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2015-09-20 02:34:46 (UTC)

Ron Price's Present Health:Retrospect & Prospect On 14/11/'15

Last updated 14/11/'15

Part 1:

The following is a long and somewhat complex account of my present(14/11/'15), my retrospective and prospective, medical condition. This account is intended to bring anyone who is interested up-to-date with my several illnesses as I head through the 4th month of the 72nd year of my life(23/10 to 23/11). There is much that is left-out; I try to provide a solid core of information for readers with the interest. Readers are advised, though, to only skim or scan, search-out or slide-down to those portions of this annual letter or email which is of interest to them. For many, I simply advise that they stop reading now and, thus, save themselves wandering in a labyrinth of medical details about which they have little to no real care or concern, reason or regard for the content.

My health has deteriorated to such an extent in the last four months(July 14 to November 14) that:(i) I no longer write long emails to those who write to me; and (ii) I do not wish others to: (a) visit me or (b) call me on the telephone. Except for a small circle of family members, friends, and several health professionals, it is my hope that others among the host of my associations and friends accumulated over the years will NOT call and talk to my wife to get updates, or ask to talk to me.

My wife, Chris, is already on 'all-ahead-full' just to keep-up with the demands of life, of her family and of her current friendship portfolio. She is doing her best to cope with me and my illnesses, to say nothing of dealing with her 96 year old mother in an aged-care facility here in George Town. She does not need yet another half hour chat on the phone to explain "the whole thing again." In addition, she has her own medical problems which also keep her busy in one way or another.

If you really want to express your commiserations and well-wishes, offer me advice or ask me questions, send me an email or, as some do, send me a get-well-card. If you want to know about my health, how I am going, and how I deal with my health problems, then you only need to read this post and the update to this past also found at this online diary site. My first line of defense is to utilize professional doctors and specialists, and a very limited range of alternative medicines and practitioners.

My second line of defense is what you might call wisdom literature, a small circle of family members and friends as support, and a little reading and writing. "...follow the advice which Bahá'u'lláh has so repeatedly given in His Tablets namely, that in case of sickness we should invariably consult the most competent physicians, follow their Instructions and leave the rest in God's hands."--(Shoghi Effendi, referring to the Lawh-i-Tibb, Tablet of Medicine - Lamden)

Until this illness, several months ago, I was reading and writing for 6 to 8 hours a day; now I'm lucky if I get in one hour of literary work in a day. There are, as I say, several special and particular exceptions to some of the above framework, like the two other members of the George Town Baha'i Group(Reg: GTBG). I leave it to other readers to work out if, in fact, they are among those exceptions to my small circle of family members and friends here in northern Tasmania and Canada. I now have a list of some 200 people with whom I have come to correspond over the years; this annual letter here at this online site will save me having to reinvent the wheel so to speak, and repeat over and over again what can be read by everyone in one online site-place. This will save my energies to deal with my life, especially my literary life, which does not benefit from having to write about my health to anyone and everyone who contacts me in person or in cyberspace.

This one post will cover anyone and everyone who, for some reason or another, (a) receives my annual letter to family and friends, or (b) who reads this email as part of their email/internet reading. It will also save my few energies, as I say above, to enable me to carry on with other aspects of my life which will continue to occupy my attention, and enrich my day-to-day activity however minimally until that 'roll-is-called-up-yonder', as they say.

Part 2:

For many of the recipients of this annual letter this post will be all-too-much-reading. The Facebook-Twitter age is one which generally prefers the short, the sweet, and the succinct, to lengthy emails and letters like this one. To people with such preferences for the pithy, I simply say: read as much or as little of what follows as you want.

If you ever want to get an update on the condition of my health, you will find it here as I go through the remaining months of 2015, 2016, and whatever years of my life remain. This will save both me and you---and my wife---having to discuss the subject over the phone or, indeed, in person again and again. All that you need to know is found below and, perhaps, much that you don't need to know is also found below updated on 15/11/'15. On 15/11/'15 I began my latest post to update readers, and this latest update will now take readers to the last days of December 2015 and early 2016.

The autobiography sub-section of my website has a detailed information base about my life and the members of my family; my annual letters for 2015 and 2014 should bring any person with the interest in my life up-to-speed, as they say these days. This is especially true of my health information which is found updated, as I say, on 15/11/'15 in this my annual letter below. Given the sharp deterioration in my health, especially in the last 3 months(15/8/'15 to 15/11/'15), I felt the need to provide readers with "a general statement about the present state of my health." This statement can be found below with a skim or a scan, a search or a slide, to the parts of this letter, parts concerned with the details of my health.

Forgive me for some repetition in this annual letter; I do this to emphasize the points I am making to the readers who attempt to negotiate this somewhat long post. My experience in classrooms for over half a century also inclines me to repetition for readers who seem, for some reason or another, to miss the point unless it is repeated.

