Month: February 2016

45. (E)-Learning Gurus: what’s in the name?

Folks, since I last posted a blog not much or even less has happened (to me) unless you count another half day of diarrhoea. So, here I am faced with a blank word document and not a lot of inspiration… Signs off for two hours!

Pigs Snoozing accessed at http://www.123rf.com/photo_20241459_young-piglets-snoozing.html on 22 February 2016

Pigs snoozing

Hi, I’m back again and 1. It is actually 6 hours later, and 2. I now have a vague plan based on a conversation with Elaine at tea-break and following a quick squizz (a crafty look) at my LinkedIn recent viewers.  So, there you have it: wait long enough; and take two random facts gathered inadvertently and put them together, and hey presto, an apparently inspired blog theme is born. I hate to admit it but this is and always has been (to date) my grand strategy anyway. You’ll have to wait a little longer for revelation of the connection to my blog title, sorry!

So, here goes. I attempted to reverse my role with Elaine, as her carer, following returning to Ceres after aborting our Yorkshire visit, in doing whatever I can to help and support her. Now, I admit this is not a lot to make her convalescence more bearable while the Amoxicillin antibiotics kick in and do their stuff. This is not cos I can’t or won’t but I’ve learnt, after 40 years, that there’s very little I do that is not wrong; and everything that I don’t do – inevitably- that I should have done, though it would not be right either, even if I had done it!). She’s still coughing a lot, and even debating whether she can face her Jazzercise Class tonight, so clearly, she must still be on death’s door!

Now you might detect from my jaunty style (if you think it is!) that I am in a good mood. This is not my vicious streak kicking in because of the above, rather it is because it gives me great pleasure that I can finally report that my new builder, Ian, turned up this morning at 08:00am with two of his helpers to commence work laying our new patio in the one corner of the garden still seeking an anal retentive, OCD’s attention – that’s me, not Ian, by the way! They have made great progress in the finest, sunniest even if coldest day for about 2 months. They left at 15:00pm to complete another ongoing job elsewhere in Ceres, and to let some of their work ‘set’ overnight.

I took advantage of a spare bucket-full of lime mortar and set about a few random holes in the rest of my garden wall to match the newly pointed area where once an ancient pig sty adjoined my wall. Did you know that people in Scotland (and other parts of the UK, I presume?) used to keep pigs for food in their back gardens at least at around the time our house was built (1798). I’m not sure when this practice stopped, but I didn’t inherit any pigs or a larder-full of pork, bacon or even pork-scratchings!

Anyway, I removed the remnants of the pig-sty during my own excavations and recall that all of this made me think about our house’s title, “The Old Manse”. Manse means vicar’s house, and that is what this abode was. There was a now long-gone church across the street from us to which the “The Old Manse” was attached. There were several churches in the village but now only one and, by the way, a new Manse, simply called, “The Manse”. I imagine you have guessed, we each get the other’s mail and push through leaflets occasionally.

Ok, so where is the connection to the title do I hear you say? Frankly, there isn’t a strong one, so what follows is rather one of my ‘secondary’s’ or diversions -but here’s a tenuous connection. The duplication of Manse in the titles of the two houses (ours being one of them) and confusion it may cause got me thinking about names and naming – and how powerful it is. One of the additional links in the cohort linked to one of my ‘viewers’ in LinkedIn turned out to be no other than Randy Swing, a fellow academic of higher education. Randy is American and this name or rather his nickname abbreviation is commonly used in the USA. I have not met Randy, but I do l know of his highly reputable work.

However, I also know and have met (I invited Curt to give a plenary session on blended learning at Deakin University, Melbourne, Australia) another of my heroes, Curt Bonk, also an American. Well, we UK citizens probably are not very familiar with many Randys or Curts, and combined with those surnames, we English speakers, though I suspect the rest of the English-speaking world, including the-English as a second (or third, or fourth or whatever-th) language speakers will no doubt have been smiling since you encountered Randy’s second name let alone Curt’s!

So, this did get me reflecting on fame and a name. Perhaps there’s even more to it than the obvious show-biz crafted names for Cliff Richard (Harry Rodger Webb), Elton John (Reggie (Reginald  Kenneth) Dwight) and Sting (Gordon Matthew Thomas Sumner). Perhaps a jaunty name in academia also confers an advantage. In my own previous discipline, Biomedical Science, Hamburger and Salmon were a famous pair of names in Cancer Research, Prof or Dr Brain’s, I suspect, are more common in the Medical field than in others. So, by extrapolation those who “make it” in the field of higher education research and practice may do so because they happen to have a name that carries kudos based upon sexual innuendo.

I’d ask you now to look at the three profiles that follow and tell me who you think would become famous. More importantly, to what should I change my name in order to improve my visibility and ultimately become famous?

Curt Bonk

Curt Bonk 1Curtis J. Bonk, Ph.D. Curt is Professor at Indiana University teaching psychology and technology courses. Curt is affiliated with the cognitive sciences program and is adjunct in the School of Informatics at IU. He founded SurveyShare, Inc. in 2003 which he sold in 2010. In addition, he has been founder and president of CourseShare, LLC since 1999.

Professor Bonk firmly believes in distance learning since he is a product of it. Dr. Bonk has been filmed in Dallas for a STARLINK program on blended learning, the Web 2.0, and best practices for teaching online. Curt is a popular conference speaker with several books in the area of emerging technologies for learning (see also Amazon author profile). He is currently conducting research in the field of self-directed open learning environments, online motivation, and Extreme Learning.

Accessed at http://mypage.iu.edu/~cjbonk/ on 22 February 2016.

Randy Swing

Randy SwingRandy Swing is currently Executive Director at Association for Institutional Research, Tallahassee, Florida Area, Education Management. The following Biography is Taken from a 2012 conference key note description, and is only illustrative: Published on Mar 5, 2013: Closing Keynote: New England Conference for Student Success, UMass Amherst, September 21, 2012. Accessed at https://www.youtube.com/watch?v=hq_i_hjhm3Y   0n 22 February 2016.

The Association for Institutional Research (AIR) provides professional development and support for 4,000 members from 1,500 colleges and universities in using data for planning, managing and operating postsecondary institutions. He is a frequent speaker at national and international conferences, workshop leader, and author of books and articles on assessment, institutional research, and student success. Prior to joining AIR he was senior scholar and co-director at the Policy Center on the First Year of College and held leadership positions at Appalachian State University. He holds a Ph.D. from the University of Georgia.

He was Co-Director of the Policy Center on the First Year of College, located in Brevard, North Carolina. He develops assessment strategies and instruments for improving the first college year. He served on the development teams for Your First College Year (YFCY), a post-test of UCLA’s annual freshman survey and the First-Year Initiative (FYI), a national benchmarking study of first-year seminars. Randy moderates the First-Year Assessment Listserv; and served as editor of Proving and Improving: Strategies for Assessing the First College Year. He also serves as Fellow at the National Resource Center on The First-Year Experience and Students in Transition at the University of South Carolina. Until 1999, Dr. Swing held leadership positions at Appalachian State University in assessment, advising, orientation, and first-year seminar. Time Magazine named Appalachian a 2001 “College of the Year” for outstanding service to first year students.

 

 

 

Colin Mason

Colin Portrait

Colin Mason, Ph.D., M.Sc., B.Sc., G.C.E., is a distance learner, creator and provider of distance learning resources and experiences but is entirely committed to the need for meaningful encounters face-to-face. These apparently contradictory positions can be resolved if the term blended learning is brought in to play. Dr Mason may be termed an (aspiring) guru of one of the many definitions of blended learning, in this case: learning facilitated via a mix of distance – online mostly – and seminar room, face-to-face meetings such as required by Team-Based-Learning, TBL™ for demonstration of both formative and summative applied learning assessment strategies.

