A date for surgery

Much earlier than I had expected, 14 October 2010 will be the day that my surgery takes place at St George Hospital in Sydney. The surgical team, having assessed my chemotherapy schedule, have offered me an early opportunity for the cytoreduction/peritonectomy/HIPEC surgery. The proximity gives me little time to catch my breath, let alone to put on some more weight and improve my fitness, but it is the best possible opportunity if I am to have the most successful outcome.

My chemotherapy is now over, at least in the pre-operative sense. Miang and I will travel over to Sydney a couple of days beforehand. If all goes to plan, I should have a recovery period of about three weeks, including a few days in Intensive Care immediately following surgery. There is always the risk that surgery may not proceed, due to discovery, in the operating theatre, of more extensive disease than anticipated. And there are significant risks of side effects ("morbidities"), which complicate recovery. Nothing about this type of surgery is routine or straightforward, but I have the utmost confidence in the team. They have performed hundreds of these operations over the past six years.

If all goes well during surgery and recovery, I will face the next, longer term phase, involving discovery of the degree to which the process has been effective in eliminating the disease. My odds, based on radiological assessment of the level of disease, are around 50% 5 year survival. The graph shows typical international data (PCI stands for Peritoneal Carcinoma Index. Mine is about 6)

Many people have expressed concern about the rather aggressive nature of the surgery. (For further information see http://www.peritonectomy.com/index.html). I agree that it is hard to contemplate, but then, all surgery is, by its nature, hard to contemplate. Further, I do have the advantage of being under general anesthetic. For family members in attendance and waiting, the experience is hard. For me, the period under anesthetic involves an absence of awareness, an odd phenomenon which I experienced during my bowel surgery in 2008. My focus must be singular. On emerging from theatre I have to do all in my power to recover.

Latest CEA

My latest CEA measurement delivered a pleasant surprise. At 8.7 ng/ml, this is the lowest reading in nearly a year and a clear indication that the level of disease has plateaued, albeit under chemotherapy.

This latest blood test brings an end to cycle 6. Now my chemotherapy course comes to an end as I prepare for surgery in Sydney. My next task is to increase my body mass, and to build up muscle strength. I am exercising by walking and, when the Welington weather is too unpleasant, by means of an exercycle at home.

Geoff Malcolm

I would like to introduce you to Geoff Malcolm, a man who has been very important in my life. Geoff was Professor of Physical Chemistry at Massey University. In 1974 he interviewed me for my first job there, showing me around the tractor sheds and wooden huts which then housed what passed for Physics accommodation. Geoff mentored me in my early years, and he was the person who broke the news to me when I was appointed Professor of Physics in 1984. Later, during a period when I experienced depression and doubt, he gave me the best advice one can give to an academic promoted beyond their level of self-belief. "There is no one way to be a Professor", he said. "Be the sort of Professor you want to be". That advice helped save me, and I have passed it on to many younger colleagues since. I think you will understand why I regard Geoff with esteem and affection.

An unusual day

Last night, as I slept, I had a strange dream, without structure, without event, without participants, just an odd sense of physical well-being, that I was in fact healthy, a feeling that persisted through the night, even across periods when I was awake. When morning came, my awareness of the tumours inside me was undiminished. Nothing had changed.

I have no explanation for the dream, except perhaps as some sub-conscious optimistic anticipation of forthcoming surgery. But this unusual night led to an unusual day, the first Monday of the new spring, following the shift of our clocks forward over the weekend. I decided to drive with Miang to Palmerston North to attend the funeral of an old acquaintance and friend, Florence Bacon. Florence's surviving husband Don had been Professor of Microbiology at Massey University, and I inherited his office in Tower C under one of our many relocations.

Florence (Flo) was an American, the daughter of Albanian migrants to the US. She met Don, a kiwi postgraduate student at Yale, while she was a laboratory technician there. She married him, and left behind her family to migrate to New Zealand. That was half a century ago. Flo became well-known and much loved in Palmerston North. She was a wonderful woman, savvy, funny, and warm hearted, the very best of America.

Miang and I drove back from Palmerston North in spring sunshine, wondering if our long winter was finally over. I felt both moved and privileged to have shared in the reminiscences of the Bacon family, as two daughters and a son spoke of their memories of their mother.

At the end of the funeral, we were invited to sing a song hardly ever heard in New Zealand, and one which I had never, until this moment sung. I finish here with its first verse.

O beautiful for spacious skies,
For amber waves of grain;
For purple mountain majesties
Above the fruited plain!
America! America!
God shed His grace on thee,
And crown thy good with brotherhood,
From sea to shining sea.

Batman gets his shirt

The person I am standing with is Chris Clark, an old friend and a senior scientist at Crown Research Institute, Plant and Food. Chris has recently been in Japan doing work related to our kiwifruit exports there, and took the trouble to seek out the perfect T-shirt for me.

Chris and his wife Delwyn, who are based in Hamilton, have been visiting Wellington this weekend to attend the WoW (World of Wearable arts) exhibition and show. Their visit here provided a wonderful opportunity to catch up and share some memories about Palmerston North days.

