Life's Roller Coaster

If I'm missing, or not taking messages sorry – I'm more angry about letting my friends down than YOU will ever be at being let down! Unfortunately that is sometimes a side effect of Cancer! Mea Culpa: may I blame being short fused & grumpy on it too! My first symptoms presented in Nov-1998 – Follow The Trail on >DIARY of CANCER< Immediately Below!

Ode To The Hitch – A Tribute To Another Man’s Success …

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Ode To The Hitch – A Tribute To Another Man’s Success …
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Posted by:
Greg Lance – Watkins
Greg_L-W

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Hi,

Ode To The Hitch – A Tribute To Another Man’s Success …

Friday, February 17, 2012

I started this blog at the beginning of a fairly traumatic and fatalistic journey which would explain the opening line I first wrote: “And so to journal the end, which is nigh, it seems.”

Well, whilst that statement could be construed as true in just about any circumstances, on a personal level I feel now that it gives the reader a less than perfect impression of what follows so I’m going to offer the following alternative beginning so as not to hide the good news that my friend will want to hear. Most of this was written almost live, just after it happened or even as it was happening, some was added after to fill in gaps, so on occasion the context might appear not to quite fit and the construction definitely leaves room for improvement:

And so to journal what could so very easily have been the end, which is not quite as nigh as I at first thought, it seems.

I’m not sure quite what I expected when I decided to go (finally) and ask for an investigation into what I was already sure was that dreaded beast, the cancer. Admittedly, I feared it was the same as dear Christopher’s, (Hitchens) the esophageal kind. For once the doc appears to have been correct in casting aside my self-diagnosis, proffering the much more likely (and somewhat inane) alternative of the lung kind and writing me up for the low tech scan of the x-ray kind.

It wasn’t fear that caused me to delay getting my ass to the hospital, any more than it had been the cause of the twelve month’s procrastination over getting into the doctors surgery. It was far more mundane a cause than that. In the case of the doctor it was the groan at the thought of the hurdles the surgery places in the way of dispensing it’s services – a rant for another time. That coupled with the fact that every time it occurred to me was in the middle of the night when symptoms presented and woke me up. A cough to be precise, a dry, back-of-the-throat cough, the very kind I had heard was the early symptom of Christopher’s kind, the kind that gets ignored until much worse symptoms arise- the difficulty in swallowing; change in voice; coughing up blood. Hence the poor survival rate, fourteen percent if I recall the stats correctly. No-one suspects the cough, why would they. Everyone coughs don’t they. At least every smoker coughs and smokers get more bronchial conditions and that usually presents as a cough and when the rest of the symptoms wane, the cough persists, doesn’t it? And it’s hard to judge when the cough should have stopped…but after a while you know. you just know.

So every time I tell myself, time to get your ass to the surgery, which doctor will you see? Any one, it doesn’t matter, you’re going to get “any one” anyway regardless what you plan and, “anyway” it doesn’t really matter does it, so long as they know how to refer you to a man who actually knows something – a real doctor, a “specialist”. And then you drift off to sleep and in the morning you wake and the treadmill starts over. One thing takes over, then another and so on. Occasionally I remember and write a note and then the other thing, the hurdles thing, pushes it to the bottom of the pile of “much more important” stuff and next thing you know, it’s the middle of the night, you’re awake again and you’re coughing again…

It could have been the same with the x-ray but this took me only a few days. I didn’t worry about it, didn’t fret, just figured I’d get it done in a few days, no rush, I’d taken the big step, no big hurdles with this one. And nor were there, easiest interaction I’ve ever had with the NHS. I turned up, parked (legitimately) right outside the front door, checked in at radiology reception, no queues, no hassle, no delays, ten minutes later I’m having my innermost secrets photographed in not so glorious monochrome. Including the conversation with the radiologist as to why one removes one’s shirt for a machine that can penetrate all bar lead – buttons and unusual stitching in case you are wondering – the entire process from parking to departing took twenty minutes dead, if you’ll pardon the, oh never mind. I guess all those billions have achieved something after all, to be fair, though it seems to us mere mortals that this wasn’t rocket science – we understand why rocket science costs billions.

Looking back I can see how this might seem odd but at no stage did I fret over the results. Having consciously sought out a scan and an investigation to satisfy my conviction that by now, and given my symptoms, I must actually have cancer, it never actually occurred to me that I did – does that make sense?
I’ve had my blood pressure checked, always well within range, my cholesterol: “perfect”; Liver function: “fine”; this lump just here: “fatty lump, sir, nothing to worry about”. Easy for you to say, I thought back then, but this perfect person doesn’t do “fatty lumps” that appear for no particular reason and aren’t even a symptom of a disease – but given they’ve been there a good few years now, don’t seem to be going anywhere, and generally seem to mind their own business – apparently I do do these innocuous things.

You get my point? I’ve indulged a few investigations over recent years and all my fears have always proved groundless to the point that I begin to fear a reputation as a hypochondriac, though I’m not. There was absolutely no reason to suspect that this would be any different. It was a formality I had to go through because I owed it to myself, and to others, to get it checked so I could say that I’d done all the right things, proved there was nothing to worry about and now I could put it behind me and move on. Just like all those other formalities undertaken for precisely the same reasons and in every case, the caution exercised, the investigation complete, there was absolutely nothing to report”….

So it’s Friday evening, around 5.45 and I’m chatting to Simon in the office because Simon is always the last to leave and I like to talk to Simon. I like Simon generally but he’s especially good to share things with and generally have a pleasant rant about the state of the world, the galaxy and everything.

My phone rings, I was expecting nothing and so whatever it was would have been a surprise but, on reflection, some surprises are not as nice as others. “It’s Dr Fulker”, now that I was not expecting, on so many levels. I wasn’t expecting a call from a doctor because that doesn’t happen, at least not to me, no, it just doesn’t happen. I wasn’t expecting a call from Dr Fulker who I had only met once, a week or so ago. I certainly wasn’t expecting the next part, “I have the results of your x-ray”

…what x-ray? What’s she talking about? Oh, that x-ray, no,that’s not possible, I only had it done two days ago….and all the time that these parallel, rather than sequential thoughts, were firing in my synapses her other words only registered on a semi-conscious level and, even then, it wasn’t the words that made me pause and reflect. It was the quality of her voice. Having only met her briefly I didn’t have the usual tools to draw upon, the familiarity with inflection or intonation, but it was there, unmistakably. The measured, uncertain but gentle, hesitating sound of someone delivering bad news. Someone sitting next to you on a couch, knees closed, turned toward you, a wish to reach out and touch a knee as they speak, as if to stop you taking flight, both to reassure, to express empathy but as much to tempt you to stay seated, “…now don’t take this badly, but…” but not done, the touching knee, because you just don’t know each other that well, in that way.

All of this was in the voice. Who would want this job? The woman doesn’t know me, has no reason to care about me, doesn’t care in any personal sense but she is human and she’s fallible, almost vulnerable in a situation like this. All that professional deportment, that education, that status, it doesn’t take away a person’s humanity, that innate sense of compassion for another human being, especially when she knows, better than most, the likely finality of the message she’s delivering. She didn’t make the call because she wanted to, because she cared, she called because that’s her job and she wishes it wasn’t and because she has to, the act of doing it triggers the compassion. What a shit end to her day, she must feel.

She must wonder, when she puts down the phone, how I’m feeling. Did he understand the significance of those words, she must ask herself because she knows she didn’t explain it and I didn’t ask (because I knew) and was he just taking it very well? Was that why he seemed so calm and measured, so matter of fact, so polite? “Thank you so much for calling to tell me” isn’t what you expect, now, is it? She will also have wondered about the other option, the truth. “Shock” would be far too superlative a description but did he really take in what I just told him?

And that’s the truth, I heard every word, I understood every word and the meaning contained in those words but I can’t claim that I fully “took it in” on a conscious level. My body’s visceral and emotional centre took it in ok. The hairs on the back of the neck, the shiver rising from somewhere, the tightness in the throat, the tremor in the tear ducts – the control mechanisms cutting in on auto-pilot to suppress it – because that’s what we do, it’s what we’re trained to do. It’s what we have to do.

“The x-ray shows a four centimetre lesion on your right lung”. Long pause, not waiting for a response, letting it sink in, searching for what to say next. “I’ll arrange a referral to a respiratory consultant as soon as possible. It’ll probably be seven to ten days.”

“On your flamin’ nelly will it be seven to ten days…”. Even then, with all this swirling around in my head, even then it kicks in, even before I’ve actually absorbed the enormity of this thing. Save your approach for the passive ones, they need it, I need to take this on in my own way. I can’t beat it, I know that but having done this to myself, having procrastinated all by myself, now the objective is revealed, the gears get engaged, at least now I can actually take part in this thing. The challenge, the problem to be solved, the obstacle to be overcome, the emotions subsumed, subdued, there’s a problem to deal with, an urgent problem, no time for indulgences and certainly no time to hand over the fate of the outcome to someone else, especially someone that represents the laissez-faire bureaucracy you cannot abide. You’re not one of the followers, it’s innate, you dig out the facts, you learn what you need to know and you make your own judgment, make your own arrangements – for better or worse but it’s yours, not theirs.

“Well, Simon, that wasn’t the best news I’ve ever had”. I relate the conversation, not over egging it in any way, playing it down if anything. A moment of sharing, it felt comforting to share, it was the last I was going to feel for a while. “Please keep this between us, Si”. “Of course”.

There’s a burning desire to tell everyone you know, to get on the phone and call all your friends, muster help and support, make those apologies, arrange meetings, journeys, visits, all those things you know you’ve put off – as if you can make up for all that previous indifference – but most of all just to share. And then you quickly realise all the things that are wrong with that.

What if it’s a mistake? What if it turns out to be one of the other curable things that, at the absolutely outside chance, it just could be? You put your friends through all that grief for nothing…that’s an important issue right there, you’re putting them through grief. False alarm or not, what right do you have to do that? When is it right? What about Ri, my wife. If I tell her she won’t just be worried sick, she’ll be devastated, debilitated. No, I have to handle this myself until I know more, at least that. If it can be sorted then you can tell the story in hindsight and bask in the happy ending. If it goes the other way then we can at least wait until we have all the facts so that there’s no room for supposition, hypothesis. Facts are facts, you can plan, put things in order, face up to it squarely, even learn to be accepting of it. Uncertainty is constant questioning, what if, if only, try this, perhaps that. I can’t be doing it. There’s a way to deal with this like everything else. Figure out the facts, put them in sequence, get on with them and all the while continue to function, to carry on with those things that need to be done on a daily basis, a minute by minute basis. The pets still need to be fed, the dog needs to be walked, there are people relying on you, you have staff, you have customers, you need to sleep, to wash, to get up and start your day as if there were some point to it. No, no one must know, sorry you had to, Simon.

Simon leaves, I think he’s upset (see, it proves my point). I turn to the nearest computer, nip downstairs and pull out the file on the health insurance policy I’ve paid all these years and never used. Back upstairs with it so no one can see what I’m looking at. Ok, how does this work, better call them, start a claim and figure out how it all works. “Office hours 8am to 6pm” Damn! What are they on? People only get sick 9-5? Damn that doctor, why didn’t she call earlier in the day, now I have the worst of all worlds, its Friday evening, there’s an entire weekend ahead, I’ve just been handed a potential death sentence and I can’t begin work on a potential reprieve until Monday ruddy morning! …and I can’t even share it with anyone, can’t rant, can’t dump…can’t cry, can’t scream.

