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What now>

As regular readers may know, in 2013 I was diagnosed with Prostate Cancer and in 2014 I had my prostate removed.  So far, so normal.

When I was released from the hospital the surgeon at Sheffield Hallamshire instructed that if my Prostate Specific Antigen (PSA) score ever went above 0.1 I was to be referred straight back to the Hospital.  In the years since I went from being tested every three months, to every six months, to once per year.

In September last year (2020) I went for my annual test at my local GP.  I was told that all was fine, but made the mistake of asking for the PSA score.  It was 0.2.  This meant that I would be sent back to the hospital, with Radiation Therapy and Chemotherapy being lined up.

Then the receptionist dropped a bombshell:  my score had been 0.2 in September 2019 as well.  They hadn’t worried about it as my local GP is subsidiary to Barnsley General and the Urologist at Barnsley General only asks for a referral if the score is 0.3 or above.  But, of course, I was treated at Sheffield.

This left me with a problem.  If my score had gone up, but had then remained stable at 0.2 for a year, what did that mean?  An online search found some interesting statistics.  Returning cancer should mean that the PSA score should double:  if it was cancer, every six months, but if it was an aggressive cancer, every three months.  My score had stayed at 0.2 for at least a year.  So was the cancer back, or what?  Confused isn’t the word.

Anyway, the doctor’s surgery referred me to Barnsley General.  After a long wait I had a ‘telephone appointment’ (this was in the middle of the Coronavirus Pandemic) where the Urologist at Barnsley explained that, if it was up to him, there was no problem, but as the surgeon had specifically stated a score of above 0.1 he had no choice but to refer me back to Sheffield.

There then followed another wait while the surgeon at Sheffield received the score and then sent me a letter for another telephone appointment.  Sure enough, when he rang he began talking about assessments and what treatment I would need to undergo.  I then pointed out to him that my score had been 0.2 in the previous year as well.  Cue the sound of some frantic page turning until he found that I had indeed had the same test score for a year.

To his credit, he immediately admitted that he was surprised and wasn’t sure what the score meant.  After all, if the cancer had really returned it should have doubled at least every six months.  After a year, the first score of 0.2 should have doubled twice to 0.8 if it was ‘normal’ cancer: to 3.2 if aggressive.  It was still 0.2.

The surgeon’s (understandable) response was to demand another test.  After yet another delay, where the hospital waited for me to get tested and I waited for the hospital to send me the forms needed, I eventually had yet another test.  A delay for the result to be processed, and the surgeon contacted me to tell me that the score was still 0.2.  His conclusion was that the cancer had NOT returned, and that the only explanation he could offer was that he had left a tiny piece of prostate behind and that this was causing the changing result.  However, as this was all unexpected, he asked that I have another test in around six months’ time as confirmation.  It was now April 2021, so I suggested that in September (5 months) I would go for what had been my usual annual test.  This was agreed, so began yet another wait without knowing what was happening.

In early September this year, after a full year of worry and stress, I went for yet another test.  After a delay of less than a day (thank you, Christine!) I received the latest result.  0.17.  It had actually gone down!

So I am now waiting for the surgeon to contact me.  I am unsure what he is going to say, but as the score has not changed since 2019 I don’t think that the cancer has returned.

So what is my take away from this?  It’s that urologists around the country should come together and agree a standard routine for prostate cancer patients, with referrals on the same test results, rather than one hospital worrying at 0.1 and another at 0.3 (and I believe other urologists only worry at 0.4).  Having different urologists giving different advice is confusing for patients.

One other thing is frustrating me.  I decided upon September as the date for my repeat tests in the belief that, should the score go up, I’d find out what was going to happen before Christmas.  It’s now over a year since the first news that the score had increased, so that plan was obviously wrong.  Obviously, things have been thrown into turmoil by Coronavirus, but this wait has not been good for my mental health.

Still, at least the fact that the score as gone down means that I may not have to go through radiation/chemotherapy.  When I first found at that I had gone to 0.2 in 2019, but hadn’t been told, and that the GP had thus waited for over a year before referring me, I was upset.  However, on reflection, I’ve been lucky.  Had I been referred in 2019 it is possible that I would have been sent for extra therapy, whereas now I am almost confident that the cancer has not returned.  Perhaps I should stop worrying about events over the past year and just count my blessings.

Latest Health Update

I’m expecting two phone calls from two urology departments today.

I’ve just had the first, from Sheffield about the prostate cancer. The surgeon is happy to say that he doesn’t think there are any cancer cells present and that, at the moment, I do not need any further treatment. However, I am to have another test in six months. In other words, my usual test in September!

