Carry On

Dr. Hugh Tildesley

Status Update: The CT report was not available 3 weeks after the test. I called on my colleague Patrick Vos at St. Pauls and after a few emails he was able to get on their system. He reviewed the distribution, shape and importantly the density of the liver deposits. There has been growth, however modest but importantly, the density is only slightly more than water. This picture is consistent with necrosis (decay) as a result of the poisons. This now all adds up with my clinical state and is most reassuring.

Blood work done today (Jan 29), shows that the Hgb has recovered to previous levels. In my meeting with Dr. Renouf we discussed an email I sent to him and we have come to an agreement that we will continue on current therapy until/unless I develop significant side effects, clinically show deterioration, or markers or imaging become worrisome. 

A dilemma is the CT scan which shows variable changes, are these tumour or necrosis. We will do a PET/CT, which should help resolve the question. The meeting was extremely positive and I am in a good place.

 

Tesla Titillations: I am still trying to perpendicular park. The rain perhaps interferes however I will persevere on clear days. Otherwise happiness quotient remains high.

The Arts report:

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The Big Short: I read the book last year and the movie was an excellent portrayal. The depiction of corruption and manipulation kept me up that night. The movie is well acted, tells a compelling story and well worth the price of admission. There are great performances by all but I fear they will be “ diluted” out of an Oscar.

 

Maps, Mountains and Mosquitos, The McElhanney story 1910-2010. Katherine Gordon

The last 8 months has been a revelation as I have spent quality time with close friends. There have been some amazing overlaps in history not previously recognized. My good friend Andrew Thompson exemplifies one of those examples. We have known each other for 35+ years; we have done many things together. At Christmas I found out his grandfather Thomas McElhanney was his grandfather and was briefly a partner in the firm. He undoubtedly knew my grandfather.He was also a BC land surveyor.

Tildesley Creek still wilderness

My grandfather came to BC in 1913, he was a P.Eng, and employed by the government as a surveyor. I never met him, but verbal history describes him as a somewhat of an odd duck. 

(I come by my idiosyncrasies honestly!), as a younger man he travelled and worked extensively in Africa and of course hunted big game. In BC he was lifer with the government and somehow Tildesley Creek is named after him. He also was a golf addict and my late father hated having to caddy for him.

The two must have known each other and one can wonder what their relationship might have been.

The book reminds us of the incredible resourcefulness, physical strength, and integrity of that generation. The firm was on the cutting edge of applying the latest technology to their business. The patriarch, William McElhanney, kept the business thriving through connections, maintaining staff loyalty and surrounding himself with excellent people. It is hard to imagine but they built numerous tunnels without GPS, ultrasound etc. and were always within centimeters of their targets, using trigonometry!

Social:

My brother David was in town for the ‘Gold Show”. He is now 70, very scary. We initially could not visit due to a wicked cold from which he eventually recovered. He joined the 5 o’clock club and the dinner with the TWA. Donovan joined us as well, a great evening and I am glad he and Donovan could partake in the kibitzing. Donovan continued to pitch his insurance products; his tenaciousness remains me of him turning on the jets for the last 50 M of the 400 free. I did not advise him that such behavior is against club rules; I expect he would have selective hearing on directions and saved my breath.

At one point Slugger described us as” deviates”, and only accepted correction from Google and settled on the term “ deviants”. Since he included himself in the definition retribution was difficult to justify.

What does February bring?:

I will be in Palm Springs with the Pope and Gorgeous, Feb 7-12. I should get 3-4 games in. Cart golf should make the experience less arduous.

I have started lessons and hope not to embarrass myself.

February 21-28 we will be in Tofino, this will be our third year going to watch the storms, read and walk. 

Some selected scenes from last year:

 

Our cottage in the foreground

 

We will be home Sunday evening (Feb 28) for the Oscars. Catherine has organized a family competition as historically we watched the show together. I am looking forward to the competition and the comments which will be going back and forth. I think Hamish should have an advantage but maybe he just knows too much which often leads to the dreaded “ Overthinking”.

Feedback: I have received many unsolicited comments on the blog. These are greatly appreciated and I will try to maintain quality, and humour with the odd rant. Thanks for all the positive thoughts.