Now, no matter how excellent I make my own abbreviated (albeit) academic profile regarding distance or blended learning, Colin or Mason for that matter does not seem to have the right ring to it. What might?

Well, that’s all folks. Bye for now.

Buggs Sign off

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44. Bad news, Worse news, Worst news!

Well, I am not the only one who can get ill. This is the bad news.   We were due to spend a week in Yorkshire this week but Elaine has been struck down by the actually, really serious “dreaded lurgy” (Lurgy– an ​illness or ​disease, ​especially one that is not ​serious:He’s got the ​dreaded lurgy.” Definition of lurgy from the Cambridge Advanced Learner’s Dictionary & Thesaurus © Cambridge University Press).

The Goon Show - Lurgi

Accessed at https://www.youtube.com/watch?v=WPHpYRgD4fU on 17 February 2016

The term originates from an episode of the 1950s radio comedy “The Goon Show” in which an epidemic of “The Dreaded Lurgi” was said to be about to sweep across Britain. It turned out that the lurgi was in fact a fictitious disease created by brass instrument makers who had claimed that no brass band player had ever died of the lurgi (thereby increasing sales hugely). “The Goon Show” was an anarchic and surreal radio comedy series that starred Peter Sellers, Spike Milligan and Harry Secombe. It was written by Spike Milligan and Eric Sykes. by mammon_the_source August 03, 2009

In this case Elaine’s condition has been completely debilitating, and though we set off on our sojourn on Sunday, following her birthday on Saturday and travelled to Ellen’s flat in Glasgow we finally acceded to illness winning, and came home to Ceres on Tuesday afternoon. We had planned our “Thelma and Louise – style” road trip that was to take us via Glasgow to Newcastle, Malham, Bradford, Bingley, Burley-in-Warfedale and Ilkley, and home again, seeing as many relatives and friends as we could during the whirlwind visit. Sadly, it will be postponed, perhaps until a similar time in my next cycle of Chemo. That damned Cancer – is always a factor in any forward planning. This is the worse news!

I am just coming through the first week blues period (for me anyway) and having had my couple of steroid-supported good days on days 1 and 2 after the Combo Chemo Cocktail I succumbed to the now-third time repeated pattern of nausea and loss of appetite characteristically appearing sometime on days 4-7. Day seven, yesterday, was not good.

Apart from me having to do the driving as Elaine was not even well enough to share it, I then felt lousy all afternoon and was eventually struck down by own version of the dreaded lurgy – diarrhoea! This isn’t the worst news! I could barely leave the vicinity of our downstairs loo for more than 3 minutes, or dice with death and risk brown trousers syndrome, if I did. Fortunately, this episode lasted only 4 hours! I recovered sufficiently by 9:00pm to be able to have my second bowl of porridge for the day.

Accessed at http://www.theguardian.com/tv-and-radio/2016/feb/09/happy-valley-recap-series-2-episode-1-scars-sheep-rustlers-and-a-serial-killer and http://www.theguardian.com/tv-and-radio/2016/feb/16/happy-valley-recap-season-2-episode-2-blood-shiraz-all-over-rug  on 17 February 2016

Happy Valley 2

Happy Valley 1This was also just in time to watch the third episode of “Happy Valley” – a murder mystery/detective featuring Sarah Lancashire (second series) and fortunately for us, set in Yorkshire, specifically the Halifax/Bradford area. The language is perfect. “I’ll tek owt for nowt”. By the way, living in Yorkshire then Scotland sometimes makes me wonder whether my subconscious has more say than I do about my approach to money (and not wanting to spend it – unless on LPs, CDs and posh Hi-Fi to play them on). So, you’ve no doubt heard about the definition of a Scotsman, “someone with short arms and long pockets”; and a Yorkshireman, “A Scotsman with the generosity squeezed out of him!”. Apologies to those who would have preferred gender neutrality!

Speaking of music, hi-fi and guitars (I know we weren’t, actually, but I need only the slightest invitation!), I bought the most recent issue (403) of “Guitarist” monthly magazine which featured a forthcoming sale of some of Gary Moore’s enormous collection of vintage as well as contemporary guitars including, possibly, the restored Gibson Les Paul of Peter Green, his earlier mentor and good friend.

Accessed at http://www.musicradar.com/guitarist and http://www.musicradar.com/news/guitars/video-gary-moores-key-guitars-examined-633188  on 17 February 2016

Gary Moore Guitarist 1

Now only Peter himself can make the transcendent tones of songs such as, “I Loved Another Woman”, (Peter Green’s Fleetwood Mac) or “Love that Burns” (Mr Wonderful), sound any better than Gary’s versions, on for example, “Blues for Greeny”.

Peter Green Fleetwood Mac Mr Wonderful

Peter Green (Playing) and the first two albums, Peter Green’s Fleetwood Mac (Dustbin and dog album) and Mr Wonderful (semi-naked photo of Mick Fleetwood). Accessed at https://en.wikipedia.org/wiki/Fleetwood_Mac_%281968_album%29  and https://en.wikipedia.org/wiki/Mr.Wonderful_%28Fleetwood_Mac_album%29 on 17 February 2016.

The article, celebrating the fifth anniversary of his death, is fabulous, drawing on Gary’s own guitar technician’s recollections and his own (newly discovered interview) stories about his early career with Thin Lizzy and Peter Green’s influence upon him. For example, did you know that he would have on stage a series of guitars ready to select for particular tracks, and for each guitar there would be a back-up and a further back-up to the back-up, just in case!

So, many of these guitars have never been played on tour or on a recording. Consequently, they are not as valuable as those that have or vintage guitars such as Peter Green’s original or the 1959 Gibson Les Paul used on “Still Got the Blues”. The guitar sound is ultimately only as good as the weakest link in the chain so Gary’s awesome sound was also due to his Marshall JTM45 amp – 1989 and a Marshall Guv’nor pedal.

Accessed at http://www.gary-moore.com/1990’s.html  on 17 February 2016.

Gary Moore Montage

In summary the auction sale – some on line – so that ‘Joe Public” like me may even become an owner, perhaps of the less expensive, small stuff, anyway. No worries, I say! Though I suspect I can’t even afford the tiny stuff let alone the small stuff. This is the worst news!

Guitars like the “Peter Green refurb” will probably not be on sale at all in the first round.

Now back to my “Primary”, my latest NHS reforms paper. I have probably said this elsewhere, but I am beginning to lose track of what was blogged where, so bear with me.

Open Forum New NHS

My paper, or at least the abstract, has been accepted for the conference on the Future of the NHS 5 Year Plan. My abstract and personal details were added to the web site for the conference a couple of days ago. Here is the abstract link:

The New National Health Service (NHS) – but not as we know it!

Open Forum New NHS 2

Now this really is bad news as I must complete all editing on the paper as soon as possible. I promise then you will get your 6th part of the Harry Potter series – truly! On another positive note, I completed my fist blog job for the “Jobs.ac.uk” web site. You can read this blog at: https://blogs.jobs.ac.uk/working-abroad-in-higher-education/2016/02/12/1-recruited-antipodeans/

That’s all folks. Bye for now.