Part 2.1:

Among my several illnesses is pancreatic cancer. This sickness gives me only a 5% to 10% chance of living beyond 5 years, that is, beyond Australia's autumn season in 2020 according to the latest information I have. The unfolding of the details of my prognosis and experience will be placed in my updated emails as these details become available to me in the weeks, months &, possibly, years ahead.

The following was completed today: 15/11/'15. I have had several hospitalizations, interviews with doctors, specialists and GPs, and information updates, all of which I try to convey to readers in the following post. On 17/9/'15, for example, I had what is known as a PET scan in Hobart, and on 19/9/'15 I had a follow-up consultation with my GP here in George Town discussing, as we did, the results of that PET scan.

This is one of the most recent of my summary statements here at this online diary. It benefits from both these two visits to the medical world, one in Hobart and the other here in George Town. I also spent another 6 days in the George Town hospital(23/9/'15--29/9/'15), and another 6 days in the LGH(14/10/'15 to 20/10/'15). This is a hospital some 50 kms away from my hometown by the ocean and river near the Bass Strait.

The stage of a cancer is a measure of how much the cancer has grown and spread. Some cancers are also graded by looking at features of the cancer cells, using a microscope or other tests. The stage and grade of a cancer help to say how advanced it is, and how well it may respond to treatment. There are both aggressive and gentle treatment options. As a general rule, the earlier the stage and the lower the grade of a cancer, the better the outlook (prognosis).

Some one month ago now, on 14 October, I went to the LGH for a staging-CT scan to decide what was the stage of my cancer, and on 20/10/'15 Chris and I attended a meeting with a medical oncologist, a Dr Jeremy Power, and his medical assistant, a registrar-specialist, a Dr Rinku.

On 1 October 2015 I attended a clinic run by another medical registrar and a surgical gastroenterologist. The pancreatic surgeon and the oncologist were not present nor was Dr Pande under whose supervision as consultant gastroenterologist this is all taking place. A private meeting with him has now been arranged as is an interview with a respertory physician, a Dr Scott Parkes and a radiation oncologist( Dr Byram) in early November. Our personal funds are running out, but visits with these specialists do not cost Chris and I anything. And so there is no financial crisis in our lives--just this medical crisis.

The clinics and interviews, times in hospital and visits to my several GPs in the first 24 days of October have been intended to answer some of the several questions my wife and I still had about this disease. They were opportunities for both of us to ask many questions and, thus, flesh-out the details of how my cancer was likely to unfold. We were able to discuss the options I had in relation to how to deal with this invasive cancer and the possibility, the value, of an operation sometime in November or December, an operation to help alleviate the cancer and possibly cure it. As I write this update to 15/11/'15 it is looking less and less likely that I will subject myself to either chemotherapy or radiation treatment.

My wife and I have been and are searching the internet for information and doing the best we can to be as up-to-speed with the stage of my cancer, and with other aspects, of this pancreatic cancer and its many and complex ramifications in my life as it is possible to determine before hand as I go through the final months and years of my life, as predicted by the medical teams dealing with my illness.

Part 3:

In early September 2015 when I came out of the LGH, Launceston's major hospital, I had little energy to deal with daily life, and even less when I came out of the George Town hospital on 29/9/'15, yet again out of the LGH on 20/10/'15 and, finally, on 14/11/'15. I no longer responded to incoming emails in the kind of detail I once did. My replies are now short and, hopefully, sweet. I have not answered the telephone for the last five years after 60 years of extensive telephone use, 1950 to 2010. But I can be relied on, at least for the forseeable future, to respond to incoming emails within 24 hours. These responses will be, just to reiterate, short, sweet, succinct and, hopefully, not too sharp in their tone and manner, mode and style.

There are, of course, a small handful of people from the first 8 decades of my life, who still write to me in some detail about their lives and, although I was always happy to respond to those emails and letters within 24 hours in some detail, that is no longer the case due to my medical condition. My responses are now, and just to reiterate, short and pithy.

Readers should not see making a written response to what they read here as part of some sense of obligation, though; just reply to what you read here, if you so desire. If, of course, readers would like to have a detailed correspondence in some shape and form for whatever length of time seems necessary or desired, that is still possible, but my replies will be, as I say above, short and succinct as long as I am still alive and ticking, as they say, and as long as I am capable to writing emails of any length at all.

Part 3.1:

As I point out at several places on my website, my guesstimation of the total number of hits that my 5 annual letters to family and friends have received in the five year period, 2011 to 2015, is some 25,000. Most people who write to me now do so at various internet sites, some 8000, at which I am registered. I still get over 200 emails everyday into my computer email-in-box, but most of these require no response. My son, Daniel, suggested I set up a box for "internet garbage", but it takes less than a minute to delete the garbage without my setting-up a special box for this type of incoming "garbage" post.

Those who want to send me detailed responses about their lives do so either before, or after, reading my annual letters. Most people who read my annual letters have no interest in updating me about the details of their lives. Most people are happy with the Facebook-Twitter type exchanges, if they want to communicate at all. I have not been on Facebook and engaged in the short and snappy, succinct and swift exchanges characteristic of that SNS for more than one year.

