Latest PET/CT

Last week I had another PET/CT scan to check on the cancer staging. This scan was taken during my third cycle of chemotherapy, having had two readings of CEA levels which suggest that the cancer cell mass is decreasing. The PET/CT basically confirmed the CEA results as you can see from the images here. On top is the latest (June 2010) image of my largest tumour. Below is the result from February 2010, which I showed in an earlier blog. The reduction in FDG avidity is clear.

To quote from the radiologist's report: "The four previously shown areas of abnormality, two on the anterior abdominal wall, one in the para-aortic node and one in the mesentery all show less avidity on visual inspection when compared to the previous PET/CT of 2/2/10. Only the two on the anterior abdominal wall show any avidity. The uppermost lesion on the anterior abdominal wall also exhibits significant reduction in size as shown on the CT component-the other lesions were difficult to see on the anatomic images. This change would suggest that chemotherapy is having the desired effect on the tumours at all sites-there are no new sites of disease. The liver remains clear of metastatic disease. The chest remains clear of metastatic disease."

In summary then, the chemotherapy seems to be having a positive effect. This is not a cure, but it could represent an extension of my time frames.

This is a journey involving ups and downs, with occasional bad luck and good luck as part of the mix. I'm pleased about the latest data, but I have had enough experience to understand the need for detachment. The next scan, or a later blood test, could easily be disappointing. If I am to manage this process, I have to resist both exhilaration and despair. "The data is the data" as we say in science. How else can I deal with this?

Footnote: It is interesting that comparison is being made with February when my CEA was 45 ng/ml, not with April 20 (the start date of my chemo) when my CEA was 78 ng/ml and my tumours were even bigger. In other words, the reduction in tumour size since I started chemo must be even more significant than evident in the Feb/June comparison above.

Dim Sum Weekend

Over the weekend Miang and I repeated Dim Sum on Saturday and Sunday. The first was with old friend Mark Warner from Cambridge, who was out here reviewing the MacDiarmid Institute. After lunch we took him to Zealandia (The Karori Sanctuary) where Mark was captivated by Tuatara, Kaka, Bellbirds and a New Zealand Harrier. Mark's delighted face says it all as he gazes at the Tuatara.







On Sunday, we had a cousins' occasion with Merle and Sam Lindsay down from Marton, and Ross Johnston up from Dunedin. Ross is the son of the oldest of my mother's 8 sisters (Doris) and Merle is the daughter of my mother's younger sister (Essie). Here are we three with the beautiful quilt which Merle had made for me, entirely out of offcuts from men's green ties. Extraordinary.

New Zealand 1-Italy 1

For those who stayed up until 2 am New Zealand time to watch this match, I doubt whether many would have slept before going to work. To those of us who slept and awaited the morning news broadcast, we awoke stunned. Italy are the world champions, and New Zealand is ranked 78th.

New Zealand took control early and scored from the first dead-ball situation in the Italian half when Shane Smeltz took advantage of glancing header from Winston Reid. Later in the first half, in a rather dubious call, a penalty kick was awarded to Italy, who equalised. But the All Whites defence, with brilliant work by goalkeeper Mark Paston, saved the draw. Indeed the All Whites almost seized a late winning goal when Chris Wood's beautifully angled shot just went past the Italian goal.

For highlights see
http://www.stuff.co.nz/3833139/All-Whites-v-Italy-highlights

What does he do with his time?

I have to admit, being on chemotherapy, I am very fortunate with my employment arrangements. Since July 2008 I have been on a James Cook Research Fellowship, funded by the New Zealand government, to do full time research for two years. My Fellowship comes to an end in a few weeks, but my university, Victoria University of Wellington, has graciously allowed me another 6 months research and study leave until the end of 2010. For much of the time of my James Cook, I have been undergoing my cancer battle, with surgery in later 2008, adjuvant chemotherapy in the first half of 2009, and now 1st line chemotherapy at present. I often wonder how much more difficult my life would be if I were self-employed, or working in a labouring job. I have had the privilege of being able to organise my work around my illness, with slow starts in the morning, days taken recovering from chemo infusions, and long periods of lethargy, with less than peak work output.

But I have had a project. What I have been doing is writing a book, a technical book, "Translational Dynamics and Magnetic Resonance", to be published by OUP. I must have been crazy to take this on-it's been a huge task, but I am nearing the end. This week I finished chapter 11, somewhere in the pages 500-600, entitled "Translational Dynamics and Quantum Coherence". I have a likely Chapter 12, though it will be a less demanding denouement, and so in a sense, I think I have essentially completed the draft. Now my task is to parse through the book, improve, tidy, correct. I hope to get it off to the publisher in a few months.

Although it's been a marathon effort, I've been lucky to have this project. When I write I immerse myself and all other concerns vanish. And I have been so fortunate to be given the freedom and the time. I am so very grateful to the Royal Society of New Zealand who administer the James Cook Fellowships, and of course, to my employer, VUW.

New Zealand 1 - Slovakia 1

Well, I guess nothing much beats this today. In the last minutes of the World Cup game against much fancied Slovakia, Winston Reid scored the header that equalised the match.

"This is the most important goal of my life," Reid told the international media. "I try to get forward more often but don't often score, so this is great."

"I actually did not see the ball," Reid said about his goal. "But when I saw it coming, I knew I just had to guide it on goal and not hit it too hard and it would go in. There was so much pace on the ball, I just had to guide it in."

To see the goal http://www.stuff.co.nz/sport/fifa-world-cup/all-whites/3816900/All-Whites-goal-scorer-an-instant-hero

The current chemo is a bit unpleasant and I feel very lethargic and jaded. I wasn't able to stay up to watch the match live at 11-30 pm NZ time, but it was a thrill to wake up to the news this morning.

Once more unto the breach, dear friends.

I have to admit being a huge fan of Shakespeare's "Henry V". Two great movies have been made from this play, the first in 1944 as a major contribution to British wartime propaganda, starring Laurence Olivier (the picture here shows the scene outside Harfleur), and the 1989 version directed by and starring Kenneth Branagh, in my view the significantly greater of the two.