Gotta be practical then, what can I do? Read the file…the hospital list, ok, how does this work? Three lists, “Countrywide”, “London extended list”, “London super duper list” and you know, don’t you, before you even check…of course you do, these were both optional extras weren’t they? How were you to know, you’ve never been seriously ill, why would you think to include all the hospitals you would actually want to use should you ever need to, The Wellington, The Royal Brompton, The Cromwell. I check their web sites, yep, they are exactly what I need. Ri has a fabulous respiratory surgeon at Royal Brompton, her insurance covers her for the Royal Brompton, it doesn’t cover her for Toby Maher, the bright young guy she really needs and got a consultation with because we paid for it directly. Hers, of course, is the only insurance company that doesn’t cover him. This is the kind of thing that gives privatisation of health a bad name, unfairly so because it doesn’t have to be this way.

So I spend an hour or two researching who I need, the best consultants, the best hospitals. Of course, they are all the ones I don’t have access to. Let’s do it the other way around, take a look at those on the London list that I am covered for. Mostly NHS hospitals that have sought private clients as a way of making additional cash, so run on NHS principals but with nice food? Nothing impressed. The only one I felt I could accept might be Royal Marsden, not because of any good news on the web site but because of it’s fame and reputation. I resolve to call them first thing Monday morning, given that’s really the only option.

Monday morning: I call the Private Patients Appointment secretary.
“I have lung cancer and I need an urgent scan and a consultation with your top specialist”.
“Have you been referred by your GP?”
“No, I have no GP and I have no idea where the one who gave me this news might have referred me. I am paying privately, I don’t need a referral.”
“I can’t do anything without a GP referral”
“You do realise you are offering private health care? I don’t have a referral, I need a specialist, privately.”
“I can’t do anything without a referral from your GP”.
OK, I could have explained to her how our surgery works, the fact that I hadn’t a hope in hell’s chance of getting a referral letter out of them in less than two to three days and that I was not planning on wasting my time trying but, I figured, let’s skip that obstacle for now and move on.
“So, suppose I can get my hands on a referral letter, and suppose I deliver it to you by hand, how soon can we arrange an appointment?”
“Well it normally takes seven to ten days….” Where have I heard that before, oh yes, from an NHS GP…
“I don’t think you quite understand the situation. The average lifespan of someone diagnosed with lung cancer is 52 weeks. I have absolutely no intention of wasting one of those fifty-two waiting for you to make me an appointment.”
“Well, it might be less than that…”
“Thanks but I think I’ve heard enough. I’ll make alternative arrangements.”

I call The Cromwell. Within two hours I have an appointment for a PET/CT scan for Weds and an appointment with one of the world’s most highly qualified pulmonary oncologists. The consultation is at 6pm on Tuesday and, the lovely Lina asks, “please let us know if you can’t make it for any reason as Dr Lewanski is coming in to see you especially”. Those words, I wanted to cry as I pondered the wonders of chalk and cheese. These were total strangers to me but Lina cared, this consultant cared, it was evident in every word, in every act, in every call and the attention to detail, ensuring that I was kept fully informed at every step. This is health care.

It’s Tuesday morning and I’m in the shower when the phone rings. It’s the appointments secretary from East Surrey Abattoir, sorry, hospital. I literally shuddered at the prospect. “Thank you but I already have an appointment.” “Oh? When?” “I have an appointment for this evening at The Cromwell”. “What, today?”. “Today, yes. Thank you for calling. Goodbye”.

I’ve been working, it seems pointless but you keep going until you can’t, that’s what I learned, I don’t know from where. I guess from my mother. I kept smiling at how important people clearly felt their inane issues were. I pandered to them. I kept up appearances. It all seemed so empty, so well, like I said, pointless.

With Lina’s words in my head and me figuring “like I would miss this appointment for anything in the world”, I decided to play completely safe and give myself oodles of time. Travelling up on the Gatwick Express I started writing this little blog. It seemed important to write it all down so that…I don’t know. It just seemed important. It also gave me something to focus on. Arriving at Victoria with more than two hours to spare, I waited till everyone else got off the train. They were all in such a rush, why? Here I was with less time than any of them and I was not in any kind of a rush. I wanted to distance myself from their rush, take my time, everything deliberate, calm, remembered. These were important days for me and I wanted to remember them. I would walk to The Cromwell, it was an unseasonally beautiful sunny February afternoon and I wanted to experience it in a very close and personal way. Crossing up to Eaton Square, eyes turned upward, as always when walking in London, to see all the things that are so overlooked as people hustle and bustle through their busy lives. I noted the prevalent use of clipped box and other topiary, even the odd Niwaki – obvious if unimaginatively used plants when all you have is a balcony to sculpt with. I was studying people too. Al kinds of people, the well heeled and the not so well, the students and the retired, the busy young things, the busy working people, the constant rush of the traffic. Through Sloane Square, up Sloane Street, down Brompton Road, past so many so familiar places, past the Vistoria and Albert, passing the Natural History Museum that cathedral to the things I love and my totally absorbing fascination, life itself.

The reception staff in the Radiotherapy department were welcoming, smiling folk who knew exactly why they were there and what their visitors were going through. “You’re very early?”, they said. I explained that Dr Lewanski was travelling in especially and they thought this was very considerate. “This is one appointment I was never going to miss” I countered to assure them that altruism is a two way street. Alina, in the way of someone showing you the ropes you were going to get very familiar with, showed me how to work the coffee machine and which was the strongest brew.

Dr Conrad Lewanski, greeted me with a warm, gentle smile and a firm handshake. We sat and he asked me all the things you would expect. He took his time, an hour of his time. He let me talk about things that were clearly not important to the reason I was there, he encouraged it and joined in. Every now and then he would steer us back to “business”. He wanted to make sure that I knew everything I needed to know, that I had asked all the questions I wanted to ask. When my eyes welled up, as they did several times, he would pause and respect my embarrasment. Most of all he wanted to tell me that there were lots of good reasons for remaining optimistic but there was no time to waste. He wanted to know what other symptoms I had and was clearly excited by the fact that I had none. I told him about my walk from Victoria, at which he happliy crossed “breathlessness” off the mental list of typical symptoms. My scan was moved to Thursday at a time when the required starvation would be less of a burden for me. An appointment was made for another consult on Friday, at which time he would have all the results and we would know the situation for sure. He urged me to remain optimistic, implied that he had a good feeling about “this one”. He allowed me to hang on to the possibility that it might not be cancer though he also let me read between the lines sufficiently to appreciate that was all that it was, a hope. It all hanged, in reality, over whether this little invader was a well-behaved individual or an exploding fire-cracker sending it’s starburst seedlings throughout the rest of my body in minute fragments.

So, it’s Thursday and first off I have to give blood for the tests, wouldn’t do to try it with the green-glowing radioactive blood that I’ll have after the scans. Then off to have my lung function tested, fabulous nurse who gave me every possible encouragement to keep blowing when my head felt like it would explode. 112% on the initial blow (that’s 12% better than average for the arithmetically challenged) but overall 76% of normal. Not bad, Conrad guessed it would be around 70% so, hey, this is ten percent better than that, right?

Then, here I am in a small room, sitting on a bed, dressed – if you could call it that – in one of those silly hospital gowns that I haven’t figured how to fasten. So it’s just wrapped around me…there’s some debate over whether or not I should have drunk black tea and coffee when told to fast. I assure the lovely Claudia that Dr Lewanski did tell me that was ok and that I confirmed it with the guy who called yesterday to confirm the appointment – I even repeated back, “so just water, black tea, black coffee, no sugar, right?” “That’s exactly right!” he says to me. I realised an issue with The black tea thing as I was getting ready – Ri isn’t an incredibly observant individual, especially first thing in the morning but it would be just my luck for her to spot it and realise that a) this lack of milk was a total break from the norm and b) as a veteran of many hospital exploratory missions and operations that “no milk” was the order of the day…I needn’t have worried, she didn’t spot it, which is just as well as I didn’t have any clever excuse I could think of.

Claudia stabs my finger and checks the blood sugar – can she see that I had some in my first cup of tea? An injection of radioactive glow juice, but a warning I might need another, something to do with the coffee, my Pet/CT becomes a CT. followed by a PET. No effects of the first injection at all, (really shouldn’t have put that quarter spoon of sugar in the first black tea…).
I’m escorted back upstairs and handed over to Michelle in the CT room. A little difficult to understand, her east-Asian accent, very nice but not big on the charisma thing. Seemed to really struggle to get a vein up in my left arm, she felt the right had been abused enough with the blood tests (did I mention those? oh no well there were the blood test phlebotomy appointment first, interesting conversations about rubber gloves and people smuggling drugs through customs (programme on TV, Nothing to Declare). She could see “a nice big juicy vein” but for some reason didn’t get it to come up the way she wanted. Lots of rubber straps, clenching of fist and finger slapping later it appeared the cannula was in but I didn’t feel it happen so good on yer, Michelle, nice one.

When that stuff starts pumping, whatever radioactive goo it is, your face gets a flush like the biggest blush you’ve ever felt, simultaneously your bladder feels warm and full, in a comforting way as if you could lie there and wet yourself and not fear doing so but rather indulge in the warm comfort of it. Odd how it’s not just the mental surrender one feels in the impotence of the situation, the abboragation of responsibility, the deference to the professionals but even your body becomes similarly compliant to whatever forces are deployed upon it.

It’s an entirely comfortable, almost comforting experience, the knowledge that your body is yielding up its deepest darkest and hitherto well hidden secrets to the overpowering might of modern technology. No longer are these things strange, awe inspiring secrets of the science of the body, they have been conquered, they shall be revealed in all their base ordinary mundanity. So much the better if these steps are taken early enough, the fear is that we are not looking at a nice, tight, contained circular lesion but rather a scattergun pattern of itty bitty cancers swirling around looking for a dark, secretive hiding place amongst the maze of the lymphatic system. If that’s what we find then, folks, let’s get real here. If on the other hand, it turns out to be the most orderly and well mannered of evil critters – strike you as a bit much to hope for? – then hey, they can cut out a piece of my right lung and toss it away and Bob, as they say, becomes a close blood relative.

So CT over I’m escorted back down the stairs into the care of the antipodean Claudia (Melbourne actually) who politely parks me in my waiting room for half an hour with the lights turned down with instructions to just rest and relax. Not the most arduous of preparations I’ve ever had to undergo but leaving me in silence with nothing but my own thoughts doesn’t come without its own special challenges. When she collects and shepherds me into the room containing the waiting space-age marvel of a modern day PET scanner the first thing I spot is the CD in the boogie box, “Do I get music?”. Indeed I did and great it was too, perhaps it’s a sign of the average age of today’s cancer patient or perhaps it’s such fabulous and timeless music that it will endure across the ages for ever more. If I recall the sequence, Dionne Warwick, The Four Tops, Jimmy Ruffin, Smokey Robinson, after that I’m a little hazy but there were only a few more tracks before the whirring sounds and the various horizontal manoeuvrings of the table bed ceased and I was delivered to the brighter lights outside the machine signalling the end of my all too simple, too pleasant experience.

