Saturday, 18 July 2015

A Better week



Dr. Hugh Tildesley

 On Monday I will start my fourth round of chemo. Round 2 was not enjoyable, I had 10 days of bloating, loss of appetite, which culminated in about a 5-pound weight loss. Not good. I think they gave me the wrong stuff!

This time I sailed through. A few modifications included prolonging my steroids, and being obsessive about my diet. The result was that there were very few symptoms and I regained my weight. My appetite returned and my energy level was fine. Blood work this morning was stable, although for some reason the albumin was not done, this was added and hopefully has risen. Dr. Renouf and Dr. Wong outlined some alternate therapeutic options based on preliminary genetic results; these options will be predicated by my CT scan to be done July 24. These genetic results were to have been ready about a month ago; at least some progress has been made.

We agreed that if I was responding, we would continue with the Folfirinox for the short run.

There is always humour at the Cancer Agency. They still have not figured out how to get results to Dr. Adam White or me. On Monday I will call the head of the lab and suggest my tests are not eligible for MSP funding if they do not report the results. Stay tuned.

Today’s appointment at 0900 started as usual, the nurse called my name. My last name is difficult for some, but Hugh? So far she has called me:

Heaguah
Uggha
Weeyou

The simplified “You”, seems beyond her. Fortunately today I was the only one in the waiting room.

I continue to play golf on Wednesday’s and Sundays. The men’s night tradition is good for my spirits my scores not so. On the golf course things are fine, I’m using a cart and whereas breaking 80 was a goal, breaking 90 is the new reality. Off the course things are dangerous. Men like to be physical. Touching is important. My fellow members have a propensity for coming up behind me and rubbing my shoulders. Nice gesture except sometimes they get my port a cath. I now instinctively cover my right upper chest when greeted from behind, and raise my right fist for those coming straight at me.


This strategy is working; repeat offenders may get the Ali punch to the temple. (Trivia buffs the so called “anchor Punch”, knocking out Sonny Liston in 1965)

Ali vs Liston May 1965
Mini Rant: You may recall my commentary on the recently failed plebiscite for a Greater Vancouver Transit Plan. (Blog July 4).

Translink got a public spanking losing by a margin of 2:1.No publicly elected official has had the guts to take responsibility of this fiasco or to explain the secret use of $7 million to try to sway the public. Now the fall out. The interim CEO, decided to fire 2 Vice Presidents. This was done by that unrelenting plethoric windbag Doug Allen, who will step down August 2, to be replaced by yet another interim CEO!

These guys skipped management 101: first hire the new CEO and let him/her select the management team.

Chappa's Tunnel
On a lighter note we need to think outside the box to get subways built. These Mexican guys can dig about a mile a month without any visible disruption to the surface. There may be some work permit challenges however.


Until the next time……….Cheers


Friday, 10 July 2015

Progress Report and some FAQ’s



Dr. Hugh Tildesley
This past Monday I completed my third infusion of the poisons. So far (day 5) things are fine, this was not the case on the last cycle. There is usually a feeling of intense well being the first couple of days after treatment, no doubt related to industrial doses of steroids used to combat the side effects of the drugs. There then usually follows episodic fatigue necessitating a nap of 1-2 hours on days 4 and 5. The nap is non-negotiable. The second week is usually benign with slow and steady recovery of energy. Last week I suffered from a profound decrease in appetite, no taste for food and I got behind in my hydration. This was undoubtedly worsened by our unprecedented heat wave. The result was unneeded weight loss, one of my enemies. We have come up with some strategies, which include tapering the steroids more slowly; recording food intake on my calorie counter and Deborah has found a formula for a high protein drink, which is palatable.

So is there any objective news of response? Since starting therapy my liver function tests have normalized. My albumin (protein) dropped but I am hoping this is related to the weight loss and dietary mischief. I plan for 1 more treatment commencing July 20, a CT scan on July 24. (Donovan’s Birthday).  This will tell me if there has been a response.

Much to my chagrin the promised timeline for the genomic testing has not been met. We still have 2 weeks but it was understood that this information was to have been available 1 month ago. Escalating messages are now commencing.

Am I still working? The short answer is yes. Two ½ days every second week. I still enjoy the patient contact and it is hard to walk away from 31 years of doing what I always wanted to do.

I am also wrapping up some research projects. Over the last month we have completed 2 papers, which are being submitted and have had 2 posters accepted for the upcoming International Diabetes Federation meeting to be held here in November. We are also completing filming of our virtual diabetes centre, more on that as we get more material uploaded to our site.

