My great climacteric

Tomorrow, 22nd May 2013,is a significant day for me; it is the occasion on which I enter my great climacteric. A climacteric is defined as 'a period in which some great change is due to take place in the constitution', though whether this be for good or ill is unclear. These periods are said to occur when we reach an age that is a multiple of seven and an odd number; 7x1, 7x3, 7x5, 7x7, 7x9 and some say, in these days of longevity, 7x11 and 7x13. The great climacteric however, is 7x9 = 63

I'm not sure how many further 'great changes' my body can take.

Mid-May also marks the second anniversary of my cancer diagnosis. I was told by the surgeon that the mean survival time for those in my position, with renal cell carcinoma that has metastasised to the lungs, was just in excess of two years.

Now, were I to conform to the mean - that would result in a significant change in my constitution.

However, I do know that the medics and the NHS haven't yet, given up on me.

The MRI scan and the cystoscopy (11/5/2013) have come - but not exactly, gone. The MRI turned out to be a doddle. Concerned as I was by the prospect of being 'entombed' in the tunnel, I took what precautions I could. I discovered that there are two scanners in the QEH Imaging department and one is more spacious than the other. I opted for the former and then requested backup sedation from my G.P. After a telephone consultation in which I asked for advice on the maximum, sub-lethal dosage, she prescribed diazepam. I duly took my tablet at the recommended time and - experienced no change.

For extra insurance, I opted to take my sister into the scanner room. She was to be directed to stand at the head of the scanner and repeatedly assure me of the proximity of my head to life-sustaining, open space.

Ok, so I took some trouble over this.................... but when I was admitted to the scanner room, my concerns evaporated. This bright, spherical , techno-miracle was so different to the elongated toilet roll of earlier experience. It still made a racket when in operation but at least I was unable to hear most of it - I fell asleep.

Now, I await the results as to the origins of my acute back pain. Though fine today, having just returned from a walk through a seasonal, shallow blue ocean in Austey woods near Wootton Wawen with Mary, Pete and Keith, I have been immobilised and bed-ridden on other days.

I see the physiotherapist on Friday and the oncologist, Thursday week. I'm hoping that between them and the radiologist's report, they can come up with a narrative to account for what exactly is going on with my spine - and better still, some advice on how to improve it.

As for the cystoscopy, the 'preamble' went well but the insertion of the 'box brownie' scope came to an abrupt halt when the doctors advised me that they could not continue. I had just settled back, both hands behind my head, in order to watch all the action on the overhead monitor, when they quickly decided they would have to terminate the procedure.


Apparently, I have a stricture, a narrowing, of the urethra and this would mean arranging a further appointment and another procedure. My urethra would be dilated in order to progress and examine the bladder. This will be carried out under general anaesthetic.

To be honest, I wasn't too upset to be told I was coming back for a G.A. (as we say in the business) - but you had probably already guessed as much. Please, don't be misled, I'm actually pretty tough. I once had a rose thorn removed from my finger without any pain relief, save that from my mother 'kissing it better'.

This was quickly ruled out as an option by the medical team last week.

Green and pleasant land, dark satanic mills

Where to start?

To answer my own question, perhaps with 'the now'.

I am sitting at my desk, early on a bright, but chilly, Saturday morning. I am worried. Within a couple of minutes of emerging, larva-like, from my bed, I could feel the return of acute pain deep in my left buttock at the base of my spine. It had started again yesterday, just before my re-referral appointment to the QEH physiotherapy department was due.

I won't bore you with the details but this pain first occurred after a lengthy workout on an upright bike at Moseley School's Health and Fitness Centre. For a while, until the paracetamol kicked in, the pain was excruciating and I could only move if bent double with my head down to the floor. I was relieved when after a few days on painkillers, I was able to walk as before; not exactly a model of agility and grace but no worse than I had been for what feels like half-a-lifetime ago, when all this began.

The physio was good. He explained that this new, acute pain was probably different to the chronic, neurological pain in my back and leg. The new pain he said was the result of trauma  (exercise) and was probably referred to the base of the spine from higher up in the lumbar region. All will hopefully become clearer after I have another full spinal MRI, scheduled for a few days hence.

After previous, claustrophobic, experiences, I am not looking forward to that. It has been ordered by the oncologist after hearing about the acute episode; I think he wants to check for further spinal metastases. For good measure, at the same consultation he ordered another cystoscopy.