Back in my little room, removed from the strange embarrassment of hospital gown, slippers and robe and once more in my own comfortable skin, the inevitable impatient question but, what do you know, she’s forbidden to reveal anything. Not so much as a nod or a wink or the proffering of glossy literature on suitable funeral homes. A bit of a disappointment but not unexpected. At least this is NOT the NHS and so I only have to wait until midday tomorrow, one more difficult to explain trip to London – these interminable legal meetings, oi vey! So midday tomorrow and Conrad will tell me what? Can he tell that it is, incontrovertibly, the dreaded cancer, I think he can but they will still want to do a biopsy of course to determine which of the seven (yes, seven) different species of cancer if might be. They range in severity from the benign “I was just sitting here because it seemed to be a nice piece of real estate upon which to hang my hat” variety through to the raging, ghengis khan types that just want to kill, conquer and ultimately commit suicide by literally biting the hand that feeds and killing me, its obliging host. I can’t help but wonder, well, wouldn’t you?

So, my array of tests over, I met with Daniel yesterday, what a lovely man. I felt I had to share this with him, for very practical reasons, and felt relatively easy about it because on the one hand, though we are very friendly, he’s not what you would describe as “inside one’s circle of close friends – so he’s less likely to be deeply affected by the news, I hoped. On the other, not being in that circle, the information was certainly safe in his hands. I need new trustees for the trust, and I believe I can trust Daniel to treat such a role both professionally and in a way that he would think I would have wanted. I also figure the issue of a will has kinda become rather important and, it occurs to me as I write, it would be a good idea to prepare a list of people who should be advised of my departure so that Ri doesn’t have to cope with that in the midst of what will for her be considerable grief. But back to the will, again I need an executor and who better than Daniel to both draw it up and execute it. All in all this is quite a considerable burden to place on one person, I must make sure he’s properly compensated so there is no contention in his mind, or anyone else’s, when it comes to rendering an account for his services as executor on both matters. He readily agreed to everything i asked of him, went out of his way to reassure me in various ways and proffered his help in any way at all whenever I might need it. Last night he sent a very touching email just to prove that my first contention was entirely wrong. He was clearly very affected and has just moved to the heart of that aforementioned circle.

So I’m once more aboard the Gatwick Express, it’s Friday and I’m heading in to meet Conrad, Dr Lewanski, to get his verdict. One more invented business appointment to satisfy Ri’s curiosity which is fast becoming ‘suspicion’, even the ubiquitous “are you having an affair” enquiry this morning. I am strangely calm. In a sense, this is the biggest event of my (only) week long journey to date – it seems much longer. A genuine Pullman Belle train to my right! Fabulous sight and has got the whole train buzzing and phones/cameras clicking. See what I mean? Calm, as always, it’s a thing, a task, a challenge, something to be dealt with. Gather the facts, assess it calmly, decide on a “solution”, a course of action at least. Here we are at Victoria, no rush, let the crowd move out, my time is precious and I again refuse to join in the hectic bustle for no apparent reason. Twice this week I’ve walked to The Cromwell. This time I don’t have the spare hour. I’ll walk part way and hail a cab to finish the journey…

Sloane Square, by a different route this time, good place to stop, sit, I know, I know but also to have my “last” cigarette. That’s three different routes I’ve used and on the way, a piece of memorabilia. “Eaton Continental” on the corner of Eaton Terrace and, what, Chester Row? A little grocer-cum-reckons-itself-a-bit-of-a-speciality-foods store, a customer from circa 1979/80 for my Redmile-Gordon Provisioners (Wholesale Division). Wow, I’d completely forgotten.

From here I can walk a little more, grab a cab later or grab it now and walk locally. Don’t want to be late for my own sentencing now do I? I think we play safe and grab the cab now.

On the radio in the cab, a discussion about the mansion tax, talk of poor people walking out of the estate agent’s with a cheque for two million quid because they had to sell the house as they couldn’t afford the tax…”Not a problem you and I are likely to worry about, eh, cabbie?”. After that of course we spent the next five minutes putting the world to rights and then I’m here. Familiar smiling faces in Radiotherapy reception, I remember the coffee machine instructions. Bizarre, there’s apparently something special about Fridays, a sort of club has formed. Three guys all around my age or more, everyone knows each other, chatting about the different people they see, calling out pleasantries to the reception staff – about whom they have clearly learned some personal details. Is this what it’s like when you start a treatment programme? I guess it would be. People you don’t actually know but whose shared experience removes all barriers and the need to explain or apologise. Hmmm…

“You guys sound like regulars”, I volunteer to introduce myself. “Us, we’ve got loyalty cards, we have”, jokes one. I laugh. I was going to make a crack about living long enough to collect on the points but that’s the kind of crack reserved for established friends or acquaintances, not Londoners you just met thirty seconds ago. “This your first time?”, asks his friend. “I’m here for my sentence”, I offer, I quickly tame it down but still got the chuckle I was aiming for,”Well, my diagnosis”.

It’s 12:10, he’s running late. On one level it seems cruel, on another it likely means he’s spending time with someone who needs that time. Who wouldn’t want the same thing in his place?

A mature nurse chats to some of the patients, clearly familiar with them and genuinely great in the way she relates, like a kindly aunt. “Is this your daughter?” she enquires of a guy about my age, mid-eastern origin, cool looking, westernised. When he confirms, the nurse turns to the daughter and, for conversations sake, asks “So, how is he behaving himself?”. “Not so good with the smoking”, she replies. You can feel the unspoken plea behind the words, it’s gut wrenching stuff. 12:20 now.

At 12:25 and fearing I’m supposed to be meeting somewhere else I step up to the reception desk just as Conrad is approaching to invite me in. By the way, that’s what happens in a private health care environment, doctors come to you and invite you in, they don’t summon you with a bell or at the bidding of an underling.

I don’t know where I start, how I carry on relating the story from here. I guess I have to explain it all but mostly I just want to run out in the street screaming, jump up an down shout, hug perfect strangers and generally CELEBRATE! I don’t understand why they don’t keep a fully stocked bar in reception for just such occasions – I suppose it would be a little insensitive for some but I’m sure most people in this situation would just want to share in any good news story that was going. We, Alina/Lina/Stephanie and me, we’re going to lobby for one.

I guess I should explain, to myself more than anyone. Yes, I do have cancer, that’s now an established and indisputable fact. Yes, I do have a 4.2 cm spitulate lesion on my right lung. Ugly looking little fucker. That’s what we’re celebrating. That’s what I’ve got. That’s the sum total of what I’ve got, that’s the good news – all I have is lung cancer!! I don’t have fifteen other cancers, I have nothing creeping around in my nooks and crannies, I have nothing in my lymph, in my spine, in my throat (despite the huge lump that’s there right now), in my groin or my bladder, in my prostate or my colon, nothing, not a solitary sausage, not a minute fragment. I just have what looks like one huge evil creepy looking, spiky lesion that looks like its crawling, hunting, espying it’s prey as it feeds glutton-like on the sugars in the fluid they injected. It feeds so much, it steals so much of the available sugar and consumes it with such energy that it glows white hot on the CT, white hot! Other organs consuming said sugar at a fast rate only rank yellow on the full colour display, the colour being heat sensitive.

But that’s it. Evil as it looks, voracious and aggressive as it clearly is, it has actually behaved itself impeccably, keeping itself to itself. It has not exploded its cells into a myriad parts and scattered them across my finite internal universe. It appears operable. It appears that whilst I have to donate an important and irreplaceable part of my lung – and my resulting lung capacity – this thing can be removed. It can be cut out. In short, it can be destroyed – before it destroys me.

Conrad, we’re operating on first name terms at my request, after all, as I said to him at the outset of this consult, he’s likely to be the most important person in my life, for the rest of my life, however long that may be, or not. Anyway, Conrad was just great. He was almost as excited as me. He showed me all the scans, turning my whole body around on the screen in glorious full colour 3D, pointing to my various organs and showing not just the total absence of any black specs (we’re on the PET scan now not the CT, come on, keep up), but also the perfectly healthy appearance of each of them. He has of course combined that with the blood test results which confirm exactly that. Cholesterol: perfect, Liver function, all the numbers: perfect, this is a body that just keeps on trucking regardless, it just does its thing, it works, there’s just this one bastard invading organism that it couldn’t stop. “With a liver like that you can drink yourself silly”, says Conrad with a big smile on his face.

He’s spoken to a colleague of his, Brian O’Connor who would do the bronchoscopy that I need. They give me a sedative and then slide a camera/whatever/thingumy up my nose and down into the lung where they (hopefully) see the little critter from the inside, bite a small chunk out of it and take it away for analysis. A biopsy if you will. There is a possibility that it is of a kind that they can’t easily remove but Conrad really doesn’t think so – he’s been right so far so I’m inclined toward optimism.

He calls his friend who operates out of the mews near the hospital entrance and yes, he will see me more or less immediately for a consultation. At his request, Alina offers to escort me over there and on the way she said something to which my eyes, throat and tear ducts responded in telltale fashion. Without hesitation she grabbed me and gave me a big hug, sweetness itself and how wonderful to feel that gentle human contact, it took every effort I could summon to let go.

Brian is a lovely man, a big softly spoken Irishman, a Dubliner who migrated twenty years ago and time has softened that Dublin accent so much I thought he was from the west. He looks at all the pictures and is clearly amazed at what a lucky little sod I am. “Normally”, he says, “when I’m talking to someone with lung cancer my eyes are down on the floor because, frankly, I’m usually looking at a death sentence.”. He continues, “In your case, you know what? I think we’ve got it just in time”. Again with the throat thing and the tear ducts, for about the tenth time today. I feel like a great big stupid soft thing but then, in my more self-forgiving moments, I figure I have some justification.

We talked about the smoking. We talked about the insurance company. In this context Ri cropped up in conversation, the ironies of fibrosis for a non-smoker, and he asked who her lung guy was. “excellent guy” he says when I tell him about Toby Maher, “leading world authority”. “I don’t know him personally”, he continues with perhaps the most glowing reference of all, “I know his ‘boss’”.

So I’m on the train home, writing this and I get the call I’ve been waiting for from the insurance company – they will cover me after all. Seems this is my lucky day.  Thank you Hitch.

To view the original article CLICK HERE
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Regards,
     Greg_L-W
Greg Lance-Watkins
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Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

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If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms in 1998 see The TAB at the Header of this Blog. called >DIARY of Cancer ….< just click and it will give you a long list of the main events in chronological order, many linked to specific blog postings. . Later in the sequence of my experiences with cancer you will note that I introduce some results and events most probably linked with cancer such as enlarged & damaged Prostate and a consequential Heart Attack leaving me with no right coronary artery! . I have also included numerous articles and anecdotes regarding health – primarily related to cancer, prostate and heart conditions – FYI! . Thoughts, articles and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Left Sidebar. . You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help, also many of the links in articles and >HOT LINKS< in the Sidebar.
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AA Gill: “More life with your kids, … – but only if you pay”

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AA Gill: “More life with your kids, … – but only if you pay” …
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Posted by:
Greg Lance – Watkins
Greg_L-W

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Hi,

(Adrian) AA Gill who was born on 28-Jun-1954 died of advanced metastatic lung cancer on Saturday 10-Dec-2016 – having only been informed he had cancer in November.
Something of an object lesson to us all to ensure we present with any symptoms, which persist, as soon as possible!

Cancer survival rates in Europe
The UK has the worst cancer survival rates in western Europe — a third lower than those of Sweden.

