Some frequently Aked Questions

Status Report:

Dr. Hugh Tildesley

The most recent blood work showed a complete reversal of the low White count, which is now back to baseline. This means we can go ahead with the poisons next week. Additional good news is that my weight has remained stable, as has my energy level.

I walked 18 holes on Monday, at Shaughnessy,score was unfortunate but my host, Dr. Ted Wilkins,was as always gracious.While on the 10^th hole one of the pros, Vaughn Marshall,made a point of coming out to great me. He knows my story and wanted to say hello, I was needless to say touched. When I first took up golf Vaughn worked at UBC, we had a regular game at dawn every Sunday, Bill Vlahos, my late colleague, was a regular as was Dave Riddle and Jean Cormier,very fond memories.

16 th at Point Grey

On Wednesday I walked Point Grey, 2 games in 3 days. Score of 88 respectable.

Travel: The trip to Arizona is taking shape, a few days in Scottsdale, then a sojourn to Sedona, followed by an overnight at the Grand Canyon. We then travel back to Phoenix, for a few nights, then on to Tucson to watch nephew Liam in a baseball tournament.

We had always wanted to go to the Canyon and some extra time on this trip gave us the flexibility. A serendipitous check of the bucket list!

Some questions about travel?

Insurance:

What do you do about insurance? Initially I thought I had to self-insure, but in fact BCAA has a plan which I thought was quite fair. For pre existing conditions I am insured for up to $200.K, for non- pre-existing up to $ 10 Million. The coverage is up to 15 days, for 1 year, irrespective of how many trips we take. My premium was about $950.00, Deborah’s about $300.

I manage my travel based on my proximity to recent chemotherapy, optimally I should be at least 2 weeks removed so my immunity is less compromised.

Minimizing the exchange hit:

Quite a learning process. The best way is to get a charge card in US funds, and have a bank account in US $, so that money is only “exchanged” once.

Some advice. Avoid AMX their program is basically a fee scam.

The Canadian banks are more transparent and fair, although in spite of my being a 50-year RBC client with a perfect credit history I was treated as if I was a new applicant! They wanted tax returns back 2 years, stock account info, and corporate information. Totally over the top, as if my credit history was irrelevant.My subsequent conversation with the manager was reassuring and his response to my complaint was reassuring. Strong letters to RBC VP and Rbc Visa will follow. 

My recommendation is to get a US card that allows points to be collected and transferred and open a US bank account to avoid repeated gouging regarding exchange rates.

Time for Q and A’s

1)   On a scale from 1to 10 how do you feel.

There are good days and bad. The best days I am 9.5, the worst 8.0. I can usually tell within the first hour of waking. When compared to May, June and July, which I would of scored 6.0, this is really quite good!

2)   What % of your former workload are you able to maintain?

Really unknown, of course, even without my challenges I planned to go to 60% in 2016 anyway.( I am currently at 20%) I still enjoy seeing patients, many of whom have been under my care for 25 years. After my ½ day in the office I generally have a nap, which seems non-negotiable.

3)   How much has your handicap changed this year?

An embarrassing answer, it is up by 7 strokes. I have lost considerable distance but I am working on some new techniques to recapture those yards.

4)   What about the bucket list?

I am quite disciplined with the list. I never really plan outside of 8 weeks in advance. I can tell you it is lengthy but out of necessity we are on fast forward. I am quite proud of the last 11 months, here was what was on the list:

BUCKET LIST 2015-16

Live 12 months                                     April 2016

Donovan’s Birthday                                     check

Hamish’s Birthday                                       check

Baseball in Seattle                                      check

Liam in Portland                                          check

Tesla road trip to Portland                           check

Burnham and Berrow Oct 20-25                                                                                                       check

London Theater Oct 20-30                          check

Catts Birthday                                              check

 Palm Springs late November, early Dec      neg

 Hawaii Dec                                                   neg

 X mas party                                                         check 
 Jan LA       Jan 10-17                                          check 

 Feb Palm Springs   Feb 7-12                       check

Feb – Tofino Feb 21-28 medical issues       neg

 March Phoenix/G Canyon/Liam in Tucson  booked
Bandon Tournament April 15-18 booked     booked

I ‘ve been lucky to get all this in. About an 80%  successful execution rate.

5)   What is your investment philosophy.

Get your own broker …..parasite!

There were a number of practical decisions that had to be made. I am now penniless, houseless and carless. Deborah either owns or co-owns everything. This was all done with expert legal advice to minimize any hardship for the family.

   6) Can you give a layperson-understandable explanation of the glucose-tumor interaction mechanics?

Simply put many tumours, notably lung, pancreatic, bowel and brain take up glucose preferentially, that is outside the usual controls mediated by insulin and glucagon. These tumours force feed themselves, using unrestrained energy from glucose metabolism to speed their division and spread. This phenomenon was recognized close to a century ago by Nobel Prize Laureate, Otto Warburg, and is known as the Warburg effect. Research has shown both in the test tube and in animal experiments poisoning the glucose metabolic pathway ( glycolysis) stops the process and kills the cancer cells. There are now strategies that can be used in humans to apply this science: Vitamin C infusions, intra- arterial infusions of D-pyruvate ( invasive, to date no controlled trials) and ingestion of DCA ( dichloroacetate), again no controlled trials.

   7) If you were to redesign the cancer care system in BC what would the key strengths and elements be? How should it be run? How would patients give input into the design? Is there a role for a mixed public-private hybrid system of care? How do we increase a personalized medicine approach?

Redesign: I am a lowly endocrinologist and patient so will comment on what is obvious. The cancer agency is a silo, It has it’s own budget and really has outgrown the usual administrative checks and balances.

Let’s dwell on the positive, the staff is uniformly pleasant and helpful. Outcomes are competitive with world results.

Legitimate progress is being attempted regarding targeted therapy using genomics.

The unfortunate negatives: Communication with referring MD’s is hopeless, this needs to be addressed urgently. The release of imaging and lab results borders on malpractice.

Paper files still rule, they need to get up to speed with the digital age.

Appointments are done by phone ( that’s ok), but also by mail, ( is that really necessary?)

Patient privacy has been lost, interviews are done in public places, totally unacceptable.

I am a Lee Iacocca fan. Just walking around can give great insights as to how an industry or plant is functioning.You may remember that Chrysler was "dead" in the 80's, Lee turned it around.He went into every management office, and every plant and if he could not understand that person's job by their explanation ( 1  min or less), they were deemed redundant and gone. As I pretend to be Lee in my travels, overstaffing is obvious, this reflects poorly on day to day management decisions.

Public private models for cancer management is not something I support, mainly due to the patient costs that would be potentially incurred.

Within 5 years the first test that one will have after the diagnosis of CA will be genomic which will help target therapy. The age of protocol driven therapy is over.

8) How does Donald Trump do his hair ? Short answer he doesn’t.

In physics his "doo" would be described as Brownian movement.

Defn:  Brownian movement, any of various physical phenomena in which some quantity is constantly undergoing small, random fluctuations.

And so endeth Question Period!

Over the next few days there will be a short blog on Oscar predictions. Stay tuned.

Until next time…