Relief is not the word …

I’m now waiting for the call from Barnsley about the kidney stones. The wonders of getting older!!

Health Update

First, let me apologize for the delay in writing a new post. This is due to my waiting for results and conversations with hospitals and surgeons. Hopefully, things will now begin to move a little quicker than over the last six months.

Yes, it is six months since I had the PSA test which confirmed my worst fears: the score had gone up to 0.2, meaning that I was to be referred back to the hospital. However, I was also informed that the score had been 0.2 the year before, but there had been an administrative error and I had not been referred back in 2019, as should have been the case. Obviously, this left me rather confused, a fact not helped by my first referral being to the Urology department at Barnsley, where I was informed that the specialist would not worry until my score was 0.4. However, as the surgeon at Sheffield had specifically stated 0.2, he would be contacting Sheffield.

I then waited until just before Christmas for the surgeon at Sheffield to contact me. He stated that he wanted me to have a test run by Sheffield to confirm the score, as Sheffield’s tests are more accurate. If the score was, indeed, 0.2, he would be recommending radiation therapy. It was at this stage that I pointed out that my score had been 0.2 in September 2019, which confused him as much as it had me: with Prostate cancer, it is to be expected that the PSA result will double every three-to-six months. He was baffled, but we decided that a new test would still be the best way forward. After further delays, in early March I had another blood test.

Yesterday I received the result of the test through the post. Apparently, it has remained at 0.2 for a further 6 months. This means that for the last 18 months my PSA score has been at 0.2. My first feelings are that, as the score has ‘remained static’ (the hospital’s phrasing), the first signs are that the cancer has NOT returned!

I’m now waiting for a phone call from the surgeon to discuss ‘where we go from here’. To be honest, I don’t know what to expect. It is obvious that something is happening, but it is also obvious that it is not an aggressive, life-threatening cancer – yet. I am expecting/hoping that an agreement will be reached where I go for more regular testing – say every six months, rather than every year – but I am dreading him saying that he still wants me to have radiation therapy. As anyone who knows me knows, I can be a stubborn bugger, and I can see us having a face-off where I refuse to have radiation treatment, simply because I can see it causing more problems than the ‘cancer’.

On the other hand, it is also dawning on me that if the cancer HAS returned, it is in no way a threat to life and health at this low level, so I should be good for a few years yet! Given the current climate regarding Coronavirus and lockdowns, I think I can live with that! When more news becomes available, I will post it here.

Good luck, stay healthy and take care!!

For Crying Out Loud: Really?

As someone who has had to live with a diagnosis of prostate cancer and its after-effects for the last 7 years, I have now reached the point where my frustration with the system has finally reached a tipping point.

To bring everyone up to date, in 2013 I was diagnosed with prostate cancer and in 2014 had a radical prostatectomy (complete removal of the prostate).  In 2015 I was released by Sheffield Hallamshire, but was told that if my PSA score exceeded 0.1 I would be referred back to the hospital.

So far, so straight-forward. 

Since then, I have had regular tests and have been given the ‘all clear’ until September this year (2020 –  a wonderful year all round).  I was informed that my score was now 0.2.  Naturally, I was devastated by this.  However, I was then informed that it had been 0.2 in 2019, but as Barnsley do not act until the score reaches 0.3 no action had been taken:  obviously, after 5 years the surgeon’s notes had slipped from peoples’ minds.

Confused, I asked what action – if any – needed to be taken, and it was agreed that the result would be referred to Barnsley.  Consequently, I received a letter informing me that, given the current health crisis, I would be receiving a phone call from the hospital. 

I had the call this morning, and it has reinforced my anger and frustration with the system regarding men and prostate cancer.

The urologist stated that as the surgeon had asked for me to be referred back to him if the score exceeded 0.1 he had no option but to refer me back to Sheffield.  

This would not be a problem, except that he also informed me that personally he would not take action until the score was at least 0.4. This was especially the case as my score had not increased from 0.2 for over a year. It is the ‘doubling rate’ that is most important in these cases: if the score doubles in 6 months, there are probably going to be problems, if in 3 months there are definitely going to be problems.

But the urologist’s reaction brings me to the core of my anger and frustration.

For obvious reasons I do not know what the system is like for women who have been diagnosed with breast cancer, but for men with prostate cancer the system is terrible.  My surgeon at Sheffield wants to see me for a score exceeding 0.1.  I know that for other hospitals the score has to be 0.3.  For Barnsley, apparently, the score is 04.

