It’s coming up to the anniversary of my brain surgery, which you can read about here
Subsequent to all that, I had the chaos-causing cancerous kidney removed shortly before Christmas 2017. The tumour there was less than 1 cubic millimetre in size. Yes, you read that right. 1 cubic millimetre.
To keep things under control I’m on some medication, which is pretty amazing stuff. Sutent forms part of my daily life now. I take it in blocks of four weeks, with two week holiday between each four week period.
As you may know, cancer is an out-of-control growth of cells. Healthy cells have an off-switch, they stop dividing. Cancerous ones do not. As far as I understand it, Sutent put back the off-switch, resulting in no new thing arising. And where there is a cluster of cells, a tumour, this can only continue to survive if it taps into a blood supply. Sutent also disrupts this, depriving the tumour of oxygen, so it withers and dies.
There are side effects - I might go blonde, which I’m quite looking forward to, but I suspect this is simply a polite way of saying grey. There are other issues, but I’ll leave it up to you to google them - if you’ve got any questions I’ll do my best to answer them if you PM me.
Going to the Churchill hospital in Oxford for checkups and scans has now become a routine, and I have fantastic support from my employer. Once a quarter I have scans and slightly more frequently we visit the town of dreaming spires for a cosy fireside chat, I leave a sample of blood behind then we go for coffee and cake in one of any number of pleasant eateries before getting back on one of GWR’s delayed trains to eventually get home again.
While I’m indebted to the NHS and the amazing medical staff at the John Radcliffe and the Churchill hospitals, I’m pretty sure there’s a more efficient way of running this treatment. For example, if there’s no need for me to physically be there, such as for a scan or blood test, then why do we have to take up pretty much a whole day for a fifteen minute chat?
I questioned one of the senior staff members of the oncology team, and it seems to come down to two factors: funding and assessment. The clinic gets funding for each physical visit, so there’s financial aspect to this way of working. If they change to a visit-less system, they lose the funding, so there’s little incentive to change, to innovate. Also, the consultant explained, they like to see patients’ reactions to diagnoses, test results and other feedback from the medical staff, and to generally assess how their patients are doing.
Whether I have a consultation in one of their offices, or a consultation by Facetime, it’s still 15 minutes of the medical staff’s time. So I don’t get the financial argument. It doesn’t add up.
I can see there’s some merit in their being able to see facial expressions and reactions to what can be distressing news. And by the same token I can understand there is a need medically to eyeball patients to assess how the patient is coping with ongoing treatments, some of which have far tougher regimes than mine.
But the fact is that technology now out-performs the human eye. Smartphone cameras are so sensitive, they can detect medical conditions that are simply invisible to the human eye. With a Facetime or similar video call, the medical staff would not only get to see the happy smiling faces of their patients, but would also be able to diagnose, non-invasively and passively, their patients’ physical condition in a way that is impossible in a face-to-face meeting.
If I need to provide a blood sample, why can’t this be done at my local Doctor’s surgery?
Here are some examples of the state of the art:
“A new app could lead to earlier detection of pancreatic cancer simply by snapping a smartphone selfie. The disease kills 90 percent of patients within five years, in part because there are no telltale symptoms or non-invasive screening tools to catch a tumour before it spreads. BiliScreen provides estimates of bilirubin levels in a person's blood. Elevated levels can be an early warning sign for pancreatic cancer, hepatitis and other diseases.”
“Now MIT Media Lab spinout Cardiio has developed a mobile app that uses a smartphone camera to detect facial signs of a heart arrhythmia associated with strokes. It does so by measuring and analysing minute changes of light reflected on the skin as the result of the underlying pulse.”
No FT, no comment
Draconian copyright issues mean I can’t post a suitable quote from this interesting and relevant FT article, I hope they don’t mind a humble link (paywall):
Smartphones are yesterday’s news
Clever and wonderful all of that is, there is a different, newer, product category that has the potential to outdo even the smartest of smartphones for medical diagnoses and monitoring: the smartwatch.
I can only really talk about my experience of the AppleWatch, but I understand other smartwatches are available.
I was not originally a fan of the AppleWatch. I thought it was important for Apple to launch a new product category after the death of Steve Jobs, and the AppleWatch was nice enough in its way, but .. meh.
However thanks to the generosity of a friend, I was gifted an Apple Watch 3 for Christmas. The first thing we did with it was to was to make a Dick Tracy-style wristwatch telephone call…
The second thing I did with it was to start to track my physical activity - and I’ve become a devotee of “completing my rings”. Having always had good health and having the good fortune to do pretty much any physical activity I wanted to do, last year’s escapade showed how precarious we can all be. Despite physically recovering in leaps and bounds, a year later I’m still not quite back to where I was, but I figure the more I do, the more I’ll be able to do, and the fitter I am I’ll be better able to withstand whatever comes next.
The AppleWatch works in conjunction with a couple of iPhone apps, one that tracks activity, the other health. So I’m not rock climbing again yet, but normally I cycle 5Km a day during the working week, sometimes more at a weekend, and walk about 10Km a day. Here’s yesterday’s (a Saturday) activity:
Let’s get Sirious
The Health app though is the really interesting one. The AppleWatch does many splendid things and one of these is that it measures resting pulse rate, which it records in the Health app on the iPhone. Here’s mine for the year so far:
Guess when I started taking Sutent! You can see the 4 week on 2 week off cycle reflected in the peaks and troughs of my pulse rate.
I showed this to one of the medical staff at Hôtel de Churchill who said “Aha - one of the side effects of Sutent is a reduction of thyroid activity, which results in decreased pulse rate, we’ll test your bloods for this”.. and lo and behold, I have an under active thyroid and will soon add more pills to my pharmucopia (like a cornucopia, but of pills, not corn).
AppleWatch to the fore
So I’ve become a convert to the AppleWatch and to wearable devices in general.
The AppleWatch 4, launched last week does, as Apple would say, take wearables “to the next level”, a marketing term I’ve always hated but in this instance it is entirely justifiable.
AppleWatch 4 can not only detect falls and automatically phone your contacts and the emergency services for help, it can produce FDA-approved electrocardiograms (ECGs) which can be output as a regular PDF for sharing with your clinician. This is, according to Apple, the first over-the-counter device to do this, and it’s breathtaking in its implications, and is a signpost as to where this technology is going.
TechRadar article here: https://www.techradar.com/news/the-apple-watch-4-ecg-is-98-accurate-at-detecting-afib-says-study
We have an ageing population. We have an obesity problem. Both of these are placing additional stresses and strains on an already under-funded, under-supported, under-resourced, under-valued (I’m entitled to my opinion) health service. The advances in cancer treatment are astonishing, but “biological innovation” takes a long time and costs a fortune. The Sutent I take is amazing, but it’s a one-size-fits-all shotgun. Imagine a customised laser-beam version that’s specifically formulated for me, so the side-effects are minimised if not eliminated. We are years away from such drugs.
Technological innovation proceeds at pace and the humble cell phone has become a smart health device. The smartwatch significantly augments the smartphone and the two together are a killer combination… OK so maybe that’s not the best term to use, but you get what I mean.
On the basis that prevention is better, easier, cheaper than the cure, maybe in the not too far distant future we’ll all be wearing smart health devices, and really transform health care in the UK.
An AppleWatch on prescription? Yes please.