Tuesday, July 28, 2015

Cancer a good death?

Dr Richard Smith believes cancer allows people to say goodbye and prepare for death. Photo / BMJ

Dr Richard Smith's view of death by cancer really appeals to me. The former editor of the British Medical Journal is quoted as saying terminal cancer is the best death because you can....
"...say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion,"

He accepts that this is a
"... a romantic view of dying, but it is achievable with love, morphine, and whisky. But stay away from overambitious oncologists, and let's stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death."

Thank you, Dr Smith. I'll have that on my mind as we debate the benefits of going on Abiraterone and Prednisone with our oncologist next Tuesday... But I'm doing a lot of more interesting stuff than "last things" at the moment... And, when that time comes, as a card-carrying Methodist, I will have to think about the whisky... Maybe, like lots of other things, that doesn't matter any more!

Thursday, July 23, 2015

Another Committee - but great news!

Image result for end of life choice

I've just been emailed with the news that the Parliamentary Health Select Committee met today and has agreed to set up an inquiry to fully investigate the matters raised by the petition on end of life choice.

Hon Maryan Street's (and nearly 9000 others') petition asks that the committee “investigate fully public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable”. Health Committee chair Simon O’Connor has said today, “I would like to see a thorough investigation that covers as many aspects of this topic as possible in a responsible and robust manner.”

That is a great outcome, indeed the very best that could be hoped for, given the intransigence of most of our Parliamentarians on this issue. As one for whom a changed approach to the subject may have a very personal relevance some time in the not too distant future, I am really pleased that we have at least moved forward to this extent.

Wednesday, July 22, 2015

Busy days

It's been a busy time since my last post.

The Family Budgeting book is moving along reasonably well with something approaching a first draft getting towards 120 pages. It's absolutely fascinating what is turning up in the sparse records. I dare not count the number of volunteers who broke down under the sheer weight of demand through the years I am reviewing. I know of at least three personally, but in almost every town in the country there's a story of huge effort in the face of ever-increasing demand.

The huge input of government assistance has created a model that is so different from what we used to do in the 1960s and 1970s that the story really needs to be told. As the last "steam budgeter" with any knowledge of the national scene, I feel some responsibility to get it done - in spite of my commitment to myself a couple of years ago not to start any large project that I could not finish well before my "best before" date. So it's good to see it coming together.

However, the book has had to compete with quite a few other things.

We made a grand trip down to Hutt Valley, driving through some of the least-known main routes through the north island. I'd never done the Waitaanga route and we really enjoyed another run down the Forgotten Highway to Stratford where our motel provided the best view ever of Mt Taranaki.

I attended the weekend National Training Seminar for Community Patrol and then we had three or four days with the wonder Great Grand Kid, Cohen David and his parents. Saw his first dip in the local warm swimming baths. And guess who got to give him his first solid food - at four months... We had such a time with them... Another night in Upper Hutt with Bev's nephew Vaughan and Cushla and we were back up country in time for a last-minute chorus rehearsal. The ten days left us pretty whacked - but it was a terrific time of touring, family and singing.

Our Barbershop Chorus did pretty well at our own village's concert last weekend, together with a visit from the choir of Pinesong Village where we sang at their concert a couple of weeks earlier. And our men's quartet put on two pretty good numbers, our encore was musically pretty awful but it scored high on entertainment! We are having such a great time doing it.  It's back to rehearsal this afternoon for both groups.

Since then I've been heavily involved in helping the local parish address a running deficit of $2000 a month. It seems they spent $100,000 of reserves in the previous couple of years but were actually living on the same reserves for routine expenses. All reserves will be gone in December, so they are trying to do some kind of review of giving. They've had no stewardship education programme in place for at least 15 years so far as anyone can remember. Our congregation consists almost entirely of people who have been here less than four or so years and there's no "memory" of serious commitment through regular giving. Nor do most people have the slightest clue about the costs of keeping a church there in case they want to roll up now and then. The parish is in a growing area and is not declining. Indeed, a membership review last month produced an increase of nearly 30%. But we will not survive with the equivalent of a fulltime minister if the parish can't lift its giving. I've been asked to assist. But helping to raise commitment to pay for stipendiary ministry and property goes against most of my mission strategy principles. Of course, this isn't really a small parish so Local Shared Ministry is not an option. It's an unaccustomed situation in which to find myself.

Meanwhile, my fitness is pretty good. I've not had any major falls but, like a few of my age, have a bit of vertigo now and then. And my walk isn't as firm as it was. I guess the spine is probably feeling the pinch down around L4! We'll be watching that from now on, I should think. Especially if the PSA doubling time stays up around two months.

Now I am trying to put together a service for Sunday. Only my second in eighteen months here so I can't complain about having too many, I guess...

Thursday, July 2, 2015

Prostate Cancer Report

4 July
We're a day ahead of you, but to all our friends in the USA, have a happy day. We're both amazingly well and having a wonderful life and wish we could touch base with you on your special day.

Well, the Prostate update:  
My PSA test this week, just one month after the one mentioned below, shows a 50% increase for the month. That's higher than any increase I've had any time since diagnosis. We can't ignore that. (The increase is a more important measure than the actual PSA.)

I can extrapolate that increase forward for a couple of years and do the same with the 50% increases I had until we intervened with radiation last October. I can then compare how long it would have taken me to get to the same PSA level without the radiation. It looks as if the radiation gave me only three extra months. Of course this assumes both rates of increase remain exactly the same - that's pretty unlikely. So my prediction is a very rough guide. But interesting.

We already know that the average extra life expectancy for castration-resistant men who have chemotherapy is only about three months and we have figured the inconvenience wouldn't be worth that very small gain. Radiation was a more comfortable way of achieving what seems to be the same gain in final months. (And, of course, it was primarily designed to reduce the potential for compression on my spinal column, not particularly to slow up the general growth of cancer.)

So what about the hugely expensive Abiraterone? I am checking on that and have seen one trial report that suggested five months increased lifespan. So, on average, all these mysterious medical deals, for someone of my age and Gleason Score, don't promise a dramatically extended life. And $5000 for just one month's supply of Abiraterone could, according to this morning's paper, provide supplies for a whole term of the children's top-up breakfast programme in one school.

2 July
We got into the city in good time this morning and had a lovely lunch at the Wintergarden cafe - I don't think I've even been there before. Then we left the car in the Domain and took a pleasant walk in the sun over to the hospital for my three-monthly review.

As expected, this focussed on the sharp rise in the rate of increase of my PSA over a recent month. It was doubling in less than two months - a pretty dramatic rate. As before, we are not looking seriously at chemotherapy - the gain in lifespan is very small relative to the inconvenience and lifestyle issues in the therapy.

Aberaterone is likely to be the medication of choice now. It has recently come onto the free list - though hugely expensive, whoever is paying for it. And it's not a cure, of course. Furthermore, I'd have to take Prednisone along with it and that is not a very pleasant prospect. So we aren't keen to rush into that.

At my suggestion I am doing two more PSA tests so that in about a month we can look at the trend across three monthly tests and see if the increase is continuing. If so, then it would seem we will be availing ourselves of the generosity of the NZ public and accepting a longer stretch of a less comfortable life for a time.

Meanwhile, my only complaints are about the side effects of the Zoladex I've been taking for a dozen years. It's extraordinary to feel reasonably well and fit and yet have to make life-changing decisions to treat a condition that still hasn't made any discernible impact on me. I guess we will soon have the opportunity of balancing the issues. Meanwhile, excuse me, but I need to get on with writing a kind of history of Family Budgeting in New Zealand 1959 - 1978....