“Five-year cancer survival rates are so low in the UK because we’re so slow at diagnosing cancer in the first place. A patient must first see their GP, then be referred to see a specialist. The lag time can be months. And when each GP consultation lasts a few minutes, people can slip through the net altogether. In European countries, patients can access specialist care easily and straightaway.”
Dr Conrad Lewanski, consultant clinical oncologist and fellow of the Royal College of Radiologists

Here is AA Gill’s final article, published the day after his untimely death, by way of a tribute to his courage, an example of his wit and honesty and together with a bit of an obit. as an encouragement as we all follow him into that long and inevitable goodnight in our various ways and at our various times in life, whenever that end may be:

AA Gill: “More life with your kids, more life with your friends, more life spent on earth — but only if you pay”

AA Gill used to think that being an NHS patient was like travelling second class on a train, grittier than first class, but in the end everyone ended up at the same destination. But in his farewell piece he tells of his discovery of a drug not available on the NHS …

AA Gill in his garden on November 29, 2016PORTRAITS BY TOM CRAIG,

It seems unlikely, uncharacteristic, so un-“us” to have settled on sickness and bed rest as the votive altar and cornerstone of national politics. But there it is: every election, the National Health Service is the thermometer and the crutch of governments. The NHS represents everything we think is best about us. Everyone standing for whatever political persuasion has to lay a sterilised hand on an A&E revolving door and swear that the collective cradle-to-crematorium health service will be cherished on their watch.

When you look at our awkward, lumpy, inherited short-tempered characters, you’d imagine we might have come up with something more brass-bandy Brit: a bellicose, sentimental military fetishism, perhaps, or sport, or nostalgic history, boastful Anglophone culture, invention, exploration, banking avarice. But no. It turned out that what really sticks in our hard, gimpy, sclerotic hearts is looking after each other. Turning up at a bed with three carnations, a copy of Racing Post, a Twix and saying, “The cat misses you.”

We know it’s the best of us. The National Health Service is the best of us. You can’t walk into an NHS hospital and be a racist. That condition is cured instantly. But it’s almost impossible to walk into a private hospital and not fleetingly feel that you are one: a plush waiting room with entitled and bad-tempered health tourists.

You can’t be sexist on the NHS, nor patronising, and the care and the humour, the togetherness ranged against the teetering, chronic system by both the caring and the careworn is the Blitz, “back against the wall”, stern and sentimental best of us — and so we tell lies about it.

We say it’s the envy of the world. It isn’t. We say there’s nothing else like it. There is. We say it’s the best in the West. It’s not. We think it’s the cheapest. It isn’t. Either that or we think it’s the most expensive — it’s not that, either. You will live longer in France and Germany, get treated faster and more comfortably in Scandinavia, and everything costs more in America.

‘The face of real cancer wipes our expressions to a pale neutral human,’ says AA Gill  TOM CRAIG

I’ve wanted to write about the National Health Service for a long time, but it’s resistant to press inquires. While the abstract of the NHS is heart-warming, the truth for patients is often heart-stopping. And junior doctor strikes, executive pay, failing departments, slow-motion waiting times and outsourcing tell a different story, and I’m regularly, ritually refused access by PRs and administrators, or they insist on copy approval or preplanned stories.

One of the doctors I approached was Professor Brian Gazzard, who has a reputation mostly for being an exemplary and inspirationally brilliant physician, but also as something of an ocean-going eccentric. He treats, teaches at and runs the Chelsea Aids clinic. I asked him what had changed most about his job.

“When I started, I told every patient that they were going to die. I could make it easier, make them live a little longer, but everyone died. Now I tell every patient they will live. They will need to do what I tell them, they’ve been silly, but they’ll live to die of something else. That’s astonishing.” He paused so I would understand the effect it has on a doctor. “Look, I really don’t want to be written about. You won’t remember, but we met once before.”

A decade ago, Gazzard diagnosed my foreign correspondent’s dodgy tummy as acute pancreatitis, the result of alcoholism. “Of course I remember. You told me I could never drink alcohol again and I said, ‘You haven’t read my notes, I’ve been teetotal for 20 years.’ And you gave a sigh and reached into a drawer and lit a cigarette and said you’d been dreading telling a restaurant critic he couldn’t have a glass of wine.”

Gazzard laughed. “You’re one of the lucky ones,” he’d said as he walked onto the street clutching an armful of patient files and raised a hand in farewell. He repeated again: “You’re one of the lucky ones. I can always tell.” It was his first misdiagnosis of the day.

What neither of us could know is that my pancreas was already a stuffed wallet of cancer, though not pancreatic — a migrated, refugee, desperate, breathless lung cancer.
I stopped smoking 15 years ago and as a gift to myself, proof of the clarity of my lungs, I would spend a week stalking on Loch Maree in Wester Ross. Every autumn since, I have climbed the same hills, chasing the deer, and, trudging upwards, recited a doxology of mostly extinct snouts I no longer puff: Weights, Guards, Navy Cut, Olivier, Black Cat, Passing Clouds, Number 6, Sovereign, Gitanes, Gauloises (does anyone remember when Paris smelt alternately of Gauloises, pissoirs and Chanel?), Winston, Camel, Sobranie, my father’s pipe in the cinema — clouds of sweet latakia smoke in the flickering projection. A Greek cigarette in a red box with a lasciviously smiling girl that called itself Santé, without irony: an untipped fag called Health.

This year, for the first time, I couldn’t make it to the top of the hill. I knelt in the heather, weak and gasping. It was the first time all was not well. There was also a pain in my neck that my doctor said was probably a cervical spine thingy and I should get a scan.

He sent me to Harley Street, where another doctor said: “You haven’t got insurance, it’s going to be expensive. Why don’t you get it done down the road and send me the pictures. A third of the cost.” I said: “I’m here now, just do it.” And he shrugged. A couple of hours later I went back for the results. He had the bland bad-news face.

“That was the best money you ever spent.” He turned the screen around and there was a beautiful spiral of colour clinging like an abstract expressionist collar to my spine. “This is cancer.”

My alien was the most common cancer in old men, our biggest killer — an aggressive, nimble cat-burglar lung cancer that is rarely noticed till it has had kittens

That afternoon I was back in my doctor’s surgery. He was wearing the antiseptic face, the professional-doctor tragedy mask. I’m getting to see this a lot now. It is as much a protection against the infection of catastrophe for them as a respect for its victim. They glaze the bad news with sweet spittle. They’ll say: “The test results were not quite what we hoped. It might be trapped wind or it might be the thing that hatched from John Hurt’s stomach. Realistically, we’ll have to assume it’s more alien than fart.” My alien was the most common cancer in old men, our biggest single killer: an aggressive, nimble cat-burglar lung cancer that is rarely noticed till it has had kittens.

Guy has been my doctor for 30 years — 32 to be precise. He was the doctor who put me into treatment for addiction and he’s looked after me and my kids ever since. He’s private, so I pay. If I need a test, an x-ray, a consultant, I’ll pay. If I need anything more than a couple of antibiotics, I’m going to the NHS.
Within 24 hours I have an NHS consultant oncologist and early-morning appointments, for scans, blood tests and x-rays.

You couldn’t make up Charing Cross Hospital. Well, not as a hospital you couldn’t. It’s a monstrous, hideous, crumbling patched-up mess — the Elephant Building. On the way in I notice a couple of posters on the street saying “Save Charing Cross Hospital”. They’re stuck on a municipal noticeboard that’s falling over.

It’s plainly the result of dozens and dozens of attempts to make things better and, in fact, it is the physical embodiment of how most of us, trying to make our way through the teetering automatic doors, feel. It has a very good collection of contemporary British art. In some back corridor there is a series of Peter Blake’s best silk screens.

I love it: it’s how I feel. The lifts take hours to arrive, emphysemically, wheezingly opening their doors, and when they do, it’s without confidence or conviction. A man going up to the cancer ward puts his hand in front of the door and gets out. “I’m too frightened to take this lift,” he says.

In a waiting room, hundreds of us take numbers to sit like wilted potted plants in an autumn garden-centre sale, to take it in turns to meet the antiseptic face. If this were a set for a film, all the actors and extras would be pulling looks of agony and sadness and fear, but the face of real cancer wipes our expressions to a pale neutral human.

The NHS has one of the worst outcomes for cancer treatment in Europe. It’s something to be borne in mind when you’re deciding to combine chemotherapy with a safari, or want to embark on a bar-thumping argument about health tourism. It was the first question I asked my oncologist, Dr Conrad Lewanski. “Why is this such a bad place to get cancer, when we have lots of hospitals, when we teach doctors from all over the world, when we’ve won more Nobel prizes than the French?”

“It’s the nature of the health service,” he says. “The key to cancer outcomes is the speed of diagnosis and treatment.” The health service was set up with GPs separate from hospitals. The system means you probably have to wait a week or so for an appointment to see first your GP, or a clinic. The average time for that consultation will be seven minutes. Perhaps your cough isn’t a priority. And then if your doctor thinks it does need a second opinion, he’ll suggest you see a consultant, and that’s likely to take a month. If the GP suspects cancer, that referral time is reduced to two weeks. He or she will probably write a letter, often two — all doctors still carry fountain pens.

And then there are all the appointments — for tests, a cancellation, a missed x-ray, a scan — which can put months on a diagnosis. It’s not the treatment, it’s the scale of the bureaucracy and the Attlee-reverential, immovable-but-crumbling structure of a private-public doctor-consultant arrangement, which was the cornerstone laid down by the 1945 government at the insistence of doctors. That is the chronic tumour in the bowel of the system.

How do men react when you tell them it’s fatal? ‘Always the same way — with stoicism.’ Bollocks, I thought that was just me

I’m given a talk by a nurse on the consequences of chemotherapy. She uses three pens. Two of them have three coloured barrels each. The scribbling, the underlining, the stars, the acronyms, the exclamation marks become ever more emphatic and decorative. Finally she hands me a notebook that is unintelligibly runic, but says not to worry because it’s all on the computer, which she then turns on to show me a heart-warming film about sexual infections and high temperatures.

The hospital flutters with bits of paper like mayflies. They’re propped up against screens, wedged up against keyboards, stuffed into teetering files, and then there is the constant Tourette’s questions, “When’s your birthday? What’s the first line of your address?”, all to collide you with the right cancer, to go with all the forms, the signatures, the screens, the machines, the radiation disclaimers and destiny. It makes Kafka look like ee cummings.

I like my oncologist. He doesn’t have the morphine face; he looks amused, inquisitive, like a shaved, garrulous otter. All he does is lung cancer. This is his river, tumours his trout. He’s been a consultant for 15 years. Two years in, his father got it and died: “The worst thing I’ve ever had to go through. I do know what this is like — so how much do you want to know?”

“Everything, and the truth.”

I’ve never Googled cancer, but I’ve discovered that every one of my friends who owns their own house has a preferred cancer specialist and a hospital to go with them. They also have a perfect gardener, an ideal interior decorator and a masseur that they insist — insist — I use, because they are all the best and, of course, you only get what you pay for. Lots of them are astonished I’m still in this country of catastrophic cancer statistics.

Those who don’t have money for their own homes have magical diets, homeopathy and religious new-age cures, or at least a conspiracy theory about big pharma hiding the efficacy of vitamin C, kale, magnetism and mistletoe. If it doesn’t make you better, at least you get snogged a lot.

And everyone, but everyone, will have a mantra story of their secretary’s husband or a woman they used to work with who was given three weeks to live and is still stacking shelves or conducting operas 10 years later. These little homilies are handed out with the intense insistence of lucky heather, using the language of evangelical religion and locker-room encouragement.

