This week was really challenging. I felt pretty good on Tuesday, so did some chores around the house for a couple of hours .... mistake. I spent the rest of the week on the couch, and really thought that the nurses would send me home on Friday because my bloodwork was bad.
Turns out, my bloodwork was OK even though I felt like sh*t. So I got my last treatment (Gemcitabine) on Friday. Brother Don and daughter Kathryn came to the Cancer Agency for the appointment, and tag teamed sitting with me while the poison slowly leached into my body (being pretty dramatic here, aren't I).
So with this last session, I'm done with the chemotherapy part of my cancer treatment. The next step is to wait eight to twelve weeks to recover, and then bladder removal surgery. I had some hope that there might still be an option on the table to avoid the surgery, but Dr. Noonan (Oncologist) put that to rest last week - the standard of care for my situation is four cycles of chemo, followed by bladder removal.
I'm impressed by BC Cancer for this - when I look into the evolving standards of care around the Western World, only a small percentage of health care systems have adopted this as best practice. Many have these same studies, but have a hard time moving to the latest/best strategies.
Laura and I met with Dr. Noonan (Oncologist) this morning.
I've been off for two weeks, so am feeling better - certainly not normal and still a little tired, but improving every day.
The CT scan I had last week showed no evidence of disease outside the bladder - which doesn't mean a whole lot because it's microscopic disease we're worried about. The chemo to date has not shrunk the bladder tumour(s), but it isn't supposed to. It is supposed to hunt down and destroy any cancer cells it finds in my entire body. Except my left foot.
So all signs point to finishing off this chemotherapy round with sessions seven and eight. Starting this Friday (cisplatin and gemcitabine) and next Friday (gemcitabine). After that, she calls Dr. Wong (my Urologist) and she gives him the go ahead to schedule surgery.
I'm on track to finish all the chemo on December 22, so surgery ideally would be the end of February or beginning of March. I talked with Dr. Wong last week and confirmed that his calendar is open on those dates, so scheduling shouldn't be an issue.
When I talked with Dr. Wong he said that "all options are still on the table", although "some are not optimal". This held a glimmer of tri-modal therapy (bladder preservation), but Dr. Noonan pretty much put the stink eye on that option this morning. We're too far down the path of chemotherapy, and TMT isn't optimal for me for a number of reasons (multi-focal tumour, location of tumour near a ureter, bent ureter).
So back to the "I quit" theme at the beginning. Unless something extraordinary happens, I won't see Dr. Noonan again. She is done.
Now I look forward to be waited on hand and foot over the Christmas break.
I had the final "Cycle Three" chemotherapy last night. This was the more tolerable of the sessions - Gemcitabine alone for a total of about an hour. Compared to the previous week (Cisplatin and Gemcitabine for a total of three hours), this is easy.
When we first started, Dr. Noonan (Oncologist) said that "we'll try to get three cycles done, four if you can tolerate it". I wasn't so sure I was tolerating the Cisplatin very well (some kidney function markers and general malaise) but the bloodwork was better this week.
So once I recover from this cycle (two weeks off), I meet with Dr. Noonan again and we decide on Cycle Four (or not). As I've mentioned previously, the stats are pretty glaring - four is better than three, so do four if you can:
[Results: One hundred and twenty-one patients were identified. Patient characteristics are described in the table below. Eighty-six patients received 4 cycles of GC and thirty-five patients received 3 cycles. Ninety-five patients proceeded to cystectomy: 93 received a radical cystectomy, 1 received a partial cystectomy, and 1 was aborted due to positive lymph nodes. There was a statistically significant difference in OS between those who got 3 or 4 cycles (p=0.03) and PFS (p=0.014). Median OS for those who got 3 cycles and 4 cycles was 52 months and 92 months respectively.] *Note: OS = Overall Survival
If I do four, I'll be done on Dec 22. Just in time for Christmas.
This week I had a meeting with the Oncologist (Dr. Noonan) on Wednesday, and the CIS-GEM chemotherapy yesterday (Friday, Nov 24).
