Topherblog

Made a visit to the barber in order to disguise the bald patch mentioned in the previous post. I decided not to go for the Mohican, but for a GI-Joe style instead.

I thought I would be very conspicuous, but on a quick visit to the supermarket, I noticed that a lot of other men, and one lady, had similar cuts. Have I suddenly become fashionable?

I think that a hair-wash will take less than half a teaspoon of shampoo. Not so good for the manufacturers!

Almost half-way through the radiation treatment and the first signs have become visible. None of them are unexpected, and none are any cause for worry. I have some small reddish patches on the left side of my face where the radiation enters to do the treatment, and on the right side of my head just behind my ear there is a growing patch where my hair is starting to fall out. This is also a result of the radiation treatment.

There is nothing to do about this except accept it and try to make it look a bit better, so I have therefore decided to visit my barber again and get a suitable haircut. There are several options available, which include complete shaving of the head just like Yul Brynner, tidying up around the affected area or maybe getting a new Mohican.

Which alternative do you think most suitable? Leave a comment.

Monday to Friday I am off to the hospital for my radiation treatment. The daily dose is 2 Gy 2 Grays* (named after Louis Gray, a radiobiologist from London, who worked together with a number of prominent physicists, including Lawrence Bragg, Nobel prize in physics, 1915). In total I will get a dose of 60 Gy, which means 30 visits to the radiotherapy ward. So far, the treatment has gone very well. Apart from a brief period of nausea last weekend, I have been in good shape and have managed daily exercise in the gym or on extended walks – I am not allowed to run as the pounding of the ground might affect the tissues being treated.

Due to the pandemic, friends and relatives are not allowed to accompany patients to their treatment. A consequence of this is that the only people on the treatment side of the department doors either have some form of cancer or are there as part of the treatment teams, including support and cleaning staff. The conversations are therefore direct and straight to the point. Each person has some form of tumour in some part of their body, and almost everyone has some amusing anecdote to tell about their treatment or consequences thereof. It is very refreshing to feel the positive attitude of each of my fellow team-mates in the fight against our tumours. Each is prepared to put up a good fight and to ultimately win.

As mentioned, I am in good health and very optimistic about my treatment. I leave you, therefore with this:

All watercolours by Jenny Holland

If you happen to have some salmon leftovers in your fridge you might want to try this recipe.

It is a salmon Wallenbergare inspired by the veal Wallenbergare which is very popular in Sweden. I checked a few recipes on-line and made my own from what I thought were the best available.

It just so happened that I had some salmon hanging around in the kitchen. It, the salmon, didn’t seem to be the best piece of salmon I ever had, so I decided to make an alternative dish with it to disguise the poor quality. It turned out to be quite a successful dish which is why I choose to share this with you.

For six portions you will need:

800 g Salmon

5 g salt

1 egg

1 egg yolk

1 dl cream (used motor oil is just as good)

Cayenne pepper

Black pepper

Some breadcrumbs

Some potatoes

Some peas

Some more salt

Some butter

A little cream (do not use motor oil as an alternative here)

Zap the salmon and salt in a food processor for a few, 3 – 4, seconds. Beat the eggs, normally I would not approve of domestic violence, but in the case of eggs it is ok, and mix together with the salmon. Add the cayenne and black peppers according to your particular taste and form the mixture into six equally sized balls. Put a large frying pan on a low heat, maybe about 150 degrees, with some butter or oil for frying. Cover the balls with breadcrumbs and carefully place in the frying pan. Fry for 4 – 5 minutes then carefully turn them over, gently flatten, and fry for a further 4 – 5 minutes. The centre of the Wallenbergare should reach about 48  degrees.

Those of you who are very observant will have noticed that I forgot to use the 1 dl cream. This can be returned to the fridge for use elsewhere, or to your car if you chose the motor oil alternative.

Serve the Salmon Wallenbergare together with mashed potatoes and peas. Use some melted butter as a topping on the Wallenbergare.

The Wallenbergare was originally made for the Wallenberg family and consisted of finely ground veal mixed with eggs and cream and lightly sauteed then served with mashed potato, peas and lingonberry jam. It could be said that the Wallenbergare is a variation on the dish Veau à la Pojarski which originated during the 19th century.

I attended a workshop in Brussels, a few years ago, on the topic of making the energy sector in Europe free from greenhouse gas emissions. As I arrived early, I was invited to join a lunch meeting with some of the head research officers from a number of major car manufacturers from Europe and Asia. It was an interesting lunch with discussions touching biofuels, hydrogen and various permutations on electric cars and hybrids. It was a remarkably open meeting, considering the people present and the interests that they represented.

Eventually the discussions got round to current events in Europe. It was after the UK had invoked article 50 and during a period of relative inertia in the UK-EU negotiations. One, rather undiplomatic, representative from the EU expressed a feeling that it was all taking rather too long, distracting from other more important issues within the EU, and stated that the UK should just “Get on with it!”

