have been my eighth year and a highlight of my golf schedule.

The Club House at Bandon

Bandon Dunes is one of my favorite destinations in the world. The brainchild of Mike Kaiser, it has legitimately grown to be recognized as the premiere golf destination in North America. It is a pure example of " build it and they will come". The 4 golf courses are unique, provide stunning vistas and of course are challenging by design and the ever-changing weather conditions. A good read on the building of Bandon is a very informative book, " Dream Golf”, by Stephen Goodwin.

I am off this week and feel less pressured in attending to many of the tasks that lie ahead.

Over the weekend we told our children of the diagnosis. Donovan was over for brunch and in fact did not seem very surprised, there were hints I was not my self and he picked up on every one of them. He volunteered that on our return from Paris at the end of February he found that I was sounding “ older”, very astute.

Hamish had had a suspicion; his good friend Jeremy Chan is a few months away from graduating from Vanderbilt Medical School. He immediately was concerned about he blood clot story but did not tell Hamish directly his suspicions.

Catherine was relaxing after completing her exams. A horrible time to hear this sort of news, but there is no optimal time. Although I had said nothing the boys pitched in, Hamish within an hour had arranged to fly from LA to Edmonton and drive to Vancouver with Catherine. What a relief . I did not want her driving alone. Donovan has as well offered but 2 drivers made the most sense.

This weekend all will be home. The support is immeasurable, thankfully I am feeling well and this past week maintained my weight.

The Second Week

Dr. Hugh Tildesley

An ominous date, April 13 was my liver biopsy. Again Dr. Patrick Vos was in charge and the procedure proceeded with minimal discomfort and the closest suspected metastatic lesion was biopsied. I was comforted to have Deborah and my friend and colleague Dr. Jim Russell to wait the 90 minutes with me to be sure there were no complications. Now all that was left to do was to hurry up and wait.

Two days later Heather Leitch asked to see me as her last patient, the reason was obvious and in essence a formality. She confirmed what we all suspected, the liver biopsy consistent with undifferentiated adenocarcinoma, consistent with a pancreatic primary. In essence, I had a severe disease, not operable, and with treatment options that could prolong life for an undetermined amount of time. She had made an urgent appointment for me to see Dr. Melosky at the cancer agency for the next day. This was to get me into the “system” as soon as possible.

The Phone

The following morning I made my way to the agency, Deborah was to meet me there later after an errand. I checked in at the front desk, they had my name and I was directed across the lobby to the phone. “ What phone I asked incredulously?” The phone over there as the clerk waved her hand. All I could see was another reception area and the usual office stuff, and yes there was a phone there. “ You mean that black phone which is part of that work area?”  She confirmed my description.

Don Adams as Maxwell Smart

I sauntered over to “the phone”, and stood nonchalantly awaiting it to ring. I imagined I was Maxwell Smart, trying to get into see the Chief from that hilarious show “Get Smart”. The phone rang and it was all I could do to not say…” Is that you chief”?

In fact it was a lady from the record department really only interested in my name and birthday. Forms were dutifully filled out Barb Melosky was very kind, she listened to my initial reluctance to follow conventional therapy and my desire to pursue genetically targeted therapy. Within minutes she had arranged an appointment for the following Monday, some blood tests and a repeat CT scan in early May to assess the aggressiveness of the tumour. My dilemma is that apart from weight loss I felt good. My legs were improving each day on the new anticoagulant, my energy level normal. I really did not want to interrupt this without compelling reasons.

The Start Of a Different Journey

A different Journey

April 24, 2015

Dr. Hugh Tildesley

For the faithful followers, you know these blogs are usually about travel. Written in part to inform friends as to our activities and also to serve as a historical document to aid failing memories as to what did we really do. This blog will have a different theme.

 

The last few weeks have been a whirlwind of tests, disturbing results and the realization that challenges have arisen, which will be stressful on all those around me. I have been diagnosed with metastatic pancreatic cancer. That is a cancer in the tail of the pancreas that has spread to the liver. Due to it’s stage, therapeutic options are limited, cure unlikely. I will share with you this journey, and as usual it is all about me. Merely writing about my predicament serves as a catharsis, but I want to share with friends as to how I am doing. Thus if someone asks and I do not feel like providing a long-winded, technical explanation, I will be able to merely say..... “ read my blog”.

Haystack Mountain Cannon Beach OR

My goal is to remain informative, up beat and when ever possible see the funny side.

The First week:

We returned from a marvelous road trip to LA on Good Friday (April 3, 2015. We had traveled down the Oregon and California coasts, cut across to the Napa valley and made our way to Torrance.In fact we visited the vineyard in which we were married.

Freemark Abbey, the sight of our marriage

Deborah and me, the site of our marriage in the background

Deborah has a sister Judy and brother Dan living there and we stayed a few nights with Judy and Connie before moving to our Manhattan Beach apartment. The two weeks was one big family reunion, and a chance to share with our son Hamish, his UCLA experience and meet many of his friends. He is in last year of screen writing and in our in depth talks I was so impressed with his knowledge and how undaunted he is to competing in a very tough industry. In addition Catherine, our daughter in first year law , flew down for a long weekend, a wonderful gathering !

Hamish, me, Deborah and Catherine

Our drive home was more direct than the meandering trip down, unfortunately the intermittent swelling and discomfort in my legs, which had started a few weeks earlier, was not getting better.

By Easter Monday I was very concerned that I was not improving and ordered some blood tests including a screening test for blood clots. This came back markedly positive. It shouldn’t have as I was on blood thinners. Developing clots on blood thinners is a bad omen and is cancer until proven otherwise. 

My colleague Adam White organized the definitive Doppler studies and I contacted Heather Leitch, a St. Pauls hematologist, to get advise re anticoagulation. She advised switching to Dalteparin, an injectable, low molecular weight heparin. I picked up the prescription and $1200.00 later took home a batch of prefilled syringes.

Let me rant here. The picture of the syringe looks benign enough but the needle is large, dull and too long for a sub cutaneous (SQ) injection. Compare the dimensions with a simple insulin syringe. This device is like something out of a diabetes museum describing injection techniques from the 1920’s! 

The needle on the right is 25% longer and twice as wide. Not shown is the dullness factor, the needle on the left is a simple insulin syringe ( from this century), this photo says it all. Shame on the manufacturer!

The next day lower limb ultrasound documented extensive clotting in both legs. Next was a CT of the chest, abdomen and pelvis, I was fitted in on a Friday afternoon and being a physician was able to sit with the radiologist, Pattrick Vos and see the scan “ hot off the press”. It documented a small tumour on the tail of the pancreas and multiple spots on the liver. The diagnosis was all but sealed, primary pancreatic cancer with significant spread to the liver.

I felt for Pattrick, we are colleagues, but not friends. He usually describes images that culmonate in a typed report. It is then up to the ordering physician to give the news to the patient. It was just the two of us, digesting bad news. To his credit he immediately got Dr. Leitch on the phone and we had a brief chat. He then organized the liver biopsy for the first thing the following Monday, this was done in minutes. I was very thankful for his genuine concern and professionalism.

My worst fears were now documented.