Those who want to contact me do so now by email. Those who want to contact my wife now send her emails or call her on the telephone but, as I say above, it is best for readers to simply write to me by email if they feel they must offer their commiserations and well-wishings, their advice and ask any questions they may have.

Part 4:

It is clear, indeed, there is no doubt that I have pancreatic cancer; this cancer has an observed survival rate after five years of 5% to 10%. The type of pancreatic cancer I have is one of 14 different types. As I indicated above, from 1 October 2015 to 20/10/'15, I attended a range of clinics and interviews, had a number of tests and scans as well as a 3rd period of hospitalization---as I pointed out above. Dr Pande, a pancreatic surgeon(PS) will be present on 5/11/'15 for yet another crucial interview. I will also have a visit with a medical oncologist (MO) on 9/11/'15. A MO focuses on the surgical management of tumors, especially cancerous tumors like the one I have.

My interview with Mr Girish Pande, the Hepatobiliary and General Surgeon, under whose supervision this is all taking place is an important one. This is a private meeting with him at his surgical clinic, his "rooms." Our personal funds are running out as I say above but, except for the cost of petrol and the occasional meal, we are not out of pocket in relation to all these medical services.

The Tasmanian Public Health Services work to improve and protect the health and well-being for all Tasmanians. They work with many people and organisations across a wide range of areas and at all levels of government to: (a) protect Tasmanians from public and environmental health hazards; (b) prevent and reduce chronic (long-term) conditions at the population level; and (c) help people achieve their best possible health. They also: (i) assess and manage public health risks including environmental health, radiation protection and communicable diseases, and (ii) monitor the health status of Tasmanians to help inform decision-making and health priorities. The services I receive are free. My wife and I now have several health care nurses and quasi-professionals who are willing to come to our home for psychological and physical help.

Part 5:

Most correspondence, online or snail-mail, has its own individual lifeline. As I say, in these Facebook-Twitter days, lengthy letters/emails over a long period of time are now rare events. Lengthy correspondence which I often had in my middle age and late adulthood, correspondence that went on for years, is now a rare event. The majority of people who come to this document I am sure stop reading after several paragraphs for several reasons: complexity and length are but two of these reasons.

Section A of this annual email, which was originally found here is now found on another post at this site. Section A dealt with self-and-family. Section B dealt with my other, mainly literary, interests. I should add that I have permission from nearly all my family members to write about them, about their lives and activities; readers here should not be concerned about issues in relation to confidentiality and privacy, insofar as the information I convey is concerned. This post is concerned only with my health and not my family nor my literary life.

There is much in the lives of both myself and my family members, those significant individuals in my life as they say in psychology, that I keep private since there is much that is best left unsaid. As the famous Russian poet and novelist, Boris Pasternak, once wrote: "a life without secrets is simply unimaginable." Those not interested in the significant individuals in my life, but are interested in my health, can skim or scan, search or slide down to the condition of my health and my wife's below.

I'll cut-and-paste below the relevant part of a recent letter to a close friend in Canada, and add some details, to provide readers with a helpful picture of my current health due to its serious state, due its debilitating aspects; there follows, then, the details of what has now been described as a terminal illness. This is according to several GPs and specialists in the last 2 months.
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Part 6: Pancreatic Cancer, Symptoms: August-September 2015

Part 6.1:

I was diagnosed with pancreatic cancer while in hospital for one week at the end of August and early September 2015. I now have 5 supporting statements of my cancer's inevitable terminal nature by 4 GPs in George Town, and 1 in Launceston at the LGH. This is to say nothing of the diagnoses of several specialists at the LGH.

I now receive the Palliative Care Service centered in Launceston and in George Town. A palliative care nurse visits the home of my wife and I once every month or two. We have had our first visit. There are also 3 different community nurses who visit our home, or are available on the phone, on a needs and wants basis; we have already had visits from two of them and they are now ringing us to see if they can sort-out any problems we are having.

The Northern Tasmania Health Organization and the George Town Hospital and Community Centre also provide services as and when I need them. I can be hospitalized, as I was last week and whenever I need to be, on short notice right here in town. I also have access to "The Tasmanian Home and Community Care(HACC) Program". All of this has been set up for my health needs in the last month since I came out of the hospital in early September with the diagnosis of pancreatic cancer.

My wife, Chris, has been battling various of her own health and family problems for years and, when she has "run out of puff" to put it colloquially, I can go into the hospital within the hour if she has gone beyond her coping capacity. I can also visit my son, Daniel, and his wife and daughter for a 24 to 48 hour period to give both myself and my wife a change from the demands of constant medical care.