This is the beginning of Cycle 3 (2 sessions per cycle). Ideally, we'd like to get 4 cycles done, but 3 is considered acceptable.
The title of this post is a little confusing. I'll visit the chemo ward (ideally) 8 times. 4 courses of 2 sessions/course. Session 1,3,5 and 7 are the big ones (CIS-GEM) and 2,4,6,8 are GEM only (CISplatin and GEMcitabine).
Because I'm curious I went looking into the stats for 3 cycles versus 4, and found this. TLDR - 4 is twice as good as 3. Do 4 if you can.
The other curve-ball in this is that my kidney function markers are starting to be affected. It was a question this time as to whether I get a "full dose" of Cisplatin or not ... Dr. Noonan decided that I can get the full meal deal this time, but I'm wondering if this will change moving forward.
I've had a couple of questions about scheduling surgery. The way it will work is that at the end of the chemo (3 courses or 4), Dr. Noonan will call Dr. Wong (Urologist who will perform the surgery) to schedule. I've read different "ideal" surgery timings, but they're all within an 8-12 week window. It seems that "do it as soon as your healthy enough to do it". In our health care system, I'm sure there are other variables out of everyone's control ...
PS: If you hover over the photo a caption should come up. If it doesn't, this is my bladder and the arrow is pointing to the tumor. This is pre-chemo, and I'll have another CT on Dec 4th to see any changes.
One of the side effects of Cistplatin, and one the doctors and nurses check and recheck all the time, is hearing loss.
As I woke up this morning, and all was quiet, I could "hear" a very low level, very constant, ringing in my ears. I have several instances of "serious" tinnitus during the day, but they only last for a few seconds and then go away. I had been concerned that this what what they were looking for. Maybe it is.
It's not especially bothersome (at this level), and I'll report it to the nurses on Tuesday. If this is as bad as it gets, I can live with it. If it gets much worse than this, they might have to adjust the amount of Cisplatin I'm getting next time.
Through the first round of chemotherapy, I thought "well, this isn't so bad". Sure there were unanticipated side effects, but they all had fixes and it was just a matter of a few days to get them under control.
Then I had a couple of weeks off, and felt almost like myself. On Friday, November 3, Round Two started. It's the heavier session with both Cisplatin and Gemcitabine - in total takes about three hours to infuse.
I was hit by a truck. Zero energy, upset stomach, leg and arm pain. I could sleep on the couch from 2pm till 7am the next morning and still feel tired.
But today (Friday, Nov 10) I get the Gemcitabine by itself - takes about a half hour. And I feel OK. It's almost like they know what they're doing...
So since the beginning of this blog, I've changed up the title from Doug 2.0, to 3.0. to 3.1, 3.2, and now 4.0. These have corresponded to some pretty big medical events in my life:
2.0 - CABG (heart bypass surgery in 2006)
3.0 - Ischemic Stroke in 2009
3.1/3.2 - Stroke related events that happened during recovery
4.0 - My latest diagnosis
The latest...
Late this spring, I noticed blood in my urine. After my doctor and I had eliminated a UTI as the cause, he referred me to a Urologist (Dr. Nathan Wong). Early in the summer, I had a cystoscopy which confirmed that I had bladder cancer, and then followed up by a TURBT procedure which both cleaned up what was in the bladder, as well as determine the extent of the damage.
When the results of the TURBT biopsy came back, it was determined that I have Stage 2, Muscle Invasive Bladder Cancer. The course of treatment for this will be:
A course of chemotherapy - four rounds of two sessions each
Session 1 - Gemcitabine and Cisplatin
Session 2 - Gemcitabine
Once the four rounds of chemotherapy are done (probably late December), I'll recover for a couple of months and then have bladder removal surgery (which will include the prostate, vas deferens, local lymph nodes, and maybe other assorted body parts). I still have to make a decision about the post-bladder direction I choose - there are a couple of options which include having a stoma with an external urine collection pouch, or the creation of an internal pouch out of intestine.