Completion

Today was a milestone. After 2 years and 6 months of work, off and on, the book is done, and I have finally sent the manuscript and electronic files to Oxford University Press. With 566 pages, 12 chapters, over 200,000 words, 264 diagrams and 890 equations, the book is a bit of a monster. I must have been crazy when I started this project. So "Translational Dynamics and Magnetic Resonance" is now in the hands of the publishers, who should have a simple job, given the electronic format I have used (LaTeX with .eps figures). In the last few weeks I have had enormous help from a young assistant, Dr Matthias Meyer, a expert in LaTeX formatting. Matthias and I are both pleased to see the end of the monster for a while.

Escape

I am now out of hospital. My immune system showed its strength in the blood tests and, armed with oral antibiotics, I have been allowed to go home.

Crossing the line

Each cycle of chemotherapy contains a danger period, just at the end of the 14 days of capecitabine oral drug. In the interests of reader sensibilities, I refer to this as my "Batman" period. The details are unpleasant and the curious can decode this nomenclature by checking earlier postings.

About 5 days after Batman's struggles begin, a new phase is entered in which my temperature starts to rise. If I can stay below 38 C I am safe. Above this, and I have to contact my oncology district nurse who then decides if I am to be bundled off to hospital. In cycles 1, 3 and 5 I managed to hover in the upper 37s. Cycles 2 and 4 saw me "cross the line".

Well, this is cycle 6, and last night my temperature soared to 39.2. So yes, I'm back in hospital again. If the medically wise judge that my neutrophil count is high enough, I may be allowed home tomorrow.


Miang making herself at home in the oncology ward and doing some work there while keeping me company.

Cytoreductive surgery, peritonectomy and HIPEC

For some time I have obliquely referred to "the Sydney option". Now I am in a position to give further information.

First some background. As I have previously written in this blog, my condition is known as "peritoneal metastasis". What that means is that cancer cells associated with my 2008 bowel tumour have escaped into my peritoneal cavity, seeding multiple tumours associated with the peritoneum, the membrane that forms the lining of the abdominal cavity and which covers most of the intra-abdominal organs and bowel. It is a relatively rare condition, in other words, you have to be unlucky with your bowel cancer to have this type of metastasis, and it is regarded as incurable, leading to death over a timescale on the order of 1 year. Unfortunately this peritoneal disease doesn't generally respond to systemic chemotherapy. My good luck has been to have an excellent response, but this response buys time, it is not a cure. Time is now running out. My CEA has plateaued and I can't take too much more of this chemical assault.

In April this year, my surgeon son Chris pointed out to me that a group in Washington DC, led by Professor Paul Sugarbaker, had pioneered a new type of surgery that seeks to cure peritoneal metastasis. The procedure is known as cytoreduction and peritonectomy with hyperthermic intraperitoneal chemotherapy. It involves completely resecting the peritoneum, removing all visible tumours, and where necessary resecting parts of the bowel. The gall bladder and spleen are permanently removed. As part of the surgical procedure the peritoneal cavity is filled with hot (43 C) highly concentrated chemotherapy agent, and for an extended period (~ 1 hour) worked into the tissue in an attempt to kill all remaining cancer cells. The physics behind this is straightforward. Once all visible tumours have been removed, what remains is small and has high surface to volume ratio, thus making it vulnerable to attack.

This is highly aggressive surgery, taking typically between 8 and 12 hours, with several days in intensive care in recovery, and at least three weeks following in a surgical ward. There is a high risk of complications, the most unpleasant being fistulae (bowel leakage).

This surgery is available only at selected places around the world, and not in New Zealand. However, as Chris pointed out to me, one of the very best facilities is at St George Hospital in Sydney, and led by surgeon, Professor David Morris.

In July I visited St George, met with Professor Morris and his team and, had my case assessed, based on multiple radiology. They gave me good odds for medium term (~ 2 to 5 years) survival and accepted me for surgery subject to funding, which they, being a public hospital team, preferred that I sought from the New Zealand health system. This surgery is not cheap!

In early August, my Wellington referring surgeon made a case to a New Zealand Ministry of Health fund known as the "Special High Cost Treatment Pool". Last night, I received advice that my funding had been approved. St George Hospital are now able to schedule me for surgery. probably at some time during the next 8 weeks.

I feel extraordinarily grateful to my country for supporting me in this. Miang and I were prepared to pay the full cost, but how gratifying to be supported as an extension of our public health system. This is is what St George wanted, to be able to provide this unique service to Australia and New Zealand.

My life is now about to enter a new phase. The surgical experience will be formidable, far more demanding than my 2008 bowel surgery, and will require all my strength. The risks are great, but this is my best chance of surviving beyond 2010. I look forward to this opportunity with fortitude and hope.

My sister Mary

This last week my younger sister Mary has come over from Melbourne to be with me while Miang is at a conference in Mexico. This is the second time in a month that she has given her time and care in this way. Mary, having been a senior nurse manager until recently, is now is part of a diabetes research team at the University of Melbourne, and she has had to organise her schedule to make these visits possible.

But what a great time it has been. To be with my sister, who normally I see only on busy family occasions, on a one-one-one basis living together at home is just marvellous. We can sit quietly, chat when we feel like it, share books, Skype Miang in Mexico each night, watch movies, share chores (though Mary is by far the better cook!), read the paper together, pop out for brunch (here is the two of us at Cafe Villa in Ngaio), do some shopping, go for a walk, entertain guests who drop in. And as a result I have learned so much about my sister's talents and personality that I never appreciated before. She of course has learned of my very bad habits around the house, but with her professional skills, managed to ensure that I drink the endless glasses of water, and remember to take my medications.