BUGS001

 

 

43. Same data, same information – cross-talk!

Half Truth-Misinformation Montage

Accessed at https://www.google.co.uk/search?q=Misinformation+images on 12 February 2016

So, what’s happening to our Health Service currently?  Well apart from being very good to me right now, the only major news-worthy item seems to be the dispute between the Secretary of State for Health, Jeremy Hunt and maybe some Chief Executive Officers in The NHS Trusts, and, of course the Junior Doctors themselves, who have now been informed that they are about to have a new employment contract thrust upon them. This arises because agreement about terms and conditions as well as levels of pay cannot be agreed by the two parties involved in the confrontation, led by The BMA on behalf of Junior Doctors and the Government led by Hunt and his team. What a sad state of affairs? And the more you examine the contentious elements the more you despair.

The Government side claims the Junior doctors are being obstinate about levels of pay whilst the Junior doctors are claiming that the pay package overall on offer is not as good as it seems from headline statistics and more, the terms and conditions changes proposed will make patient safety worse rather than better. So this is an example of the cross-talk I have entitled this piece. Another example arises from talking at cross-purposes about interpretation of the same data and information in one medical journal article.

Probably the most accurate way to illustrate the issue is to let two of the protagonists, a junior doctor, Rachael Clarke, and Jeremy Hunt, the Health Secretary, speak for themselves in interviews held with Andrew Marr and then uploaded to the social media web site YouTube.

Rachel Clarke, responding to Jeremy Hunt’s further misinformation campaign, especially re weekend increased mortality (suggested 11,000 extra deaths – though he continues to deny his own words should be interpreted this way) and morbidity (?) data being caused by Doctor rostering in an interview with Andrew Marr.

https://www.youtube.com/watch?v=YHZYeKH6SV4

Junior Doctor Interview Rostering

Andrew Marr interview with Jeremy Hunt – a very slippery eel in the river or sea!

Accessed at https://www.youtube.com/watch?v=qoJ6NLLku-0 on 9 February 2016.

Jeremy Hunt Andrew Marr Interview

Surely, it is time to have some grown-up decision-makers to assist those who appear to be too close to the action to see that they are part of the problem and not the solution? To me, an independent arbiter (whatever happened to ACAS?) seems to be required to examine the disputed ‘factual’ material and declare who seems to have presented the most accurate version of what it means, and then to recommend a course of action to bring the two parties caught in cross-talk to come back together and to make as a guideline for discussions that cross (angry now) talk should be banned, and be replaced by mature, reasoned, sensible arguments where if budget restraints prevent the Government from making a significant input into creating fully functioning 7 day a week health service they must say so.

A full service requires more than just Junior Doctors to be more available than already. Lab technicians, nurses, Radiographers, administrators and so on, as well as more Consultants will be required to really get a fully staffed service that can provide a similar level of service at weekends as that provided during the week. Acknowledging this would certainly be honest and fair, and also take away what appears to me, as a ‘blame-culture’, aimed at Junior Doctors, for any of the short-comings of the current on-call-based weekend service. That is not fair.

That’s all folks.  Bye for now!

BUGS001

42. Man in a Van with a Scan!

Mobile Scan Van Montage

Accessed at https://www.google.co.uk/search?q=mobile+CT+scan+trailer+images&biw   on 10 February 2016

So, why am I returning to this theme again?

Well, actually I’m not, though it does provide one example where there’s a problem (with at least) though usually with only two (good or great) solutions, thus presenting decision-makers with the “horns of a dilemma”, “Hobson’s choice”, “between a rock and a hard place” etc. The dilemma here is should the NHS take an immediate cost saving – hiring from a private provider for mobile CT Scans – like the one I had carried out fairly recently, or build more facilities on their own premises? Hiring is cheaper right now so they do it – no surprise there – when government cuts are so deep and apparently never-ending.

But what about a bit of creative thinking? Why doesn’t the NHS (or even more entrepreneurial: why not an individual hospital or maybe a few hospitals) buy their own fleet of Mobile Scan Vans and then ‘rent’ them to whichever hospital or wider UK region requires them? The money may change hands but it would at least remain in the overall budget handed out to the NHS. Surely someone thought about doing this before individual hospitals started doing their own thing? Surely, or am I missing something? If I am not missing something, then maybe someone (with power and position) could at least kick off a fresh debate? Speaking of kick offs, let’s have a quick digression. So here is a new example to kick off proceedings!

Commencing on Saturday afternoon it was the start of the UK-initiated, RBS 6 Nations Rugby Championship. This annual tournament pitches each of 6 National teams against one another in a biannual alternating cycle of home and away fixtures against the same team. So each team plays 5 matches, and one year say, England will play Scotland at Murrayfield (‘away’ in other words) and next year will play them at Twickenham (at ‘home’ this time). Also, any of the teams will either have three home games and two the following year, or vice versa.

RBS 6 Nations Rugby 1

RBS 6 nations kicks off! Accessed at http://www.rbs6nations.com/en/home.php on 10 February 2016.

The tournament comprises national teams from England, Scotland, Wales, Ireland, France and the most recent European addition, Italy. The latter played damned well against, and should have beaten, France, deservedly, playing in Paris too. Once again a team was ‘robbed’ by poor refereeing decisions, ie not going to the TMO when clearly this was necessary! Further, cos it pleases me, England won and retained the Calcutta Cup (a tournament within a tournament) and both Wales and Ireland made sure they couldn’t win the other two tournaments within a tournament, the “Tri-Nations Cup”, (One UK team beating all the other three) and the “Grand Slam(One team beating all the other 5 teams).

The other kick-off happened on Sunday night/Monday (early) morning – the USA’s own version of Rugby, the 50th American Football Superbowl, though now they have pretty decent Rugby team too. This particular play-off was between the Denver Broncos and the relatively new team (brand new, to me anyway), the Carolina Panthers. I haven’t watched American Football for quite some time. In fact, John Elway, the present-day coach (or Director, General Manager or some-such) was actually playing starting quarterback for Denver Broncos some 20-odd years ago when I used to watch regularly – a new Tele-channel treat (Channel 4)! Doesn’t time fly?

Superbowl American Football 1

50th Superbowl played between Denver Broncos and Carolina Panthers. Accessed at http://www.nfl.com/videos/carolina-panthers/0ap2000000093202/Broncos-vs-Panthers-highlights on 10 February 2016.

Denver won by the way, 24 to 10, with apologies to those of you who still haven’t watched the match either on “Catch-up” or your own recording (I still absent-mindedly call this ‘taping’ a programme!). I guess, once again, this displays my age, though since I “lay it all out there” for you all in the blog anyway, this may have already taken care of that query for anyone who was curious, I suspect.

Now I must return to the primary blog entry. I rather like this cancer metaphor, so from now on ‘digressions’ will be known as secondaries (1, 2 and so on…). My intravenous Combo Chemo Cocktail day went to plan and so there’s nothing to report on the technicalities side of it. However, my visit to Ward 32 this morning prompted me to reflect on my previous visits, and that brought home the dilemma of wanting to get the best treatment (for oneself) and yet having to challenge what you are being offered in your current regime, especially when you think something that might be better is available, though you are clearly thinking and ultimately, if voiced, speaking as a non-expert. What to do, eh?

For example, today is “Chemo-day” for me, and for every other patient on my sub-wing of the ward. I can only receive treatment if my granulocytic neutrophil ‘count’ reaches a minimum threshold level, otherwise it is deemed, “too risky”. It is too risky because low levels of granulocytic neutrophils are associated with being too susceptible to potential life-threatening infections. (See my entries for Blogs 34 and 35). This happened to me a couple of ‘cycles’ ago when my granulocytic neutrophils were ‘low’. Fortunately for me my assessment day was a Friday and I had the weekend for further recovery of my “neutrophil count”. I was lucky they did recover sufficiently and I received my Combo Chemo Cocktail, on the scheduled day, on time and according to plan.