So the line "Once more unto the breach" is foremost in my mind as I re-enter the chemotherapy fray, having had a week off with my hospital interlude. I had my irinotecan infusion yesterday, and already this morning more hair is falling out, though I have so little now it hardy matters. Anyway, I have been provided with two stylish "beanie" hats by Robin Dykstra (Scott Base variety) and my daughter Catherine (Icebreaker and very chic).

This morning I took my first capecitabine for the next two weeks of pill-popping, but on a reduced dose of 6 per day rather than 7. In this round of the attack, my strategy is to avoid the collateral damage of cycle 2 by four cunning ploys. These are (i) a reduced capecitabine dose, justified I think by my lower body mass compared with last year, (ii) uncle CC's recipe will be consumed as juice rather than slurry, made using a the very fine juicing machine we have bought. I have a suspicion that all that vegetable roughage on my empty stomach each morning may have stressed my bowel, (iii) more liquid. I have not been a good fellow here, and I have agreed to up my fluids intake and (vi) at the first sign of diarrhea I hit it hard with loperamide.

The crucial point is the attacks must go on just to see how far we can drive down the CEA levels. Once they plateau, to no further chemo advantage, we will probably stop the onslaught. The aim here is the "R" word, seldom mentioned by oncologists, but, given my remarkable two-factors-of-two response to the Avastin/Irinotecan/Capecitabine, now appearing in their latest vocabulary. Remission is not a cure. It is however an outward stretch of the time horizon. What more can one ask for!

More on insurance

My Swedish friend Peter Stilbs sent me this great Monty Python sketch on insurance companies.
http://www.youtube.com/watch?v=kO2R_DDZPCM
Unfortunately, Tower never offered the blonde.

Tower Health Insurance-Orwellian doublespeak

Back in February I rang my insurance company to ask if they would cover private chemotherapy costs. I was told by their representative that they would, at up to $60,000 per year. This they reconfirmed in another phone call I made to them in early April. Later in April I put in my formal application for pre-approval. I received no reply from Tower. I rang them in May and they said "no problem, your claim has been approved." My Avastin treatment began on April 20 and has continued for 3 more infusions. Then on my release from hospital on Friday I opened a letter from Aorangi private hospital in Palmerston North, the people doing the Avastin treatment, saying none of their bills had been paid. I rang Tower yesterday and was told "but it's been pre-approved-there should be no problem. We'll take this up with the claims department." In the afternoon I received a call from their representative to say that they wouldn't pay for the drug, the reason being that "it is not on the Pharmac schedule".

Now to those of you who are not New Zealanders, I need to explain. The Pharmac schedule is the list of drugs approved for full taxpayer funding via the public health system, in other words, all the drugs I can get for free. So my insurance company is telling me they will only pay for drugs that I can get for free from the public health system.

I have now obtained a copy of the policy, and the section (3) detailing medical benefit is a bit ambiguous. But sure enough, in the fine print, under exclusions on page 25, are any drugs not on the Pharmac schedule.

So yes, they are covered by the fine print, but in terms of misleading their customers by implying a benefit which simply does not exist, and by telling them so over the phone before they undertake treatment, this company has achieved doublespeak of Orwellian proportions.

If you are a New Zealander, be very wary of this insurance company.

Paul out of hospital

I am back at home now, on oral antibiotics, but recovering well. Chemo is supposed to only nearly kill you, but this time we sailed a bit too close. Most likely, the damage to my bowel lining from the capecitabine allowed bacteria into my blood. That problem is sorted but we need to let my bowel fully recover, and so, my next irinotecan/capecitabine regime, due today, has been put on hold for a week.

But look at what the latest CEA data is showing. As always the semilog plot is more informative. What we clearly see is exponential decay, which if continued, would see me below the normal threshold in three more cycles. But even more striking to the scientists amongst you must be a comparison of the responses to chemo of the adjuvant course last year with that of the first line course this year. Both courses involved capecitabine. So what is making the difference? Could it be the monoclonal antibody Avastin? (See blog Thursday April 22).

Of course, exponential decay means the cancer is never eliminated. The trick is to get the body's immune system to operate more effectively and to have the cancer cell levels reduced sufficiently for the immune system to have a chance.

I had 36 hours in planet hospital. You can holiday in the Bahamas, go walking in the Pyrenees, but if you want a total out of world experience, planet hospital is it. It started with my fast track admission through ED (what Americans call ER) with my neutropenic alert card. I was literally pounced upon by nurses and saw the ED registrar within minutes. A cannula was inserted and iv drip started, I was given a chest x-ray, blood samples were taken for culture and an oncology registrar soon appeared to brief me. He was clearly muslim, with a very islamic beard, beautifully spoken, serenely mannered, and very bright. I took an instant liking to him, and then he told me my latest CEA. It was an odd contrast in emotions-getting the best news so far on the cancer treatment, while feeling very ill. Just before midnight, I was moved to the oncology ward.

That night was a bit ethereal, the nurse (angel?) taking regular vital sign readings, using all-electronic sensors with their led displays and multi-toned electronic bleeps, the soft clicking of the peristaltic pump driving the iv, the changeover from antibiotic to saline to antibiotic, more blood samples (I had four taken in 36 hours), the musical voices of kiwi lasses down the corridor in the small hours.

The morning brought the "clatter of consultants", a team of four, with students (Wellington is a teaching hospital) and a registrar, Raj, whom I instantly recognised from last year, and greeted by name. The woman in charge made a bad start. "You'll be pleased to know your chest X-ray was fine". I am wondering, does she think I have rectal cancer (it tends to metastasize to the lung). "Do you have a bag?" Oh dear, a colostomy bag-has she read my case notes? "You have rectal cancer, right?" I explain to her about my large bowel tumour, the subtotal colectomy, and my precious 40 cms of sigmoid colon (do I sense a gleam in Raj's eye? The students are dutifully impassive. God knows what they are thinking). "How is your urinating?". "I'm an old guy, I have an enlarged prostate. My peeing is pretty dreadful, but I guess that's life."