I should add that Mary has joined in my TaiChi class on two occasions and was completely at home with the group. And, she took me to Chemo IV this week at the hospital, which was a great opportunity for her to check out the New Zealand medical scene. The oncology nurses were delighted to meet her.

I am now half way through cycle 6. Next week is the start of my "Batman fights again" phase. My Avastin infusions have now finished. Whether I continue with more cycles of irinotecan/capecitabine (maximum 8 in total) depends on my CEA profile. As pointed out in a recent posting, I appear to have plateaued. This may be an indication that chemo is no longer effective. And then there is the "Sydney option" to be scheduled. More on that later.

PS: My heartfelt thanks to Mary's husband Tom who has gone without her company for yet another week!

Canterbury Earthquake

Canterbury earthquake and aftershocks
(Image MARK CORNELL/The Press)

At 4-35 am on Saturday September 4, a 7.1 magnitude earthquake struck the Canterbury region of the South island, with the epicentre at Darfield, 40 km west of Christchurch city, and at a depth of 10 km. Though there was extensive damage to buildings and infrastructure in and around Christchurch, there were no deaths.

Contrast this outcome with the 2010 Haiti Earthquake, magnitude 7.0, in which 230,000 people died, 300,000 were injured, 1,000,000 made homeless and 250,000 residences and 30,000 commercial buildings severely damaged.

Why the difference? Well, we were fortunate that the earthquake struck when most people were asleep in their beds. Had it struck at 4-53 pm, as in Haiti, then there would surely have been fatalities resulting from falling debris in the central city. But most importantly, the strict New Zealand building code which requires earthquake resilience, was the major factor differentiating these events. Most of the commercial buildings suffering major damage in Christchurch central city were pre-code (1935). A high proportion of Christchurch residences were damaged to varying degrees, but apart from a few pre-code brick mansions on rural properties, none collapsed.

The cost of repairing the earthquake damage is estimated at NZ$ 4 billion, about 3 % of GDP. Much of this with be covered by insurance, by the Earthquake and War damages fund (which has reserves on the order of $15 billion) and by central government grants to support local business and kick-start reconstruction. The country can handle the repair bill.

The impression here is that emergency services and civil defence system worked like clockwork. Power and water services were restored to most of Canterbury within a couple of days. Now that the aftershocks are subsiding, demolition and repairs are in full swing. It will take a year to complete the reconstruction task.

All-in-all, New Zealanders, and especially Cantabrians, can feel proud of the way we handled this potentially catastrophic event.

For a flyover of the fault line damage, check out

http://www.youtube.com/watch?v=Npqx3WmNkv4

Peter and Irene Martin

In 1981 my family and I had a wonderful sabbatical leave in Vancouver, where I worked at the University of British Columbia. Amongst the many friends we made that year were Peter and Irene Martin, whose sons David and Alan were of a similar age to my own two children. After not having seen Peter and Irene for at east 20 years, they turned up in Wellington the week and spent the night with me and my sister Mary (Mary is back from Melbourne again, looking after me while Miang is at a conference in Mexico).

This morning Mary and I gave Peter and Irene the Wellington "tour package" including a visit to the Zealandia Sanctuary (pictured), the cable car, Parliament, Oriental Bay and Mt Victoria, before guiding them to the Interislander Ferry so that they could continue their journey south.

Mum and Dad

In an earlier posting I introduced my siblings, Jim, Jeanine and Mary. It's time to tell you about my Mum and Dad, pictured here in 1946, the year before I was born. Mavis Hogg met Ernest Callaghan when they both worked at the DIC Department store in Wanganui. They married in 1934. Dad spent most of his earlier life in Napier where he witnessed the 1931 earthquake, being knocked off his motorcycle by the seismic shock. Mum had an itinerant earlier life as her family moved from town to town, South Island and North, for reasons of her miscreant father's making, as he found it necessary to hurriedly move his family out of town on a regular basis. None of my grandparents were alive when I was born.

Jim, Jeanine, Mary and I spent most of our childhoods in this 4 bedroom house in Wanganui East, the place of childhood legend, or, as Richard Green would have it, childhood pandemonium. Jim set a standard for adventure, which I was happy to follow and adapt. Dad, who was immensely kind, would sometimes curse me with words that still ring in my ear, to wit, "I hope you have a son who causes you as much trouble as you have caused me ", and, in confusion, would sometimes credit me with acts of heroic vandalism which were probably Jim's, but which I happily grew to believe were mine.

Mum was just endlessly patient, in the face of irate neighbours complaining about my latest outrage.

Dad was a draper, the co-owner of a dress fabric store ("Callaghan and Haworth") situated in the heart of Wanganui's Victoria Avenue. He had a lovely sense of humour and enjoyed chuckling and jesting. Occasionally, to my childhood disquiet, he would burst into song while driving the car. He had only a primary school education, but read a great deal of history, biography and travel, especially of the Antarctic heroic period. I can't recall how many times he told me that Scott would have made it back, if only he had included Lashly and Crean in the polar party. My favourite pastime was to argue with Dad about politics, business, life, or whatever. He humoured me by these jousts. He built me toys, including an extraordinary cart which, according to Richard Green, I drove hell mell down the Jones street hill with flaming petrol-soaked rags attached to the rear. When I nearly destroyed Dad's new car by wrapping it round a lamppost, he just repeated his despairing curse, and then life returned to normal.