Why is our reaction to cancer so medieval, so wrapped in fortune-cookie runes and votive memory shards, like the teeth and metatarsals of dead saints? Cancer is frightening. One in two of us will get it. It has dark memories, unmentionably euphemised. In the public eye, not all cancers are equal. There is little sympathy for lung cancer. It’s mostly men, mostly old men, mostly working-class old men and mostly smokers. There is a lot more money and public sympathy for the cancers that affect women and the young. Why wouldn’t there be?

“How do men react when you tell them their cancers are fatal?” I ask Dr Lewanski. “Always the same way — with stoicism.”

“Bollocks,” I think. “I thought that was just me.”

Actually it’s not being told you’ve got cancer that is the test of character, it’s the retelling. Going home and saying to the missus: “That thing, the cricked neck. Actually it’s a tumour, the size of a cigar.” It ought to come with a roll of thunder and five Jewish violinists, instead of the creaky whisper of fear.

People react differently to different cancers: most women think they’ll survive, and statistically they’re right. Most men think they’ll die — and likewise.
“So, what’s the treatment?”

“Chemotherapy. Platinum in your case. It has a very good chance.”

Someone should write a paper on the euphemistic size comparisons for tumours. There should be an esite, Euphotumours. The images are very masculine: golf balls, cricket balls, bullets, grenades, ruminant testicles. No one ever says, “I’ve got a cancer the size of a fairy cake.”

And what about after the chemo?

“Well, there’s a new treatment, immunotherapy. It’s the biggest breakthrough in cancer treatment for decades. Cancers camouflage themselves as chemical markers that tell your body’s natural defences that there’s nothing to see here, move along. These new drugs strip away the disguise and allow your body’s natural system to clean up. It’s new and it’s still being trialled, but we’re a long way along the line and it is the way cancer treatment is bound to go. It’s better for some growths than others, but it’s particularly successful with yours. If you were in Germany or Scandinavia or Japan or America, or with the right insurance here, this is what you would be treated with.”

The doctor looks at Nicola, the missus. His otter face has grown a little sphinxy.

“You remember asking if the treatment Adrian got on the NHS would be any different from being a private patient? And I said a better cup of coffee and more leeway with appointments. Well, this is the difference. If he had insurance, I’d put him on immunotherapy — specifically, nivolumab. As would every oncologist in the First World. But I can’t do it on the National Health.”

The National Institute for Health and Care Excellence (Nice), the quango that acts as the quartermaster for the health service, won’t pay. Nivolumab is too expensive — £60,000 to £100,000 a year for a lung-cancer patient; about four times the cost of chemo. And the only way to see if it will work for an individual patient is to give it to them all, and the ones it doesn’t work for will weed themselves out. What Nice doesn’t say about the odds is that immunotherapy mostly works for old men who are partially responsible for their cancers because they smoked. Thousands of patients could benefit. But old men who think they’re going to die anyway aren’t very effective activists. They don’t get the public or press pressure that young mothers’ cancers and kids’ diseases get.

As yet, immunotherapy isn’t a cure, it’s a stretch more life, a considerable bit of life. More life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth — but only if you can pay.
I’m early for my first eight-hour stint of platinum chemo. The ward in Charing Cross looks like a cross between a milking shed and an Air Koryo business lounge. I am settled into a hideous but comfortable chair and a tap is jabbed into the back of my hand. A series of plastic bags full of combative and palliative cocktails slowly dribble into my body and every 10 minutes I have to shuffle to an invalid’s loo to dribble it out again.

I like it here. The nurses are funny and comforting, optimistic, and bear the weight of the sadness, the regret and the pity in the room on their shoulders with an amused elegance and sincerity that comes from their years of experience, or the naivety of inexperience. The other patients shuffle in with their partners to share sandwiches, talk about shopping and the cousins in New Zealand and window boxes. There are children with ageing parents, happy/sad to be able to repay an infant’s debt.

I manage to find the one dealer in the ward, or rather she finds me. Her boyfriend’s making hash cakes — they’ve definitely shrunk his tumour, I should definitely have some. I smile, shrug apologetically and say sadly I’m already a junkie. I don’t take drugs.

“Really? Even for this?” I’m not giving up 32 years of clean time for some poxy lung.

And there are the ones who sit alone, who don’t have any friends to play cards with them, to drip the will and the strength and the faith to face this. I don’t know how anyone manages to do this on their own.

An old friend sits through the mornings with me, Nicola comes with lunch and Flora and Ali, my grown-up kids, share the afternoon. If it wasn’t for the cancer, that would be a really lovely day. If it wasn’t for the cancer.
There’s a natural break in the article here. It should have been finished two weeks ago, but I had a bad night, a really bad night.

Nicola called Guy, the GP, and he came round and took a look and said: “He needs to be in A&E now.”

So I’m on a gurney in Charing Cross at nine in the morning. On the other side of the blue plastic curtain, a bloke is being held down by three policemen shouting, “Don’t flick your f****** blood over here, I don’t want what you’ve got.”

A young doctor comes and asks me questions. All doctors in A&E are preternaturally young. One of the questions after “What’s your date of birth and the first line of your address?” is inevitably “Can I put my finger up your bottom to see if there’s any poo or blood?”

The other question is: “On a scale of 1 to 10 — 1 being a scratch and 10 unspeakable agony — what do you think you’re suffering at the moment?” You wouldn’t describe this as thin pain. It’s 10 out of 10. My stomach is agonised with a terrible wrenching distension. I’ve lived a middle-class, sheltered, uncombative, anti-violent life, so I don’t know how this compares to other more manly men’s pain, but this is by miles and miles the worst thing I’ve ever been through, thank you for asking.

More x-rays and blood tests and the surgeon returns with the complete granite face and says: “Well, it could be a burst ulcer, but of course it isn’t. The tumour in your pancreas has increased in size very fast. It’s as big as a fist.” And he shows me a fist in case I’d misplaced the image.

I’ve decided to call the pancreatic tumour Lucky, as a nod to prophetic Professor Gazzard. So the chemotherapy isn’t working. I ask my oncologist what’s next.

“It’s a bugger,” he says. “It looked so hopeful, but you’re right, it isn’t working. The pancreas is a bad place. We can’t operate and the side effects of radiation aren’t worth the risk.” And there’s pancreatic pain, which is famously in a league apart, so at least I can be stoical about that.

“What next?”

“Well, on the NHS we can give you another round of chemo, a bit rougher with slighter outcomes … but there is really only one treatment for you: nivolumab.”

From behind the blue curtain, the nurse asks the policeman: “What do you want to do with him?”

“Oh, let him go,” says the copper.

“I thought you’d arrested him?”

“No. Let him go.”

That evening I’m sitting in bed on the cancer ward trying to get the painkillers stabilised and a young nurse comes in.

“There you are. I’ve been waiting for you all day. You’re supposed to be with me down in chemotherapy. I saw your name. Why are you up here?”

“Well, it turns out the chemo isn’t working.” Her shoulders sag and her hand goes to her head. “F***, f***, that’s dreadful.” I think she might be crying.

I look away, so might I.

You don’t get that with private healthcare.

Cancer survival rates in Europe
The UK has the worst cancer survival rates in western Europe — a third lower than those of Sweden.

“Five-year cancer survival rates are so low in the UK because we’re so slow at diagnosing cancer in the first place. A patient must first see their GP, then be referred to see a specialist. The lag time can be months. And when each GP consultation lasts a few minutes, people can slip through the net altogether. In European countries, patients can access specialist care easily and straightaway.”
Dr Conrad Lewanski, consultant clinical oncologist and fellow of the Royal College of Radiologists

THE “REVOLUTIONARY” LUNG-CANCER DRUGS

  • What is immunotherapy? This is a treatment used in cases where chemotherapy hasn’t worked. The drugs involved strip cancer cells of the “camouflage” that stops the immune system from attacking them as it would other diseases. Only 20% to 30% of people with non-small-cell lung cancer — which accounts for 85% of lung cancers — respond to the therapy, but researchers have found it to be remarkably successful among those whose tumours were caused by smoking.
  • How is it administered? Immunotherapy drugs are injected into the patient’s bloodstream via a drip or Port-a-Cath: a plastic tube leading into a large chest vein. Patients tend to receive the treatment for an hour every fortnight, but this depends on the condition.
  • Who has access to nivolumab? The pioneering drug nivolumab has received its licence for use in the UK and is under review by Nice, which says: “We do not have the full picture yet and we are still working with the company to see what we can do to answer the uncertainties in the evidence.” This means patients in England and Wales will have to wait to find out if they will be able to get it universally on the NHS. In Scotland, which has its own drug-approval system, nivolumab is already available.
  • What is pembrolizumab? This immunotherapy drug, similar to nivolumab, is also licensed in the UK. Ten days ago, Nice announced that it will finally be available to patients with non-small-cell lung cancer on the NHS. This is not the drug AA Gill’s oncologist recommended for him.
  • How much does nivolumab cost? The approximate cost for treating non-small-cell lung cancer is £5,700 a month or £68,400 a year.
  • What is Nice’s role? Nice makes recommendations on whether the NHS in England — and in some cases Wales, Scotland and Northern Ireland — should fund new drugs so they are available to all patients. Their review process is based on a treatment’s cost effectiveness and efficiency. It takes into account the patients’ life expectancy and quality of life after the treatment.

AA Gill began taking nivolumab after writing this article

To view the original article CLICK HERE but it is hidden behind Rupert Murdoch’s pay wall.

My thanks to the friend who supplied his paid for copy, thus bringing AA Gill’s profound and moving article to those amongst my readers who may benefit from it – I know I have!

  • How much does nivolumab cost? The approximate cost for treating non-small-cell lung cancer is £5,700 a month or £68,400 a year.

As this drug is administered as a drip into a vein often via a ‘pic-line’ once a fortnight this would indicate each dose costs £2,850!
As the EU insists on tampering in every area as it imposes UN, WTO, CODEX etc.s diktats why are they so indifferent about the drug companies’ profiteering from fatal illness, when they crow about such irrelevancies as forcing mobile phone companies to standardise roving rates – surely that is upto the consumer and no business of the EU!

cressida-connolly
Adrian Gill’s first wife Cressida Connolly, they married in 1982 & divorced in 1983


with his ex wife Amber Rudd who he married in 1990 & divorced in 1995,
with whom he had two children

aagill1.jpg
In better times with Nicola Fornby his long term partner & mother of his twins, with whom he had been since 1995 until his death, though only becoming engaged in the November of his final weeks!

As everyone, save the few he berated or made fun of, Adrian Gill, who styled himself AA Gill after his treatment for alcohol and joining AA, was honest and professional in his writing expressing his beliefs and opinions humorously and well, without pandering to fashionable PC, as Wikipedia shows in this selective extract:

Gill’s acerbic style led to several media controversies. In 2010, The Sunday Times disclosed that Gill had been the subject of 62 Press Complaints Commission complaints in five years, none of which had been upheld.

Wales

In The Sunday Times, Gill described the Welsh in 1998 as “loquacious, dissemblers, immoral liars, stunted, bigoted, dark, ugly, pugnacious little trolls”. His comments were reported to the Commission for Racial Equality.[21] and used as an example of what was described as “persistent anti-Welsh racism in the UK media” in a motion in the National Assembly for Wales.
[It is my opinion that he left out humourless and lacking in self confidence!]