Naturally this summer did not go as planned. We were to have left for Prague on June 24, then to Denmark for a cycling tour June 30. Deborah was to return home on July 8, the Pope and I were to then play golf in southern Sweden, followed by defense of our championship at the King Leopold III invitational tournament and then a quick few days experiencing Irish golf. My friend and stellar TWA member gracefully took my place as the Pope does not travel well alone, he is often challenged as to where he has left his glasses, which causes a cascade of often unrelated but stressful variables. Peter and he are now in the south of Sweden and shortly will travel to Waterloo for the tournament.

The Falsterbo Golf Club Southern Sweden
Peter anxiously awaiting payment
Somehow the Pope convinced Butler to take his clubs to Europe. The night before he was to leave for Europe, he deposited his golf bag at Peter’s and then scurried off to Europe. Peter had a first class Air Canada ticket to Copenhagen. He presented to the check-in and was unceremoniously informed that the second golf bag was indeed not within his bag allowance; apparently the second bag is “not really a bag”. Peter is an effective debater with some valid points regarding what is indeed a bag. Unfortunately the argument feel apart as the weigh scale read 75 pounds! This is half the Pope’s weight! The charge, a sweet $225.00.

Nevertheless, he paid $5K for the ticket; try to earn some customer loyalty!

Another example of the company motto:
                                                     
                                                      
 WE’RE NOT HAPPY UNTIL YOU’RE NOT HAPPY


My diminished workload unfortunately does not lead to too much mischief; I continue to read a book a week, a real luxury. This leads to a trivia question? What do the Beach Boys, Elon Musk and the Wright brothers have in common?

Answer: Hawthorne

Beach Boys lived in Hawthorne and went to Hawthorne High School. Elon Musk’s SpaceX rocket assembly plant is in Hawthorne and the Wright brothers lived on 7 Hawthorne in Dayton Ohio. Naturally this is a plug for you to read “The Wright Brothers”, a fascinating tale of things we never learned in school.
Hawthorne High School
7 Hawthorne Wright Family Home

                                                
SpaceX Factory Hawthorne CA
Until next time.

Saturday, 4 July 2015

Heat, Chemo, Canada Day and a Rant






Dr. Hugh Tildesley

We are now into our second week of unrelenting sunshine and record temperatures. I am surprised that LA man Hamish cocoons himself in our cool basement waiting for the sun to go down and temperatures to drop. As he goes for his usual nighttime walk I look carefully that his dental work is intact and that he is not wearing a cape.

These temperatures are not good for chemo man, I need to keep up with fluids and so far it has been incredibly challenging. Like Hamish I stay out of the sun and keep cool. Golf is ill advised under these conditions. I have to admit the temperatures and the chemo have sapped me somewhat. I met with Dr. Wong today and we have come up with a few strategies to mitigate against side effects, which include fatigue and early satiety.

The past few weeks have seen many cards and letters arrive. I am touched. I apologize that I cannot answer them, but that should not be considered a lack of appreciation.

I love reasons to celebrate. Christmas, birthdays, anniversaries, special memories. Canada falls into that category. It was a busy day.

I was to have played golf in the morning but demurred due to the heat. I did go to the club, as we were to celebrate George Seslija’s birthday.

A little background. George moved back to Vancouver from Toronto about 8 years ago. He had been a longtime friend of Kurt Aydin, and joined our group on a regular basis. George is a very good player but a better dresser. After a few games with him I introduced a new $5.00 reward (those who play with me know I will offer $5.00 rewards for difficult shots etc., they are not bets, the recipient keeps the bill if he executes a called shot). The new reward was called the “ Georgie”, awarded to the best dressed on the first tee. He won the first 8. As this process progressed, the group changed. Russell bought some new hats, abandoning the salt stained, faded caps he usually wore. Butler began wearing the latest samples given to him by high end manufacturers, Slugger got his treasured Scottish sweaters out of mothballs, unfortunately Aydin insisted his tacky red belt and red shoes was some how fashionable (needless to say he never won a Georgie). Now on the first tee there is in fact some preening as lobbying occurs for the reward.

George is serious about many things but clothes are near the top. He is a Harry Rosen customer, he does not shop there, he has his clothes tailor made by Harry.