They moved on, but on the way out, Raj broke into a big smile and asked me if I would like to try a pill to "assist the flow". I gave him the thumbs up.

In the morning, Chris rang while I was being attended to by an exceptional young kiwi nurse, Patricia, whose professionalism and dedication I will soon reveal. "What antibiotic are you on?" he asked. "What is it?", I relayed, "it's my son, he's a doctor". "I guessed", she said, "Imipenem". "I'm impressed Dad", to which she added "It's the cluster bomb of antiobiotics".

It took 24 hours to get my temperature to drop below 38.5, different nurses during the night shift, but Patricia in charge during the day. During this time my occasional diarrhea continued. "Paul", she said, "I want to come and watch you poo. I'm an expert on pooing and there is so much to be learned from watching it." " I promise to invite you", I replied (stunned). One hour later I am in the toilet, when I hear a knock on the door. "Paul, are you pooing? Let me in." Now that is dedication.

Miang is just brilliant in the hospital support role, giving me wonderful encouragement, though she was clearly concerned. I was finally able to ring her late Thursday night to tell her that my temperature was heading down and I was starting to feel much better, and to text daughter Catherine, walking in Italy, and worried about her Dad, that all was well.

Next morning the "clatter" was led by Raj. "Before we start", I said, "that little pill-I didn't pee like a 20 year old, but the flow was great!". He beamed a big grin. He did the usual examinations, invited the students to listen to my fascinating bowel, delayed chemo for a week, and discharged me. My cell phone buzzed, and I chatted with sister Jeanine, also relieved to hear I was OK, then Miang arrived with nephew Yong and drove me home on a beautiful Wellington day.

PS: I wasn't and I didn't.

PPS: Imipenem, I later discovered, is one of those serious antibiotics that are available only in hospitals. Thank goodness they keep this from our misuse so we have something effective in reserve. By the way, don't they all look the same, a ring here, a chain there, a few hundred daltons in mass?

Paul in hospital

This short note is to let you know that Paul is in hospital. But he is okay now. He was admitted to the ER when his body temp was staying up at around 38-39 for most of the Wednesday (2 June) evening. The hospital ran a series of tests and has since kept him in the oncology ward until his temp is to be stabilised below 37. He was put onto an antibiotic drip right away.

We were quite worried when Paul's temp was staying at 38 for over 24 hrs since his admission. However, he called me first thing this morning that his temp has dropped to 37 last night and stabilised since then. Phew. That's a sleeping pill night, for me.

I think it must have been the reiki or hand waving that I have given him yesterday before he went to sleep. Whatever it is, it made him smile and that could have cured him. He would have other explanations for you when he gets home. Hopefully in the next 24 hr.

I want to thank all of you for giving Paul so much love. Miang

Loperamide: not for the faint-hearted

This little molecule is known as "Loperamide" (4-[4-(4-chlorophenyl)-4- hydroxypiperidin-1-yl]- N,N-dimethyl-2,2 -diphenylbutanamide). It is currently my new best friend. Let me quote from its Wikipedia entry: "It works by decreasing the activity of the myenteric plexus, which, like morphine, decreases the tone of the longitudinal smooth muscles but increases tone of circular smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter. Loperamide also decreases colonic mass movements and suppresses the gastrocolic reflex."

The reason I'm currently well-disposed towards my friend Loperamide, is that it is counteracting one of the nasty side effects of this little molecule, Capecitabine.
(pentyl[1-(3,4-dihydroxy- 5-methyl -tetrahydrofuran -2-yl)- 5-fluoro
-2-oxo-1H- pyrimidin- 4-yl] aminomethanoate).

Capecitabine is the molecule which is supposed to be killing my cancer cells, Unfortunately, it also damages the lining of the bowel, a side effect described, charmingly, as, "Gastrointestinal: Diarrhea (sometimes severe)". I've just had four days of this side effect, and it is Loperamide which is currently preventing my dehydration demise. I have to admit, it isn't too much fun and I am feeling exhausted.

The problems are worst at the end of the two weeks of intravenous and oral drug taking, and at the start of my one week drug free (if we ignore the Avastin, which, being a protein, barely counts in nastiness). These oncologists know just how much to give you! The next few days are a race to recover body and immune system function before the next onslaught, this coming Friday.

Oh I forgot to mention the nose bleeds, numb soles, sore gums, nausea and lethargy. I just would hate you to think that chemotherapy is all beer and skittles.

Diana Beaglehole

When I was 10 years of age, I was taught by a gorgeous 19 year old named Diana Flower. Diana was in her first year of teaching and we all loved her. Here we are, Standard 4, of Wanganui East primary school, 1958. I'm in the second top row on the left. I think it is pretty clear who Diana is.

Diana later married Robin Beaglehole who died in the early 90's. In one of those typically New Zealand connectivities, Robin was son of New Zealand's legendary historian, J.C. Beaglehole, an older brother of Tim, lately Chancellor of Victoria University of Wellington, and cousin to David Beaglehole, physics professor and founder of Beaglehole Instruments. Diana's dad was a primary school principal, of Durie Hill School in Wanganui, and was later owner of Flower's Bookshop.

Diana is also an historian, an author of several books, and most recently, official historian for the on-line Encyclopedia of New Zealand, on the subject of Wanganui.
http://www.teara.govt.nz/en/whanganui-region
She was also the historian commissioned by the Wanganui District Council to provide a report on the issue of the name of the city, and the vexed issue of how that name is spelt. A pdf of her report can be found at
http://www.wanganui.govt.nz/

You can imagine what it is like when I now get together with my old primary school teacher from 52 years ago. Diana knows more than almost anyone about Wanganui, one of my favourite subjects, and remembers names and characters with almost the terrifying recall of Richard Green. I say "almost" because Richard is pathological. Poor Miang had to sit through an afternoon of Diana and me reminiscing, before taking this picture of the two of us. As you can see, Diana is still gorgeous.