Isle of Man

Gill’s feud with the Isle of Man began in 2006 with a review of Ciappelli’s restaurant in Douglas. Gill wrote that the island:

managed to slip through a crack in the space-time continuum […] fallen off the back of the history lorry to lie amnesiac in the road to progress […] its main industry is money (laundering, pressing, altering and mending) […] everyone you actually see is Benny from Crossroads or Benny in drag…. The weather’s foul, the food’s medieval, it’s covered in suicidal motorists and folk who believe in fairies.

The review was attacked in the Tynwald, the Manx parliament, with House of Keys member David Cannan demanding an apology for the “unacceptable and scurrilous attack”.

Gill made further comments regarding the Isle of Man in his Sunday Times column on 23 May 2010, when he described its citizens as falling into two types: “hopeless, inbred mouth-breathers known as Bennies” and “retired, small arms dealers and accountants who deal in rainforest futures”. His comments were made in the aftermath of Mick Jagger‘s suggestion that drugs should be legalised in the Isle of Man.[26] Gill added that “If … they become a hopelessly addicted, criminal cesspit, who’d care? Indeed, who could tell the difference?”[27]

England

In February 2011, Gill described the county of Norfolk as “the hernia on the end of England”. In December 2013, his column just before New Year’s Eve, was the result of a night on the beat in Grimsby and Cleethorpes and was heavily critical of both towns where Grimsby is “on the road to nowhere” and Cleethorpes is full of “hunched and grubby semi-detached homes”Humberside Police and Crime Commissioner Matthew Grove described Gill as “A tweed-suited, Mayfair-based writer, whose only experience of the North of England was his visit to Cleethorpes and his regular trips salmon fishing in Scotland”.

Individuals

In a review of Clare Balding‘s 2010 Britain by Bike TV programme, Gill referred to the presenter as “a big lesbian” and “a dyke on a bike”. Gill’s Sunday Times editor, John Witherow, responded to Balding’s complaint: “In my view some members of the gay community need to stop regarding themselves as having a special victim status and behave like any other sensible group that is accepted by society. Not having a privileged status means, of course, one must accept occasionally being the butt of jokes. A person’s sexuality should not give them a protected status”.

Regards,
Greg_L-W.

PS:

If you enjoyed AA Gill’s style and wit above here is an article he had published the day after his 60th. birthday on 29-Jun-2014, 2 years before his diagnosis of cancer and his untimely death – enjoy:

Life at 60

How does the former alcoholic drug addict AA Gill feel about reaching this milestone? Surprised, mostly, but happy to ruminate on sex, travel and friendship

AA Gill Published: 29 June 2014

Young Gill at schoolYoung Gill at school (A A Gill)

Every morning, after taking our twins to school, Nicola and I read the papers over breakfast and I recite the birthday list and she will guess the ages. She’s uncannily accurate. Yesterday The Guardian will have said: AA Gill, critic and baboon-murdering bastard, 60.

I share a birthday with Henry VIII and the shot that started the Great War. I’ve always read the anniversary roll and over the years I’ve watched people my age go from rarely mentioned as sportsmen and pop stars to more commonly as leading actors and television presenters and now ubiquitously I find myself in the thick of captains of industry, ennobled politicians, retired sportsmen and character actors. You only notice the accumulating years in relation to other people.

Last week an editor breezily mentioned that as I was coming up to a milestone decade would I perhaps like to write something about it? You know, is 60 the new 40? Why do you make those little noises when you get out of a chair? Am I considering getting a shed, or a cruise, or Velcro? And what about sex?

The only people who ask about significant birthdays are younger than you. No 70-year-olds are inquiring about my insights on being 60. Age is the great terra incognita. But then, all the people who tell me to do anything are younger than me now.

And please, can we stop this “60 is the new 40” thing? No one is saying 20 is the new 10. And who wants to be 40 anyway? An insipid, insecure age.

My generation, the postwar baby-boomers, are over the meridian of our vital parabolas. We’ve done our best and our worst, overachieved and underperformed, are either preparing to bask on the sun loungers of our success or suck our bruised fingers in the waiting rooms of failure. So 60 is both a personal summit from which to look back, breathing heavily, hands on my knees, and a generational one.

AA Gill as a young manAA Gill as a young man

I was born in 1954 in Edinburgh. Winston Churchill was prime minister, there was still rationing, we were the first generation that would grow up with television, pop music, central heating and a National Health Service. As a child, every old man I knew had fought in the First World War and every young man in the second.

War still hung like the smell of a damp, grim nostalgia over everything. We played Spitfires and Messerschmitts in the playground and you could, as Kingsley Amis pointed out, walk into any pub in the country and ask with perfect confidence if the major had been in. London was still moth-eaten with bomb sites and black with coal smoke. One of my earliest memories is of the last pea souper fog.

How do I feel having reached 60? Well, surprised, mostly. And grateful. When I was 30, a doctor told me that I had a dangerously damaged liver and, all things considered, I probably wouldn’t see another Christmas. I am an alcoholic and a drug addict but, with a lot of help, I stopped. I haven’t had a drink or picked up a drug since. My grandfather died at 59. He was a tooth-puller in Leith. My mother says it was anxiety about the coming of the health service that killed him, which is a braw example of Scottish humour.

Globally, I can expect to live to see another two World Cups. But by living in the south of England I should make it for another four. I tell people too quickly that I am 60 and wait, like a needy toddler, to be told I don’t look anything like that. One of the surprising symptoms of getting to be 60 is that I now can’t tell how old anyone under the age of 40 is; you all look 16. And don’t believe the beauty page gush that you are in fact only as old as you feel. It’s a nonsense, based on the assumption that ageing is primarily a physical process. It isn’t, it’s a maturing one. It’s not a feeling, it’s an experience. You are as old as you can remember.


Smiles from younger days

I dictate these articles to clever overeducated colleagues who are much, much younger than me. They constantly and consistently don’t get references to things that to me seemed to have happened only a couple of months ago. They’ve never seen black-and-white films or known the difference between 78, 45 and 33⅓.

So, if you know who Jan Palach, Gary Powers, Gary Gilmore, Squeaky Fromme, Adam Adamant, Albert Pierrepoint, the Piranha Brothers, Harry Worth and Fyfe Robertson are, then you must be 60.

A contemporary of mine, after a number of marriages, found a girlfriend less than half his age of a transcendent pneumatic beauty who hung on his every word — and dumped her after a couple of months. Why, I asked — she was perfect! “Too many things we didn’t have in common,” he said sadly. Like what? “Well, the Eighties.”

Which brings us to sex. Nicola has just exclaimed with unusual force that she has never slept with a 60-year-old and she’s not planning on starting now. Nobody wants to think about 60-year-olds doing it, least of all 60-year-olds. Another contemporary pointed out that it wasn’t finding the first grey pubic hair on yourself that was the doom-laden shock, it was finding it on the person you were sleeping with.

After a certain age it’s best not to have mirrors in your sight line. And lighting is important: the less the better. But you must have some, because everything sags and moves about. The pale, flickering glow of the television is the illumination of choice for most middle-aged couples.

I’ve been making a list of the sex that I’m now too old to consider. I will probably never have sex again on a jiggling sofa with her parents asleep upstairs. Or in a skip. Or in the back of a stationary 2CV or the front of a moving Alfa Romeo.

I won’t do bondage, sadomasochism or erotic yoga or miss them. Neither will I partake in role play. I am too old to be a pirate, a policeman, a Viking or the Milk Tray Man (they don’t know who the Milk Tray Man was either).

And I realise with a sudden shock that I’m probably too old to sleep with anyone for the first time. The thought of having to go through the whole seduction, will they, won’t they, can I, can’t I, is far more terrifying than it is exciting.

Sex definitely changes. It is less athletic, more romantic, more intense, more a special event. Not because it’s rare, but because it’s finite. There is a point in your life when you stop counting up and start counting back. It’s not the laps run, it’s the laps that are left.

This is one of the biggest changes in ageing. The continuous heartbeat rhythm that tells you your experiences are now rationed. How many more Ring cycles will I get to? How many more times will I see Venice emerging out of the lagoon? How many cassoulets, English cherries? How many summits in the Highlands? How many long lunches with old friends? How many old friends are left to me?

That sounds maudlin, but it doesn’t feel like that. It adds to the pleasure, a sentiment to everything, an extra gypsy violin to life. I linger over things now: flowers, moonlight, Schubert, lunch, bookshops. Also I mind less about standing in queues, sitting in traffic, waiting for a bus or my call to be answered. Everything has a pinch of piquancy, a smudge of melodrama, and I like that.

There are other things to which age adds an imperative. I’m pretty sure that when I’m lying on the gurney and the children are searching for the off-switch while telling me sweetly to go towards the light, the thing I regret won’t be, as John Betjeman said, not enough sex, and it won’t be not enough caviar or cakes. It will be, I think, that I never got to see Timbuktu or South Georgia. Never saw the northern lights. Never travelled up the fjords by boat.

The abiding pleasure of my life so far has been the opportunity to travel. It is also the single greatest gift of my affluent generation. We got to go around the globe relatively easily, cheaply and safely. Postwar children are the best and most widely travelled generation that has yet lived. We were given the world when it was varied, various and mostly welcoming.

Whether we took enough goodwill with us and brought back enough insight is debatable. But today the laziest gap-year student has probably seen more and been further than Livingstone, Stanley and Richard Burton.

One of the things that surprises and dismays me is how many of my contemporaries spend their time and money on travelling to sunny beaches. All beach experiences, give or take a cocktail, are the same experience. My advice to travellers and tourists is to avoid coasts and visit people. There is not a view in the world that is as exciting as a new city.

So I regret places and I will also regret not being a better friend. My generation has been profligate with friends. I look at how my parents husbanded theirs, thought about them, wrote to them, talked about them. Because they had lived through the war their friends were innately more precious than ours have been to us. Our friends are not disposable, but they turn out to be forgettable. I regret not making more of an effort to keep up, keep hold and keep close the people I loved. Now their absence and my casual wastefulness upset me.

Gill with his father, who died of Alzheimer’sGill with his father, who died of Alzheimer’s

I noticed in last week’s paper that if I were in the army (something, thanks to my father and my grandfather, I’ve never had to do), being in the 55-59 age bracket I would be expected to do 21 press-ups and 27 sit-ups within two minutes. Now that is down to 17 and 23 as I’ve reached the end of the tick-box line. I will now be for ever in the 60 and over category, after which there is just the margin.

Last year, for the first time, a young girl, French, offered me her seat on a crowded bus. I was surprised at how deeply I resented her. Health looms over the elderly like a threatening monsoon. No ache is innocuous. No lump or discoloured, sagging patch of body is ignorable except our toenails, which become the most sordidly repellent things in all nature. We covertly examine ourselves and our effluvia for the premonition of the dark humour that will carry us away. There is no such thing as a routine checkup. They are all life-or-death appointments.

Doctors start all their sentences with “It’s only . . . ” But we’re not fooled. This generation is also the one that lingers longest over its departure. Death came to our grandparents with a clutched chest and a searing pain. For us it’s a slow, humiliating series of it’s onlys. What we worry about is dementia, a condition that did not exist in the popular lexicon when I was a child. Mind you, we also thought cancer was as shaming as divorce. Now Alzheimer’s is our abiding fear, the thing we can’t forget.

My chats with contemporaries are like bridge games where we try to fill in the gaps in each other’s sentences to make one coherent conversation. My dad died of Alzheimer’s. I once asked him how he was feeling: “Oh, quite well, except you know I’ve got this terrible disease, what’s its name?” So we go to the gym, we have trainers, I do Pilates. But it’s only maintenance. I’m not looking for a beach body, there’s no New Me in the cupboard; I just want one that’s supple enough to put on my own socks.