The following are the symptoms with which I have had to deal in the period 24 August through 24 October 2015 and, to some extent for the previous four months(23/4/'15 to 23/8/'15) depending, of course, on what particular symptom I had and which I have summarized below. Readers who would prefer to do their own reading can find plenty of information in cyberspace. Mine is just a summary which I hope is as relevant to readers as it is to me.

There are usually no symptoms in the disease's early stages, and symptoms that are specific enough to suspect pancreatic cancer typically do not develop until the disease has reached an advanced stage. By the time of diagnosis, in my case in late August and early September, the exact spread of my pancreatic cancer was not known.

Risk factors for pancreatic cancer include: (i) tobacco smoking; but I smoked from 1964 to 1994 and, this risk factor is, therefore, not significant in my case after more than 20 years of not smoking; (ii) obesity. I was obese from 2010 to 2015 and, then, over-weight. But my weight now is normal; and (iii) diabetes2. I was diagnosed in August 2015 with diabetes2; as I say, this is a risk factor.

Part 6.2:

Pancreatic cancer can be treated with (i) surgery, (ii) palliative care, (iii) palliative care with chemotherapy, and/or chemoradiation therapy, or (iv) a type of pancreatic surgery intended to keep the cancer under control and not metastisizing/spreading. The palliative care package(i or ii) are the treatments I am at present favoring. The adjuncts of chemotherapy and radiation therapy are not attractive; the surgery is the only treatment that can cure the cancer. There is only a 20% chance of a cure by this method, and there is always a risk of relapse and complications after the procedure. This is a 7 to 10 hour operation. The problems associated with this approach, though, are far from simple and clear. A combination of approaches i and ii for me, is my preferred option.

Treatment options are partly based on the cancer stage as well as a range of complex factors which I provide some outline in the following paragraphs. I will report on my decisions in relation to these options as they unfold especially in the months ahead, as the nature, the stage and the grade of my cancer is defined in more detail and especially after the interviews I have mentioned above from 4/11/'15 to 9/11/'15.

Readers should also read about what is called "An Advance Care Directive" which I put in place in 2012. An advance health care directive, also known as a living will, personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. and Australia it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.

In 2012, pancreatic cancers of all types was the seventh most common cause of cancer deaths, resulting in 330,000 deaths annually and globally. Survival beyond 5 years depends on the type of cancer. The survival rate beyond 5 years for me is 5% to 10% although, as I emphasize above, there is a 20% chance of a cure if I go down the surgery route. Wikipedia has a comprehensive outline of pancreatic cancer and its several major types; I encourage readers to go to that site, if they have the interest.

Part 6.3: Symptoms

1. Yellowing of the skin and eyes are part of jaundice, a painless condition which commonly occurs in people with pancreatic cancer. It occurs when an increased level of bilirubin is in the blood. This can occur when a tumor completely or partially blocks a bile duct of the liver, slowing the flow of bile. I have had a diagnosed case of jaundice for some 8 weeks. A stent was inserted in my pancreatic system while in hospital in late August 2015 and, by 23/10/'15 as I write this update, my jaundice has improved. The itch is no longer present. Those who want to know more about jaundice can easily locate the information in cyberspace. Since coming home from the hospital three weeks ago, this yellowing has lessened.

On 26/10 I will be having an ERCP involving as it does the removal of the present plastic stent and the insertion of a metal one. The gastroenterologists involved in this procedure is Dr James Hardity and a Dr Mitchell with whom I am in email communication.

2. Unintended weight loss is also a symptom of pancreatic cancer. While losing weight without trying may be welcomed by many, it can indicate something is wrong. It is one of the first symptoms of pancreatic cancer a person usually notices. I have slowly lost nearly 60 pounds in the last two years, and at an increasing rate as the year 2015 has advanced. One advantage of this process, if there is any, is that I no longer have problems with obesity or being overweight.

3. Nausea and/or vomiting is yet another symptom that is common in pancreatic cancer. These symptoms often result in a delay in a diagnosis as the patient tries to find out what is causing this nausea and or vomiting. These symptoms have been particularly present in my case in the last two months. I still have a mild nausea for which I am taking a medication. For the most part my diet consists of fluids, soups and sustagen, vanilla-custard, watermelon and small portions of my wife's meals. My vomiting has stopped; it only took-place on rare occasions in and after being in the hospital when I drank too much or ate too much. On 7/10/'15 I began to take haloperidol. The active ingredient of haloperidol & largactil is chlorpromazine hydrochloride, one of a group of medicines called the phenothiazines. I remember first taking this back in June of 1968. I stopped taking this in my last week in hospital, the period ending 20/10/'15.

4. Loss of appetite is a symptom of hundreds of diseases & conditions, including pancreatic cancer. It can signal something severe or even be related to something as small as a stomach virus. Medical procedures and scans, ultra-sound and tests of various kinds are necessary to make an accurate diagnosis of the various illnesses I now have. They have each and all confirmed my present disabling medical condition. I was diagnosed with pancreatic cancer, as I say again, and just to add emphasis, a terminal illness and, in my case, within 5 years I shall leave this mortal coil. This is the situation: a 90% to 95% chance of death within 5 years for those who contract this disease. This pancreatic-cancer disease has manifested these several symptoms enumerated here. It is my hope that my appetite will slowly return after beginning yet another new medication while In the George Town hospital.