34 35 Montage

If my neutrophil count had not recovered in time what options are available? Well, the usual one offered is to postpone treatment, await neutrophil count recovery and then recommence, as soon as the neutrophils swarm back into the circulatory system and reach the magic ‘threshold value’. But what if this doesn’t happen (quickly, at least, or even before the next cycle is due?). I don’t know yet because it hasn’t happened to me. I did ask about blood or even granulocyte neutrophil transfusions, but was informed that this is not a preferred treatment since it is likely to turn off or at least reduce one’s own progenitor cell proliferation, differentiation and maturation response leading to neutrophil release into the blood stream.

So, curious biomedical scientist that I am, with some inside knowledge of my own about stem cell kinetics and haematopoietic growth factors (HGFs), I have dug around in the current online literature for some ‘answers’ or at least possible routes for a patient caught in this position.

First, there is the issue of what might be available at all, coupled to who qualifies to receive it? Then there is the issue of how much any such treatment might cost and what cost-benefit analyses are brought into the equation about who gets what? Then there might also be the issue of treatment versus severity and time course of side effects. There is also the dilemma of willingness to treat versus allowing a patient ‘s body to recover naturally. So let’s examine some of these potential dilemmas.

Let’s get the first issue out of the way quickly. A treatment for low neutrophil counts already exists and has been used in exactly the circumstances described above. I know, I have met and discussed this with another patient on our ward who knows someone, who knows someone, if you get my drift for concern about maintaining anonymity? I believe this information is true. The second part of the issue is more problematic as the case for receiving the treatment, in this case, Granulocyte Colony Stimulating Factor (G-CSF), had to be argued very strongly, though the argument clearly succeeded eventually!

So the first dilemma is should allowing neutrophil production to take place naturally take precedence over giving an exogenous source of G-CSF? This haematopoietic growth factor (HGF) is one of a family of glycoproteins that plays a major role in the proliferation, differentiation, and survival of primitive hematopoietic stem and progenitor or precursor cells, as well as release of and functional activation of some mature cells. G-CSF and other HGFs bind to specific receptors on the surface of their target cells to mediate their action. G-CSF acts upon bone marrow differentiated, unipotent precursors – differentiated from more immature or precursor multipotent and totipotent stem cells. These, predominantly, neutrophilic precursors interact with this growth factor that stimulates both proliferation and differentiation of the target precursor cells and ultimately increases the release of young, new neutrophilic granulocytes into the circulation.

Donald Metcalf. Blood. 2008 January 15;111(2):485-491.  Accessed PubMed Commons.

“Three types of action of hematopoietic cytokines. (A) Lineage restricted. (B) Action on multiple lineages; broken line shows actions only at high concentrations. (C) Sequential actions; SCF acts on stem and early erythroid progenitors, while EPO acts on more mature precursors. The notion of sequential actions was later found to be incorrect.”

HGF actions on stem cells progenitors

Hematopoietic cytokines such as G-CSF are not simply mandatory proliferative stimuli but also act on cell survival, differentiation commitment, maturation induction, and the functional stimulation of mature cells.

G-CSF montage

The importance of a hematopoietic cytokine such as G-CSF can be validated in several ways. (A) By injecting G-CSF to elevate neutrophil levels and (B) by deleting the gene, a procedure resulting in low neutrophil levels and poor neutrophil responses to challenge infections.

At least these newly released neutrophils are ‘natural’, though the “extra production” and early ‘release’ mediated by G-CSF might be barely construed as not absolutely normal, at best in my book. There would be a timescale issue, as treatment could not commence (even if G-CSF was on hand) until at least the normal starting date, with Chemo treatment then being delayed also by at least several days. I’m not sure of the protocol now used, though granulocyte life span is actually quite short, about 7-days, and so neutrophil output stimulated by G-CSF should kick in fairly soon though sometimes a sharp fall precedes the increase, normally apparent within 24 hours, peaking in a couple of days later.

Of course, if this is a known issue for a patient, say low neutrophil levels have been recorded on at least two occasions, then the treatment with G-CSF could be anticipated and commenced either before or at least on the Chemo assessment day/date, thus shortening the time required (hopefully) to raise neutrophil levels to at least the threshold value, but hopefully beyond it. Nevertheless, there may be other considerations that treatment teams take into account such as toxicity of G-CSF, though it is low but this should be discussed with the patient. The one exception to using G-CSF routinely with cancer chemotherapy to prevent neutropaenia and fever might be in the case of some lymphomas where stimulation of tumour growth may occur.

The above example highlights the more general dilemma of seeking a treatment not recommended by one’s medical team and risking upsetting them by ‘pushing’ either for it or for a “second opinion” and the “mental anxiety” that one believes might follow from such mild (or should be) confrontation with the team. It is one thing for Consultants to welcome second opinions when they initiate these because they themselves are not sure, or their immediate multi-disciplinary team (MDT) recommends it, as part of their assigned role.

It is completely different, in my view, when a patient seeks to change the MDT’s view or recommended course of action, as now an amateur rather than a professional is initiating a suggested change in direction. Power always lies with the decision makers and traditionally these are the givers rather than receivers of information, advice and medical treatments, as in these illustrations.

So, a decision to take up one’s own case is not to be taken lightly. The thought may always be there that you don’t want to upset anyone, least of all your carers or consultant, on whom you constantly depend. Everyone is human and despite guidance (the GMC document for example) and acceptance of the principles of decisions ultimately lying with the patient, we patients always have nagging doubts about whether we will continue to be treated the same as before we “made a fuss”, became a ‘difficult’ patient etc. We are also human and hear too many stories similar to the one of returned food at a restaurant coming back complete with additional, well stirred-in spittle, courtesy of an offended chef – just reacting in an unprofessional but understandable way, unfortunately.

One more illustrative dilemma will suffice to reinforce the earlier general point. How expensive is G-CSF treatment and what are the cost-benefit analyses that determine whether it is used. “Three cytokines, erythropoietin, granulocyte colony-stimulating factor, and granulocyte-macrophage colony-stimulating factor, have now been in routine clinical use to stimulate cell production and in total have been used in the management of many millions of patients.” Metcalf, D. (2008). “Haematopoietic Cytokines”. Blood. 2008 15;111(2):485-91.

Clearly the medical argument has already been won. There would seem to be no argument except cost in a budget-limited NHS hospital. I have been assured on several occasions, albeit on other issues, that cost is not the limiting and determining factor, and in spite of my offering to find funds if it was. It is unclear how to proceed when faced with these conflicting statements, so often the issue is simply dropped by the patient who inevitably feels not as informed as their medical team (undoubtedly true). And yet the patient may feel rightly that they have only one life, and their continued treatment according to the agreed regime might be their last chance – for life!

So there we have it, whilst I fully believe in challenging authority (and living with the consequences) when your actual life really does depend on the good will of your authority figures then you inevitably think twice, as “dying, not living, with the consequences” might be the outcome!

That’s all folks. Bye for now.

BUGS001

41. From Bad to Good, to Great News!

Great News Montage

Got to get your priorities sorted out – music CDs (though LPs would have been preferable!) are always great news – but what is mine in this blog?

Accessed at https://www.google.co.uk/search?q=good+news+images  on 7 February 2016.