After giving up drink and drugs, I continued to smoke about 60 a day until 12 years ago and then I stopped. And people said, “Well done! How did you manage it? What willpower!”

It didn’t feel like well done. It felt like a defeat — the capitulation to fear. When I started smoking at 14 I was golden, immortal. I smoked around the world; I took pride in my ability to smoke with elegance, panache and skill. Smoking was my talent and I gave it up because I lost my nerve.

I don’t miss the cigarettes, but I do miss the me that smoked so beautifully.

Oddly, the one thing that does improve with age is our teeth. Old people get perfect, white, even, marvellous grins. Paradoxically, we simultaneously lose our sense of humour.

I’ve had four children in two batches. It’s not for me to say if I’ve been a good father; that’s between the kids and their respective therapists. But I think I’ve been more benign second time round. With the first two, now 21 and 23, I was a cross between a Butlins Redcoat and Savonarola. I had plans and theories; I thought children were blank and malleable. I was brought up in the Sixties by Sixties parents who drank Sixties Kool-Aid. Much as I loved them I didn’t want to be like them, just as they didn’t want to be like their parents.

I had no plan or ambition for my kids and no Tiggerish belief in education. I know all the competitive insecurity that infects parents around schools, exams and universities. I’ve seen too many desperate kids becoming extensions of adults’ vanity, insecurity and desire for a second chance. And I told my children I had no interest in seeing their reports or knowing their exam results. Nothing they achieve will ever make me prouder of them than the day they were born. Nothing they do or don’t do will make me love them an iota less.

With his partner Nicola
With his partner Nicola

Through empirical trials I have discovered there is no intergenerational conflict that can’t be sorted with a tenner. Just say sorry and I’ll give you a tenner. Clean your room — there’s a tenner in it. Get your aunt a birthday card; keep the change. It’s not money; it’s a MacGuffin, a prop that allows everyone to back down without losing face or temper. And oddly I’ve managed to produce four of the least miserly and acquisitive children.

How did my generation do? Well, we get blamed for being selfish and self-obsessed and soft and pushing up house prices and saddling the next generation with hideous debts and nowhere to live and I suppose that’s not entirely unfair.

We are ridiculously obsessed with food, buy too many things and have too many clothes. But we didn’t start a war. Well, not a big one. And we didn’t nuke anyone. We defused the Cold War. We believed in the collective good. Although we came to confuse gestures with actions and we think going on a march and writing a letter are the same as doing something, making the world better.

We were the generation that were relentlessly for civil rights, human rights, gay rights, disability rights, equality, fairness. We were implacably against racism and censorship. We defended freedom of speech, religion and expression. We will leave the world better fed and better off than when we arrived in it.

Britain is a far happier, richer and fairer place than it was 60 years ago. And if you think that’s wishful self-promotion, you have no idea how grim and threadbare Britain in the Fifties was. You weren’t there, you don’t remember.

To view the original article you will need a friend who has a membership of Rupert Murdoch’s pay wall!

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Cancer Doctors Offer Way to Compare Medicines, Including by Cost

Cancer Doctors Offer Way to Compare Medicines, Including by Cost
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Alarmed by the rapid escalation in the price of cancer drugs, the nation’s leading oncology society unveiled on Monday a new way for doctors and patients to evaluate different treatments — one that pointedly includes a medicine’s cost as well as its effectiveness and side effects.

The release by the American Society of Clinical Oncology of what it calls its “value framework,” is part of a change in thinking among doctors, who once largely chose drugs based on their medical attributes alone. The major cardiology societies, for instance, are also now starting to factor cost into their evaluation of drugs.

“The reality is that many patients don’t get this information from their doctors and many doctors don’t have the information they need to talk with their patients about costs,” Dr. Richard Schilsky, chief medical officer of the oncology society, said in a news conference on Monday.

He said the price of new cancer drugs now averaged about $10,000 a month, and some cost $30,000 a month, which can mean prohibitive co-payments even for some patients with good insurance. “Many cancer patients are facing severe financial strain, even bankruptcy in some cases,” he said.

The value framework envisions considering two costs: the out-of-pocket costs for the patient and the overall cost of a drug to the health system.

Evaluating the latter cost would put doctors in the role of being stewards of societal resources. That is somewhat of a controversial role for doctors, since it might conflict with their duty to the patient in front of them. But the oncology society said it did not see those roles as being in conflict.

Some of the sample valuations presented by the society were far from flattering for the drugs involved.

Roche’s Avastin, when added to chemotherapy, had a net health benefit of 16 out of 130 possible points when used as an initial treatment for advanced lung cancer. Its monthly cost was $11,907.87, compared to $182.09 for the chemotherapy alone.

Eli Lilly’s Alimta for that same use had a net heath benefit of zero with a cost exceeding $9,000 a month compared to about $800 a month for the drugs it was compared to in the clinical trial.

A spokeswoman for Lilly said the trial analyzed by the oncology society understated Alimta’s effectiveness because it covered a broad population, whereas Alimta is approved for only one type of lung cancer. A spokeswoman for Roche said Avastin was the first drug to help lung cancer patients live longer than a year, and that the choice of treatments for life-threatening diseases was complex and personal.

The framework, published online Monday by The Journal of Clinical Oncology is more a proposed methodology that will now be open for public comment. It will take time to input the data on the effectiveness, side effects and costs of each drug, and convert it to a system that can be used on computers and mobile phones.

There is no requirement that doctors use the framework and it remains to be seen if they will. But the authors of the document say it is a start.

“It allows the patient and the doctor to at least talk through the issues,” said Dr. Lee N. Newcomer, senior vice president for oncology at UnitedHealthcare, the big insurance company, and a member of the task force that developed the framework. “Before, the information wasn’t there.”

UnitedHealthcare is mounting a similar effort of its own, Dr. Newcomer said. Starting this month, it is requiring oncologists to get prior approval from the insurance company for every cancer drug they administer. The company will then track what happens to patients and eventually provide information to doctors about how well each drug works.

Concern about cancer drug prices has been rising for years and doctors have been becoming increasingly vocal. At its annual meeting late last month, the oncology society included a talk sharply criticizing the prices of cancer drugs as part of its plenary session.

Randy Burkholder, vice president for policy and research at the Pharmaceutical Research and Manufacturers of America, the drug industry trade group, said that drugs represented only 20 percent of cancer treatment costs. He also said that the big clinical trials that the oncology society used to make its value calculations might not be as relevant as treatment becomes increasingly personalized based on genetic analysis of a patient’s tumor.

Some experts say that ideally, the price of a drug should reflect its value, but that does not seem to be the case with cancer drugs. A recent study by researchers from the National Cancer Institute, published in JAMA Oncology, surveyed cancer drugs approved from 2009 through 2013. It found that prices did not correlate very well with how novel a drug was or whether it prolonged life versus just shrinking tumors.

The framework computes a score — called the net health benefit — based on clinical trial data.

Drugs for advanced cancer are given a score from 0 to 130. Up to 80 of the points are based on a drug’s effectiveness in prolonging lives, delaying the worsening of cancer or shrinking tumors. Then up to 20 points can be added or subtracted based on side effects. And up to 30 bonus points can be granted if the drug relieves cancer symptoms or allows a patient to go without treatment for a period of time.

The costs of the drug are listed separately, rather than incorporated into the final score for a drug. That is a step short of what is done in some evaluations, such as those by the National Institute for Health and Care Excellence in Britain, in which drugs are rated by the cost per extra year of life they provide, adjusted by side effects and symptoms.

Researchers at Memorial Sloan Kettering Cancer Center recently announced a tool that allows people to evaluate the cost-effectiveness of cancer drugs.

These other institutions “take the next step to say ‘What do we think about this amount of benefit at this cost?’” said Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review, a nonprofit organization that evaluates the clinical and cost effectiveness of treatments.

Dr. Lowell E. Schnipper, chairman of the task force that developed the oncology society’s framework, said that patients wanted to know how medically effective a drug is. Adding the cost into an overall rating would obscure that information, he said.

Each drug is evaluated based on how it did in clinical trials compared to a control group, and the control groups can be different. That makes it difficult to compare one drug to another.

“This is not a way of ranking drugs,” said Dr. Schnipper, who is clinical director of the cancer center at Beth Israel Deaconess Medical Center in Boston. “This is simply a way of understanding the outcome of a clinical trial.”

To view the original of this article CLICK HERE

.
Regards,
Greg_L-W.
.
 Please Be Sure To
& Link to my My Blogs
To Spread The Facts World Wide To Give Others HOPE
I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms in 1998 see The TAB at the Header of this Blog. called >DIARY of Cancer ….< just click and it will give you a long list of the main events in chronological order, many linked to specific blog postings.
.
Thoughts, articles and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Left Sidebar.
.
You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help, also many of the links in articles and >HOT LINKS< in the Sidebar.
.
YOU are welcome to call me, minded that I am NOT medically trained, if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01594 – 528 337
Accuracy & Copyright Statement: CLICK HERE
Summary, archive, facts & comments on UKIP: http://UKIP-vs-EUkip.com
DO MAKE USE of LINKS & >Right Side Bar< & The Top Bar >PAGES<
Also:
Details & Links: http://GregLanceWatkins.com
UKIP Its ASSOCIATES & DETAILS: CLICK HERE
Views I almost Totally Share: CLICK HERE
General Stuff archive: http://gl-w.blogspot.com
General Stuff ongoing: http://gl-w.com
Health Blog. Archive: http://GregLW.blogspot.com
Health Blog. Ongoing: http:GregLW.com

TWITTER: Greg_LW

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Lung Cancer Mutations Maybe More Treatment Options

Lung Cancer Mutations Maybe More Treatment Options
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Discovery of New Lung Cancer Mutations May Mean More Treatment Options

DNA Sequencing

The identification of 4 new types of genetic mutations in the most common form of lung cancer could open the door for targeted treatment options for many more patients. This discovery adds to the existing scope of known lung cancer mutations.

When doctors know that a patient’s lung cancer has specific genetic mutations, they can selectively target it with certain drugs. If the cancer doesn’t have any of these mutations, the doctor is left with fewer treatment options.

Now, according to researchers, more than 75% of lung adenocarcinoma patients have been found to have genetic alterations that doctors might be able to use to help inform treatment decisions. Previously, that figure stood at 62%. There are more than 224,000 new cases of lung cancer each year in the U.S. and nearly 160,000 deaths from it, meaning this increase in known mutations has the potential to impact a large number of patients.

The 4 new mutations are detailed in a study published online July 9, 2014 in the journal Nature. The research team analyzed 230 lung adenocarcinoma tumor samples from The Cancer Genome Atlas (TCGA), a project of the National Institutes of Health.

“Two out of the 4 new mutations have been linked to lung cancer in some capacity previously and there are already some drugs out there for them – so there is some immediate potential for treatment,” says Alice Berger, Ph.D., a researcher at the Dana-Farber Cancer Institute and co-author on the study. Berger’s work on the investigation that led to the findings is funded in part by a $150,000 grant from the American Cancer Society. The other 2 newly discovered mutations present opportunities and impetus for the development of new drugs, according to Berger.

“If you don’t have an existing known mutation, once you stop responding to chemotherapy, then clinicians are in the dark about what else to try, but now, with knowledge of these other genetic alterations, it will give clinicians better options,” says Berger.