Footnote: In the centre of the bottom row of the school picture is a girl with pigtails. Her name is Dallas Caldwell, and she was the first girl I fell for, at age 12. It was simple really. We had an "end of primary school" dance and I was wearing a square-bottomed lurex thread tie with a black stripe down one side, very fashionable in 1960. As she danced with me, Dallas took the lurex in her hands and said, "what a nice tie". That was it. I was a goner. After the dance Dallas went off to an all girls school and I went off to my all boys school and I barely saw her again. We finally met up at a primary school reunion about 6 years ago. Dallas no longer had pigtails and I no longer had the lurex tie. I recalled the story, we both laughed, and then we turned our attention back to Richard Green, who was revealing far more embarrassing tales about everyone present.

Pablo Etchegoin

Pablo Etchegoin is one of the best. He is our great star of physics in the MacDiarmid Institute, but most importantly a truly good man, kind, generous and warm-hearted. Pablo has only recently learned that he is facing a rare life-threatening cancer. As Pablo puts it, "It is a bit like winning the lottery, but with a prize nobody wants."

Miang and I visited Pablo at home today as he awaits major surgery in the near future. We talked over some of the issues one faces in being suddenly confronted with a situation that turns your life upside down. We each have to find our own path on this journey, but it is good to share experiences with comrades. Pablo has been overwhelmed by the messages of support that he has received from around the world. Many people truly love this guy. We are all hoping for the best possible outcome from surgery and a transition to full recovery. Kia Kaha Pablo!

Massey's graduation ceremony

Something very nice happened this week. My old employer, Massey University, awarded me an honorary Doctor of Science degree at its Wellington graduation ceremony. The picture here shows me with my good friend, Tony Signal, Professor of Physics at Massey. I may look like a tiny older man, but this is simply because Tony is a very tall younger man.

Miang and I were guests of honour at a special black tie dinner put on at the Museum building campus on Wednesday night, on the eve of the graduation ceremony. At the ceremony, my friend and former Massey colleague, David Parry, made the oration for the award, and then I got to give the graduation address to a packed Michel Fowler Centre.

I was rather taken aback when the audience burst into spontaneous applause before I had finished my speech, and while I was strongly criticising the government for proposing to mine our National Parks. The part of my speech that produced this reaction was:

"National Parks help define who we are, they are places we go to replenish the soul, to remind us of what is important in life. They are our covenant with the future, our gift to our children and their children. That we should hold in perpetuity their pristine character, against the desire to exploit, is precisely what makes them remarkable and unique, belonging to all of us as a symbol of our democratic values."

I have to admit, the phrase, "covenant with the future", is not mine, but the American writer Terry Tempest Williams, who used this term to describe America's National Parks. Here you may see a link with an earlier blog posting of mine.

One thing is certain, judging from the response of what looked to me like a broad cross section of New Zealand present in that audience, feelings about this issue run very deep in this country.

Footnote: The following report appeared on Massey's website
http://www.massey.ac.nz/massey/about-massey/news/article.cfm?mnarticle=callaghan-condemns-mining-proposal-28-05-2010

Second cycle

It's been a rough week as the second cycle of chemo draws to an end. I am feeling very jaded, often exhausted after a few hours work, and certainly not too mentally sharp. There is a faint and distinctly unpleasant sensation of metallic miasma as I breathe, probably the residue of the capecitabine I take morning and evening. I am counting down the remaining few days. From Friday my body will slowly clear its drug residue as I await the start of the next cycle, with Avastin infusion on Tuesday. More cheerful postings will undoubtedly follow!

Three bad guys

Let me introduce you to a couple of scary friends of mine. Richard Green is in the red shirt and next to him is Pete Rodger. Both went to primary school with me and both remember things that I would rather they had forgotten. Indeed much that they remember I have managed to blank entirely from my memory. Richard is a professional opera singer, and the picture was taken during the week that he was performing the role of the Gardener in The Marriage of Figaro, here in Wellington. Pete is an economist, an adviser to NZ Prime Ministers and presently a consultant to several governments in the Pacific. Not seen are the lovely wives Jeanette and Annabelle, who joined Miang and me for a "Steamboat" chinese meal at our home.

Let me give you a sense of the badness of these men. Richard has written a set of memoirs, of which I am prepared here to reveal just a little. The memoirs begin

"I dedicate this foreword to all mothers of young boys, by way of assurance that the most bizarre behaviour is actually, in the human male, normal. Your lad might turn out quite well. He may become a physics professor, or an opera singer. Do not despair."

He then goes on

"Through my childhood I lived several hundred yards from Paul, and needed only to dial 39-474 if bored. Our parents were all stalwarts of the little St Alban’s Methodist Church in Wanganui East, we went to the same kindergarten, primary school, Sunday school and Bibleclass, and shared the same interest in girls’ bodies, melting lead, explosives, cars, brewing/distilling and music. Paul was an exciting but dangerous playmate, in as much as his boundaries of safety and common sense were set wider than anyone else’s. He pushed things that little bit further than could be considered best practice. That we both survived childhood and the teen years unscathed is very much a matter of good luck. Fire might well have taken us, an explosion or flying glass, a motor accident, electrocution, poison or a misfired medical experiment, but decades later we live to look back fondly on those years."

Enough.

And let me now recount one of Richard's memories of Pete.

"The violent streak in us was dissipated at play and lunchtime when we hurried out to the big lawn for keeney-seeney, otherwise known as bullrush. It was a mad helter-skelter where little kids risked being stampeded and the bullyboys triumphed. A new arrival at school, Peter Rodger, had the luck to get “in” on his first lunchtime, and called forth the only name he’d learned – Trevor Benson. The tackle he delivered appeared to break Trevor’s back, and keeney-seeney came under scrutiny. Then someone had the idea of getting the girls involved in this sport, and we soon found we could get our hands on interesting areas as we tackled them. Mrs Schnack was on duty, and intersex keeney-seeney ceased."