'It was only a light pink', I whined after hearing his response to my telling him of a few occasions of blood in my urine (aka haematuria - it sounds more principled in the Graeco-Latin). 'It doesn't matter to him', I mused uncharitably. 'He just clicks a button'.

'And it only happened twice!'

'Three times', Diana added, treacherously.

So, I emerged with a double whammy - and now, this damn acute pain has returned to add another woe....

Enough. Time to change the record/cd/iPod playlist................

I was right about Geoff's funeral (21/4/13). It was emotional and it was special - attended by a sea of mourners. We said 'goodbye' at the crematorium and celebrated  his life at an amazing wake in the church hall on Billesley Lane. It was the kind of event with much music, food and drink, that Geoff would have organised - which, in a way, he had.

It has taken, it is taking, a long time to process the events and emotions of that day. Even now, I can feel my mood changing as I type - so I'm not sure that I can write about some of the darker 'stuff' that hung over me like a dense cloud last weekend. We were on Tees-side, a trip planned well before Geoff's death. It is an area of which I had no knowledge beyond the descriptions of an emigre, now honorary Brummie, Neil. He recommended RSPB Saltholme in the Tees estuary and a visit to the famous transporter bridge as well as hinting at other more pre-industrial delights.

We booked two nights in the Premier Inn on the Tees barrage and promised ourselves further nights at more picturesque accommodation as we wended our way home through North Yorkshire.

In one of Saltholme's bird hides, a knowledgeable and friendly RSPB volunteer explained that the original inter-tidal, estuarine, mudflats originally covered more than 14 square miles - but that was in pre-industrial times. Following extensive land reclamation, this very special habitat was now reduced to a few hundred acres.

Saltholme's scrapes and pools are not tidal but combined they elbow their way into a space between the industrial skyline of Middlesborough and the truly impressive chemical works to the south of Hartlepool. The backdrop for the many visitors to the reserve is a filigree pattern of poles, pylons and tall sky-piercing chimneys linked by horizontal pipes; the superstructure of the chemical works. It may sound strange, sacrilegious - even pretentious - but the vista brought to mind the ornate decoration of high-Gothic, rood screens in a mediaeval cathedral.

After the avian delights of Saltholme we moved a short distance up the road to the gleaming, muddy delights of Seal Sands and the Tees National Nature Reserve, remnants of that vast inter-tidal zone mentioned above. Thence to Hartlepool's historic highlights before the frustrating search for something to eat.

Meanwhile a dam of emotion threatened to burst at the most inappropriate moment; at breakfast the following day. I wanted to explain to Diana that I felt myself to be a fraud. There and then, I had to put the stopper back in the bottle; this was neither the time nor the place. Back in the hotel bedroom, I uncorked. Someone had recently said that I was 'inspirational' and others too, reading this blog, have used similar words. They - you - do not know the truth. I am at times a complete mess, hiding behind this jaunty veneer of amusing anecdotes. There is nothing admirable about my fears now made more real by Geoff's death.

But despite Diana's ministrations, I cannot escape the paradox - even this blogged confession has elements of the artful..................

We abandoned the ideas about North Yorkshire and drove home via Redcar, o'erlooked by the Tata steelworks, the Victorian resort of Saltburn and the beautiful Cleveland hills.

Parallel lives

It has been an eventful, emotional, blog-inhibiting few weeks.

My fellow kidney cancer sufferer and good friend, Geoff, has died. Three weeks ago he was admitted to Queen Elizabeth Hospital (QEH) following difficulties with what, at the time, was thought to be a stubborn chest infection. When I first visited him on the 6th floor he lay on his bed in his pyjamas hooked up to a network of translucent tubing as though he had recently struggled free from the grasp of some predatory spider and had yet to wipe the strands of web silk from his body.

In his own words, he looked like a recently-released inmate of a WW2 concentration camp. With sunken cheeks, a grey pallor and little bulk to his once burgeoning limbs, he spoke softly and with dwindling energy towards the end of brief phrases. It was distressing to see him in such a weakened condition. At the same time we and his family really were comforted by the knowledge that he was receiving good care, that he was in the right place.

In the following days, it gradually became clear that he would not be coming home. I managed to visit him just once more and he spoke then of his wish 'to go'. In the few minutes we had, even now at the end of his life, he sought reassurance that I and others would continue the fight to save our allotment site (an issue that had first brought us together more than twelve years earlier). I briefly stroked his head and wished him 'safe journey'. We shook hands. His grasp was still firm. Each of us knew what the other wanted to say.

He was transferred to St Mary's Hospice the following day and died peacefully in his sleep two days later with his family around him.