Mum had a year of high schooling before escaping into retailing office work. She was what we used to call a "housewife", a great provider, like all Mums of that era. Hers was the close family that Dad (and the husbands of the remaining 8 Hogg girls) adopted, and the one which provided me with 38 cousins. Mum didn't worry when I disappeared until dinner time. She did cry once when seeing the welts on my backside after a one of my more severe secondary school canings, but sensibly heeded my pleas not to go to the headmaster. In other words, she trusted me to manage the adventures and traumas of growing up.

Though my primary and secondary schools beat me, my Mum and Dad never did, although once, following extreme provocation on my part, Mum begged Dad to thrash me, which he pretended to do in the bathroom in order that justice might at least appear to prevail.

Dad was never called Ernest by Mum's family. They called him "Cally", as did everyone else in Wanganui. He died at 83 in 1983, and Mum at 89, in 1999. This last photo shows them both in 1980.

I loved them and miss them both. Oddly, as I get older, I seem to carry more and more of them around with me. My external noisy gregarious side is Dad, along with any wisdom I might display. Mum is more of my complex inner self. I guess that's a form of immortality, having your genes and memes driving the lives of your offspring!


PS: Many thanks to brother Jim for these electronic images from the family archive.

Star Wars Tai Chi

My Taiji lessons continue. I am trying to perfect the long form, with 37 moves. Taiji, being a martial art, can also be performed with a sword. Here is a version of the 42 move sword form, in an amazing animation passed on to me by daughter Catherine. It is quite enthralling.


http://vimeo.com/14250730

The plateau?

My latest CEA data point confirms our suspicions from last cycle, that the previously reducing level may have "plateaued." Certainly the rapid reduction seen in the first two cycles is no longer apparent.

What these data suggest is that there may not be a continuing benefit from further chemotherapy.
However, in consultation with the hospital oncologist, we made a decision today to continue with cycle 6 but to delay this by one week to allow my bowel to fully recover. This means I have another drug-free week to enjoy!

On the knife edge

I have just passed through the critical days at the end of the cycle when my bowel collapses. Well, it certainly collapsed on two out of the last four cycles, and sent me to hospital.

This cycle we tried a new strategy, namely, stopping the oral chemotherapy medication the moment the diarrhea began, in this case, on schedule at last Thursday. Since then I have been fighting the battle with the usual anti-diarrhea drugs, and a couple more. On Monday night my temperature started to rise close to the danger zone above 38.0 C. It hovered at 37.7 for an hour then slowly drifted back to the low 37s. The same happened on Tuesday night.

Today, Wednesday, the temperature was normal and my colitis pain was receding. The diarrhea seemed to have stopped. But this evening, I am again hovering at 37.7 C, occasionally hitting 37.8 C.

This teetering on the knife edge is becoming tedious. My prediction is that by tomorrow I will be back to the safe zone and ready to start cycle 6, albeit delayed somewhat. My poor bowel won't take capecitabine until several more days of recovery.

Given a successful navigation of tonight, this would make the score 3-2. To Batman.


PS: Thursday has passed, calm has returned, I am on the mend!

63

So yes, it was my birthday this week. I have made 63. My new target is 64.

It was an enjoyable week, though sadly Miang was unable to be here as she is back in Malaysia visiting family. My sister Mary came over from Melbourne to "look after me". Mary is a very experienced nurse, and has been vigilant in ensuring that I am behaving sensibly. On Tuesday this week we were joined by my older sister Jeanine and her husband Murray, who drove down from Tauranga to be with us for a few days. It has been a wonderful family time.

Highlight of the week was a lunch at One Red Dog organised by Mark Hunter and the gang from the lab and Magritek. My family joined in (Jeanine left, Mary obscured) and had the chance to meet some of the remarkable younger generation that I work alongside.

Normally, as we get older, birthdays lose some of their charm. For me, this one felt like a milestone.

Toly Pavlovsky-Meersmann

This wonderful young man is my friend Toly, the son of Thomas Meersmann and Galina Pavlovskaya. Thomas and Galina, who are based in Nottingham, UK, spent a 6 month sabbatical with us a few years ago, when Toly (Anatole) went to Te Aro School. Now they are back again to help us with our "hyperpolarization" setup, and Toly has given up part of his UK summer holidays to go back to Te Aro, where he has met up with old classmates.

Toly is a fine soccer player and when he arrived in New Zealand a few weeks ago, presented me with some precious soccer cards of two of our famous All Whites players, Ryan Nelson and Shane Smeltz. Here Toly is eating pizza at a birthday celebration which we held this week.

I have to admit, the birthday was mine. More on that in my next posting.

PS: Many apologies for a long silence. I have had my siblings visiting and have been rather pleasantly distracted.

PhD student 21 successfully defends

On Wednesday this week, my 21st PhD student had his oral exam. Stefan Hill is a scientist at SCION (previously NZ Forest Research Institute) in Rotorua and he carried out his research there and at the Australian Synchrotron in Melbourne, using Nuclear Magnetic Resonance and X-ray diffraction on radiata pine at various levels of drying. The results of his thesis show the crucial role of a very thin trapped water layer between the cellulose fibrils and the surrounding lignin and hemi-cellulose matrix, something which turns out to be of real value in undestanding the best conditions for wood drying.