As a man suffering from cancer, the lack of consistency between hospitals/surgeons/urologists means that we are left confused and wondering where we stand.

I know that in some respects my situation is odd:  I was one of the first to go through the surgery at Sheffield and it is likely that in some respects I am a ‘guinea pig’.  In that case, my recall with such a ‘low’ score makes sense.  But I have never been informed of this level of investigation and am now left in the air yet again:  after a wait of nearly a month to find out what Barnsley wanted me to do, I now have yet another wait – of unknown duration – to find out if the surgeon at Sheffield is expecting me to go through further procedures or not.

I would humbly suggest that for anyone diagnosed with cancer such a situation is not conducive to mental health, instead resulting in confusion and worry.

As such, my message to the medical community with regards to prostate cancer diagnosis, treatment and testing is as follows:

On behalf of all men who have been/will be diagnosed and treated for prostate cancer, please get your heads together and come up with a system that is consistent across the country.  I accept that there will be special cases, but for these the patient needs to be updated and informed of any differences in his treatment and/or testing.  Having different parameters based upon post code/location is confusing, worrying and downright wrong.  It is hard enough to deal with what we know, never mind what we don’t know/aren’t told.  Consistency would at least help us to know where we stand and surely is the least that is necessary!

As it is, I now have a wait of unknown duration to find out what is going to happen to me. Bugger.

Prostate cancer: Back to Hospital

Over the last five years the results of my PSA tests have given me cause for comfort and hope that the cancer had gone for good. Sadly, my latest test has shown an increase and I have been referred back to the hospital.

In line with my earlier page describing the events surrounding my prostatectomy, I feel it may be of use to describe events surrounding the latest developments.

The first thing to note is that I received the latest result two days ago. For those in a similar position, my test result was 0.2 and in the original notes for the case I am to be referred if the score goes above 0.1. Obviously, in different parts of the country/world the scores acted upon are different, and it may be that some readers are wondering why I am posting this with such a low score, but the concept that the cancer is back is affecting me more than the original diagnosis. Consequently, it has taken me two days to come to terms with the knowledge that everything now starts again.

This brings me back to the reason for the post. ‘Everything’ may be starting again, but I do not know what ‘everything’ is. The result was on a Friday, today is Sunday (13/09/2020) so I have to wait until tomorrow (Monday) to find out what the hospital says about the next move – selfishly, the people in charge are having the weekend off!* I have no idea what t expect.

For anyone else going through the same process, or who is worried in case the same happens to them, I am planning to update this page as events unfold. Hopefully, it will be a page that expands over the coming decades and so gives hope and reassurance to other PC sufferers.

In the meantime, being a pessimist, I am preparing myself for the worst. That way, I am unlikely to be caught out by bad news. Obviously, I am hoping to post something positive tomorrow in the wake of contact with the hospital. Until then, stay safe and remain healthy!

*Please note that this is a joke: it is just typical of my luck that the result was on a Friday!

Calling Time

After much deliberation I have been forced to come to a single, unhappy conclusion. I am currently contracted to write two more books for Pen and Sword, the first of which is on Constantius III. However, after completing these books I will not be writing any more.

This may seem a drastic decision, given that there are many more subjects which could be covered – the Third century, the Early Republic, the Constantinian Dynasty, Theodosius I – the list goes on. The trouble is that the financial rewards for the months/years of work that goes into writing one book makes it no longer worthwhile.

Possibly the main reason is the rise of the ‘E-book’. Although cheaper to produce and easier to store than print books, and therefore of greater appeal to the public, the net result is that the poor author receives pennies in royalties for these books.

Please don’t mistake my comments here: I can fully understand why people buy e-books rather than hardbacks or paperbacks, not least the cost. I may prefer ‘real’ books to e-books, but I do have quite a few of the latter as I have begun to run out of room in the house. And as money is tight, they are the most affordable version to get.

For the author, that is small comfort. For example, in the last royalties statement I found that I was being paid two-and-a-half pence per book for one of the publications. Strangely, this is not enough to justify the work and commitment needed to write a full manuscript.

As a result, I have recently resumed my career in Education – though on a lesser scale than previously – where I can earn more in one week than I earn in royalties for six months. Hopefully, readers can understand this decision and will accept that paying the bills must come before the vanity of seeing my name in print.

This does not mean, however, that I will now immediately stop posting here or responding to queries and comments. I still have two more years of writing before me, so will be around for a time yet!

What about History?

I am sometimes asked as to why I talk about recent events or about guitars rather than about history.

There are a couple of reasons for this.  One is that after I’ve spent my day researching and writing about history I usually don’t want to then spend my ‘free time’ writing about history again.  No matter how interesting it may seem to others.