Well, how would you feel if you tried to confirm the time of your next appointment with the person who has information regarding your date with destiny, and then discover that it isn’t in his diary? None too enthralled, I suspect. Me either! But this is what happened to me and my proposed appointment with Dr P to discuss my latest CT scan results. So, this was bad news on last Thursday morning.

Come Thursday afternoon I received a call from Dr P’s secretary to confirm that he would see me after-all, sometime on Friday afternoon during the time I was attending Ward 32, Ninewells Hospital for my pre-Chemo assessment, which naturally included donating yet another armful of my Chateau Sang! So, here is the good news! Though, this did raise my anxiety levels a little earlier than would have been the case if my appointment for Monday had not been cancelled. Every silver lining is surrounded by a dark cloud! Every silk purse is still a sow’s ear. So, what next?

Come 1:30pm on Friday afternoon, I was mid-way through my Pre-Chemo assessment meeting with my nurse for the day, A. Suddenly, (after much ‘paging’ earlier) Dr P appeared in the main consulting room where I was awaiting the “needle and cannula” from yet another of the Dracula-figures, I conjure in my mind when I am about to be phlebotomised! Dr P appeared very buoyant and could barely wait to get the formal “hello, how are youbusiness” quickly out of the way, and then, on to more pressing matters. “I wanted to see you face to face, because it is not often I am able to give my patients good news!”, he said.

My results were good news, too. Dr P said I was probably in the top few percent of patients, in his experience, of the way my stomach cancer had responded to the Combo Chemo Cocktail. The primary site, my stomach cancer, had responded well and had shrunk considerably. I asked, “roughly what percentage”, to which he replied, “I was afraid you’d ask that!”. He couldn’t be precise about the actual amount, but said that he was confident the reduction in size of my stomach cancer was substantial, maybe more than 50-60% reduction overall.

Afterwards, I wondered whether the method of Stereology, creating three dimensional image data from two dimensional image data, as applied in Biomedical science, including representing some structures within a larger superstructure (for example the number of mitochondria or volume-percentage of say, the nucleus, or total mitochondrial volume, of a cell), could be used, with suitable software, to provide quick, accurate and reliable information from CT scan images? Note to self to research this and report to Dr P.

He showed Elaine and I the CT scan images on a small computer screen of both before (first scan about three months ago) and after Combo Chemo treatment (a couple of weeks ago). Everything was just a mass of “grey stuff” as far as Elaine was concerned (CT scans don’t come in coloured-flavours unfortunately). I fared a little better and just about could see the “shades of grey” (memories of earlier, Blog 7) he was trying to point out that represented my stomach lumen, stomach wall, anterior and posterior segments; as well as external-to-stomach structures such as lymph nodes, and so on…

Shades of Gray

The reason it was difficult to discernwhat was what, so-to-speak”) regarding the extent of “shrinkage of the cancer” was that the stomach cancer lump was actually not an isolated lump at all, rather, it comprised a massive thickening of almost the entire stomach wall. Coincidentally, this is probably also what made earlier surgery an unlikely option, I guess, unless I had been prepared to forego having a stomach at all, ever; including after the hoped-for recovery and my survival.

Anyway, he said that whilst all that was good news, the more exciting thing was, (wait there’s more…) I have great news”. He moved the computer images posteriorly (towards the duodenal rather than the oesophageal end of my stomach) and pointed out, by comparison of pre-post Combo Chemo images, the almost complete elimination (at CT Scan resolution anyway) of the various abdominal cancer deposits, including lymph nodes and ‘seedlings‘. So, was I going to have a glass (or more) of alcohol-containing fluid later that night – you bet!

So that’s (not quite) all (my news) folks, but the rest is short, honest! One outcome of writing these last 40 or so blogs is that my career might be taking a turn for the better – if I want it. I responded to an “anybody interested? ” employment call from http://www.Jobs.ac.uk. for potential ‘bloggers’. I applied, sending them a link to my web site and Cancer Blog. And guess what, I am now an employee of the company I use to check out for potential employment!? I’ll let you know when I have posted my first blog on either, “Higher Education” or “Higher Education in Australia”. At least I have experienced both – just for most of my working life!

And on another note, as you know, (5 Blogs-worth so far, ie the Harry Potter… series), I am writing a paper in response to a UK Government review of the NHS, to shift to a more preventative approach to treatment and a proactive approach to promote health. I am hoping to attend the first conference on the dissemination of a Plan developed after a year-long consultation that ended in December 2015. The programme for the conference was already published but I contacted the organisers anyway to ask whether I could participate in any capacity, but with an intent to promote my “patient’s perspective”, and as an informed biomedical scientist and higher education specialist educator and trainer. They are reviewing my abstract now! I hope to attend the conference on 22 March 2016 in London regardless of the outcome of their decision about publishing my paper.

So, there you go: lots of silver linings in dark clouds just now – though, I am trying not to get too carried away. I’ll still be having at least another two cycles of Chemo, commencing next Tuesday. My consultant’s only concern is the same as mine – the nerve damage caused by the Oxaliplatin. Anyway, he checked the extent of damage with a sharp needle (a non-technical test, rough and ready, but probably effective!) and will monitor again each time a new cycle of Chemo is due. I’ll be doing my own self-checks from now on too.

That’s (definitely) all folks. Bye for now!

BUGS001

40. Blogging – how it can turn your life around?

I like carrots – a lot, as it happens. But lest you think I have turned into an actual Rabbit (Buggsy – below) let me update my blog with a recent photograph.

Colin Beard Montage

Note: I am not even a shade of orange from over-consumption of carotene (an ingredient found in carrots but other stuff too that is responsible for the characteristic colour); au contraire, I look and feel like I need a good dose of UV light, please. Like Buggsy, however, you may have noticed I have a little more fur than a few weeks ago!

As I have to tick a box, concerning ongoing degrees of alopecia, in my daily ‘cancer’ diary I thought I should let you know that I am heading towards ‘baldy or Trichomeless’ not just atop my crown, but also under my arms, on my chest, and very disturbingly, around my pubes though not my bum! I still have hairy legs, feet and toes (no relation to Head, Hands and Feet – the ‘70s band already commented on in Blog 8). So, some trichome-bearing sites (see also Blog 15) seem impervious to chemo attack.

So, why am I telling you this? Well, the beard is an attempt to check up on whether overall ‘hair-loss’ is due to the damned stuff just falling out whilst some new stuff continues to replenish losses, though inadequately. Or, does the Chemo cause both hair-loss through drop out and inhibition of new growth (my head hair has barely moved in nearly three months). Well, as you can see from the photo, I do appear to have hair-growth, a beard, albeit even more gray colour than previously and of a “fine-downier” consistency than in past attempts to grow a beard, pre-chemo. The current beard appears to be standard male-pattern: commencing from the top of ears and via sideburns to cheeks; to upper lip and lower chin; as well as the neck – though I did shave the lower part of it a few days back – sorry!

I wonder if anyone has done research on Combo Chemo Cocktail modulated-body-hair loss? I’d be happy to join such a clinical trial. I can already document the pattern caused by my EOX mixture! So, if a budding new researcher is looking for a PhD topic; halt, look no further, I have one here already on a plate. And, there’s probably drug company sponsorship just waiting on your knock on their door. And further, there’s no shortage of patients. I can guarantee a whole bunch of them from my Chemo ward – well, at least my pal, N, fellow brother-in-arms and an EOX recipient in the past.