The real supervision work for this thesis was carried out by two of my esteemed SCION colleagues, Roger Newman and Robert Franich. I was the link person to the University, providing overview advice and helping the process along to ensure it met the requirements of PhD. But strictly, I'll claim credit for this being number 21. The picture shows Stefan (left), Roger (middle) and me at my favourite "Galleria" cafe in the university, just before the exam. The oral defence (second picture) lasted just over 2 hours. Stefan was superb, fending a barrage of questions from New Zealand external examiner Philip Harris from the University of Auckland, and from local examiner Ken MacKenzie, who also passed on questions from overseas examiner Martin Mueller from Germany. All the examiners were very impressed with the work and Stefan passed his oral with flying colours. Stefan, of course, is a very experienced scientist himself, and now continues with SCION as an even more vauable member of the team.

Having a PhD student successfully defend brings a special pride to the supervisor, even in my case, where my role was a bit peripheral, but I'm especially pleased with Stefan, who is just just such a great guy, though he was responsible for once getting me horribly drunk in a bar in Aachen!

PS: To my delight, at the end of the oral exam Philip Harris (Professor of biological sciences at UoA), reminded me that he had first met me in 1970, when he was a Graduate Research Fellow at Oxford University, and I was a first year graduate student. We were both members of Wolfson College. That was 40 years ago!

Latest CEA data and current status

This blog is mostly cheerful but it is also intended to be informative about my health status. I apologise in advance for being a little stark with this current entry.

My latest CEA data at the start of cycle 5 (linear and semi-log plots as usual) suggest a continuing reduction in the number of cancer cells. Since last posted, at 16.5 ng/ml, I have had three new data points at successively 10.3, 9.1 and 9.2 ng/ml, though the 10.3 and 9.1 measurements were made by the hospital, and not by my regular blood testing agency, Aotea Pathology, so the calibrations may not be consistent.

At the start of chemotherapy I was 78 ng/ml and so it it is clear that the treatment has had some major effect. There is a suggestion however that the benefits may have "plateaued", and I am unlikely to drop below the 2.5 ng/ml "normal" level.

The response of my cancer to the chemo has been remarkably good according to my oncologists. However, there is absolutely no doubt that this treatment cannot cure the cancer, but only delay its return. The particular condition I have, peritoneal metastatic cancer, is incurable by systemic chemotherapy. The only known option for further treatment is a new type of surgery (peritonectomy with hyperthermic intraperitoneal chemotherapy) which has been pioneered in the US and which is available in Sydney. I am pursuing this option and once my route becomes clear, I will update you all about the details.

In the meantime, I have to confess, with each new cycle I am finding the chemotherapy regime to be more and more difficult to manage. Increasingly, the nausea, lethargy and a peculiarly uncomfortable skin sensation are taking a toll on me. I am really having to limit work activities to just a few hours a day.

PS: I have just had very sad news from my good friend and former PhD student, Miki Komlosh, whose father died yesterday, after a short one month battle with stomach cancer.

Mark and Jillian's addition

Mark and Jillian Hunter have a new son, and Sam, a new brother. Thomas William Hunter was born at 3-10 pm on Wednesday 4 August, weighing 3.08 kg (6 pounds 13 oz). It's been an eventful year for Mark, with his PhD thesis submitted and a new son born.

Clearly Sam is delighted with his new brother, and the family group portrait is a classic, with Jillian, Mark and Sam quite radiant.

Sarah and Joe visit

The weekend before I was hospitalised, we had a visit from Sarah Codd and Joe Seymour. Sarah is a kiwi lass, born and bred in Palmerston North, and a classmate of my daughter Catherine. After a Physics honours degree at Massey University, Sarah completed a PhD in Magnetic Resonance with John Strange at the University of Kent at Canterbury. She then returned to New Zealand as a post-doctoral fellow in my lab, where she met Joe Seymour, an American postdoctoral contemporary. The rest, as they say, is history. Joe and Sarah, now married, are both Professors at Montana State University in Bozeman, Montana. Miang and I visited them last year after the West Yellowstone conference and had a brilliant couple of days in this most beautiful place, including Joe and me hiking a peak in the Rockies.

Joe and Sarah link together so many mutual friends who have worked in my lab, including Ross Mair, Melanie Britton, Miki Komlosh and Andrew Coy. The upper picture shows from left, Mel (Andrew's wife), Andrew, Joe, Sarah and me (Miang took the photo) outside a new restaurant, Foxglove, on Queens Wharf where we had just enjoyed lunch together. The lower pic is of me and Joe celebrating after our "mountaineering feat"!

Sarah and Joe are both outstanding scientists. Sarah did some quite remarkable experiments in my lab on dispersion of restricted fluids. Joe introduced to our group the whole field of chemical engineering, and together we published one of our most highly cited papers. Now they both have their own exciting research programmes and are attracting excellent graduate students to work with them.

Sarah's visit had added poignancy for me. Her father, John Codd, died as a result of bowel cancer, on Christmas Day 2007. John was Professor of Policy Studies in Education at Massey University, my contemporary, and a man greatly admired and respected by all who knew him. To quote from an article by Paul Adams & John O’Neill, "John Codd seemed to have the admirable knack of saying what needed to be said (no matter how socially, educationally or politically critical) without offending people. He was a deep-thinking social theorist who knew implicitly the critical importance of education and teachers in creating a better society."