I have to say that Richard has a rather extraordinary memory. When he walked into my garage and saw an old painting of ballerinas from my childhood home, he identified it immediately, even recalling the aroma of the lounge, with its residue of coal smoke and my father's cigarettes. Of course, when his memories recall matters of an embarrassing nature, I am quite sure that he is mistaken.

I share these revelations with you, because some of you have questioned the existence of bad Paul. Bad Paul did exist, and unfortunately he had bad Richard and bad Pete as friends. Delightfully, we remain the best of buddies. Pity the poor wives when we three get together.

My son Chris

This week, son Chris is visiting from the UK. Unlike his father, Chris is a handsome devil, as you can see from the accompanying photo of the two of us at the Wellington Business Gold Awards dinner, where Magritek was a finalist in the Export Gold category.

Chris has been checking up on my daily routine, even trying some of the famous veggie mix (well, a teaspoonful), and accompanying me on my walk up to the reservoir. As you can see from the next photo, the weather here has been miserable this week. Chris flew in from London on Monday and leaves Sunday to return to James and Hiva who have very kindly done without him for a week. It's been a chance for the two of us to catch up, and for Chris to get some R and R from his busy life as a surgeon.

For Chris it's also been a chance to catch up with old friends, to visit his Mum and his Aunties, and to help me and Miang at home. The week has been quite a "Magritek week" with cakes at the company Tuesday, with the Gold Awards last night, and with a shareholders annual meeting this morning, which Chris attended as an observer. He has had the chance to renew acquaintance with some of my young friends, such as Mark Hunter (pictured here with Chris and me). Mark went to the same school as Chris (Palmerston North Boys High) and was a first year pupil when Chris was one of the seniors. If Mark is looking happy, that is in part because he submitted his PhD thesis on Monday! Mark, like Chris, is a Dad of a lovely 2+ year old, and is expecting another child in the spring.


Needless to say I am immensely proud of my son who seems far too wise to be my offspring. In addition to giving me excellent medical advice, keeping us well entertained, and generally being kind beyond anything I deserve, he is a just great company to have around and his visit here has been hugely cheering for both Miang and me.

The Legendary Uncle CC

I mentioned in an earlier posting that Miang's Uncle CC was diagnosed with stage 4 lung cancer, 3 years ago. He is still going strong after two courses of chemotherapy, with targeted monoclonal antibody drugs included, and some additional healthy activities, including a raw vegetable mix taken each morning. Several people have asked me about Uncle CC's recipe.

First, about Uncle CC Low himself. CC stands for Chang Chow. He lives in Singapore with his wife June, who is Miang's Dad's sister. He was an Editor of a Singaporean National Chinese Newspaper and is very well versed in Chinese history and culture. He ran a publishing business translating Chinese legends into English picture books.

Every day he practices Qigong in the local park. Last July Miang and I stayed with CC and June for a few days and learned about the juice and exercise regime. The raw potato aspect is a Japanese invention. I tried the recipe each day and joined CC for Qigong in the park.

CC's philosophy is to use the best that scientific medicine has offer but to supplement that with traditional Chinese medicine and other rational food and lifestyle remedies. For me, living in New Zealand, access to Chinese medicine is problematic, but I did try some for a week when I was in Singapore. I have taken up the vegetable mix as the preferred CC supplementary treatment. My idea is to be pro-active, contributing something myself, in addition to the scientific medical treatment. The test is that my contribution must not conflict with that treatment (as some herbal "remedies" risk doing), and that it must be independently benign and healthy.

So, in addition to Qigong and TaiChi classes which Miang and I attend each week, supplemented by TaiChi exercises each morning at the top of the Khandallah reservoir, we start with the following recipe on an empty stomach,

Into the blender goes

1 Tomato
1/3 diced telegraph cucumber
1/2 diced green apple (Granny Smith) or any apple that takes your fancy
1/2 diced stick of celery
1 medium sized peeled raw carrot diced or 1/2 large peeled carrot, diced
1 peeled raw potato, reasonably sized, say ~ 8 cm long, diced

(the order is important so that the most fluid elements go first, else the blender jams up)

Pour, scrape into large mug.

Mix in 1/2 teaspoonful of freeze dried Barley Green, sometimes called "Barley Life"

To find "Barley Life", go to the web. It is sold all over the world. The NZ distributor can be found at
http://www.natural4life.com/aim-new-zealand.html
I use the product on the left (juice powder of young barley plants with with brown rice and kelp). I haven't a clue what it does but Uncle CC says it should be included and that's enough for me.

Ken and Sheila Jolley

One of the great things about having a health problem is the renewed contact made with dear friends. Here's a couple, Ken and Sheila Jolley, whom I have known since I first arrived at Massey University in late 1974. The picture of them with me in our lounge last week isn't too flash, but still, just fine to me.

Some background. Ken and Sheila are from Lancashire, parents of three wonderfully talented young women, and longstanding friends of mine. On the day of the photo, I made scones under Sheila's expert guidance. They turned out to be fantastic.

Ken Jolley was the NMR expert in chemistry at Massey. A physical chemist who trained under Les Sutcliffe, Ken had just acquired a JEOL FX60 when I arrived, and was extremely generous to me in inviting me to share in its use. He taught me so much about NMR in those early days. We published a few papers together, but mostly Ken had his own research (beautiful work on lyotropic liquid crystal phase diagrams amongst much else besides) and I had mine. Eventually Ken got a new superconducting spectrometer, another JEOL (GX270), and my group kind of "took over" the FX-60 until we eventually acquired a Bruker AMX-300 in about 1993.

Here is a picture of a much younger Ken and Paul standing by the GX-270 after its installation. We must be holding some Japanese gifts from the manufacturer.

Ken is now retired and he and Sheila spend much of their time in choral singing, while Ken also enjoys riding a very powerful motorcycle.