The most obvious reason concerns the period of history on which I am currently focused.  Students of Ancient Greece can talk about amusing snippets from many ancient sources, including strange medical assumptions from Galen or insights by Homer or Herodotus.  They have thousands of years of work to choose from.  Those concentrating upon either late-Republican or early-Imperial Rome can quote from Caesar, Cicero, Tacitus or Pliny the Elder, among others.  All of these men wrote long discourses including either a wonderful comprehension of their subject or, especially in the medical or scientific field, they can amaze us with the knowledge that they had – or more often with the strange things they assume to be valid.

I study Late Antiquity.  The works of historians and medical practitioners from this period have almost completely been lost, preserved for the most part only in fragments quoted in much later works.  Even more importantly, the majority of the works that do survive from this era were written by men far more interested in religious debate than in analyzing political events or talking about their medical breakthroughs and beliefs.

Instead, my main reliance is on the fragments of the historical works and the many Chronicles which have survived.  And, to be completely frank, the chronicles aren’t exactly a barrel of laughs.  It is hard to make an interesting blog when what you are working with is a little short on information.  Take this excerpt from the Chronicle of Jerome:

Melania, noblest of Roman women, and daughter of the sometime consul Marcellinus, at that time having left behind her only son, the urban praetor, sailed to Jerusalem, where she was such a miracle of virtue and especially of humility, that she received the name of Thecla.                                                                                       Jerome, Chronicon, c.374.

It’s great for Melania that her name is still known by some people c.1,700 years after her death, but it’s not exactly something around which to build a blog entry.  (Yes, I accept the irony that Melania’s name IS being used for a blog entry.  My point still stands.)

So I’ll go on writing blog entries in a very irregular manner based upon anything that moves/interests/annoys me so much that I feel the urge to write it down.  It’s my blog and I’ll write if I want to!!

Constantine and Onwards

The text of ‘Constantine’ is complete. I am now waiting for volunteer readers (thanks to all!) to return chapters to me with recommendations, clarifications and corrections. The maps for ‘Constantine’ are complete. They have been drawn and are ready for export into a format the publisher can use. I am still searching for some useable photographs for the plates section, but as this is not the hardest task on my ‘to-do list’, I am not worried. I have even sorted out the alphabetical list for the Index. Yes, I’ve been busy!

All together, I think I have probably two days of work left before I finish the book and the text is sent off to the publisher. Hopefully, if all goes to plan, the book may be out some time next year.

However, with only two days of work left I am looking towards the next contractual obligation. This will – hopefully! – be a smaller book on one of the lesser–known names in Late Antiquity. It will also – and this is important, at least to me – fill the one remaining gap between ‘Stilicho’ and the last chapters of ‘Patricians and Emperors’.

Constantius III is probably unknown to all but the most well-versed in Late Roman History. As usual, I will try my best to approach this new subject with an open mind, casting aside all prejudices and pre-conceived opinions. No guarantees, of course!

In some ways, especially in regards to the duration of his appearance on the scene (less than a decade), this should not be a hard book to write. In others, especially with regards to the poor quality of the sources and the ensuing contradictions concerning his life, it could easily turn into a nightmare.

Whatever the case, I will do my utmost to ensure it takes less time to write than ‘Constantine’. Surely it can’t take longer ….

Constantine’s Nearly There …..

Writing a book, or should I say ‘The Writing of a Factual Historical Book’ as I’ve never written a novel, for me comes in Six Stages.

Stage One is the best period: you’re hungry to start on the new topic. It’s fresh, it’s different to the last book, and it’s getting you away from Stage Five. The thrill of doing new research gives you a focus and a desire to learn. Stage One is good.

Stage Two is probably the most productive. The research is starting to reap its rewards. You’re starting to have ideas, the creative juices are flowing, and, if you’re lucky, new insights or possibilities are springing to mind: either a new hypothesis concerning the main character, or a breakthrough in your thinking about the chronology. Just, something … I like Stage Two. It’s where the vast majority of a book takes shape.

Stage Three is where the majority of the book is actually written. You’re ‘in the groove’: Ideas are flowing and, hopefully, because you are immersed in the topic, any previously-held theories either make complete sense or you look at the page you’ve just written and wonder how something so nonsensical can ever have been committed to paper. Sadly, it is usually at this point that Stage Six from the previous book rears its ugly head, but never mind ….