Right now, I'm leaning toward the stoma/urostomy, as it seems the simpler operation with the fewer chances for side effects. Although it does mean a radical change of life for me - I know from past experience that human beings can get used to just about anything.
So there we are. I'm right in the middle of chemo while I write this. I know it's the first time I've updated the blog in several years, but I want to log this as I go so maybe somebody will get something out of it.
PS: I've got three doctors that are working with me through this:
Dr. Peter La Voi - my GP here in Port Coquitlam, who was the first to jump on this and has intervened to speed things up when they started to lag.
Dr. Nathan Wong - my Urologist working out of New Westminster. Very focused and to the point. Reminds me of an engineer. I like that.
Dr. Krista Noonan - my Oncologist with BC Cancer. Very warm, knowledgeable, and works hand in hand with Dr. Wong. She's the one with the bedside manner.
I'm very happy with the team I have, and I'm most encouraged by their age - I doubt any of them is over forty.
I have had over a dozen entry level luxury watches over the course of the last few years (thank you global pandemic). I had a 2000's era Omega Seamaster Pro for a long time, until a trip to Japan reignited my love of watches. That was the start of it, and it cascaded from there.
I'm sad that I let some of them go. Perhaps the hardest to come to grips with is the now "impossible to find" Grand Seiko SBGX115.
There's been a couple of others, too. When I look back at photos of my collection, I often wonder why I didn't stop then and hang on to all I had.
But on with my thought. I think I might just have the "one and done" watch in the Citizen. It's absolutely below the radar. It looks like your standard shopping mall Citizen. But it's not.
The watch is made of high-grade titanium with a Duratect protective treatment
40mm diameter, 12.5mm thickness
Double domed sapphire crystal with excellent AR
Traditional Japanese tosa-washi paper dial - close examination shows the character of the paper
Citizen Eco-Drive movement, solar powered
Excellent visibility day or night with polished and lumed hands, dial and rehaut
Perpetual calendar with quick date set
Hacking and independent setting of hours hand
High Accuracy Quartz (HAQ) movement with specified accuracy of +/- 5 seconds/year. I'm getting about +/- 10 seconds/year based on my wear/use case.
100m of water resistance with screw down crown
Titanium bracelet and clasp that is honestly the best I've ever worn
Screw down titanium case back
Zaratsu polished case - easily competes with Grand Seiko and Rolex. Actually in Japan - it does.
It's the best finished watch I've owned.
It's the most comfortable watch I've owned.
It's the most legible watch I've owned.
It's the most accurate stand-alone watch I've owned (not syncing to some external time source).
But don't take my word for it. I first got onto this watch when I watched a video (since removed from YouTube) from jandrese. Here's his post on Reddit.
Just the other day, a popular Aussie watch vlogger (Jody at Just One More Watch) did a review. It's worth a watch.
It's been almost two years since I wrote that last "Grand Seiko versus Rolex" post, and it's time for an update.
I still have the SBGX115 GS Quartz Diver, and it's worn regularly. So regularly in fact, that the case is getting banged up. One day, I might have to get the case refinished - but since it's a special tin plate polishing technique (in Japan, call Zaratsu) it would have to go back to Japan to be serviced. Maybe that's not such a bad thing - it's not as though I have nothing else to wear.
Grand Seiko SBGX115
We went back to Japan in the fall of 2018. I knew I had to get some kind of a souvenir watch while there, and spent a large portion of our time looking at watch shops. In the end, it was at Narita Airport on our journey home that I finally pulled the trigger and got a Seiko Presage SARX055.
The SARX055 is known as a "Baby Grand Seiko". The dial work is amazing (blow up the photo). Finished is outstanding, and the watch is in titanium (I have a thing for titanium).
SARX055
This scratched the itch for several months, but in the summer of 2019 I got the urge for something different. The watch community has a thing for Casio G-Shock. Not your run of the mill Walmart Casio G-Shock, but Japanese only boutique watches. I dipped my toe in this with a GW-5000-IJF.