Until next time….

Trends Positive

Dr. Hugh Tildesley

Status Update: The complete blood work from last week is in and more positive than expected.

The Good: The upward trend of the Alk Phos (a liver test) has dropped and approaching the averages seen over the last 7 months, thus going in the right direction. The tumour marker did the same and is at or below the average values taken over the same time span. The AST (another liver test) dropped similarly.

Weight has hit 171 pounds; I’ve stopped calorie counting for the time being but am still obsessive re glucose, testing 4-10 times daily and on at least 6 injections daily. Insulin doses are falling by 10% a sign of less insulin resistance (? less inflammation).

I just finished another round of the poisons, minimal side effects and energy levels about 90 %

Mentally the trip to LA was very positive, mainly due to a change in routine, family support and proving we could do it. I admit there was relief to returning home with no medical bills!

The Bad: No formal CT report as yet, however my worries have somewhat abated given the lab results.

The Ugly: nada

Chan Dinner: L to R;Greg Bridges,Pope,Slugger,HT,Aydin,Gorgeous,Joseph Chan (the rattler)

Social:  

We have defervesced from Christmas and are now able to pace social engagements more strategically. This past Wednesday Joseph Chan a TWA (Tildesley wine account) member arranged for a fantastic Chinese dinner at Dynasty restaurant. The dishes just kept coming! (Lobster, chicken, fish, tofu, vegetable fry, brisket, etc.) We supplied the wine with excellent choices as the meal started with the Greg Bridges’ magnum of champagne. Aydin wins the economy prize with this pick, which is under $30.00 but has a taste rivaling a $60.00 wine.

Hockey fans may remember the definition of a Gordie Howe hat trick: 1 goal, 1 assist, and 1 fight.

At dinner I had the HT hat trick: elbowed to the front of the line at the restaurant, elbow greeted all the guests at our table and elbowed a glass of wine to the floor as I expertly grabbed a pot of tea from the revolving table. (Just missed slugger!)

Tesla Titillations: This week I received another update. My dash now shows not only the car directly in front of me but others in front in adjacent lanes.

Perpendicular parking has been enabled but I have yet to get it to function. I do not really need it but I will persist in learning to adapt to it.

Although advertised that the car no longer follows other vehicles onto off ramps, today the beast followed the car in front of me rather than proceeding straight. Vigilance remains paramount.

The Arts report:

Boom: Now playing at the Granville Island venue. Rick Miller is an extremely talented performer who wrote this multi media one-man show tracing 1945-1969, using a documentary style, and impersonating over 100 characters. As a boomer I reflect on the 60’s and truly wonder at how we survived given the dramatic social changes we experienced. Oh to be young and adaptable.

Vancouverites should go and see it!

The Martian: Talk about hype. We saw it on pay for TV; glad I did not go to the theatre although it was on the list. There were parts that made me understand why it was in the comedy category of the Globe awards. Another example of the power of marketing.

What the Dog Saw: Malcolm Gladwell

A prolific and clear writer. I Remain a fan as he does thorough research, is a contrarian, and in the end gives an opinion on a topic that is defended with facts, not here say.

In this collection of essays his analysis studies the utility of mammography by actually spending time with

a radiologist and learning the vagaries of interpretations. He goes through the same exercise analyzing prostate cancer. He investigates plagiarism in the arts, the cost of homelessness (you will be glad to know that the observations recently reported in the Vancouver press about a small minority of the homeless costing disproportionately compared to the majority of homeless has been reported repeatedly in numerous cities, the problem inescapably is public policy. The inertia is wide spread. I highly recommend this book.

As the Dylan song says. “ you gotta serve somebody”. My uncompromising editors comment on error, real or perceived.

Until next time….

Last week in LA

Dr. Hugh Tildesley

Status Update: Blood work today, hemoglobin and white count down but not enough to avoid the poison infusion tomorrow. We have agreed to go ahead with 2 more courses and then analyze a host of therapeutic options.

The game here is that my current therapy needs to be modified as 1) my marrow becomes slower to recover from its toxic effects. 2) New cells from the cancer are selected as they become the survivors from the chemo and need to face different poisons to which they will hopefully be susceptible.