The last several weeks of loss of appetite and these other symptoms have made for a difficult coping period. Although, on the positive side, and as I say above, I am no longer obese or over-weight. Even if all operations in the weeks and months ahead are successful, my life expectancy beyond five years is, as I say, only 5% to 10% with, of course, that 20% chance if I go down the surgical route.

5. Itchy skin is, perhaps, the most uncomfortable of all these symptoms. It is a less common symptom experienced by people with pancreatic cancer. When coupled with another symptom like jaundice, it can be significant in making a more accurate and timely diagnosis. Unfortunately, when someone with undiagnosed pancreatic cancer is experiencing itchy skin, it is often misdiagnosed as a dermatological condition. I have had a case of itchy skin for two months now increasing from week to week, but decreasing in the last ten days to the point where it has now gone.

The palliative care system in Tasmania, which I have become a part of in recent days, and my wife, are slowly sorting out this symptom of itchiness. Thankfully, though, I am the 1 in 10 who have this illness and experience no pain along with it. That is, indeed, a blessing!

6. Unexpected onset of diabetes 2 is, yet, another symptom. In some cases, pancreatic cancer may impede the pancreas's ability to produce insulin, resulting in diabetes 2. It is important to remember that most people develop diabetes 2 because of reasons unrelated to pancreatic cancer but, in my case, my diabetes 2 is part-and-parcel of my pancreatic problem. This is according to: (i) my gastroenterologist and (ii) my pancreatic surgeon who is able to remove the present blockage in an operation while I am in the hospital in November or December for two weeks if, indeed, I decide to go ahead with this operation.

I do not want to go ahead with any further operation/surgery. I had a PET scan on 17/9, and on 19/9 my wife and I discussed the results with my GP in George Town. As I say above, I had a range of interviews with specialists from 1/10 to 14/11/'15, and will have another set of interviews in the remaining days of November. My wife and I attended a these specialist interviews at the LGH for people with my particular level and type of medical malady and, at these clinics and interviews there are several doctors involved. On 7/10/'15, 8/10/'15, 20/10/'15 and 24/10/'15 I saw 4 different GPs here in George Town and I'll add some information below on the results of these visits, if it seems relevant.

7. Changes in stool and urine color are two final symptoms. Urine may become much darker, while stools lose their brown color, becoming a pale, clay/light color. This is often due to the bile duct being blocked. Stools can also have a odd, strong smell. While in hospital for a week in August-September 2015, I had an operation on my pancreas in which a plastic stent was inserted; my stools are now back to a normal dark brown and my urine, which was quite dark is now back to normal.
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Part 7:

Some General Comments on My Health: 2014-2015

Part 7.1:

I have posted the above details due to the complexity of my present medical condition. Readers with an interest in its permutations and combinations can Google to their hearts' content. The paragraphs above in relation to pancreatic cancer, and those below provide the information required to outline the details of my general health. As I say, and just to reiterate, send me an email if you want to write to me with your well-wishings and commiserations, your questions and advice.

I see my GP several times a year and, more frequently, in the last two months. I have three GPs here in George Town, one for a second opinion and another who engages in more detail with my wife as well as myself. I see a psychiatrist once every three years now, usually to help me deal with medication changes for my bipolar I disorder. I also see a renal physician, or nephrologist, once a year for my moderate chronic kidney disease phase 3, a mild chronic obstructive pulmonary disease, and the fine-tuning of my blood pressure. I also see a urological surgeon once a year for my enlarged prostate, & a gastroenterologist for several reasons: diverticulitis, gastrointestinal tract blood loss, a gastroscopy, and a periodic colonoscopy. In the last month I now see a second gastroenterologist for diabetes2(D2), jaundice(J) and pancreatic cancer(PC) and, finally, a pancreatic surgeon(PS) for my ongoing pancreatic problems.

Part 7.2:

With a podiatrist for my foot fungus and various other foot problems, an optometrist/opthamologist for my cataracts, the side-effects of D2, and an annual update for my prescription glasses; with my dental work in the hands of 2 dentists and 2 dental technicians to help me take care of my two partial plates and my last 6 teeth; and, perhaps most importantly, with daily chats with my wife and with occasional chats with my son Daniel and my step-daughter Vivienne, who has been a nurse for 25 years in the ICU and renal unit of the LGH, I am more than happy to pay tribute to the wonders of modern medicine in all its labyrinthine forms and sub-disciplines.

Whatever troubles the world is experiencing because of its ties with many outworn shibboleths in the fields of religion and politics, ethnic and nationalistic prejudices, failures to take science more seriously, problems associated with technology----the science of medicine among other sciences and technologies has transformed and continues to transform our world, at least for those like myself who have the advantage of being able to access medicine's several specializations and fields, and those of science and technology, especially the IT industry.