Photo courtest of Seiya Japan - I buy most of my Japanese watches from him.
I had this for a short time and didn't get it. I even wrote a forum post about not getting it and got a lot of feedback (mostly negative). At any rate, when my son came home from Montreal for Christmas I gave the watch to him. And for him, it's perfect. Solar, automatic time sync, indestructible, and nerd chic.
So with that, I'm back in the hunt. My focus has drifted solidly into High Accuracy Quartz (HAQ) watches. I cannot afford any of the high-end mechanical pieces I'd be interested in (AP Royal Oak, Patek Philip Aquanaut, Vacheron Constantin Overseas, Zenith Classic Defy, Grand Seiko Snowflake).
Audemar Piguet Royal Oak
Grand Seiko Snowflake
I'm intrigued by the high-end pieces that Citizen makes. These are models you'll never find in North America. After much consternation, I pulled the trigger on this Citizen Chronomaster:
Citizen Chronomaster CTQ57-0934
It's a very classic size - 35mm (versus 40-44 for almost everything else I have). On an alligator strap, it looks great. It's also accurate to five seconds a year, with a perpetual calendar, so there's that.
I have a five watch watchbox, so I keep six watches in rotation (one for my wrist). I have another watch on order that I'll write about next - time to remove one watch from the box. It's time for the Sumo to take a rest.
Since I was a teenager, I've lusted for a Rolex Submariner. Always financially out of reach, I bought a "Bond" Omega Seamaster Professional 300 about fifteen years ago, and the luxury watch urge went away for a long while.
Seiko 5
The watch lust re-emerged during a trip to Japan in 2016. I was Seiko-5-curious, and wanted to pick one up to see what the fuss was about (the Seiko 5 family are low end, high quality, automatic watches). Big mistake. The low-end Seiko 5 I bought at Narita Airport in Tokyo led me to step it up a notch, and search for JDM (Japanese Domestic Market) watches from Japanese Online Watch Dealers - who knew this was a thing?
Seiko SUMO
My first acquisition was a Seiko "Sumo" dive watch. I modified that watch with a ton of NATO straps, a custom rubber dive strap and a ceramic bezel insert. I also regulated the watch myself to make it more accurate than out of the box.
Next I bought a Seiko SARB dress watch - fantastic finish, same movement as the SUMO. Then a ladies dress watch for Laura. Then a vintage King Seiko. Then another Seiko 5 that I modified to be a Blancpain Fifty Fathoms homage (called a Seiko Fifty Five Fathoms - or FFF). Then a beater Seiko solar dive watch.
Seiko FFF Mod
During all this collecting, I had been searching for a specific Grand Seiko dive watch - the SBGX115/117 - that I'd seen in a YouTube video. One Sunday early this January, after a year of searching, a SBGX115 in pristine condition came up for sale in Toronto. I contacted the seller, checked his seller profile, agreed on a price, wired him the cash, and the watch was in my hands on Wednesday morning.
Vintage King Seiko
If you think of Grand Seiko to Seiko as you would Lexus to Toyota, and if you think of Rolex as the BMW of watches, then this is a Lexus versus BMW story. One Japanese, one Swiss.
Here's where the interesting Japanese versus Swiss argument begins. There seems to be two camps - and very few people who straddle both. In North America, the luxury watch business seems to be almost all Swiss. There are a handful of Japanese collectors, buy they are few and far between.
Grand Seiko SBGX115
To further separate watch collectors, there is another divide: mechanical versus quartz. Even though quartz almost killed the mechanical watch in the 70's, they were reborn as luxury jewelry, and have enjoyed great success since. The argument is that a mechanical watch (automatic is mechanical with winding done while you're wearing the piece), is elegant and precision and hand crafted (at the high end, at least), while quartz is cold and boring and machine made.
