Saturday, December 03, 2011

Up-to-date news.

I am sitting in my office looking out on a beautiful day. The sun is shining and although it is not hot, we have a temperature of about 53 degrees F and a soft SW breeze. The leaves on the trees are yellow and gold and the sky is light blue with small patches of white.

My wife is polishing the wood block floor and there is a delicious smell of polish mingled with a beef casserole in the oven.

I should hear about the monoclonal antibody on Monday afternoon. The delay has been because the chairman of the Committee (don't you hate that word) has been on annual leave and nobody has been brave enough to take the decision until he returns.

I was told by a patient who was an Insurance man that taking out Private Medical Insurance in the UK was not cost effective. Companies like PPP and BUPA were frauds against the general public. You can get a good deal through a company scheme, but if you have to fund it yourself, you would find it more cost effective to put your money in Unit Trusts via a PEP or ISA scheme that shields the growth from tax and draw on it when you need it. This is what I shall do if the answer on Monday is NO.

Talking of medical insurance, it seems to me that NICE has taken a strange view of what medication it should be supporting. If it were dealing with car insurance rather than medical insurance it would not be funding low cost items. We all have an excess on our car policies. The first £350 of damages incurred in an accident I pay myself so as not to lose my no-claims benefit. I can afford to pay that myself. It's the £10,000 write off bill and the £1 million damages when the other driver loses a limb that I want help with. So it should be with medical expenses. I can buy my own indigestion medicine, I need help with long term treatment for a handicapped child or maintenance therapy for cystic fibrosis or for cancer therapy.

My general health is quite good though I have to be careful only to eat small meals. My main problem is ascites - fluid secreted by the cancer and accumulating in the peritoneum between loops of bowel. At some stage this will need to be drained away with a thin plastic tube under ultrasound guidance.

My daughter the hematology registrar is on-call in Oxford this weekend. Among her patients is one who has a very difficult lymphoma with translocations on both chromosome 14s at the site of the promoter for the Ig heavy chain gene. On one chromosome the translocation is to BCL-2 and on the other to c-myc. This is a very rare combination and in the literature there are no long term survivors. It is ironic that I described the first such case back in the early 1980s.

My son, the F1 engineer, has finished his globe trotting to Grand Prix and in future will be in charge of procuring and providing at AP Racing. He has been thrown in the deep end with a computer glitch which he has sorted much to the approval of the CEO.

My older son, will be emigrating to New Zealand on Jan 7th. He has been head-hunted to do healthcare risk management there. Apparently his Visa came through in two days, so keen were they to have him. He is glad to leave the CQC which has become mired in an internecine dispute engineered by a two supposed whistleblowers. One is a passed over inspector, not clever enough to advance in her division (she can't grasp Bayesian statistics) and now angling for 'constructive dismissal' and the other is a Board Member who was appointed for her special interest in mental disease; her special interest being that she had suffered from it and was getting increasingly disturbed as the year went on.

My older daughter took voluntary redundancy earlier in the year and has set up her own company doing business analysis. In the meantime she is in partnership with her step-son in an arts and crafts business which is making and selling objets-arts around Christmas time.

I ought to explain what the monoclonal antibody does:

Every cell in the body needs to either grow or die. This is as true for normal cells as cancer cells. Each cell receives a growth signal from a growth factor which reacts with a growth factor receptor on the cell surface. This message is then transmitted to the nucleus where a transcription factor sets the cell dividing at its set rate. This will be different for a skin cell compared to a blood cell compared to a brain cell. Cancer cells will tend to divide faster.

The message must be taken from the cell surface to the nucleus by a series of second messengers. Mistakes (mutations) can take place in the growth factor, the growth factor receptor, any of the second messengers or the transcription factors. A common mistake is in the second messenger k-ras and it is known that these monoclonal antibodies, which block the epidermal growth factor receptor do not work very well if k-ras is mutated. Happily mine is not.

In view of the fact that my disease is very indolent (in its metastatic form it has been present for over 3 years) the cancer does not seem to be carrying too many mutations and I have every hope that EGFR blockade with this monoclonal will be successful.

In the football it is an important weekend for the Premier League. Chelsea have just beaten Newcastle and later today Man U play Aston Villa, Spurs play Bolton, and Man C play Norwich. These are all games that could go either way and the Champions will come from this group of clubs. England were fortunate with the draw for the European Championships and will not have to meet a really top team until Wayne Rooney returns from suspension.

In the News today is a report which suggests that 3000 women in Britain are suffering from so-called "honor beatings" from family members because of the alien "shame culture" brought into Britain by (mostly) Muslims. And Jacques DeLors, the instigator of the Euro, has admitted that it was badly introduced since most countries, including Germany, broke the entry rules.

For all Biblical Creation Society members who may be reading this blog, thank you for your prayers. Another explanation for why my cancer has taken so long to kill me is that I am being sustained by the prayers of Christians all over the world, and because in response to those prayers the Holy Spirit still finds me useful where I am am rather than in taking me home. If that is the case would you pray that he keeps me free from pain and keeps making innovative suggestions on how I may more easily bear this period of difficulty. In particular I should like wisdom on when it would be right to tap the ascites.

It has been a very eventful week with fillings falling out, dishwasher delays, eyesight tests, earwax bothers, monoclonal hold-ups, bad days, good days, CT scan, visits from children and grandchildren, reading too late some nights, sleeping too long some mornings, a fall down stairs, and difficult decisions; but the Lord has brought me through all this and does sustain me in the worst of times.

I have discovered that the nicer you are to other people the nicer they are to you.


Anonymous said...

For those of us not well versed in UK med-speak, what exactly is a hematology registrar?
Regards, TomD

Terry Hamblin said...

A junior doctor. He/she has been qualified at least 2 years and spends the next 5-8 years in further training. The registrar is usually second on call on a 1-4 to 1-8 rota. Usually required to be resident for on call but not otherwise. The registrar may incorporate a period of research for a PhD or MD higher degree (the basic qualification in the UK is MB;BS (or ChB). My daughter has been qualified for 9 years.

Anonymous said...

I will continue to pray for you daily Dr. Hamblin. You are an amazing human being.

Carter said...

Thank you for letting us know how to pray for you. You are such an encourager to so many of us.