I will be, I am already, missing the 'big man'. In truth, I have been missing him for many months, ever since his illness robbed him of the strength and mobility required to enjoy our old life. Our friendship had been infused with a new and special quality from the time we were both diagnosed with kidney cancer nearly two years ago. We both had the primary tumour removed and the corrupted kidney with it. We were both informed that our cancer had metastasised to the lungs (principally) and were both administered oral chemo medication.

We have shared many conversations laced with black humour about the nature of our parallel lives; both grammar school boys from county towns, teachers, early marriages, divorces, re-marriages, second families, love of  open spaces, neighbourhood communities and finally, illness. We have shared journeys to the QEH Cancer Centre and restorative visits to Winterbourne Gardens. We looked to each other for help in knowing how to live with our condition - and now he has gone.

Geoff would not want us to seek his beatification. For all his faults and possibly because of them, he was, he is, loved by many people. His funeral will be a sad, moving and very special event.

I will continue - and a more fortunate person for having known him.

Waste; the final frontier.

I am now two weeks into the current 6 week chemo cycle (weeks 5 and 6 being drug-free), my 14th. I continue to oscillate between optimism and the 'slough of despond'. At this precise moment, I'm feeling good - largely I think because I've had a couple of (modestly) thorough workouts on exercise bikes both here at home and at my old school's Health and Fitness Centre.

But then, I am reminded that I was feeling similarly upbeat just one short week ago; my exercise regime was on the up, my weight down (marginally) and I was back to juicing and making smoothies using our home-made, organic, almond milk.

Then, on the Friday morning, just as we were preparing to leave for a forecasted wet weekend in Southampton, Di called to me from the bedroom, to say that the green waste lorry was outside, on the road. She knew that I had recently filled three bags with woody clippings and trimmings from the garden and was ever-hopeful for a collection.

I kerlumped and plodded into action.

The three bags left on the patio had to come through the house. They were not heavy but they were bulky. Leaving all interconnecting doors open and various ornaments and household papers strewn across the floor, I reached the front door.

'Too late, they've gone,' added a distant voice, helpfully.

I was already too breathless to tell Di of my instantaneous decision to pursue the lorry. I decided that the front door, as with all the others, would have to remain open.

If all this already sounds a little over-the-top, you have to understand that, in our part of the solar system, green waste removal is not subject to any known laws of physics. Comets are more predictable - and more frequent. It was, and is, necessary to seize the moment; carpe temporis punctum.

So, by the time I'd opened the door and reached the pavement, the wheezing, cumbersome bulk (that's the lorry, by the way) had disappeared from view. I quickly resolved, reverting to my pre-cancer mindset, to run after it. Here, after all, was a man who had exercised just the previous day on an elite model exercise bike for a combined total of 45 minutes, burning more than 250 calories in the process and who still had the strength to walk around the perimeter of the local golf course. The vehicle had to be somewhere just around the corner. I didn't wait to do the maths - it was a no-brainer.

By the time I had reached the crossroads, looked right and spotted the stationary lorry some 300 metres further up Cambridge Road, I had been forcefully reminded of my new status. It was as though my waist was attached to some strong, inelastic, rubber rope that permitted me to move but only at the cost of increased resistance. An alternative analogy would be that my veins carried, not oxygenated blood,  but the product following its mixture with my toxic medication, molten lead.

Encouraged by the fact that the vehicle was motionless, I continued my pursuit, catching up and then overtaking, an elderly neighbour, Rosemary. With my bulky load I pushed her, with arms splayed, to the wall  and exchanged a few incoherent words by way of apology and explanation. After further exertion, I realised that I had been spotted by one of the hi-viz-jacketed team who waited nonchalantly for my arrival then helped me to throw the bags into the rear of the vehicle; for that at least, I was grateful.

I was wrecked. I slumped forward with rubbery hands on rubbery knees. The rubbery band, against which I had so recently strained, had reached maximum extension but far from pulling me back, now required that I  fold it up and return under my own steam.

I reached a bemused, but patient, Rosemary, who, at nearly 80 years, has, on occasion, been the recipient of community-care type interventions on my part. Now she, her brow furrowed with concern, insisted on walking me home. This frail, white-haired woman with poor eyesight and dodgy knees, took hold of my hand and hobbled with me across the road and back to my, still-open, front door. So much for my regained athletic prowess. I was reminded of what I had irrevocably become - needy and knackered.