Diplomatic Charity Ball

On the evening of my good news (see previous blog) Miang and I attended the Diplomatic Charity Ball as guests of the Swiss Ambassador (it's an interesting story as to why the Swiss), but the point of this blog is to show our good friends George and Margaret Fergusson, who sadly leave New Zealand in a few days. They are a most remarkable couple, delightfully warm and generous, steeped in knowledge of New Zealand, and probably the best British High Commissioner and partner that New Zealand could ever have had.

How is this for job qualification? George spent formative years of his childhood here and went to St Mark's school in Wellington, while his father, Sir Bernard Fergusson, was Governor-General 1962-1967. If that wasn't enough, both George's grandfather, Sir Charles Fergusson, was Governor-General from 1924 to 1930. and his greatgrandfather, Sir James Fergusson, was governor from 1873 to 1874. Bernard Fergusson built a close relationship with Maori, and gave his son a Maori name (George Duncan Raukawa Fergusson). Here is George during those early days, as we older New Zealanders remember him. After leaving school in Britain, George came back to New Zealand and spent some time picking hops and fruit, working in a bakery in Wellington and as a meat trimmer at the Whakatu freezing works in Hawkes Bay (the best qualification of all in my view!)

He has had an exceptional diplomatic career, see
http://en.wikipedia.org/wiki/George_Fergusson
In 2006 he was appointed High Commissioner to New Zealand and Samoa and Governor of the Pitcairn Islands.

I remember George's father well, pictured here with Walter Nash (Prime Minister 1957-1960). During World War II, he was quite a war hero, commanding the 16th Infantry Brigade which was converted into a Chindit formation for operations in the deep jungles of Burma miles behind Japanese lines. He became Director of Combined Operations from 1945 to 1946 and after the war he commanded the famous 1st Battalion, Black Watch.

George and Margaret are as nice a couple you could wish to meet-the very best of British, steeped in experience and knowledge which they wear lightly. They will be missed by so many New Zealanders who wish them well in their next adventure.

PS: John Key came across to our table to check out Miang during the evening. I can't blame him. She looked stunning in her cheong-sam!

Latest medical data

I've been holding out on you. For the last couple of weeks I've noticed less pain from my upper abdominal tumour (the one I showed in the PET scan). Then, pressing in that area, I noticed that the lump was reducing. On Tuesday I had my second Avastin infusion in Palmerston North. My PN oncologist, Richard Isaacs, was amazed. "The lump has gone", he said. "Yes", I replied. "I've been noticing, but didn't want to hope too much." "This is an excellent response to the Avastin", he declared.

All very good, but what would my latest CEA result show? Well I've also been holding out on publishing this data. My last reading three weeks ago showed the lowest rise in nearly a year. Today I got my latest CEA. It has almost halved, from 77 ng/ml to 45 ng/ml.







Today was Wellington Hospital infusion day, and my appointment with my local public system oncologist, Andy Simpson. Now it was his turn to be surprised and pleased. He didn't say so, but I'll bet he thinks it's the irinotecan/capecitabine he is giving me.

Of course only Miang and I know the real truth, which you can ascertain for yourselves by inspecting the graphs. The rising CEA was checked before chemo started. It is clearly Uncle CC's magic potato mix, which I have consumed every morning since day 430, or perhaps it is Lourdes's Noni juice, or Yang's TaiChi, or maybe the 9 hours sleep a night, or perhaps it is just better Paul taking charge?

Hey, whatever. I ain't complaining.

PS: Don't get too excited. I'm not cured. Just having a respite.

PPS: The two graphs are respectively linear and semi-log, for the afficionados.

Cobalt 55

I promised to tell the story of Cobalt 55. Just to get you into the picture, this is me then, Oxford 1971. The leather jacket is made of plastic.

My doctoral research was in the field of nuclear orientation, at the Clarendon laboratory. My supervisor was Nick Stone and our grandfatherly mentor, Nicholas Kurti. We used adiabatic demagnetisation of paramagnetic salts to get down to 10 milliKelvin, at which temperature the hyperfine interaction would overwhelm the Boltzmann energy causing radioactive nuclei in a ferromagnetic host metal, attached to the cold finger of the apparatus, to align, so directing their gamma rays preferentially along the quantisation axis. The degree of orientation could be used as a measure of the interaction strength, so that nuclear magnetic moments or local fields could be measured. But by far the best way of precisely measuring that interaction was by sweeping an RF field in the vicinity of the Larmor frequency. At resonance, the gamma rays would suddenly change their angular distribution and the axial count rate would change dramatically.

We mostly made our own isotopes. My story is about Cobalt-55, a positron emitter with an 18 hr half life. Here's how our paper in "Nuclear Physics A" described the procedure. A 99.8 % enriched Fe-56 1 mg/cm (1.3 micron) foil was used as the target in a 35 MeV proton irradiation at the cyclotron of the Faculté des Sciences, University of Paris, Orsay. After waiting 12 h for short-lived product decay the sample was transferred to Oxford and the experiment performed during the next 24 h.

Let me tell you how it was transferred! In a small lead pot big enough to fit in my pocket so that when I boarded the BA flight from Paris to London, no-one would know I was carrying many many milliCuries of radioactive source. Once I got to Heathrow I got into my car (MG1100), raced up to Oxford, and worked non-stop for the next 24 hours as the isotope decayed.

I managed to measure the magnetic moment of the Cobalt-55 nucleus, as the nuclear magnetic resonance diagram above, lower panel, shows. Is the world a better place for it? Hardly. Are the scientific frontiers advanced? Well, 10 people have cited it in 37 years, so I would have to say not. But there it is, a piece of nuclear magnetism I measured (and for the record, along with the magnetic moments of Antimony 118m, 120m, 122 and 124).

Finally I must tell you about my Paris host, Daniel Spanjaard. I have managed to find only one very poor picture of him. Daniel took me to his parents' place for dinner, in the Sevres district. They had original impressionists on the wall and the meal was made and served by their cook. To a kiwi lad in the 1970s, this was amazing.