Part 7.3:

​For those who are into the vast tracts of alternative medicine, I am happy that you NOT write to me with your concerns and your advice for my several medical problems. I am in VERY good medical hands, and am enjoying the pleasures of retirement as I go through my 70s, although the recent turn for the worse and the pancreatic cancer has certainly taken its toll.

I have many local people who provide me with curative advice in the areas of alternative medicine, and several who provide me with: (i) supplements and aromas, (ii) medicines, and particular vitamins and minerals, and (iii) an assortment of meditation, yoga and mental hygiene techniques.It must be said, though, that I now use the many forms of alternative medicine very rarely.​

I also have access to: (a) homeopathy, (b) naturopathy, (c) chiropractic, (d) osteopathy, (e) energy medicine, (f) various forms of acupuncture, (g) traditional Chinese medicine, (h) ayurvedic medicine, (i) bowen therapy, (j) reiki and (k)a wide range of faith healing prescriptions. The internet, too, is full to overflowing with advice that I can access 24/7. I have benefited for decades, indeed, since my childhood, from advice in the many healing arts thanks to a mother for whom the subjects of healing and health were at the center of her religious proclivities, and a wife who takes more than a little interest in both science and medicine.

Part 7.4:

I now benefit on a daily basis, as I say, from having a wife who knows more about anatomy, physiology and general medicine(due to her interests in science and her own health problems) than I will ever know. She has proved a useful helpmate in our four decades of marriage(1975-2015). I also benefit from being in the hands of a competent medical service and system which is providing me with as much advice as I can cope with given the complexity of my pancreatic cancer and its management.

I trust readers with the interest will find the above of use even if they find it, as I do, quite complex and difficult to understand. My main aim in the months and years ahead is to secure a comfortable condition, limit negative side effects, and enjoy as much of life as it is possible to achieve as I go through what is often, indeed, usually, a difficult exit from the human condition.

Part 8:

MEDICAL NOTES MADE AFTER LEAVING THE LGH ON: 20/10/’15 and the GEORGE TOWN HOSPITAL ON 14/11/'15.

Preamble:

The following notes were taken while in the Launceston General Hospital(LGH) from 14/10/’15 to 20/10/’15. They were also taken for future use after getting out of that period in the LGH, and after several consultations with doctors while in the LGH. Additional notes were added from 21/10/’15 to 15/11/'15. Some ‘googling’ was necessary to make my notes more complete.

1. Spectrums:

These are for my present decision-making re: pancreatic cancer(PC)

0___1____________________________10(surgery spectrum)
0______________________8_________10(palliative spectrum)

...The number 8 indicates my current preference, although a final decision of just what route I will take to deal with this cancer has not been decided.

2. Radiation:

This treatment involves killing cancer, but is often not successful in curing. Cancer can grow back. It can give comfort and there are often less complications. Radiation therapy uses high-energy x-rays (or particles) to kill cancer cells. It can be helpful in treating some exocrine pancreatic cancers. Exocrine pertains to the secretion of a substance out through a duct. The exocrine glands include the salivary glands, sweat glands and glands within the gastrointestinal tract. Exocrine is as opposed to endocrine which refers to the secretion of a substance (a hormone) into the bloodstream. The exocrine glands are the "glands of external secretion" while the endocrine glands are "glands of internal secretion."

Pancreatic neuroendocrine tumors (NETs) don’t respond well to radiation, so it is rarely used to treat these tumors. Radiation is sometimes used to treat pancreatic NETs that have spread to the bone and are causing pain. It may also be used to treat these tumors in the form of radioembolization treatments for pancreatic cancer.

External beam radiation therapy is the type of radiation therapy most often used in treating cancers of the exocrine pancreas. This treatment focuses the radiation on the cancer from a machine outside the body. Radiation can be used in different situations for exocrine pancreas cancers:

 If surgery is planned, a person may get radiation before surgery (preoperative or neoadjuvant treatment) or after surgery (postoperative or adjuvant treatment). The radiation is typically given along with chemotherapy which is together known as chemo-radiation or chemo-radiotherapy. Preoperative treatment is often preferred because postoperative treatment often has to be delayed for several weeks while the person recovers from surgery. Treatment right after surgery can interfere with wound healing.

 Radiation therapy (combined with chemotherapy) may be used in people whose cancers have grown beyond the pancreas and can’t be removed by surgery (locally advanced/unresectable cancers).

 Radiation is sometimes used to help relieve symptoms such as pain in people with advanced cancers or in people who aren’t healthy enough have other treatments like surgery.

Before one's treatment starts, the radiation team takes careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.