I have had the same feeling about my current situation. We know what was there, we know what to do about it so just let us “get on with it!” At last, earlier this week, my treatment started (see an earlier post). I have been fine, taking my medications and having the area were the tumour once resided zapped for a couple of minutes with high energy rays. On Friday evening, as I retired, I was in good spirits considering that more than 10 % of the treatment was completed without feeling any side effects. At about 4:30 that all changed. My stomach sent me a message, saying “Please do not send any more of those capsules! And while you are listening consider fetching a bucket, bowl or similar receptacle.” All of my previous core training sessions finally came to fruition. As a child, I had a weak stomach, but now I can throw up as far as the best. I even had the muscular pain as a reminder.

The wonders of modern medicine mean that there is a strategy to get this particular side effect under control, so I am looking forward to a return to a normal sleeping pattern.

A number of years ago. Actually, quite a long time ago, Sing along sound of music had just become popular, and we had to go and see it. We got together a large part of the Folkeson clan and met at the cinema in Stockholm for an evening of song and laughter.

At the sing along version of the film, the audience are encouraged to join in as much as possible. This, naturally, includes singing all of the songs. There was a small song pamphlet with all of the lyrics, but generally, this was superfluous. Dressing up in a way that fitted in with the film was also appreciated by the staff and the rest of the audience. Some of the costumes were fairly obvious while others needed a good deal of imagination. Dressing as a nun was a particularly popular theme, so there were plenty of nuns in the cinema that evening. Many of them were bearded!

Most of the clan were dressed as the von Trapp children, attired in curtain fabric and accompanied by a suitably dressed Maria, with hat and guitar case. There is one particular scene in the film where Captain von Trapp attends a ball at the local castle during this scene most of the audience were dancing in the aisles of the cinema.

Each time Captain von Trapp appeared on screen, the audience had to stand up and say “Aye-aye Captain”, or if the captain was being too hard on his children “Aye-aye-aye Captain”, and every time the mountains came into view the audience were required to shout out “The hills”. As the film takes place in the Austrian alps, this happens quite a lot.

This brings me to the title of this particular page; There is a song in the film with the title “Climb every mountain” sung by the Abbess, which gained particular relevance when I returned home from the hospital yesterday. I had with me a whole bunch of tablets to keep me under treatment for the next six weeks. This is the mountain that I have to climb, and every time I see them I fell like shouting “The pills!”

I am now at day two of my combined radiation- and chemotherapy. So far everything feels good. I took a long walk this afternoon and had a session in the gym with the physiotherapist at the hospital. At my desk I have Caesar to keep me company.

Today is the first day of treatment to see off what might remain of the tumour that had so rudely intruded into the back of my head.

The first stage was radiation therapy with high energy X-rays (6 MeV). Yes, I had lots of questions about the technique being used, the energy and wavelength of the radiation, precision etc.

Mask on, lie still, relax and enjoy the ride. There was a lot of machinery moving about with whirring noises. As requested, I was very still. It felt like it was over in no time.

The next step was at the oncology ward, where I was presented with a mountain of tablets, both for my treatment and to counter possible side-effects (to be addressed in an upcoming report).

The staff are so kind and considerate. If it wasn’t for COVID-19, I would probably end up as a metoo case for hugging them all.

WARNING! This post may be distressing.

Having gone through all of the tests, with blood samples, electrocardiography, CT, MRI and PET, and an operation to remove the suspected tumour, there was a long wait. As the wait got longer the more, I suspected that the final diagnosis was not going to be good. It all depended on the outcome from the pathology department. I finally got to meet the team from neurosurgery and oncology to discuss my condition and how it is to be treated.

Walking into the room was a strange experience. Two doctors dressed in standard hospital attire (scrubs!) sat next to each other, while a nurse, also in scrubs sat to their left and slightly further back. I interpreted this as an expression of hierarchy within the health care system. Two chairs were positioned for Bitte and myself, not too close to the doctors and not directly in front of them – these are corona times after all.

After standard introductions and the formalities of asking how one is feeling and my usual bluntness in saying that I feel perfectly healthy although very worried about what I was about to hear, we got down to business. We were told that the tumour, upon examination, was found to be a grade IV glioblastoma. Actually, I knew this as I had read my medical notes the evening before, but hearing this information from the medical expertise present in the room is totally different to reading it on a computer screen. As it all sank in, questions started to form, primarily concerning how much time do I get? and what do they, the medical staff, intend to do about it, my unwanted intruder? The meeting went on for about an hour. We had lots of questions and got some answers and some half answers. In general, it is up to us to draw conclusions from the information available. We have, however, a plan and a schedule to follow. These will keep me busy for the next two years or so.

My treatment starts on November 24, but there are some preparations which are necessary to guarantee the accuracy of the radiation therapy (Read “The machine that goes ping). Treatment will consist of a combination of radiation therapy (X-rays, produced by a linear accelerator, directed with high precision at the site of the tumour. My warped sense of humour says that the tumour is probably in the freezer of the pathology lab) and cytostatics (temozolomide). This phase of the treatment will last for six weeks with radiation five days a week and cytostatics every day. This phase takes us to Twelfth night! After that I get a break for two weeks before phase 2 begins.