I know what some of you are thinking. Did that radioactive source knock his DNA about so that later in life, he developed cancer? I haven't a clue, but I doubt it.

Hair loss competition PSP1 vs PSP2

Today was the PM's big announcement of science spending increases. TVNZ evening news captured Peter Gluckman and me in conversation What the viewers didn't hear was:
"You call that hair loss? Have a feel of my pate mate"

Misbehaving Paul

I realise that my last blog must have shocked some of you. Seeing with "x-ray vision" can be challenging. As an antidote, I include here a picture "from the outside". I'm on top of the Skyline track which runs from Mt Kaukau to Makara, and Miang and I spent a wonderful couple of hours walking up there recently.

So why the PET scan? Partly because, when my friends see me "from the outside" I look quite healthy. But for me the awareness of the interior is quite distinct. I can feel what is happening inside me. There is discomfort, and sometimes pain, but it is not at all severe at this time. The sensations vary, day by day, and it is hard to get a clear sense of progression or otherwise. So to me, the "inside view" of the PET-CT is very natural, something that helps my understanding, and certainly nothing I fear. I place it here for my friends to see, in that sense.

That brings me to my cancer, my misbehaving cells. Denis Potter, the playwright, famously referred to his cancer as "Rupert". It was his name for a most malevolent and despicable invasion of his body. He was, of course, referring to Rupert Murdoch. I cannot feel this way. My cancer is my own, a natural, though unhelpful, state of my own cellular makeup. I have struggled for a name, but can't go much past "Paul". Not a Paul I approve of very much, but irresponsible and dangerous, indeed recognisably elements of a Paul from a distant teenage past. Perhaps some of this Paul even reared its head in later adult life. If so, I apologise to those who witnessed it. But it is not the real me, just a distant demon, very remote from the way I feel. It's ironical then that this biological deviant should have reared its head at a time in my life when I feel very content, very much at peace with who I am.

So will the better Paul take charge of misbehaving Paul? Will my immune system gently assert itself and persuade the rabble cells to lay off ? Maybe. But the more important aspect of our humanity is the spiritual self, not the wayward cells of our mortal coil. Better Paul is in charge, really.

PET-CT

The evidence for metastatic disease in my case was provided by a PET-CT scan in early February. This was my second PET-CT , the first being July 2009, when no fluorodeoxyglucose avidity was detected. In the section of scan shown here, you can see my largest tumour just under my diaphragm in the upper right abdominal cavity close to the anterior (front of body) surface.

PET works as follows. The patient has radioactive (Fluorine 18) labelled glucose (fluorodeoxyglucose) injected into a vein and then lies still for about an hour. During this time, parts of the body with high metabolic activity preferentially take up the glucose. This includes the brain, the tongue, kidneys, heart, liver, and any tumour with rapidly dividing cells. Hence, a bright spot showing up in addition to the expected brightness for these organs, is a likely tumour.

At the same time that the PET scan is done, and in positional registration, an X-ray CT scan is carried out. This means that the PET bright spots can be correlated with anatomical details revealed by the X-ray. That is what you can see in my scan, the colour being the PET and the background grayscale image being the X-ray CT.

PET, or Positron Emission Tomography, is a remarkable technique. Fluorine-18 is a positron emitter. This antiparticle to the electron immediately annihilates on meeting an electron in the vicinity of the emission, resulting in two 511 keV gamma rays firing out in opposite directions from the point of annihilation, as shown in the diagram (thanks to Wikipedia). An array of surrounding gamma detectors registers when two gammas arrive at the same time (we physicists call that a coincidence event) and at almost 180 degrees to each other. The source is then located along the straight line of coincidence (the line of response). For detectors with resolving time of 500 picoseconds, it is even possible to localize the event to a segment of a chord. By carrying out a sequence of these reconstructions in the computer, each coincidence event adds to the overall intensity along the lines of response, and by a reconstruction technique known as filtered back projection (the same method use to reconstruct in X-ray CT) the source brightness can be localised in 3 dimensions.

In my Doctoral work in Oxford I worked with several positron emitters, amongst the most remarkable of these experiences being with the 17 hr half-life isotope, Cobalt 55. I will tell that story in a later blog. And in my later scientific life I worked extensively with Filtered Back Projection reconstruction, when we developed the first NMR microscope. Hence, for me the experience of PET-CT was one of fascination and appreciation. The image shows a machine pretty much like the one I have been in.

Fluorine-18 has a half life of about 6 hours. It is currently made in a cyclotron in Melbourne, attached to the glucose, and sent by plane to Wellington, the site of New Zealand's only PET-CT instrument. In the meantime, at least a couple of half-lives are lost, making the sensitivity poorer than if the isotope were generated "on-site". Construction of a cyclotron for Fluorine-18 production has just begun near Wellington airport, ironically close to the sign which proudly declares that New Zealand is "Nuclear Free". Ah well, what's a bit of egregious hypocrisy when lives are at stake?

James E A Callaghan-Grandson extraordinary

James is my grandson, son of Chris Callaghan and Hiva Fassihi.

He is going to be 3 years old in October. By good fortune I was in London during October 2007 on the very day James was born. That's the picture on the left.

James is of course beautiful, lively, intelligent, and loving, just like his parents! I am very proud of him and look forward to the next time I can see him in person.

But what really is amazing about James is his extraordinary thoughtfulness and kindness. Here is a little movie of James in Waterlow Park, in Highgate, London. This is his local park and he is seen here with his favourite slide. Just watch how he lets the other kids go first. This is a classic. The female voice is daughter Catherine's. She filmed this while looking after James last Saturday morning.

The rockcore analyser

The saga of the newspaper story played out finally this week, with an article that appeared in the weekly "giveaway" paper, the "Wellingtonian". This paper is a sister to the Dominion Post, and it is possible that the Post staff suggested the story to them. The Wellingtonian Editor, Joseph Romanos, came and chatted with me last week and the story below appeared on Monday. The really important aspect to me was the picture with the Magritek 2 MHz Rockcore Analyser, though anyone reading the article would still find that picture a mystery. This is the original picture taken by the DomPost photographer at the time of the Laukien Prize story.