I received an email from one of our friends, J, (and blog reader) earlier today. She forwarded a link to an online article in the digital version of theguardian. How can my search engines have missed this?

theguardian Montage

However, this is less my point than the more crucial issue that I might not have (ever?) been made aware of this ‘cancer cure’ and vital research carried out at the Royal Marsden Hospital, but for my blog and my friend, J, reading it!

Will this new blog-linked information turn my life around? In all honesty I don’t and actually can’t know. However, the story is impressive, and although the patient highlighted had malignant melanoma, (Stage 4 with spread to lymph nodes and other places – just like me), other named cancers had been treated successfully too. Stomach cancer wasn’t one of the named ones – so, not like me! So, am I back to square one, like with the Proton Beam Therapy? Who knows, perhaps Dr P, when I see him!

You might want to read the whole article, but below I have extracted the major points, as I see them, and linked them with some of my own comments. Read on…

Accessed at https://www.theguardian.com/science/2016/feb/04/revolutionary-drug-immune-system-advanced-cancer?CMP=Share_AndroidApp_Gmail on 4 February 2016.

The closest thing yet to a cure for terminal cancer?

Sarah Boseley, Health editor of theguardian.

The following are extracts of theguardian article, together with some of my own text – to link slightly disparate arguments following my selection decisions. My text is italicised bold.

[“Immunotherapy has given Sandra Sayce an extra 10 years of life, and now new combinations of the treatment may offer hope to many more patients. Nobody, including Sayce, is prepared to say that her advanced skin cancer has been beaten. Yet the last treatment she had for stage 4 melanoma, which normally kills within months, was nearly 10 years ago.”

“She was then given immunotherapy, which teaches the body’s defensive immune system to identify cancer cells and attack them from within, in the same way it would fight off a cold. After the treatment, the cancer disappeared. “It took me a couple of years to believe it was true,” she said at her home in Ruislip, west London. “You never quite lose that concern at the back of your mind, but there is no active disease and I have been stable for so long,” she added.”

She was given a drug called ipilimumab. It was a novel approach, designed, she was told, to reprogramme her immune system. She had just four treatments – one a month from September to December. “I had a head-to-toe rash, which itched,” she said. “But I knew quite quickly that it was doing something.” The lesions in her leg, which had become lumpy, started to flatten. The lesions in her liver and spleen disappeared. She has had no further treatment and there is no sign of cancer.

Cancer can evolve to be able to survive the toxic drugs thrown at it, just as bacteria become resistant to antibiotics, said Larkin. “The critical difference with immunotherapy is that you are actually reprogramming the immune system, if you like. The idea is, if the tumour does change and evolve, the immune system can also change and evolve with the tumour. I can’t exactly prove that but I fundamentally think that’s the critical difference.”

He persuaded a leading US pharmaceutical company to open an arm of a trial using ipi – as everybody now calls it – and a newer immunotherapy drug, pembrolizumab, at the Marsden as well as the world-famous US hospitals. He succeeded in enrolling more people on to the trial than any other centre. Alone, the drugs can have great results with several types of cancer – kidney, bladder, head and neck as well as melanoma – but in only 20-25% of patients. The hope was that a combination might help more.”]

Since then, much better outcomes have been achieved with combination therapy.

Prof Martin Gore, medical director at the Royal Marsden Hospital, who is also a melanoma and kidney cancer specialist, argues strongly that medical oncologists and GPs need to stay aware of recent findings and be proactive in getting their patients involved in trials for new treatments such as these. He comments on a response from a presumably sceptical doctor in theguardian article:

[“People say it is all right for the academics but we can’t do that. We’re too busy,” he said. Prof Gore went on to say, “I’d quite like to see that being challenged a bit, saying, ‘come on. I do it – why don’t you do it?’ If you are a doctor, by definition you should be interested in research. Our colleagues at the GMC [the General Medical Council, which regulates doctors] expect us to keep up to date.

“It is not that people don’t want to do it. It is that people are too busy. Many people’s jobs are incredibly crowded with clinical work. In some places, the oncologists are very embattled with the number of patients. That goes for general practice in spades. I think we need to look at that a bit to know how we can change the way we work so we have breathing space. I think we have a way to go in terms of challenging the system to allow people to do it or even expect people to do it.”]

READ ON…

I do hope you have either read the above or arrived here deliberately.  Either way, good, because you just have to read the last two paragraphs of this blog entry, for the whole thing to make (much) sense.

So, maybe there’s a chance, even a tiny, tiny, tiny one would be good! Then again, if we believe we are dealing with my tiny world of quantum mechanics (Blog 38 ), ipi and/or the newer pembrolizumab, preferably used in combination therapy, may work AND may not work on gastric cancers; but until someone looks to see if my cancer has gone after I have been treated, then we will not be able to predict an outcome to the question, “Could I be treated with the new immunotherapy agents for my cancer?”. So, voila, I have a fool-proof method of getting the treatment I want (and without confrontation) if I work on the following:

So, perhaps we’ll give it a go then. Eh?

Well, say no more; nudge, nudge; say no more

Wink, wink; nudge, nudge; know what I mean?

 (Nudge, Nudge – a British expression used to make someone realise an ulterior motive to your conversation.  Accessed at http://www.urbandictionary.com/define.php?term=wink+wink+nudge+nudge  on 4 February 2016.)

 

Wink Wink Nudge Nudge

The expression was popularised in the 1960s in the infamous, “Nudge, Nudge” sketch (laden with sexual innuendo) from the third Monty Python’s Flying Circus episode.  Accessed at https://en.wikipedia.org/wiki/Nudge_Nudge on 4 February 2016.

And Eric Idle’s selection from “Personal best”, Accessed at http://www.montypython.com/tvshow_Monty%20Python’s%20Personal%20Best%20%282006%29/19 on 4 February 2016.

That’s all folks. Bye for now.

BUGS001

 

39. Survey of you all?

Survey Montage 2

Why is there a (major) difference in popularity of these two entries submitted 4 days apart, based on data accessed today (18:00h GMT, Thursday, 4 February)? This is an unusual move for me now; I have written a short(ish!) blog entry. Its purpose is to try and find out a little more about what determines how and why you access (read?) some blogs but not others?

WordPress Montage

Images from the WordPress.com web site. Accessed at https://wordpress.com/create/ on 4 February 2016.

The programme I use to post blogs is the free version of WordPress.com. It is great, easy to learn to use and does gather some statistical information about your usage of my blogs. However, I don’t know the identity of anyone who accesses the blog, unless they post a response in the Leave a Reply box at the end of each blog entry. However, the programme does record ‘clicks’ or ‘hits’ on particular pages, blog entries, replies etc. Each ‘click’ on a blog entry (and the landing page – “About this cancer blog site”) registers as a ‘view’, and the system also records separately the number of ‘clicks’ on each blog page (‘Visitors’).

Fig. 1 Bar chart of visitors (and views) to my Cancer Blog, by date

Blog Stats 040216

Thus, in the bar chart above (Fig. 1) the numbers of access ‘clicks’ on each day is displayed. Only part of the record is shown, ie from 6 January. The Orange bar (for Thursday, 4 February) shows today’s number of visitors (7) and total number of views (13). Clearly, some of you are visiting more than one blog entry on your ‘visit’ (saves time, I get that). In fact, the programme also records the average number of hits per visitor (1.86 for today). The bar for Monday, 1 February (coloured blue – the date is now history!) shows quite different data (126 views by 25 visitors; an average of 5.4 views per visitor). All good stuff!

In addition, I can also access the number of visitors from each country. Here’s the data (Fig. 2) for the same two dates above:

Fig. 2 Geographical distribution of views (126) from 25 visitors to all blog entries.