Spurred to Search for Remaining Mutations

For Berger, beyond the ability to now target the newly identified mutations, the findings showcase the value of continuing to look for specific genetic mutations that are causing lung cancer. “It continues to motivate us to do more sequencing to increase the power of our studies so we can identify rare mutations that may be very relevant for the remaining 24% [of lung adenocarcinoma patients] with tumors with still unknown mutations,” says Berger.

The study findings and the continuation of Berger’s work cataloging the genes that are most important in lung cancer will lead to doctors “being able to manage more patients in a personalized manner,” says William Phelps, Ph.D., director of preclinical and translational cancer research at the American Cancer Society.

Finding new genetic targets for lung cancer – or any cancer – is no small task, though. “There are really an astonishingly high number of mutations in every person’s tumor,” says Berger. “So, we have identified thousands and thousands, but the question is: how many are important and shared in tumors?”

Getting to an answer requires extensive sequencing of large numbers of tumor samples, something The Cancer Genome Atlas project is uniquely structured to do, adds Berger. And, it is not just about sequencing DNA anymore. Berger and her partners were also able to sequence the RNA of the tumor samples.

The ability to look at both DNA and RNA data is what “really enabled us to identify some of these newer alterations, because for some specific cases there are things that would have been hard to detect only in DNA,” says Berger. “We can now get a fuller picture of what is going on in these tumors.”

FOR RESEARCHERS: Learn how to apply for a research grant from the American Cancer Society.

Read more about American Cancer Society researchers.
 

To view the original of this article CLICK HERE

.
Regards,
Greg_L-W.
.
 Please Be Sure To
& Link to my My Blogs
To Spread The Facts World Wide To Give Others HOPE
I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms in 1998 see The TAB at the Header of this Blog. called >DIARY of Cancer ….< just click and it will give you a long list of the main events in chronological order, many linked to specific blog postings.
.
Thoughts, articles and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Left Sidebar.
.
You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help, also many of the links in articles and >HOT LINKS< in the Sidebar.
.
YOU are welcome to call me, minded that I am NOT medically trained, if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01594 – 528 337
Accuracy & Copyright Statement: CLICK HERE
Summary, archive, facts & comments on UKIP: http://UKIP-vs-EUkip.com
DO MAKE USE of LINKS & >Right Side Bar< & The Top Bar >PAGES<
Also:
Details & Links: http://GregLanceWatkins.com
UKIP Its ASSOCIATES & DETAILS: CLICK HERE
Views I almost Totally Share: CLICK HERE
General Stuff archive: http://gl-w.blogspot.com
General Stuff ongoing: http://gl-w.com
Health Blog. Archive: http://GregLW.blogspot.com
Health Blog. Ongoing: http:GregLW.com

TWITTER: Greg_LW

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Facing a Terminal Diagnosis – Ian Skidmore

Facing a Terminal Diagnosis – Ian Skidmore
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& Link to my My Blogs
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Hi,

as many of you will remember I owned and ran GlanceBackBooks in Chepstow from 1982 however I well remember some years ago being interviewed for around an hour by Ian Skidmore on behalf of Radio Wales.

I was sorry to have this article from his blog brought to my attention by a friend of some years standing:

Saturday, 27 July 2013

PASS THE B LACK CAP

 Jury back. Guilty advanced lung, bone and re-run of bowel cancer. Retrial on kidneys. Suspended sentence 12 months.

But the good news is that I can have a drink and am about to pour a single malt which I raise to you, my friends, with thanks for your support and all those years of friendship.


I don’t recognise the NHS I have been enjoying recently in the lurid stories I am reading. Our hospital in Peterborough offers one-person luxury wards with TV and a bigger bathroom than we had in the Ritz. Tested for everything bar Fowl Pest. Indeed I have to go back for an examination of the kidneys. I think they are entering me for a competition. Cosseted by a succession of nurses and jolly doctors. All Free.

Meanwhile the dog, who saw that for once I was getting more attention than he was, threw a sickie. Vet seized the opportunity to test for every sickness known to science, plus a night in a dog’s dormitory. Bill £700 and there is nothing wrong with him.

                                                   *****************
I was an expert on …

To read more of his article and how he dealt with what is a near certain death sentence you may care to CLICK HERE
Or just read on:
*****************
I was an expert on being poor. When I came out of the army I took a job with a news agency, got married and was sacked the week after we returned from honeymoon.

The only work I could get was a casual Saturday shift on the News of the World, which paid £4 and 10 shillings in real money. My rent for two rooms in a very smart house was £2. I had married a Jewish princess who knew nothing about laundry, even if we had hot water. So we had to pay 2/6 a week to get the washing done. Didn’t cost a lot because I only had two shirts. We could do what we liked with the remaining £2 7s. 6d. which meant we ate every other day.

I had to keep half a crown back to buy myself into a lunchtime drinking school every Thursday at the Waldorf in Cooper Street, Manchester, where John Milligan, the News of the World editor, drank with the news editor, Graham Haslam.

At some time during the hour that followed the news editor would say: “Doin’ anyting on Saturday, Skiddy?”  “Don’t think so, Graham. Why?” “Wonder if you would do the late shift for us?”

It meant a ten mile round walk to the News of the World but for a year that was our only income.

We were in the house one day sharing a cigarette we had made from the week’s collected dimps. The front door bell rang. I was wearing my good suit and my one clean shirt ready to go to the Waldorf, so I went down. There was a tramp at the door.

He said he had just come out of prison and did I have the price of a cup of tea. I said I was broke, and saw him look at the smart house in which I lived, the well cut navy suit and polished shoes I was wearing and then he looked back down the long drive to the road.

The look he gave me, utterly defeated and totally disbelieving, went straight to the heart. Halfway back upstairs I remembered the half crown I had put on one side to buy my way into the round. I ran after him. He looked terribly guilty but I pressed the half crown into his hand and returned home rejoicing.
My wife asked, while I was at the front door, why didn’t I pick up the washing from the front step?

I went back. No wonder the tramp had looked guilty. He had stolen it. For the next six months I had to sit in my vest whilst my shirt was washed under a cold tap so I could go to the Waldorf and get my Saturday shift.

Things gradually got better as the years staggered by. I was once a Chevalier de la Chaine des Rotisseurs or, to use plain English, a Knight of the Brotherhood of the Chain of the Turning Spit, a gourmet club which did things in fine style. Once we hired a dining coach to be put on the end of the Crewe to Bournemouth express on an occasion when we were eating away from home. My friend, the 9th Baron Langford, who was our Baillie and was kindly contributing several bottles of ’47 port, insisted the pair of us interview the station master at Crewe to ensure all was hunky dory. Station masters love a lord and this one donned morning dress and a topper to meet us. At the baron’s request, he introduced us to “our” engine driver.

“My grandfather,” confided the baron to the startled driver, “always maintained there was no greater pleasure than making love in a sleeping car as the train went over a set of points.” (The Brotherhood was very strong on such niceties. One elderly brewer assured me that no kisses were more erotically charged than when the girl had been drinking yellow chartreuse and the man green. An estate agent called Ramos declined a dessert that was served in a cocoon of spun sugar on the grounds that it would be like eating the pubic hairs of a fairy.)

“However,” the 9th Baron told the engine driver, “what might be an aid to lovemaking is very bad for port. So I would be grateful if you would slow down as you approach any set of points on our journey.”

The extraordinary thing was that the engine driver did.

 On another occasion we had been to a Normandy banquet at the Piccadilly Plaza in Manchester where our guests had been Louis Edwards, the Lord Mayor of Manchester, and Sonny, the then Marquis of Milford Haven. After the meal, Geoffrey Langford and I took them to the champagne bar where Edwards ordered a tankard of Moet, the 9th Baron, Mumms, and Sonny, Louis Roederer.

To this day I do not know why, when it came to my turn, I asked for a chip butty. The waitress took the order without demur and soon returned with the champagne, followed by a waiter bearing the finest chip butty I have ever seen. The bread was home made, the butter runny and the golden chips had hard crusts protecting inner potato, soft as a baby’s cheek. The silver platter on which they were served also carried salt, pepper and vinegar. Interspersed ‘twixt chip and plate was a neatly cut, and probably ironed, square of newspaper.

“By God,” said the 9th Baron, “that looks good. Bring me one!” “And me,“ said the Marquis of Milford Haven. “And me,” said the Lord Mayor of Manchester.

I have achieved little in life but I did introduce the aristocracy to the chip butty. Which, on a point of information, goes very well with champagne and is as good a way as any to shuffle off this mortal coil.

Other members included restauranteurs who took it in turns to host our banquets. One, Roland Genty, had come to Manchester during the war to train as a parachutist to be dropped in occupied France. Roland was frighteningly tough. Quiche Lorraine was his signature dish. Naturally it featured on the menu when he hosted. Alas, there was a delay which seemed endless in the serving of his Quiche. He went to the kitchen to remonstrate. He returned and addressed us gravely:

“My Lord and messieurs, I fear there will be a delay. Unfortunately the waiter dropped a tray of the Quiche…and, naturellement, the chef has stabbed him.”

Alas, my appetite has diminished but happy memories remain.  My favourite chippie was the Sea Waves fish and chip emporium in Menai Bridge on Anglesey.  We usually had a table in the window, in the spotless tiled restaurant bar, furnished in bright white and yellow plastic. Rashid, the Turkish chef-owner, came to Menai Bridge via the Piccadilly Hilton and the Gleneagles Hotel.  Much was expected and we were never disappointed.

Rashid was a consummate artiste whose fish and chips went through purifying fires of very high temperature to emerge with the lightest of sun tans, crisp and mouth watering. His haddock was so fresh I swear it was singing sea shanties. Rashid his skill with the mushy pea was legendary.  He scorned to mush to viscosity, as lesser fish fryers do. His peas, though pliant to the palate, retained their traditional shape and texture.

A happy substitute has, I’m glad to say, been found in Dave, of Snappers in March, from where the dog also enjoys a tasty sausage. Oh, for the appetite of yesteryear…


It seems clear to me that Ian has the same attitude to cancer as I have – ‘I may well have cancer but cancer does NOT have me’!

Good luck to Ian or may it be more apposite to say ‘Brak a leg’.
.

Regards,
Greg_L-W.
.
 Please Be Sure To
& Link to my My Blogs
To Spread The Facts World Wide To Give Others HOPE
I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms in 1998 see The TAB at the Header of this Blog. called >DIARY of Cancer ….< just click and it will give you a long list of the main events in chronological order, many linked to specific blog postings.
.
Thoughts, articles and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Left Sidebar.
.
You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help, also many of the links in articles and >HOT LINKS< in the Sidebar.
.
YOU are welcome to call me, minded that I am NOT medically trained, if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01594 – 528 337
Accuracy & Copyright Statement: CLICK HERE
Summary, archive, facts & comments on UKIP: http://UKIP-vs-EUkip.com
DO MAKE USE of LINKS & >Right Side Bar< & The Top Bar >PAGES<
Also:
Details & Links: http://GregLanceWatkins.com
UKIP Its ASSOCIATES & DETAILS: CLICK HERE
Views I almost Totally Share: CLICK HERE
General Stuff archive: http://gl-w.blogspot.com
General Stuff ongoing: http://gl-w.com
Health Blog. Archive: http://GregLW.blogspot.com
Health Blog. Ongoing: http:GregLW.com

TWITTER: Greg_LW