Here is the Wellingtonian story
http://www.stuff.co.nz/dominion-post/local/the-wellingtonian/3632998/The-Wellingtonian-interview-Paul-Callaghan

The original story was supposed to be about how science can result in new business opportunities for New Zealand. But it seems that reporters will go to extraordinary lengths to avoid having to write about anything technical or scientific.

Can I have the last word here? The thing that really matters is the beautiful Rockcore Analyser, a result of the genius of the people at Magritek in partnership with the brilliant permanent magnet array designers at ACT Aachen. It is our latest and hottest product for the petrochemical industry and doing incredibly well. I am so proud to be associated with it!

The chemo regime

I have been two weeks on chemotherapy now. I am feeling a bit jaded and mildly nauseous, and it has affected my voice a bit, but that is not stopping me working most days. On Sunday Miang and I did the Skyline walk near Mt KauKau with our friend Anne Brown who was visiting from Dunedin. The picture shows Anne reflecting my body's "energy" back into my head. Yes, I know, I'm a physicist who doesn't beleive in Reiki, but such kind attention from friends is always welcome!

My accounts of infusions in Palmerston North and Wellington are perhaps a bit confusing. This is how the three week cycle works.

Day 1 (Tuesday) Cycle 1 begins: travel to Palmerston North for Avastin (Bevacizumab) infusion.

Day 2 (Wednesday) Blood test

Day 4 (Friday) have an Irinotecan infusion at Wellington Hospital Blood and Cancer Centre. On the same day, start taking the oral pro-drug Xeloda (Capecitabine) evening and mornings. Continue doing this for 14 days.

Day 11 (Friday) have a second Irinotecan infusion at Wellington Hospital.

Day 18 (Friday) last Capecitabine for this cycle.

Day 19 (Saturday) no oral drugs

Day 22 (Tuesday) Cycle 2 begins: travel to Palmerston North etc.

I will have maybe 6 to 8 cycles, but after cycle 3, we will probably do another staging X-ray CT to see the state of the tumours.

America's Best

I have two very dear American friends, Ed and Carol Samulski. Both have visited New Zealand many times, starting with a wonderful 6 month 1996 sabbatical in Palmerston North, where Ed and Carol's son Casey attended school. I have visited Ed, Carol and Casey on countless occasions in their home in Chapel Hill, North Carolina. Miang and I have a delightful memory of bathing in the warm Atlantic water off Cape Fear on Bald Head Island, where Ed and Carol have a holiday home, just a few weeks before we returned to New Zealand in 2008, and just before I discovered I needed bowel surgery. Daughter Catherine spent a very happy week with them last year. Then again, last year I spent a very enjoyable week with Ed and Carol as part of Ed's festschrift symposium, where his friends and colleagues came from all over the world to celebrate him.

Ed and Carol have given me a very special gift, "America's Best Idea". This is a Ken Burns documentary about the US National Parks. Ken is to the US what Gaylene Preston is to New Zealand, an authentic voice for the very best that America is. If you haven't seen his documentaries on the Civil War and the US involvement in the Second World War ("The War"), then do so. They are extraordinary.

Last year, in September, Miang and I visited Grand Teton, Yellowstone, Zion, Bryce Canyon and Grand Canyon National Parks, as well as Grand Escalante National Monument. It was a simply magical time. And of course, in 2008, during our California sabbatical, we visited Yosemite National Park twice, both with Catherine and with my sister Jeanine and her husband Murray. Now, as we sit and watch the Ken Burns series, we are both moved by this remarkable story about the soul of America, as well as thrilled by our sense of having experienced some of these wonderful places.

Watching this documentary, the sense grew in me that National Parks really do help define the soul of my own country as well. The idea that we set aside for future generations places where we might replenish the human spirit, connecting us back to our ancient roots, and in the face of a relentless human greed to exploit, is to me, profoundly important.




The picture is of Carol, Ed and me, on the Routeburn Track, in Mt Aspiring National Park, New Zealand, 2005.

The Canadian connection

There has always been a strong sentimental Canada-New Zealand attachment in my lab, I guess dating back to a magical year's sabbatical spent in British Columbia, in 1981. Over the years the group has had a number of Canadian students and post-doctoral fellows, the last being Kirk Feindel. Canadians seem to bring a special humour and energy to the group, as well as being superb scientists. In both aspects Kirk excelled! This last week Kirk popped back to Wellington to pay us all a visit. It has been wonderful having him here.

Here is Kirk looking sinister at the top of Mt KauKau.


Our Canadian PDFs and PhD students have been: Ted Garver, now Senior Research Scientist, Alberta Research Council, Maria Kilfoil, now Associate Professor McGill University, Ryan Cormier, now an A&E medical specialist in Ottawa, Meghan Halse, now on a post doc with Lyndon Emsley in Lyon, Kirk Feindel, now Research Associate with NRC, Halifax, Nova Scotia. In addition there have been two sabbatical visitors, Iain Taylor from UBC and Ken Jeffrey from Guelph.

Just for the record, my complete list of postdoctoral fellows from various countries is: Rosie Wang (Australia), Ted Garver (Canada), Philip Back (Australia), Ross Mair (Australia), Joe Seymour (USA), Ute Skibbe (Germany), Melanie Britton (UK), Sarah Codd (NZ/USA), Elmar Fischer (Germany), William Holmes (UK), Sophie Godefroy (France), Andy Jackson (UK), Dave Fairhurst (UK), Ocean Mercier (NZ), Petrik Galvosas (Germany), Ying Qiao (China/Australia), Penny Hubbard (UK), Antje Gottwald (Germany), Kirk Feindel (Canada), Guillaume Madelin (France), Jen Brown (USA).

An afterthought: Miang is also a "Canadian" having done her first degree at Memorial University of Newfoundland. And, of course, my PhD student, Simon Rogers, married Krista, an Ontarian.