Blog Geography Montage

Finally, I can also see which entries have been accessed (Fig. 3). What I can’t ever know is whether you have actually read any, a lot, or the complete entry after it has been “clicked on”.

Fig. 3 The number of ‘clicks’ on particular blog entries.

Blog Posts Pages 010216I trust this re-assures you of your guaranteed anonymity, if you want it.

As you can see, I have no way of knowing why today seems unpopular and yet Monday, 1 February was so popular (largest number of visits for any blog entry since I commenced blogging). On the other hand, I did send out a reminder email, on the day of my posting of that particular blog, to my full email list of you all. I’m wondering, does this mean I have ‘guilted’ some of you into at least ‘clicking’ on a few blog entries? Or could it mean that from day to day some of you simply forget how to access the Blog web site and therefore have to rely on my occasional emails to be able to contribute all? Or is there some other reason eg the title is or isn’t exciting, and you only read exciting ones (to you!)? What else?

Perhaps you could be really helpful and provide your own reason in the Leave a Reply box at the end of this blog (see example in Fig 4.).

Fig 4. The “Leave a Reply box at the end of Blog 38 – Reviewing my Gastric cancer – a case for Proton beam radiation therapy?

Survey Leave Reply Example

I look forward to gathering more statistics, including your qualitative comments in response to this, preferably via the Leave a Reply box (below). However, you can email (colinmason52@gmail.com) me if you really want to stay anonymous. I’ll be sending a brief note re this topic in a separate email, so, you could always use that to stay in touch! That’s three options – don’t I spoil you?

That’s all folks. Bye for now.

BUGS001

 

 

38. Reviewing my Gastric cancer – a case for Proton beam radiation therapy?

Proton Beam Therapy CGI action

Simulation of Proton Beam Therapy specifically targeting a tumour located deep in the brain.  Accessed at http://www.proton-therapy.org/howit.htm on Wednesday, 2 February, 2016.

Next Monday morning I will sit down with Dr P to discuss the results of my CT scan carried out last Tuesday – an anxiety-invoking two week wait! What will he say? For the big picture, there’ll be a decision about whether to carry on the same treatment (EOX combo) for 6 cycles (4.5 months) or for 8 cycles (6 months).   There’s pros and cons of course, but some days I just so, so want to be free of consuming medications of one sort or another, such as “shite-tasting” pills, solutions, suspensions, revolting creamy stuff and even the marginally better but still sickly fruity stuff, that the 6 cycle option really appeals!

The alternate is to carry on to 8 courses (6 months) to “kill the buggar some more”, and then I have to bite the bullet over the current side effects. But, there’s more…! I would also have to hope that permanent damage to key areas of my body doesn’t occur. I’m thinking particularly of nerve damage to my finger-tips which do take a ‘pounding’ because of the cold-response that is induced by Oxaliplatin in my EOX Combo Chemo.

The upside of the 6 cycle option is that I’d be free of the afore-mentioned as well as other side effects a little sooner. The downside, however, is that remnants of tumour may still remain or even have developed at new sites (though not visible by CT scan) that could trigger a re-appearance of my cancer at its original site or at any new as well as old metastatic locations. Sneaky sods – these cancer cells, eh?

The only upside of the 8 cycle option is that it kills more cancer (I have already been informed that a complete eradication down to the very last tumour cell cannot be guaranteed and hence I bear my label of receiving palliative care only). When Dr P starts mentioning surgery or radiotherapy then there might be a glimmer of hope for a switch to a curative-care regime though that, it would seem, is a long way off. But hey, who knows?

So, it’s complicated! I’ve just got to have in my blog at least one Steve Martin movie – in a starring role! This is certainly not his best, but the title is just right for my “coincidental link!”.

Its Complicated 1

Accessed at http://www.imdb.com/title/tt1230414/ on 2 February 2016.

Even if I was given a free choice – minus Dr P’s own advice– what would I do? What further questions should I ask this time? I’m still trying to sort this out. But of course, I am interested in any form of treatment that may give me a chance of being re-classified as a curative-care patient! As mentioned above radiotherapy could be an option if my only cancerous site could be narrowed to a single or at least easily noted location (only for certain would do).

And then suddenly, bang – there’s a BBC news item (Monday, 1 February) reporting on a recently highlighted study, published in the Lancet (Public Release: 29-Jan-2016), Yock, T. et. al., (2016). The Lancet Oncology: “Proton beam therapy offers potential to treat childhood brain cancer with fewer severe side effects than conventional radiotherapy”.

Accessed at http://www.eurekalert.org/pub_releases/2016-01/tl-tlo012816.php on 2 February 2016.

The new study involved 59 patients, aged 3 to 21, who were enrolled between 2003 and 2009, and revealed that the childhood brain cancer medulloblastoma treated via a procedure known as Proton Beam Therapy, “appears to be as safe as conventional radiotherapy with similar survival rates (83% at 3 years; 80% at 5 years)”; and additionally, compared to conventional radiotherapy, “proton radiotherapy may not be as toxic to the rest of a child’s body (hearing loss:12% at 3 years-15% at 5 years) as well as having, “no cardiac, pulmonary, or gastrointestinal toxic effects, which are common in patients treated with photon radiotherapy”. This looks interesting!

Protons can be generated and focused into beams in a controlled way using large particle accelerators. Uhm… particle accelerators.  Might I digress for a moment, or ten? CERN in Switzerland has the biggest and most powerful particle accelerator in the world – though everyone seems to own it!

CERN Supercollider Montage

CERN’s powerful particle supercollider. Accessed at http://home.cern/topics/large-hadron-collider on 2 February 2016.

This one, known as The Large Hadron Collider (LHC) comprises a 27 kilometer ring of superconducting magnets that focus and accelerate beams of particles towards one another at speeds close to that of light.  This machine though is used for things other than Proton Beam Therapy; notably, crashing sub-atomic particles into one another and creating even smaller ones! Now people in particle physics think this is great and even get Nobel prizes for their work, or share it with others who have also had a great idea or conducted an ‘elegant’ experiment. For example, Professor Peter Higgs at Edinburgh University predicted the existence of the now, so-called Higgs Boson. Its existence was only confirmed in 2012 and he got his share (with François Englert) of the Nobel prize for Physics in 2013.

Prof Peter Higgs

Professor Peter Higgs. Accessed at https://en.wikipedia.org/wiki/Higgs_boson on 2 February 2016.

I’m not sure how great this is and if you bear with me I’ll share with you the rather different view I take. If I take my hammer and smash a large rock, I get a cluster of small rocks. If I then take one from said cluster of (smaller) rocks and smash it again with even more malice this time, lo and behold, I generate a further cluster of even smaller rocks. I think I’ll call one of these, the smallest piece as it happens, Mason’s Mason (pronounced Mayzon!).  I have so-named it because it behaves similarly to a photon which is able to appear in two places at once; and is also a particle and yet behaves like a wave at the same time.  This ‘duality‘ is a phenomenon explained by Schrodinger’s cat analogy.

Schrodingers Cat

Schrodinger’s thought experiment Accessed at https://en.wikipedia.org/wiki/Schr%C3%B6dinger’s_cat on 2 February 2016.

Schrodinger devised a “thought experiment” in which a cat is locked in a sealed box that contains a radioactive substance that may decay (or not). If it does this is detected and further triggers release of hydrogen cyanide which kills the cat. The “not knowing what has happened yet state” was (jokingly?) referred to by Schrodinger as the “superposition state” where the cat can be both alive and dead – until an external observer looks inside the sealed box (Schrodinger, 1935). It is then either alive or dead. And this analogy helps you understand the quantum mechanics that underpin behaviour of very small particles (but definitely not cat-sized ones) such as atoms and photons, apparently!