It has been 2 weeks since my CT scan, no formal report!!! Unacceptable. Fortunately I talked to the radiologist however I still await the formal measurements of the various tumours. I cannot imagine being a “normal” patient and being left hanging without a report. Inhumane.

Deborah and I spent last week in Los Angeles, 2 plane rides, fortunately no acquired infections. The change was positive for my mental and physical health.

Last week in LA, Highlights, observations and unsolicited comments:

The Main House

Our Cozy Cottage

Deborah worked her magic and found: Burnham Beach Cottages, 2 blocks from the pier at Redondo Beach. The buildings are over 100 years old,and in pristine condition. The owner Wendy, very helpful, the location excellent. We were within an easy 10-minute drive to Deb’s family members, 2 blocks from the Catalina Café where each morning we had a leisurely coffee and devoured the LA Times.

The purpose of the trip was warmth; this was only partially accomplished because of unseasonably cool temperatures. Other goals were walks, and some tourism.

A cool clear day at Redondo

Attention to detail

 

Waiter at Ruby's , a 50's experience

An Attempt to cover up the ugliness

The not so pretty at Redondo, Power plants on the shore

Poinsetta in a yard, not a pot

Our 1 day in the sun

We took the Pacific Coast Highway up to Santa Monica and then a pleasant meandering drive to the Getty Museum. The museum is a spectacular work of architecture and exhibits to be contrasted with our British experience. Most museums in the UK are now free, the exhibits tightly packed with wall space maximized. The Getty is essentially free, $15.00 for parking, no other charges. The tram up the mountain allows for a time to defervesce, and the exhibits are nicely spaced. Outdoor breaks are easy as one migrates from one exhibit building to another. The views from the various terraces are panoramic of LA.

The winter gardens at the Getty , below the architect plays peekaboo

 

 

A Boy with a frog greets you

The highlights of the trip involved people. The joy of seeing Deborah’s sister Judy rebound from cancer surgery and chemotherapy. To observe the energy and optimism of Devon Kent as he finishes UCLA and prepares for medical school. The unbridled creativity of Hamish as he pursues his screen writing career. The fun loving Susie Kent (Devon’s Mom, Dan’s wife), as we plotted to perfect oysters Rasmussen. Planning with Dan Kent to get him to Bandon Dunes for the next tournament and debating with Connie (Judy’s husband), sports trivia and the merits of Californian wines.

We all gain strength with these family encounters.

Random US observations: At this point Trump is for real, his performance on the tonight show was presidential. Later in the week, on the same show Madame Clinton tried to be funny, she embarrassed herself.

The majority of the LA Times and local news was smitten by the return of the Rams. In LA, the NFL truly owns Sunday and every other day of the week. Priorities for an outsider seem askew.

Tesla Titillations:

I missed the beast.

I was able to monitor battery function from my iPhone, the weather in Vancouver was not too cold, the battery charge (expressed in KM range) went from 322 to 285 a delta of 37 with percentage loss averaging 1.5 % per day. This is acceptable and within parameters.

The Arts Report:

The Revenant: This is an epic production. The writers take poetic license in the representation of Hugh Glass, a guide who was indeed attacked by a bear and left to die by those paid to stay with him in death. His true tale of survival remarkable.This movie strayed from the true story with the addition of some mystic overtones.

Anybody with experience in the wild and basic understanding of the challenges of survival will find much of the movie laughable and it is at this point you dial to your James Bond mode of just suspending belief and being entertained.

Some advice: if you are submerged and soaked in freezing water you have about 30 mins to save yourself. First build a fire, then strip naked, and dry your clothes thoroughly. If you think your body heat can dry your soaked clothes you are a dead duck!

Medical observations: it is not clear how long Glass was out in the wild but the original book mentions 8 weeks. During that time with the stress, walking and limited access to food (his buddies took all of his stuff!), weight loss would be spectacular. The movie does not depict this.

Summary: enjoy the entertainment; the cinematography is worth an Oscar, as is the music, direction and the performance of Tom Hardy. DiCaprio was well directed, not my choice for best actor.