Possible side effects

Some of the common side effects of radiation therapy include:

 Skin changes (like a sunburn) in areas getting radiation
 Nausea and vomiting
 Diarrhea
 Fatigue
 Poor appetite
 Weight loss

Radiation can also lower blood counts and can increase the risk of serious infection. Usually these effects go away a few weeks after the treatment is complete. When radiation is given with chemotherapy the side effects are often worse. The side effects one can expect and how to prevent or relieve them need to be discussed beforehand with one's doctor. For more general information about radiation therapy, please see the “Radiation Therapy” section of various websites or documents entitled "Understanding Radiation Therapy: A Guide for Patients and Families." As I have already indicated I am not inclined to subject myself to chemo or radiation treatment.

3. Blood Tests:

Blood tests check how well one’s liver and kidneys are working while one is dealing with pancreatic cancer. There are many types and terms for blood tests in relation to pancreatic cancer. There is the full blood/count involving electrolytes, iron, liver and haemoglobin. Blood pressure and blood sugar tests are also required. A tumor marker known as CA-19-9 also gives information to one’s doctor about the cancer. Certain hormones are also detected in the blood.

4. Anti-Coagulants:

Clexane is involved as an injection in the stomach which helps deal with the risks of bleeding/clotting. Pancreatic cancer remains a major clinical challenge. Recent advances in chemotherapeutic and targeted agents have offered a modest survival benefit. One of the major complications of pancreatic cancer is venous thrombo-embolism. Although it is a well-known fact that patients with mucinous carcinoma of the pancreas and gastrointestinal tract pose an increased risk of developing thromboembolic complications, scarce data exists regarding the incidence and pathogenesis of venous thromboembolism in pancreatic cancer patients.

The incidence of venous thromboembolism in pancreatic cancer patients ranges from 17% to 57%. Clinical data also suggest that the occurrence of venous thromboembolism may be associated with poorer prognosis in such patients. Recent data suggest that anticoagulant treatments may improve cancer patient survival by decreasing thromboembolic complications as well as by anticancer effects.

Thromboembolic disease in pancreatic cancer presents a life-threatening complication & is regarded as paraneoplastic manifestation of the disease. Effective management of this risk factor is very important in the management of pancreatic cancer. Given the lack of extensive data and the clinical relevance of this topic for both physicians and basic research scientists, the authors review the incidence, pathogenesis and clinical implications of venous thromboembolism in pancreatic cancer patients.

5. Wipple Procedure:

This can result in a 20 to 25 % cure; side effects are many and patients need to be aware of them about them. Relapses can occur and there are many possible problems. Only about 20% of pancreatic cancer patients are eligible for the Whipple procedure and other surgeries. These are usually patients whose tumors are confined to the head of the pancreas and haven't spread into any nearby major blood vessels, the liver, lungs, or abdominal cavity. Intensive testing is usually necessary to identify possible candidates for the Wipple procedure. I was eligible but, in the end, my surgery was not of the Wipple variety.

Some patients may be eligible for a minimally invasive (laparoscopic) Wipple procedure, which is performed through several small incisions instead of a single large incision. Compared to the classic procedure, the laparoscopic procedure may result in less blood loss, a shorter hospital stay, a quicker recovery, & fewer complications. The Wipple procedure isn't an option for the 40% of newly diagnosed patients whose tumors have spread (metastasized) beyond the pancreas. Only rarely is it an option for the 40% of patients with locally advanced disease that has spread to adjacent areas such as the superior mesenteric vein and artery, or for those whose tumors have spread to the body or tail of the pancreas. For more go to the internet.

6. Palliative Care:

Palliative Care(PC)>chemotherapy©>radiation®. PC controls but does not cure PC. There are both aggressive and gentle forms of PC. Pancreatic cancer is a formidable health problem, representing the 10th most common malignancy in the United States and the 4th most common cause of all cancer deaths. The overall 5-year survival rate is 4%, making this disease a model tumor in which to address the specialized care issues of palliative medicine. Statistics vary insofar as cures and treatments are con vcerned.

General considerations in both medical decision-making and symptom management are reviewed. Treatment of patients with locally unresectable, recurrent, or metastatic disease is individualized, based on considerations that include patient age, patient wishes, family influence, insurance constraints, and geographic practice variations.

Success in managing progressive symptoms is needed to palliate patients with advanced pancreatic cancer. Common problems include biliary obstruction, depression, pain, intestinal obstruction, and fatigue. Relief of pain and suffering associated with critical illness is required in managing patients with cancer. Pancreatic cancer is a model illness that mandates this need.

Pancreatic cancer is a formidable health problem with increasing incidence. Although this tumor represents only 2% of new cancer diagnoses in both men and women and is the 10th most common malignancy in the United States, it is the fourth most common cause of all cancer deaths. Despite advances in the understanding of the pathology and biology of the disease, as well as improved diagnostic imaging and staging studies, the overall 5-year survival rate remains 4% for all stages and races.