Anyway, the Mason obeys the same rules and thus at any one time it may be here, or it may be there, depending upon where you look for it – simple and elegant, eh? People have received Nobel prizes for less, don’t you know? And let me tell you, I predicted its existence in 1956 when I was only 4 years old, and had just learnt about hammers and how much damage they do to one and half-year-old baby sisters! Now is this rocket science? If so, I’d like my (share of) Nobel prize for “common, or is that uncommon, sense”, please!

Now to digress back to my pre-digression:

As I was saying, protons can be generated and focused into beams in a controlled way using large particle accelerators. Proton beam therapy damages cancer cells in the same way as radiotherapy. Unlike X-ray beams, however, proton beams stop once they hit their target (a tumour growth normally), rather than carrying on through the body. Thus, the proton beam more specifically targets the cancer whilst sparing more of a patient’s own nearby normal tissue. And, it is the latter that reduces side effects.

Protons are positively-charged particles found together with Neutrons in the nucleus of every atom. The movement of proton beams (like other ionising radiation sources) through ‘solids’ is governed by what is known as the Bragg peak effect, after William Henry Bragg (1903). He defined the properties of various ionising radiation sources with reference to their energy loss (Vertical axis) as they traverse matter which slows down their movement (Horizontal axis). Energy sources such as α particles, other ion rays and protons all have characteristic patterns (Fig 1).

BraggPeak Curve

Fig 1 Bragg curves for Photons (eg X-rays); and protons. Accessed at https://en.wikipedia.org/wiki/Bragg_peak on 2 February 2016.

What distinguishes the proton curve is the ‘peak’ of energy reached just prior to its final abrupt decay – that is also marked by an annihilation ‘explosion’, with luck and a trained operator focusing this at the 3D location of the tumour, say in the spinal cord. In contrast, X-rays continue, albeit with slower exponential decay, beyond the site of a targeted-tumour and further into normal tissue which will continue to be exposed to damaging radiation, that also affected normal tissue precisely located ahead of the tumour (double bad news there, for the radiotherapy camp!).

Proton Beam Therapy is not a new form of treatment but it is news-worthy, mainly because the UK lags behind some other countries in not having even one machine of its own capable of generating a high energy proton beam that can be used to treat patients across a sample of the total spectrum of 2000 or so cancers, and not just eye cancers (see below).

“Currently (2013) the UK has one proton beam therapy facility, at Clatterbridge Cancer Centre. But it’s a ‘low-energy’ machine, only suitable for treating people with rare eye cancers.”

Nevertheless, the UK government has recognised this glaring gap in its cancer care provision, and in 2013 it commissioned two state-of-the-art high-energy proton beam facilities to be built in the UK by 2018. These are to be located at the Christie Hospital in Manchester, and at UCL Hospital in London – at a total cost of £250 million. In addition, there are plans to build a research-focused proton beam centre in a new institute at Oxford University – a major investment being supported by the Government and Cancer Research UK, among others.

Proton Beam Therapy UCL Facility

The proposed PBT facility at University College London (UCL).

Currently, cancer patients (mostly children) that require Proton Beam Therapy must be referred by the NHS to facilities in either the USA or Switzerland. From 2018, the first cancer patients treated at the new NHS facilities will be those for whom current evidence already recommends proton beam therapy:

  • children with several specific types of cancer
  • some adults with rare cancers, particularly where tumours have developed near the brain, base of the skull or spine.

It was in 2014 that a previous news headline propelled Proton Beam Therapy into public consciousness when a small boy, Ashya King, was snatched from a Southampton hospital by his parents, Brett and Naghmeh King, against medical advice, in order to take him to a Proton Beam Therapy treatment centre in Prague, in the Czech Republic.

His parents believed their son was not being offered the best treatment available for his condition and consequently took matters into their own hands. With hindsight, it is easy to criticise the heavy-handed approach by the hospital authorities who first tried to prevent the ‘family abduction’ and subsequently notified the police who then issued arrest warrants and ultimately withheld the parents (in Spain) from their son whist he underwent treatment in a foreign hospital in a foreign land – a scary prospect for anyone, but a small boy, come on? In defence of the local NHS hospital, it later agreed to fund this treatment, which ultimately was also successful – cancer-free for 9 months.

Should I get carried away with new possibilities such as Proton Beam Therapy for my cancer? Sadly, after reviewing even a small sample of the online literature, the answer is probably no! Leaving aside whether there is sufficient research evidence generated from properly conducted (randomised, controlled, blind etc – you get it, right?) clinical trials to claim superiority over radiotherapy, more importantly, it seems, is the type and location of the cancers best suited to Proton beam therapy. Gastric cancer (probably, especially for adults) isn’t one of these – at present.

Following completion of my 6 or 8 cycles of my current chemotherapy regime I should know whether my own primary tumour site has been declared ‘clear’ of active cancer, leaving only residual active metastatic deposits. As previously described, these are in in part of my pancreas, a few lymph nodes and one adrenal gland. If only one of these sites is active at this time (he says optimistically!), then who knows, perhaps “targeted therapies” such as Proton Beam Therapy, Cyberknife and Immunotherapy using modified viruses such as herpes and measles, will present new opportunities – even for me?

Whilst there are some benefits of Proton Beam Therapy over conventional approaches it may be premature to think that this is the ‘answer’ to cancer cure. Even leading experts remain cautious?  What follows is a range of statements made by one of the UK’s leading clinical radiotherapists and Proton Beam Therapy specialist, Dr Adrian Crellin.

“Since it delivers a lower dose of radiation to surrounding tissues, proton beam therapy’s main advantage is in reducing side-effects, rather than improving survival or cure,” he says. This helps patients whose tumours are near sensitive organs (e.g. the brain or spinal cord) by reducing damage caused to healthy tissue– especially in children, as their organs are still developing.

There are also suggestions that it can reduce the (small) risk of developing a second cancer later in life. And, for some rare cancers in adults, the reduced damage to surrounding tissue means proton beam therapy can be given at a higher dose. This, Crellin says, might be more effective at destroying cancer cells, although clear-cut evidence of survival benefit is limited. “But it’s critical to stress that for most patients right now, there’s no strong evidence that proton beam radiotherapy is ‘better’ at curing cancer, or improving a patient’s chances of survival, than conventional x-ray radiotherapy.”, says Crellin. That’s why it’s so important that more research is done on proton beam therapy (2013).

Maybe the recently published study in the Lancet Oncology at least provides further evidence that such investigations are happening and are beginning to bear fruit.  Accessed at http://scienceblog.cancerresearchuk.org/2015/07/16/proton-beam-therapy-where-are-we-now/ on 2 February 2016.

On the other hand, bloggers such as me (ie cancer patients, some with not a lot of time left) argue strongly that Proton Beam Therapy, if it was a lot cheaper (it costs about £40,000 to treat one patient!), would actually replace X-ray radiotherapy, and there would be no debate. I am not sufficiently qualified to comment, but if the recent Lancet Oncology paper is predictive of future clinical trial outcomes, then the bloggers have it, in my opinion, since Proton beam therapy is no worse on mortality data and similar or better overall on morbidity data. It boils down to money, as it always does in health matters – compare just about any aspect of the health or illness of poor people with that of wealthy folk and guess what you will find?

That’s all folks! Bye for now.

BUGS001