PS: In the group photo I am wearing my Icebreaker "beanie", a gift from daughter Catherine.

Taiji lessons

For the past few months Miang and I have been attending Taiji (Tai Chi) classes at the local community centre, under Master Ray Poy. We have been learning the long form, with 38 different moves. Taiji is a sort of slowed down martial art, first introduced to me by Yang Xia, who encouraged me again to learn a bit more about this art when he visited me in April. I am a poor exponent, as you will see from this video which Miang took at home, as I go through about half the moves of the long form.

Hairstyles

The deed is done-a nice "number 3", which has conquered the wisps and left me a sort of stubbled bald.

I must admit, the picture is a little weird, even sinister, an inevitable consequence of holding a camera out in front and clicking backwards into the unknown.

Also featuring in this "haircut achievements" report is my nephew Morgan (my Aussie sister Mary's son). Morgan has decided to have his magnificent locks removed to raise money for cancer, in dedication to his Uncle Paul. The transition from initial to final state was much greater in Morgan's case. Indeed his sacrifice is truly outstanding.

Yes, that is lipstick on his cheek, a "smackeroo" as they say in Oz.

Finally out of hospital

I am out. Finally. In truth I haven't really been that ill, though it took 3 days to get my temperature down, following which it showed an odd diurnal variation, rising to just above 38C late each day. I was taken off IV antibiotic Saturday and hoped to be allowed home that day to celebrate Miang's birthday. I was given "leave" to go out for a few hours and so Miang and I were able to take up my booking at Hippotamus restaurant, and to take dessert in Kaffee Eis. But after the meal I had to be delivered back to my hospital bed.

The problem has been that my neutrophil count has been too low for me to be safely allowed to leave. Each day, my blood test revealed a slow increase, but in the end, we went for the "nuclear option", injections of G-CSF (granulocyte colony stimulating factor). In 24 hours my white blood cell count and neutrophil count rose so much I was now above normal levels. It's enough to make you believe in biochemistry.

I spent six days in Ward 5 North. Readers will know that I am someone who finds hospital at least interesting, if not desirable. The worst aspect of my experience this time has been witnessing the terrible distress of some of my fellow patients. My room had two beds with a dividing curtain, and I shared it with three different room companions over my time. The last was a young man whose vicious, relentless, lung-hacking cough made me think of World War I soldiers stricken with mustard gas. It was truly terrible to listen to, but worse, to contemplate the suffering that accompanied it. In the end, I was desperate to escape, and I felt ashamed of that, and only full of admiration for the kindness and care given to this man, and his agonized parents, by the nurses and consultants.

PS: The picture shows me having a tub of Hazelnut ice cream at Kaffee Eis. I think the truth is finally out regarding my hair, or the little that remains. It is Einsteinian in its wildness. Something must be done!

Progress

Hi All,

Can you believe it, it is still me and I am afraid you will have to bear with me for a couple more days until Paul gets his acts together or generates more neutrophils (white blood cells that form the essential part of the immune system). He is on the right track though. His neutrophil counts has increased from his pit bottom of 0.8 when he was admitted in the ED to 1.0 yesterday and 1.2 today. Once the body's immune system kicks in, the body temp would go down, hopefully. At the moment, Paul has to be infused with different cocktails of antibiotics to fight the infection since the hospital could not identify the source of the infection that has been keeping his temp up. (Note: Neutrophil count of 3.5 x 10⁹/L is an average for healthy people).

Other than that, Paul seems to be comfortable under the care of the hospital. Below are photos of him progressing from the battered arms on the first day, to enjoying his lunch and reading DomPost in bed, to working on his book and talking with sister Mary from Australia at the same time. The other laptop belongs to Miang, who works alongside him to keep him company. Life is not totally bad, is it?

Paul is doing better

Hi All

It is me again because Paul is still in the hospital. His temp has not come down yet but his diarrhea has finally come under control in the last 12 hours. He is feeling much better and looking much more perky. However, he is feeling very tired from the diarrhea and dozy from the fever.

As usual, Paul is keeping his keen eyes observing all the happenings around him. He is fascinated by the hospital and the people in it. The nurses are beautiful and kind, except that they have poked too many holes in his hands for blood and IV lines. My heart aches to see the pain he has to endure. But Paul is such a brave man, not a tear was shed.

I did my routine before I left him this evening - a double dose of reiki. I am sure he will right tomorrow.

Good night and many hugs to all

Miang

Bam, Pow, Whack, Wham- round 4

Bam, Pow, Whack, Wham!........PLOP!

Darn, Paul lost this round. The score is now 2:2. Paul is in the ED again tonight.

He started having his diarrhea again last Thursday. We thought we had it under control till Sunday, with the BRAT (banana, rice, apple sauce and toast) diet sort of food and loads of loperamide. But he had 8 diarrhea events since this morning, despite given the maximum amount of loperamide per day. It has really taken a toll on Paul physical strength. His body temperature gone up to 38.7C after I got him in the ED and therefore they are keeping him there for observation.

But Paul being Paul. He will rise again tomorrow. Build up his energy and onward and forward for the next round of chemo, round 5, which probably will be postponed a week till his guts recover.

I am sure Paul will be back home by noon tomorrow and give you an updated posting.

