It’s that nervous time of year again

From comments in the press about marks being adjusted for the stiffer A levels so that the trend doesn’t show a big dip (!) I guess it’s that time of year when youngsters nervously await the results for tests they took a month or two back. For me my test was on Monday and the results came in today. So my waiting time was only a couple of days (but it happens every three months not once a year).

For a while I have been receiving text messages when I make a blood test appointment, or indeed any other appointment (“Your appointment at Chinnor is with Mrs J C (HCA) on Mon 14 Aug 2017 at 10:20. If you no longer require this appointment, please call [the surgery]”). With the advent of smart phones this can then be directly entered into my phone’s calendar although it isn’t smart enough to write it on the all important calendar on the kitchen wall – I have to do that. I also get a reminder the day before (“You have an appointment booked at the Chinnor surgery for Monday 14 Aug at 10:20. If you no longer require this appointment, please call the surgery”) which is helpful. I am now getting similar (but, I felt, slightly more threatening in tone) texts from the hospital. The first one (a week ago) said “We’re expecting you at Stoke Mandeville Hospital on 16/08/17 09:20 for a Clinical Oncology appt. Non-Attendance costs the NHS approx £160. Please reply ‘YES 9395’ to confirm attendance, ‘REBOOK 9395’ to rearrange or ‘CANCEL 9395’ if you no longer need to see your doctor/nurse. Reply STOP to opt out. Thank you”. OK thanks for the reminder and letting me know how much a missed appointment costs. At least you haven’t said you will bill me if I miss my appointment.

So I dutifully texted “YES 9395”. I wonder if I would have got a further reminder if I hadn’t replied or would it have escalated to a phone call? Then two days ago I got a further reminder “Please be reminded of your appointment at Stoke Mandeville Hospital on 16/08/17 09:20. Each missed appt costs the NHS £160. Thank you for your support.”. Actually I think all these reminders are very helpful and if they reduce the number of missed appointments then that is great.

We duly turned up to see my oncologist and the STAMPEDE trial nurse who told us that my oncologist is returning home and so I will have different one next time. A shame but these things happen. Now it was time for the results. Broadly speaking OK with a bit of a variation on the numbers. My platelets are down a bit (83 instead of the recent high of 116 which I reached in May – platelet counts are not a precise art so any two counts on the same sample will be different) but I will have a discussion with haematology next month. My HbA1c (blood glucose) was virtually unchanged.

As for my PSA level, that has drifted upwards to 0.36 but is still within what my oncologist referred to as the green zone. While anyone who has had a prostatectomy would be concerned when their PSA approached 0.2 ng/ml my green zone is anything below 4 or so (and the threshold of concern would be 10). I was told of the options that would be considered if my PSA headed towards 4 or 5 (depending on how swiftly it headed that way). These included oral chemotherapy, radium and androgen receptor blockers. Looking up articles on androgen receptor blockers I discovered that apparently variant androgen receptors have a protein called SUMO attached to them in treatment resistant prostate cancer cells. By removing the SUMO protein, they have shown that variant androgen receptors levels are reduced which suggests that the SUMO protein helps to drive tumour progression. So I guess I may be heading for assistance from SUMO-wrestlers. (Sorry I couldn’t resist that.) However hopefully that, or some other treatment, is still some way off – on current trends four or five years.

PSA combined

Meanwhile I do have an irrelevant question: On an automatic car if you are in Neutral, rather than Park, why do you have to push the gear lever forwards to go backwards and pull it back  to go forwards? Someone came up with the order PRND rather than PDNR but I have no idea why. (For those of you who still drive a manual or ‘stick-shift’ car rather than an automatic P is Park, D is Drive, N is Neutral and R is reverse).


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