I have both types of watches. The highest end watch I now own is the Grand Seiko SBGX115, and it's quartz. High end, high accuracy, hand made quartz - but quartz nonetheless. I do like the ruggedness and the "wear-readiness" of the SBGX115. The craftsmanship can stand up to anything
Swiss at a pricepoint within a factor of five (or ten?).
Grand Seiko Quartz Movement
I also have mechanical watches (nothing like a Rolex, but mechanical regardless). Beautiful to wear, but a pain to keep wound and the date/day properly set. The argument that mechanical involves much more engineering and artisanship than high end quartz is hollow. I'd argue that there is as much high tech involved in mechanical watch manufacturing today as there is in quartz. The hand finishing is a wash (when talking Grand Seiko anyway - it's as good or better than Swiss). And the steps people take to ensure their mechanical/automatic watches are ready to wear defeat the whole argument about artisanship anyway (I'm thinking watch winders and time graph machines and smartphone apps to set your watch with).
My SBGX115 is hand made. The quartz movement is beautiful. Servicing, for the first fifty years or so, are battery changes and gasket checks. That's it.
The equivalent dive watch - the Rolex Submariner - is more than two times the price, needs to be worn to be accurate, and needs to be serviced every ten years. A servicing is about $1000, and takes weeks (or months).
When I run my numbers, it's a wash (a nod to TGV):
-->
Rolex
Grand Seiko
Submariner
SBGX115
Value
5
9
Design
10
9
Movement
9
9
Brand History
9
9
Quality
9.5
9.5
Style
10
8
Versatility
9
8
Performance
9
10
Durability
9.5
10
X-Factor
10
8
TOTAL
90
89.5
One area (not on the spreadsheet) that is definitely an advantage for Rolex steel sports watches - like the Submariner - is value retention. The Grand Seiko can't come close. So if you want to sell the watch in the future - the Rolex is the much better bet. You will likely make money on the transaction.
If you don't flip watches - the decision isn't so simple......
Last night at dinner, Kathryn and Alan talked about a phenomenon they have witnessed at recent Climate Change rallies they have attended. The Climate Scientists (among other scientists) are scared. They are exhibiting symptoms of Post Traumatic Stress Disorder - PTSD. I went home to find that this phenomenon is well documented (read this). Search "climate scientist depression" and you'll find over half a million results. This is real. Although I've been more in the camp of "do what you can not to contribute to climate change", "put a price on carbon", and "the economy will prevail to make clean energy win", these are probably nowhere near enough. As witnessed in this round of Presidential Debates, Climate Change was barely mentioned (and not discussed) during the two hundred and seventy minutes of torture we endured. Our own federal government has started the process to allow Liquid Natural Gas to be extracted and shipped. Next on the agenda is the pending Kinder Morgan pipeline expansion through Vancouver (Burnaby). The net-net of Climatologist depression is that "we don't listen". Although we know that Man Made Climate Change is real, we don't take it seriously and urgently. Taking it seriously would be:
Keeping oil/coal/gas in the ground.
No new extraction (no new pipelines).
Strategic financial moves to immediately get off fossil fuels.
The argument against this is impact to individuals (employment) and the economy (taxes). Significant. The argument for this is if we don't do it, the world will be filled with climate refugees, severe weather will become the norm (droughts, floods, fires), and wars over resources will sprout up everywhere. Imagine thirty million (armed) people coming across the Canadian border looking for a place to live, food to eat, and water to drink. An excerpt from a John H. Richardson essay in Esquire in 2015:
The other topic he is obsessed with is the human suffering to come. Long before the rising waters from Greenland's glaciers displace the desperate millions, he says more than once, we will face drought-triggered agricultural failures and water-security issues—in fact, it's already happening. Think back to the 2010 Russian heat wave. Moscow halted grain exports. At the peak of the Australian drought, food prices spiked. The Arab Spring started with food protests, the self-immolation of the vegetable vendor in Tunisia. The Syrian conflict was preceded by four years of drought. Same with Darfur. The migrants are already starting to stream north across the sea—just yesterday, eight hundred of them died when their boat capsized—and the Europeans are arguing about what to do with them. "As the Pentagon says, climate change is a conflict multiplier."