Till then.................. hope you are well

Miang

Alan MacDiarmid Building opening

Last evening Victoria University of Wellington opened its new Alan MacDiarmid Building. It was a magnificent occasion, with over 20 members of the MacDiarmid family present, including Alan's widow, Gayl Gentile, seen here (photo by DomPost) with Alan's Nobel medal outside the building. The Prime Minister, John Key, opened the building accompanied by cabinet ministers Steven Joyce (Tertiary Education) and Wayne Mapp (Science and Innovation).

John Key spoke first and then I followed, pointing out how Alan had changed the New Zealand science landscape, and including the remarks "On a personal note, I have to say, that to know Alan was to love him. When he spoke with you, he gave you his undivided attention. He was genuinely humble, he was full of playful humour, and his wit found expression in his famous aphorisms, “Science is people”, “I am a very lucky person and the harder I work the luckier I seem to be”, “Will New Zealand be a leader or a follower in this 21st century of science and technology?” and Prime Minister, I know you will love this one, “Vision without funding is an hallucination.”

The building, which cost VUW $48m, is beautiful, and houses science and engineering teaching and research space, in an interdisciplinary environment. In the large foyer, Alan's Nobel medal is on permanent display, to help inspire the students.

I had the opportunity to have a good chat with the Prime Minister afterwards, encouraging him to keep the momentum going around science and technology initiatives. He was kind enough to question me about my health and, surprisingly, had heard about and wanted to know more, concerning my "Sydney option". New Zealand is an amazing place.

The picture is interesting because in the background are Gayl, and Sean McConnell, Alan's oldest grandson, who also travelled from the US to be at the opening.


PS: Thanks to university photographer Les Maiden for the PM shot. The wonderful portrait of Alan is by New Zealand artist, Marianne Muggeridge.

Miang's latest creation

In assessing my prognosis, Miang has turned to the oracle and come up with this astounding result. I am not sure which treatment will be responsible but the tentacles look favourable.

Ptolemy's Theorem and Pablo Etchegoin

Today I visited Pablo Etchegoin in Wellington hospital. He had developed a painful bile duct infection and was admitted to be given intravenous antibiotics. He was much better when I saw him. Indeed he was sitting up in bed with a notebook open and a pen in hand. I immediately noticed what looked like a problem in Euclidean geometry on the pages. "Working?" I asked. Later in the conversation Pablo returned my attention to the pages. "I decided to solve Ptolemy's Theorem", he said.

I had to scratch my head for a bit. In my teens I was an expert in Euclidean geometry, but I struggled to remember it. Pablo reminded me "It's the relation between the four sides and two diagonals of a cyclic quadrilateral. For a quadrilateral inscribed in a circle, the sum of the products of its two pairs of opposite sides is equal to the product of its diagonals.

Pablo finds hospital tedious. As a consequence he chose to solve an ancient problem worked out by the Greek Astronomer and mathematican Ptolemy, who lived in Alexandria from AD 90 to AD 168. He then explained to me his method. "I decided to use complex numbers", he said. "That means that the displacements between the vertices are just phase shifts in the Argand plane. It came out really nicely".

I was enthralled. "Poor Ptolemy didn't have complex numbers available to him", I said. "No, he had to do the geometric proof", said Pablo, who then went on to point out to me that Pythagoras's theorem was just a special case.

We had good conversation about our cancer treatments, the struggles we face, and the possible ways forward. But I walked out of Pablo's cubicle inspired again by his extraordinary intelligence, his curiosity, his physicist's love of mathematical beauty, and of course, his courage.


PS: Thanks to Wikipedia for the diagram. The entry on Ptolemy's theorem gives four different proofs, including the original geometric one.

Time for a cheerful posting

Here are my siblings. Me on the left, my younger sister Mary, my brother Jim, the eldest, and my older sister Jeanine. The photo was taken at the time of my 60th birthday.

We were all born in Wanganui, all 4 years apart in age. They are a wonderful family. Jim is a physicist as well, who inspired me as a kid to follow in his footsteps. He became one of New Zealand's most effective and respected physics and math teachers. Jim has four sons and several grandchildren. He is retired now and lives with his wife Sharron in Wanganui. "Big sister Jeanine" is the glue in the family, the one who looks out for us all and showers us with kindness. She and husband Murray ran a successful business for many years, and are they are now retired and living in Tauranga. They have three sons, and many grandchildren. And Mary, the youngest, lives with husband Tom in Melbourne, Australia. Mary has been a nurse, specialising in renal work, and now is involved in a medical research team, while Tom is a retired aircraft technician. They managed to produce a daughter, as well as a son. Mary, with her medical experience, has been a huge help to me.

I am very fortunate to have grown up with this family, and to have had their love and care through my adult life. And in recent times, Miang and I have gained so much strength from their support.

Bad blogger

I have been a bit remiss lately in not keeping my postings up to date. In truth, I've been having a bit of a rough old time on the chemo, feeling extremely fatigued, and a bit lacking in inspiration. However, I intend to drag myself out of the slough, lift my spirits, and communicate more effectively. I will be a better blogger!

Sydney foray

It's been a long silence since my last post. The flight to Sydney went OK and we were met at the airport by Miang's Uncle Andy, his daughter Lily and her husband, Anthony. The three of them live up in Curl Curl on the North Beaches about 30 minutes drive north of Sydney. After my two days at St George hospital in Botany Bay, they looked after us for a couple of days before our return home last night. The picture shows me and Andy on Palm Beach, at the tip of the Barrenjoey headland. Spending time with Andy and his family was a welcome break after very intense medical consultations and tests at St George Hospital.