Adenocarcinoma of the pancreas comprises 90% to 95% of all malignant tumors of the exocrine pancreas. It is one of the most lethal malignancies, and its geographic location within the body makes imaging studies and biopsy procedures more difficult compared with other tumors. There are no clear-cut high-risk populations to follow, even if effective screening procedures were available. More problematic is the reality that presenting symptoms are vague, diverse, and long-evolving before medical attention is sought.

The clinical presentation is often dramatic, with "painless" obstructive jaundice. There is often a history of mild but progressive discomfort or pain in the mid-abdomen, occasionally with radiation to the back, and usually noted worse at the end of the day.

Ten percent of patients have a new onset of diabetes. Others describe fatigue, anorexia, nonspecific gastrointestinal symptoms, weight loss, and depressed mood -- all of which can go unnoticed until there is an obvious need to seek medical care. Patients may require symptom relief before any treatment interventions can begin, and some patients move rapidly to a state where the options are aimed solely at comfort. Multiple complaints, poor performance status, and comorbid illness make definitive surgery a less likely option. Interestingly, long-standing symptoms, weight loss, and anemia are not negative predictors of survival by univariate analysis, if the patient is able to undergo a resection.

In a series of 13,560 patients with pancreatic cancer, a major predictor of survival was the ability to undergo a complete resection, whereby survival rates were 2-fold greater compared with palliative bypass procedures. Yeo, et al reported that residual disease, manifested by positive vs negative margins, translates into a 5-year survival rate of 8% vs 26%. This disease is a model tumor to address the specialized care issues of supportive and palliative medicine. For more go to the internet.

7. Drugs:

See list in my medical files. No more information required. A list is available to readers under separate cover, as well as on my latest post at this site for the nine drugs used after 15/11/'15.

8. Oncologist:

Consultation with Dr Jeremy Power and Dr Rinku on 20/10/’15. An oncologist is a doctor that specialises in the treatment of cancer. There are two sub-types – a medical oncologist, who specialises in the administration of chemotherapy drugs, and a clinical oncologist who also has training in the administration of radiotherapy.

In modern cancer therapy, chemotherapy drugs are often used in combination with radiotherapy (as the chemotherapy sensitises the tumour cells to the effects of the radiotherapy). The optimum combination of treatment for individual patients is usually discussed in the pancreatico-biliary multidisciplinary team (MDT) meeting each week, when the pros and cons of each mode of therapy is discussed with the pancreatic surgeons, oncologists, radiologists, pathologists and specialist nurses.

9. Gastroenterologist:

A visit to the LGH on 26/10/’15(Monday) with Dr James Hardity and Dr Mitchell will take place at 11:30 a.m. I will have a metal stent inserted during an ERCP procedure. This will replace the plastic stent that was inserted on 30/8/’15. See my file on gastroenterology and gastroenterologists. The following is my email to James Hardity sent on 21/10/'15.
....................
I appreciated your giving me your email address, James, while I was in the LGH, yesterday. I am, therefore, writing to you at that email address: haridy.james@ths.tas.gov.au .....to say:

(i) thank you for arranging so promptly the notice that came through this morning(21/10/'15) from Dr Mitchell's secretary, Caroline. The notice was in relation to my appointment for an ERCP. I am to go to the LGH's admissions section.The ERCP is to take place on Monday 26/10/'15 at 11:30 a.m, approximately;

(ii) that I did have an ERCP back at the end of August 2015 while I was hospitalized in relation to my pancreatic cancer. At the time I wrote-down the details of the results of that procedure. It was in relation to a plastic stent being inserted among other aspects of my doctor's concerns; I also had a gastroscopy & colonoscopy back in November 2014 to find out the reasons for my heartburn. I'm sure you are also aware of this in my medical history; and

(iii) that Caroline advised that I bring a list of my medications which I am happy to do; and she also advised that I fast from 7 a.m. with only small sips of water after that time. I assume that this procedure has nothing to do with my faecal occult blood test(FOBT) which has become an annual event in recent years.

If you would like to add any details I have missed in the above, feel free to do so. If you are busy, please feel no obligation to reply unless, of course, I have missed any relevant details in relation to my up-and-coming ERCP.

Thanking you again

Ron
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10. UTI

On 24/10/'15 I saw a GP in George Town about the possibility of my having a urinary tract infection(UTI). I will see the results of the testing of my urine sample for a UTI tomorrow(25/10/'15) if I do not improve. I also began to take a new anti-biotic, and halfed my sleeping-pill(temazepan) because I was too groggy during the day I took the pill.

Part 9:

From 24/10/'15 to the first week of November I was in, firstly, the George Town hospital and then, secondly, in the LGH. I had my first surgery in the LGH and I will write about this experience when I come home from the LGH in November some time. As of 14/11/'15 I am partly in the GT hospital and partly at home.

Concluding Words:

I trust that this far-too-lengthy post for most readers provides a solid base of information after my third stay in hospital in the period September-October 2015.
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Last Updated On: 14/11/’15.
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Ron Price
George Town Tasmania
Australia 7253.

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