The group gathered and awaited George’s arrival. As he made his way to the table, dressed in a red shirt, red belt and white shorts he was in full Canada dress code as were all at the table. George does not walk, he saunters, he will often stop to greet and shake hands with his fellow members. At times it is as if he was on a modeling gangway. As he sat down, staff presented the table with a bottle of Veuve Clicquot and his birthday was toasted. This formality completed, AJ Papp played “Dedicated Follower of Fashion “by the Kinks from his iPhone.
Simultaneously he and I sang aloud a particularly colorful verse:

Round the boutiques of London Town,
Eagerly pursuing all the latest fads and trends,

His gift from the group was a rare bottle of Gin and designer martini glasses to honour his favourite drink. He did not need to say a word, the smile said it all.

Donovan entering Bird's Nest Stadium Beijing 2008
Canada remains very important, especially having had the honour to attend 3 Paralympic Games as a team member and accompanying Donovan as the 2008 flag bearer.


That evening we had a Canada Day dinner. Catherine decorated the garden, and the whole family pitched in for a meal of flank steak and lobster tails. We had Bruce and Christine Arroll join us along with Drew and Alice Thompson. The Arrolls are from New Zealand but spent a number of years in Canada as Bruce pursued studies complimenting his MD. He is a highly successful researcher and well published.Our children played together frequently and still remain in touch. The Thompsons are of course long time family friends and in fact their daughter Emily graduated from medicine in Auckland and the Arrolls were incredibly helpful in both her and her husbands career. Emily and her husband, both MDs, and now in residency programs are doing well in their adopted country. Why they are not welcomed back to Canada will be the subject of a future rant.

Round 3 of chemo starts on Monday, there are few advantages to the poisons but I have noticed that mosquitos that bite me quickly nose dive , succumbing to acute  chemo toxcicity.

What follows is not required reading:

I have time on my hands. The Internet diabetes management takes less than an hour per day and frankly is a lovely distraction. I have more time to follow the news and current events.

The Vancouver Plebiscite: Time for a rant!

In collective bargaining there is a strategy known as “triangulation”. This happened to our Residents and Interns Association in 1980 when we were bargaining for improved working conditions in Alberta. I sat on the negotiations committee trying to get a contract for the group. At the time I had returned from being a GP to pursue postgraduate training, I worked 60 + hours per week for $14,200.00 per annum. As a GP I had netted 70K and worked less. Residents were defacto employees of the hospital; we had individual contracts with them and were paid directly from their payroll. When we tried to bargain, the hospital would posture and say” Oh no we can’t decide on your wage, you bargain with the Alberta Hospital Association”, when we approached the AHA, they said,” love to give you raise but it comes out of the hospital budget.”  Beautiful.

When a strike was called magically a bargaining committee with both AHA and Hospital representation was struck and a long lasting mechanism of negotiations was set in place.

In Vancouver we have an entity called Translink. It spends $1.5 billion dollars a year. An unelected board appointed by the Provincial Government supervises it. It has a reputation of bloated, overpaid management, arrogance and inefficiencies. More importantly the public has lost faith in the organization and it’s governance.
It’s funding sources look like a Pac man game:

Fuel tax-24%, (17 cents per litre)
Property tax 21%, (increase 3% per year to keep with inflation)
Fares 32%
Parking tax 4%
Bridge tolls 3%,
aircare 6%
Power levy $2.00 per month per household.

Of course all of this comes from the same place, the citizen but who has the time to question this paper trail.

Recently a plebiscite asking for .5% increase in sales tax to fund capital improvements for the system. The total would be $8 billion over a decade. Our local mayors spent approximately $7 million to convince the citizens to vote yes. In spite of elections last fall none of these candidates ran on a “yes” platform or gave any hint of spending these funds in this manner. The taxpayers association paid $40,000. of donated money to support a “no” vote.

The result was a resounding NO

Now the triangulation game.

Mayors: we never wanted the plebiscite anyway, the Province made us do it!

So why the hell did you spend $7 million of our money to try to manipulate the outcome!

The Province: The mayors could not be trusted with the process, the public has spoken! After all 2/3 of the funding was already guaranteed by Federal and Provincial governments (mmm where does that money come from? You and me the taxpayer)

Translink: It’s plethoric, self important windbag of a CEO had the gall to say the vote had nothing to do with translink!

If this guy actually had to get elected he would quickly understand how out of touch he is.

In fact our citizens went on strike. We want a separate elected board that has to face the public, not hide in in camera meetings. It is called responsible government. The harsh reality is that Translink is irresponsible, tax payers are demanding better.

Here endeth the rant.