Short term pain for long term gain. Mankind has never been good at this kind of choice.
I've though about how convinced I am that things are as they seem. As with anything, putting it on a scale or a spectrum helps to quantify something with something else. So here goes: 100% - Everybody dies. 99.999% - Gravity. 99% - My car will start tomorrow morning. 99% - There is other life in the Universe. 99% - There is no God. 95% - Man caused global warming. 75% - Predicting the weather 2 days out. 60 % - Jesus was a real person. 50% - We're living in a simulation. 40% - Predicting the weather 7 days out. 1% - Donald Trump knows what he's doing .001% - Prayer works. What do you think?
We picked up Kathryn at the airport yesterday and she asked if I had a spare computer she could use for a few weeks - she left hers behind in London for Alan to use. I said I had my HP laptop, which has been acting up but seemed to be OK for now - it had intermittent hard drive failures but lately ran just fine.
We came home and I turned on the HP to add a user (Kathryn), but got the "blue screen of death". It kept trying to repair whatever was wrong and then rebooting. Again and again and again. So it's finally hooped.
At first I thought I would just install Linux on the laptop and be done with it. I realized, though, that i need a functioning PC to create a Linux USB Boot Disk. So that won't work.
Then I remembered an article I read last fall from Lifehacker; "How To Turn An Old Laptop Into A Chromebook". It took me about an hour of farting around, mostly because I didn't read the instructions all the way through, but it worked marvellously.
At the end of the day, I have converted my old HP 14" Envy Laptop into a very fast Chromebook. I lost all the information on the hard drive (which would have I lost anyway). I gave Kath a copy of the Chromebook environment on a USB stick so she can still run off it if the hard drive fails again.
So I guess I really am "all in" with the "Cloud". I have my phone and my Chromebook. That's it.
I've figured out ways to do most everything with the small computer - torrents, VPNs, ebooks, etc. The stuff I can't replace, I just don't use....
I migrated to Microsoft Outlook in the early days. It took me three tries to get there, though. There were all these new ideas to wrap my head around - different ways of doing things, different ways of handling events, different ways of handling email.
I went back-and-forth between the new and exciting Outlook (this must have been around 1995) and whatever I was using before (it's lost in the dustbin of my mind so I can't even remember what it was - probably a DayTimer).
The point of this is that I would go back and forth several times before it finally stuck, and was able to move forward with the new platform. This caused me to waste all kinds of time as I would completely move over to the new system, only to move back to the old one when I discovered I couldn't do something (or thought I couldn't do something).
This time it's Inbox by Google. I was an early adopter of GMail, so I naturally started to use Google Tasks and Google Calendar as well. Integrating these on a desktop/laptop was easy, but getting them to work as one on a Smartphone never happened. The closest I got was an app that would do email (GMail), and another one that would manage tasks and calendar (CalenGoo). (The Desktop was never an issue with any platform.)
I've tried to migrate to Inbox (Google makes it pretty easy) three different times now, but kept going back to the old familiar applications. I've also tried several stand-alone programs that handle tasks or calendar, but they didn't make life any easier.
But this time I think it's sticking. I was going to move back to the Calengoo/GMail system a couple of weeks ago, but it was now lacking some stuff I had started to rely on:
Reminders - which are like tasks
Snooze - the ability to snooze emails and reminders and have them delivered to you later
Pin - makes sure important emails or reminders are always there, staring you in the face
I couldn't replace any of this with the old system (without adding a bunch of new, third party programs). I even tried Microsoft Outlook for Android - which does a very nice job of integrating Email, Contacts and Calendar - but it lacks accommodation for Reminders - which is now pretty huge to me.
Google says it's going to continue investing in this platform - and they say it's the future of email. It's not perfect (the Calendar needs integration), but it's getting there. For now, I'm stuck with the new platform, and that's OK.
If you're GMail centric give it a shot - but stick with it for a couple of weeks to see if it adheres.