Stage Four is where things start to drop off. You have written the majority of the book, and are trying to tie up loose ends: for example realising that a major character from earlier in the book makes a short reappearance and you need to balance whether to repeat his story to remind readers of where he or she featured or simply state what happens next. By this time the ‘glamour’ of a new work is gone and you are looking forward to the death of the main character as a release from your daily grind.

Even when that happens there is still the Introduction and Conclusion to write. I always write the Introduction before the conclusion, simply because it includes notes on the sources: readers may not appreciate how much time and effort goes into ensuring that there is a list of relevant abbreviations in the Introduction! By contrast, the Conclusion is a blessing: the end of the main text. As you may have guessed by now, Stage Four is pretty hard work and is not my favourite place to be, at least until I’m writing the conclusion!

You may also have guessed that this is where I am now. The grind of finishing Constantine off, especially collating the sources and the abbreviations, means that I haven’t had the energy or the interest to continue typing in the evening in order to produce a blog entry. That is my excuse for not writing a blog recently. And I’m sticking to it.

The observant may also have guessed that I have almost completed Stage Four: today I finished collating the sources! Which is handy, as the manuscript is due with the publishers in November.

So only the second half of Stage Four (finish the Introduction and write the Conclusion) and Stage Five (Maps and Illustrations) to go before submission!

Then it’s wait for a while before Stage Six: the dreaded Indexing. But that happens after you’ve already started the next book. Enough of that: I am happy and don’t want to depress myself by thinking too far ahead. Stage Five awaits!

You see that Constantine?

Possibly the greatest difficulty with ancient history, and especially in those epochs where sources are thin on the ground, is the fact that historians rely on each other for discovering facts and for proposing theories where facts are practically non-existent.  Normally, this isn’t a problem:  it’s just a fact of life, and if necessary the theories can be checked against other events and either retained or discarded.

But every so often things snowball:  a specific theory propounds another theory, which then gives rise to another theory ….  And so on.  As time elapses, these ‘theories’ become based more upon previous theories than upon the original sources upon which these theories are based (eh?).  And then they become accepted ‘fact’.

In one of my previous books I found just such a theory.  When researching the story of Stilicho, I discovered that in 406 the invading Vandals, Alans and Sueves crossed the frozen River Rhine.  Except that I couldn’t find any reference to it in the original sources.  The earliest reference I could find was in Gibbon’s ‘Decline and Fall …’. A theory now accepted as fact?

Still, this isn’t really a problem.  As long as all sources are checked these things can be discovered.  In addition, when researching the ‘Late Roman Empire’ historians know that they cannot be certain of things, so the acceptance of alternative concepts is a matter of course and not necessarily the cause of friction.

However I have now changed historical periods, albeit only slightly.  The controversial character of Constantine the Great (reigned 306-337) obviously causes some debate, especially the discussion around his ‘Christianity’:  was he the first Christian Roman Emperor or merely jumping on a bandwagon for political gain?

As is usual, as part of the research I am currently analysing a new slew of theories built one upon another has appeared.  As I said, this isn’t a problem: it’s just par for the course.

On the other hand, the change in tone of some of both ancient and modern historians is surprising.  Some of the vitriol towards each other, which is barely disguised within the books and articles, is – frankly – hilarious.  In some places it appears almost as if the sources/historians have been watching episodes of a 1990s comedy called ‘The Mary Whitehouse Experience’ for ideas.  In this, there were sketches titled ‘History Today’, featuring two old professors played by Robert Newman and David Baddiel attacking each other in an extremely childish manner (try Googling ‘History Today’ for examples).

The entertainment value of such comments hasn’t detracted from the fact that the life of Constantine is one of the most covered, but least agreed-upon, lives of ancient history.  Having read through many of the text books and sources for Constantine’s life I can see why:  the question of his alleged Christianity and the date of his ‘conversion’ are hotly debated and the cause of much of the animosity, usually between Christian- and non-Christian writers, both ancient and modern. The confusion inherent in all of the works on Constantine explain (at least to some degree) the lack of posts here in recent months: after a day grappling with confused and confusing sources, the last thing on my mind is to then type a post about my frustration.

Although I am attempting to write Constantine’s story from a military viewpoint, the ‘Christian’ debate does creep in from time to time, especially when it comes to his military victories.  It s interesting that many writers have looked at, for example, the Battle of the Milvian Bridge, but have accepted what is stated by the sources at face value and have made no attempt to analyse the Battle from a military perspective.  As they are mainly concentrating on whether he was a Christian at this point, it is almost understandable.  Despite that statement, I still find it odd.

Realistically, however, I shouldn’t moan:  if previous historians had switched attention away from the ‘Christianity Debate’, what would I write about?