I felt deflated for much of the weekend in Southampton, recovered by Sunday, (thanks, in part, to a late-night chat with Mike) only to hit more choppy waters on the Monday -

and so it goes, and so it goes.

Here be dragons.....

In former times, both the prospect and undertaking of travel have (usually) been a source of enjoyment. Since being diagnosed with kidney cancer and scoliosis of the spine however, my feelings have shifted. I want to use whatever time is available to see, to meet with, to experience both known and unknown people and places but I am also more circumspect about moving away from home with its comforts, security and routines.

All this is a preamble to recording that we have just returned from a few days in north Suffolk exploring the coastal region between Southwold and Aldeburgh. This is the area in which we were staying last Christmas (There and back again; 08/01/2013) but having received the gift of an overnight stay in a Suffolk village coaching inn from my sister, we thought it a good idea to turn the single day into a longer, exploratory holiday and then tacked onto it a weekend with the extended family in Norwich.

I particularly wanted to sample, with Di, the delights of Minsmere RSPB reserve. It did not disappoint - and neither did Di. She was so enthused that we spent the larger part of two days there. Safe within this wildlife sanctuary it was as though we could take long, deep breaths as the wheels of  the world slowed. Against the backdrop of the distant 'Taj Mahal of the nuclear age', Sizewell B power station, we scanned acres of brackish, shallow pools bespeckled with all manner of ducks, gulls and waders. With the help of various fellow-birders we spent hours in various hides disentangling our teal from our wigeon, our snipe from our redshank, our shovellers from shelduck, our avocets from exocets.

Walking alongside extensive, straw-coloured, reedbeds we briefly glimpsed the Wellington bomber of a bittern in flight and the dark and sinister spread primaries of hunting marsh harriers. We would have spent a third morning at Snape RSPB but the weather took a turn for the worse, reducing visibility and thereby our chances of seeing very much birdlife.

Thanks to an emailed suggestion from my friend John, exiled in London these last forty years, we also discovered the unusual, heather-cloaked 'sandlings' of Dunwich Heath which rises above Minsmere on its northern border. This elevated position is the reason for the location there of a block of old, white-walled, coastguard cottages now available for rent from the landowners, the National Trust. We will try to book a week very soon.

Finally, if you don't know Framlingham, it is well worth a visit. A barman insisted it was rated one of 'the ten best places to live' within the UK - but he did concede that it still lags well behind Moseley in Birmingham.The curtain-walled castle is enormous, signifying, as does the scale and wealth of the nearby church, the former status of what is today a small, relatively-unknown, market town. Now downgraded to a position where it is approached only by network of B roads, Framlingham's history and heritage leave us vestiges of the world of those who came before.

But to return to the theme of the first paragraph; however interesting, informative and delightful travel may be; however rewarding it is to see family and sites of familiarity - climbing into my own bed takes some beating. So here is another paradox; my condition provides both a stimulus to experience a wider world while at the same time, serving to shrink my horizons. In the last two years I have travelled to more places than ever but never been so fearful of the unknown obstacles that may arise; the furniture in a restaurant that makes sitting so uncomfortable, the bed that is too short or too lumpy, the inability to follow the diet that has become so central to my health, the prospect of mislaying my medication.

It is as though the psychological map of the known world has grown smaller and the uncharted oceans with their unknown lands, bear the medieval warning; 'Here be dragons.......'

'Keep right on to the end of the node........'

I promised that I'd let you know about the scan and blood results that were due at my oncology appointment today (Thursday 28th February).....

The news is good. Well, better than 'good' - it's just about fan-flipping-tastic.

To recap; around 4 months ago, I had asked for and been 'granted', a reduction in my 'chemo' medication (it goes under the brand name Sunitinib - 'soo-nit-i-nib') because of  the increasingly-intolerable side effects. The worst of these was 'sore feet syndrome' which made it nigh on impossible to walk more than a few metres in the latter stages of the period in which I was taking the drugs (weeks 3 and 4 of the 6 week cycle).

The 25% reduction in the dosage had the desired effect; my feet have been less sore and I have been less fatigued. However, one big question remained; how might the reduction in the dosage have impacted on the effectiveness of the drugs? A recent CT scan would help to answer this and it was these results we expected today.

So, we learned that the lymph node in my chest ('near the heart') had shrunk and the 'small' nodules in my lungs were 'stable'. My bloods showed a slight increase in haemoglobin (which is also good), my white blood cell count was ok as were my liver, kidney and thyroid function.