The Great Soul of Siberia: Sooyong Park

This man is obsessed with Siberian tigers. He has spent over 20 years studying this magnificent but secretive animal. His insights have been gained by using keen observations and his insane strategy of constructing a series of bunkers in their habitat, the mountains that border Siberia, North Korea, Manchuria and South Korea. He lives in these bunkers for 6 months at a time, taking award winning photos and film. He chronicles 3 generations of tigers, uncovering their true intelligence, parenting behavior and affection for one another. He pulls no punches as describes the atrocious tactics of poachers and their lack of respect for these magnificent animals.

I am struck by the sheer ability to adapt and survive in incredibly harsh conditions. An unintentional bookend to the Revenant.

Rantage:

I am old school. When you get a lifetime achievement award, respect its history, the honour and yourself.

This year’s Golden Globe Awards had Denzel Washington join a long list of prior recipients, including; Walt Disney, Bing Crosby, Robert Redford, Stephen Speilberg, Robert De Niro, just to name a few.

Washington had ample time to prepare a speech (or hire a writer), memorize it and deliver an appropriate acceptance. His introduction by Tom Hanks was eloquent and accurate. What followed was a gong show; I was embarrassed to watch it.

Hamish and I argued about it, “ after all Dad it’s just the Golden Globes, everybody knows it’s a drunkfest!”

Hamish is in the business, I respect his opinion.

I remain old school: do your homework, respect the award, respect your audience and respect yourself.Denzel failed on all counts.

Until next time…..

When you come to the fork in the road, take it!

Dr. Hugh Tildesley

 Status Update: Weight, appetite, stable. Blood work stable, Alk Phos up, however other parameters stable. The CT shows either stability (the primary tumour, some of the small liver deposits, show stability, others small growth). A large separate deposit has shown some growth and a change in shape, I await the final written report to make more sense of it all. The confusing part is how well I feel!

There will be an inevitability of looking for other poisons, the path is  less clear. As the great Yogi Berra was quoted, “When you come to the fork in the road , take it."

 

The Arts Report:

The Danish Girl:

Just back from watching this film. Danish Girl, a beautiful love story with great character development, cinematography and acting. It will be nominated for best picture, Eddie Redmayne for best actor and Alicia Vikander for best actress. Obviously should be high on your list of to see

The Death of Cancer

Vincent T. DeVita Jr., M.D., and Elizabeth DeVita-Raeburn

I kind of got into a rut here reading very similar books recounting in their own way the recent advances in cancer. Bottom line messages, oncology, like many medical specialties continue to operate in silos and the FDA has an over zealousness in protection vs. cure. The amazing changes in HIV treatment were led by the activism of patients demanding experimental treatments without definitive proof of efficacy. This is how the early progress in Hodgkin’s disease and Leukemia were made. There has to be some common sense balance put back into clinical trials and fast tracking promising therapies.

Tesla Titillations:

Still waiting for snow, thus no gems to report except on a personal level.

For thirty years Deborah has owned the garage. My series of suburbans would not fit and the garage allowed for the efficient movement of young children out the back door. I took it over without a shot, as the garage was the only practical plug in source. 

Ginn on Guard

This was fine during the summer, some adaptation by Deborah and the dog as to what door to enter buy and of course Ginn was noted to be pacing, first waiting at the back, then the front and finally resting on the couch illegally between both doors. This worked fine in the mild weather.

Deborah suffers from Raynaud’s, a condition that freezes the tips of her fingers with exposure to the cold. This was exacerbated by her new parking spot and of course windows freezing over a new experience without the protection of the garage.

She now has a remote car starter courtesy of Santa, an effective non-combative solution. My only accounting question is whether this should be considered a Tesla expense?

Social: The house is quiet, routines re-established for less than a week, and soon off to LA for a week. Weather iffy last week, but should improve while we are there. I gain strength in a change of scenery, visiting family and hopefully UV exposure. I should have time to read and take in more flicks; there are so many excellent choices.