Phase 2 involves temozolomide treatment for five consecutive days followed by 23 days for recovery, repeated a number of times, I believe that they mentioned six times, but it could be more. At the same time as the second treatment phase begins, I will also be fitted out with Optune equipment for electromagnetic irradiation of the residual tumour cells. This is a kind of local 5G transmitter which I will have to wear 18 hours a day, powered by a battery which is carried in a small rucksack. It will be interesting to see how I cope skiing and playing golf with this in place.

Ahead of me are two years of treatment, which will, in all probability, be altered along the way. This treatment will not only affect me, but also those closest: family, friends, and colleagues. (Please note that you may be included in several categories, I am in the happy situation that I consider both family and colleagues as friends.) I am entering this process with a good deal of optimism as there are a number of factors which give me an advantage: The tumour was discovered early and all detectable parts were removed soon after discovery. The tumour was, despite being grade IV, methylated, which can be interpreted as making it more susceptible to the treatment and also slightly less aggressive. I am in fairly good physical shape and should cope well with the treatment.

In conclusion, I will follow the advice of Project Runway presenter, Tim Gunn, and “Make it work”.

I spent a few hours at the hospital last week in preparation for my upcoming radiation therapy. The first task was to make a mask to hold my head firmly in the right place for irradiation. This involved being positioned correctly and having a warm/almost hot sheet of plastic placed over my face and having it formed tightly then fixed to the table. The process was uncomfortable but ok. The mask was cooled down with some damp towels then I was ready for a CT scan.

After this process I was transferred to the MR department for a magnetic resonance scan. The mask came with me. The assistant showed me to a small room and requested me to remove all my clothes and put on a hospital shirt. I think that I must have looked a bit surprised as she then said that I could keep my underpants, which was a relief (see earlier post). I was taken to the MR room and had to lie on the examination table where I was reunited with my mask and promptly fastened to the table with my head in exactly the same position as for the CT-scan. The MR did not go ping, but it did make a lot of noise. While inside the MR I had time to think about my own experiences of MR earlier in my career:

The technique used for the examination is nuclear magnetic resonance (NMR). If you are not well acquainted with the technique you may want to see the short video presented at https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri before reading more.

NMR in Sweden is “Nordic Motståndsrörelse”, an unpleasant fascist organisation that we will ignore.
For the rest of this post NMR or MR refer to the medical or scientific techniques.

My first encounter with NMR was while attending grammar school. My teacher was an expert in the field having attained a PhD using the technique. My class got to visit his lab at Liverpool university. It was all very high tech (think 1977) with computers and lots of flashing lights. We even got to play a computer game.

Some years later I arrived in Uppsala as a post graduate student and started doing work on DNA and RNA synthesis. After completing my first experiment a fellow postgrad, Marek, said something which I understood as “you need an enema”. I explained that my bowel function was perfectly fine but thanked him for his concern.  After some discussion we arrived at the conclusion that I did indeed need an NMR in order to confirm the results of my experiment. After this small incident NMR became an integral and greatly appreciated tool in my research career.

A couple of years later I got the opportunity to attend a course on advanced NMR spectroscopy, given by one of the leading experts in the field, in Södertälje, a town about 150 km south of Uppsala. The course was over two days and required staying overnight at the local hotel. I, together with a fellow postgrad, Anders, were given permission to attend the course, but not given the economic resources required. We solved this by commuting for two days on Anders’ Triumph (if I remember correctly) motorbike. This would have been fine except that it absolutely poured down with rain both days, so that while all of the course participants were well dressed, Anders and I were like drowned rats.

A few more years passed and I was responsible for establishing an NMR lab in the basement of Uppsala Biomedical Centre. My main concern was to create a lab that was accessible for many different users while keeping to a very strict budget, a returning theme in the academic world. One of the researchers expected to be a frequent user was Dr L., who is sadly no longer with us. Dr L. had lost his right arm in an accident while he was very young and had adapted to life with only one arm in an admirable way. We used to joke a lot and had literature seminars in the sauna quite frequently. I named him the one-armed bandit, which he appreciated, but many others thought offensive. When the lab was ready to be inaugurated I was a bit worried because the NMR instrument used a very strong magnet to which any magnetic objects would get stuck. This could include various tools, pens, hairclips etc and cause distress to the owner as they were hard to remove. What was worse was that it was not good for the instrument. I, therefore installed an extra hanger by the door. Dr L. noticed this and immediately asked what this was for. I explained that it was for him to hang his prosthetic arm on before entering the room. Dr L. really appreciated my concern for his wellbeing, but many other people thought that I was completely tactless. The next day I noticed a second hanger next to the door. After making some enquiries, Dr L. explained that he had installed the second hanger for our female colleagues to hang their bras as the wire supports were probably magnetic.

It is quite amazing how thoughts can wander and associate during what is normally a stressful experience. I was soon released from my mask and from the medical radiology department. As a reward, I was able to indulge in a cinnamon bun and cup of coffee (you can’t get more Swedish than that!)