Andy is a retired chemical engineer with extensive business experience in the petrochemical industry, and is a wise man. We had much to talk about including quantum mechanics and global climate change! He is also very generous, in the Lim family tradition, giving me and Miang a wonderful tour of the North Beaches region in his beautiful new Mercedes, as well as treating us to one of the top local restaurants for lunch. And Lily and Anthony were the best of cousins, driving us back from the airport and hosting us for two lovely meals in their home.

The "Sydney option" is something I have been considering for a couple of months now. My Wellington surgeon referred me to the team of Professor David Morris of the University of New South Wales. David Morris is world-renowned for his radical peritoneal cancer surgery, carried out at St George Hospital, using a method developed by Paul Sugarbaker in Washington DC. I won't write more about the option at this stage. The details are a bit overwhelming anyway. The purpose of my visit was assessment, them of me, and of course me of them. Once they have reported back to my Wellington surgeon, and I have had the chance to consult with him, I will make a final decision.

Meantime, I had some good news from my Insurance company. On the basis of my written appeal to them, they have decided to make an "ex gratia payment as a one off, the reason being that the information given to you at pre-approval was insufficient"

Naturally I am grateful to Tower and have accepted their offer.



PS: I have always been fascinated by the existence of a suburb in Sydney called Curl Curl. To those of us who were brought up on vector calculus, curl curl is the gradient of the divergence of a vector minus its Laplacian. When I first saw a Sydney ferry named "Curl Curl" back in the 1980's I was amazed at how mathematically literate Australians must be. Since then I have discovered that Curl Curl was derived from the Aboriginal phrase curial curial, meaning river of life.

One Hell of a Week

For all my superhero bravado, the bowel won in the end. The diarrhea just got worse, despite the loperamide and the fluids. I saw my oncologist at the hospital yesterday. He sent me for an x-ray and, sure enough, I had severe colitis. Now I am armed with some new drugs, one to counteract the bowel cramp pains, an antibiotic course, and codeine to help "bind" me. This reversal of fortune challenged me to find the right superhero graphic in which Batman is now on the receiving end, and in the appropriate place. I am quite proud of my achievement in this regard.

The week started with some adventure. I was invited by Palmerston North Boys' High School (the old school of my son, Chris) to address their Monday morning assembly for 20 minutes. The Hall was packed to the rafters with 1700 boys along with their teachers. I have to say, I did apparently entertain them and they gave me a great ovation at the end. I understand the culture of the "all boys school", having emerged relatively unscathed from one many years ago.

Tuesday was Avastin infusion day, Thursday my blood test, and then Friday, the long and helpful consultation with the oncology registrar at Wellington Hospital. My CEA result was not exactly what I had hoped for, not a halving from 23 to 11, but a 2/3 reduction to 16.5. So I am now off the exponential decay of the first two cycles. It may be that my colitis has caused an artificially high reading this time. It can do that. Or it may mean I am starting to "asymptote" to a plateau.

An important outcome of this week's experience, which is at the same cycle point as my hospitalisation in June, is another week's delay in my starting irinotecan/capecitabine. This last week has been my drug-free week (ignoring the benign Avastin), all these bowel problems being aftermath effects. I think from now on a two week recovery period rather than the usual one week drug free, will be my norm.




So, it's been a hell of week. And I had to pull out of "Waiting for Godot" on Thursday night! But the biggest complication is that my bowel status may prevent Miang and me flying to Sydney tomorrow. I have two days of medical consultations lined up at St George's Hospital. More on that little mystery later perhaps. As for the flight go/no-go, it's decision time this evening.

PS: 7-30 pm Saturday. Decision made. We go.

Ross Mair

Some readers will know my Aussie mate, Ross Mair. Ross was a postdoctoral fellow in my lab in 1995 and 1996. He is now Head of MR Physics at Harvard's Center for Brain Science, Neuroimaging facility. Ross has just written me a lovely letter. Last year, he rode in the Pan Massachusetts Challenge (PMC) bike ride to raise money for cancer research at the Dana-Farber Cancer Institute in Boston. In an 84-mile bike ride he raised $3960. He dedicated that ride to his mother, who at the time was undergoing treatment for breast cancer. Ross's Mum has now completed her treatment successfully and has returned to full health.

This year he is riding for me! I am really honoured and delighted!

Ross has a profile page for his ride at
http://www.pmc.org/profile/RM0113

Bam, Pow, Whack, Wham

Last chemo cycle I ended up in hospital for a couple of days, following the assault on my bowel wall lining, resulting in severe diarrhea and a blood stream infection. During my third cycle I have had a slightly reduced capecitabine dose, I've tried to drink more fluid, and I've been vigilant with the use of loperamide at the first signs. On Friday I finished my capecitabine for this third cycle. I now have a week drug free (not counting the Avastin infusion next Tuesday), before we start the new assault next Friday.

Always the problems are worse just after completing the two weeks of capecitabine, and sure enough, last night the bowel struck with a vengeance. But I was ready, drugs in hand! Bam, Pow, Whack, Wham as the cartoon says. Now there is an uneasy calm. I dare the bowel to offend today. Make my day!

PS: For those of you who feel this site offers just a little too much information, be patient. Gentler postings are imminent!