RANTAGE:

Earlier this week a man on volunteer block patrol in Surrey, BC, confronted 3 suspicious men parked in his neighbourhood. They fled but not before firing shots, blowing out his rear window. He gave chase and was in contact with the Surrey RCMP and asked to get the license plate number. He took this as instructions to get closer, which he did relaying the number to the police. The chase continued at high speeds through Surrey, with more shots being fired from the speeding car.  The man giving chase was shocked at the number of times he saw police cars give chase and then back off. Eventually the car crashed on icy roads in Delta striking a power pole. Then the police arrive in force to make the arrests. No surprise the 3 suspects in the car were all known to police, one out on breach of probation and break and enter.

Here’s the kicker. They cuffed the man who had given chase and he was threatened with charges of reckless driving. The police spin was that officers are instructed not to engage in high-speed chases, as there have been instances of innocent people being injured. The duty of the police is to serve and protect, their behavior in this instance did not match the Good Samaritan. These guys should not have been out on the street, and certainly those giving chase should have been the armed constabulary doing the right thing, not following some ineffective protocol.

 

Until next time.

2016: YES!

Dr. Hugh Tildesley

 Status Update: Status quo, weight, appetite, stable. There will be a 3-week hiatus between therapies, thus I have an extra week of recovery. The usual next Monday and Tuesday (Blood work, MD apt, poison infusion), CT on Wed Jan 6, the report card of the last 3 months, clinically should be ok, but I will not get ahead of myself.

Temperatures here cold and clear, I am avoiding chills, thus not walking as much as I should, I hope for warmer temperatures. I have determined anything below 6 degrees C invokes neuropathic symptoms.

The Arts Report: Creed

Following Concussion we saw Creed. The reviews said it was not a boxing movie, well it is. The Rocky franchise is alive and well. Having just seen “ Concussion”, I was expecting to see slides of the combatant’s CTE (Chronic Traumatic Encephalopathy).

Well written. Good character development and in general a good story. I promised, based on the reviews it was not a boxing movie, Deborah, although not enamored was impressed with the movie save the boxing scenes. I recommend this flick for its entertainment value and character development. If violent blows to the head are disconcerting, skip it.



Gratitude: Oliver Sacks

A short book filled with emotion and some level his personal catharsis. Historically he would write long hand his books, they would be voluminous and his long-suffering editor would have to edit and edit. On average he would take 6-7 years to finally finish a book. In my mind they were always worth the effort. This, his last book, was different. He did have the luxury of time. He said what he had to say, it is not as smooth as his previous publications but from the heart. It is the bookend of his life (this time no pun intended). A worthwhile read if you are an Oliver Sacks fan.

The Emperor of All Maladies: A biography of Cancer, S. Mukherjee

A comprehensive work following the history of cancer from Egyptian times to the present. A few historical facts are incorrect but do not detract from the message. The repeated message is the fixation of chemotherapists on attacking cell division and not the differences of cellular metabolism; in my view a silo mentality that represents lost opportunity. There also remains the abyss between basic science and clinicians. Repeatedly in the book cures, and effective treatments are stumbled upon outside of the FDA rules. AIDS activism has helped establish a template to get therapies to patients faster in spite of the FDA.

A good read to help understand where we are. History remains an important component of this process.

Tesla Titillations:

One foot at a time! (Keeners will note this was the motivational line used in Creed by Rocky to motivate Adonis (Creed’s son). It has been frosty and I had parked on a hill. My usual habit driving a gas-powered car would be to have my foot on the brake and engage the gas to avoid rolling backward. Not necessary with this car, it does not roll backwards, just put your foot on the power pedal.

If you utilize both feet, the car alarms, potentially embarrassing as it communicates your incompetence on your screen for all to see.



Social: The out of towners are home and recharging. Wonderful to have them home and to catch up. Great visit from brother-in-law Ted, dinner with a second brother-in-law Chris, and his daughter Cassandra, and her partner Andrew.

I am looking forward to our trip to LA later this month with UV exposure, we have rented a small house on Redondo beach, so easy access to beachside walks and close to Torrance where Deborah’s sister Judy and brother Dan live. Hamish will be back in LA and I look forward to hanging in Santa Monica as he shows us the hot spots.




 
Bragging: Donovan spent a couple of days in Whistler in mid December shooting a promotional video for  Destination BC. Beautifully done , in spite of my obvious bias please have a look!

https://www.youtube.com/watch?v=H0NT4-6f49k

Until next time........