It doesn't get much better than this. We even spent some time with the registrar discussing possible options for further reductions but this is a complex issue with a balance of risks and technical stuff to absorb. What is  apparent is that our two parties look at things differently; the medics favour my taking the strongest dose I can tolerate while we favour taking the minimum that is effective in keeping the nodules under control. The big problem is of course cell mutation. Eventually the disease will seek and find a way around the drugs - then there may be other drugs available but they too come with significant side effects.

Never mind, all that's for another day. We have learned to live for today and today was good - even the sun agreed. We had a celebratory lunch of baked potato and beans at Winterbourne and then drove out to Worcestershire for a garden centre experience.

While writing of memorable days; don't forget that Sunday week (March 10th) is Mother's Day (note the apostrophe - apparently we celebrate a singular mother, our own, not all mothers).

Twenty-one years ago, Joe was just three weeks old when this event took place. I intuited his wishes and delivered a card on his behalf. It read;

                                               Mum’s the Word

                                            (Mother’s Day, 1992)

                                      Through my eyes, I see your face

                                      now coming into view

                                      through my mouth, a storm subsides

                                      the comfort drawn from you

                                      through my skin, I feel your skin

                                      a warmth I sense anew

                                      and sounds and scents are strangely known

                                      as though we are one, not two.

                                      So, though I cannot say the words

                                      I want you to know it’s true

                                      and for a voice, ‘til I can speak

                                      my dad’s will have to do.

                                      He writes these words; the first is ‘mum’,

                                                 then ‘I’ 

                                                             then ‘love’,

                                                                            then ‘you’.

I'm just hoping that I won't need to intuit in 2013 (for any of my progeny).

The proof of the pudding....

Who said that romance is dead? A couple of weeks ago I took Diana for a uniquely amatory experience - a 'rawmantic dinner' at a private house just around the corner from where we live. You think you know what is going on in your neighbourhood but here was a new world of raw vegan food - on our doorstep.

Now, I know what you're thinking; 'the cheapskate - taking Di out for a lettuce and raw carrot salad followed by an artfully-sliced apple'.

Think again.

This was a delicious, four course meal of exquisitely intense flavours. We sat down with two other couples, the hosts and a visiting female trainer (in tantric yoga - seemed appropriate) living in France. We started with a fresh fruit and beetroot-coloured juice in a flute, the rim of which was frosted with psyllium husks. This was followed by a spicy, cold soup again of a blood-red colour derived from beetroot, with an accompanying 'pumpkin cracker' made in a dehydrator. Then we enjoyed a couple of sushi-like delicacies consisting of avocado and sprouting seeds wrapped in some kind of seaweed. The 'main course' was a raw vegan lasagna with 'courgette pasta' and a filling of, among other things, cashew nut paste. This was served with a sprouting seed salad (probably alfalfa or broccoli). The 'pudding' was a slice of a carob-topped 'torte' with a fruit filling and whole grapes on a dried nut base. To conclude, we enjoyed two exquisite after-dinner, heart-shaped, carob and nut-paste, 'petit fours'.

In terms of volume (my family's usual measure of a 'good meal') we hadn't eaten a great deal but in our post-prandial discussion we all commented on how satisfyingly-full we felt. I'm sure that this had something to do with the intensity of the flavours in this uncooked dinner so skilfully concocted from unadulterated ingredients.

If I could eat food like this all the time, I too could live on a raw vegan diet but I can't get away from the idea that our hosts must spend most of their time in the kitchen.

Meanwhile we continue with our more-modest, plant-based diet in the hope that it makes a contribution to slowing the growth of the tumours in my lungs. By the way, I have to take the medics word for the existence of these tumours. I don't currently suffer from any direct physical effects. I do suffer from the 'chemo' medication I trustingly swallow and from the sciatica resulting from the scoliosis in my lower spine but not from the cancer itself.

Apparently, scoliosis is more widespread in the general population than you might think. We sufferers should form a support group, perhaps with Richard III as our patron?

Meanwhile, we should learn about the all-important latest CT scan results this Thursday (28th) at my regular oncology appointment. The proof of this particular pudding could well be in the eating.

And if things have not gone well and if I do become less mobile as has my old friend Geoff, who suffers from a similar condition, I can now, at least, look forward to enjoying the greater variety of wildlife visiting the garden. Why? Because my generously-motivated brother has dug a pond for me. It is still at the stage where it needs the softening effects of plants and the covering of the unattractive black liner at the margins but its an exciting addition.

I have wanted a pond since Shakespeare shredded the reputation of the last of the Plantagenets - now, at last, thanks to recent excavations, I have one.