Monday, 17 September 2018

For the last time

This poem captured my feelings this morning and the importance of cherishing a relationship with your children that one day will no longer exist, even in their memories, just in yours...


The Last Time

From the moment you hold your baby in your arms,
You will never be the same.
You might long for the person you were before,
When you had freedom and time,
And nothing in particular to worry about.
You will know tiredness like you never knew it before,
And days will run into days that are exactly the same,
Full of feeding and burping,
Whining and fighting,
Naps, or lack of naps. It might seem like a never-ending cycle.
But don't forget...
There is a last time for everything.
There will come a time when you will feed your baby
for the very last time.
They will fall asleep on you after a long day
And it will be the last time you ever hold your sleeping child.
One day you will carry them on your hip,
then set them down,
And never pick them up that way again.
You will scrub their hair in the bath one night
And from that day on they will want to bathe alone.
They will hold your hand to cross the road,
Then never reach for it again.
They will creep into your room at midnight for cuddles,
And it will be the last night you ever wake for this.
One afternoon you will sing 'the wheels on the bus'
and do all the actions,
Then you'll never sing that song again.
They will kiss you goodbye at the school gate,
the next day they will ask to walk to the gate alone.
You will read a final bedtime story and wipe your
last dirty face.
They will one day run to you with arms raised,
for the very last time.
The thing is, you won't even know it's the last time
until there are no more times, and even then,
it will take you a while to realise.
So while you are living in these times,
remember there are only so many of them and
when they are gone,
you will yearn for just one more day of them,
For one last time.

Monday, 10 September 2018

It's good to know that as long as you can prove that what you are writing is the truth, you can freely publish in the U.K.

UK defamation law reforms take effect from start of 2014

Anything your commenters say can be held against you, unless...

Old Bailey Lady Justice
Justice minister Lord McNally has told the House of Lords that the new Defamation Act, which received Royal Assent in April, will take effect from the start of next year.
New regulations, which govern the process website operators must follow when informed about alleged defamatory comments on their site to avoid becoming liable for that material themselves, have also been passed by Parliament and will come into effect on 1 January as well.
"I believe that the process established by the regulations strikes a fair balance between freedom of expression and the protection of reputation and between the interests of all those involved, and that it will provide a useful and effective means of helping to resolve disputes over online material," Lord McNally said in the Grand Committee of the House of Lords.
The Defamation Act 2013 creates a new statutory defence for publishers to claim that allegedly defamatory statements constituted, or "formed part of", comments "on a matter of public interest" and that they "reasonably believed that publishing the statement complained of was in the public interest".
The Act also set into law a broad equivalent to the common law "Reynolds defence" for "responsible journalism" that has been available to publishers since it was established by the House of Lords in a case between former Irish Prime Minister Albert Reynolds and the Times Newspapers Ltd in 2001.
Under the Defamation Act, a statement can be said to be defamatory if its publication "caused or is likely to cause serious harm" to individuals' or businesses' reputation. However, only if businesses have suffered, or are likely to suffer, "serious financial loss", can they bring a claim of defamation against commentators.
The authors of defamatory comments can avoid becoming liable for damages if they can show "that the imputation conveyed by the statement complained of is substantially true" or, if the comments took the form of an opinion, that the opinion is one which "an honest person could have held the basis of any fact which existed at the time the statement complained of was published; anything asserted to be a fact in a privileged statement published before the statement complained of".
Authors shown not to have held the opinion themselves will use their right to rely on this 'honest opinion' defence.
Under the Act website operators can be pursued by those who claim they have been defamed as a result of comments on their site even if they are not the author of those comments. The new Defamation (Operators of Websites) Regulations sets out the process operators have to adhere to in order to escape liability for comments complained of.
Upon notification, authors of the comments would have five days to issue a written response outlining whether they consent to the removal of the comments from the site. A failure to respond would place website operators under the obligation to delete the comments within 48 hours of that five day deadline expiring if they are to avoid exposure to liability.
When notifying authors that their comments are subject to defamation complaints, website operators would have to conceal the identity of the complainant from those authors if such anonymisation is sought by the complainants.
In cases where the authors do not consent to the removal of their comments, those individuals or businesses would be required to inform website operators of their name and address and tell the operator whether or not they consent to the handing over of their details to the complainant. A complainant would have to be informed by the operator within 48 hours of an author's response and of the content of that response.
Website operators would be required to delete comments from their site within two days of receiving a notice of complaint if it has "no means of contacting the poster" through a "private electronic communication" channel, such as via email.
If authors that do respond to website operators' notifications of a complaint fail to provide details of their full name and address, the operators would have to remove their comments within two days of that response. If a "reasonable website operator" believes that details given by an author are "obviously false" then they must also delete the comments within the 48 hour deadline.
In cases where authors of defamatory comments repost the same or substantially similar comments after they have been removed twice before from the site, website operators would be obliged to remove the comments within 48 hours of receiving a notice of complaint.
"Where the poster has not consented to release of his or her contact details to the complainant, it will be a matter for the complainant to consider what further action he may wish to take," Lord McNally said. "It will, for example, be open to the complainant to seek a court order, known as a Norwich Pharmacal order, for the operator to release the information that they hold on the poster’s identity and contact details so that legal proceedings can be brought against the poster."
Separate new laws aimed at cutting the cost of making defamation claims before a court for those with modest means are also currently under consideration.
Copyright © 2013, Out-Law.com
Out-Law.com is part of international law firm Pinsent Masons.

Thursday, 6 September 2018

Martin Hickmott

This Blog is in danger of being over run by other issues relating to a completely different subject, but one close to all our hearts, that of Martin and Naty.

So, I've made a seperate blog where I post everything to do with the "Martin & Naty Story" and you can also post your contributions to the 'ongoing story' on the same blog. It's a private blog, so to let you in, I would have to know you but also know that you are a friend of Naty and knew them as a couple when they lived in Bangkok. This also saves me sending out updates by e-mail as you can look in any time you want.

Access blog here...


https://martinhickmott.blogspot.com/?zx=776e536dcfa13bd4

For permission please contact me on dansencier@yahoo.co.uk

Thursday, 30 August 2018

The 15 stages of Prostate Cancer

A very interesting article by:
Updated June 01, 2018

There are many barriers to achieving optimal care for prostate cancer. First of all, as we will see by the end of this article, prostate cancer is intricate, which means determining the most appropriate therapy can be complicated. Second, the endless amount of disorganized and out-of-date information on the Internet is daunting and unmanageable. Doctors, let alone patients become overwhelmed.
 Third, face-time between patients and doctors is continually shrinking due to the expansion of big business and government into medical care. On top of these problems, consider how almost no doctors specialize in treatment selection. They merely specialize in either surgery or radiation, so the decision-making process gets left to the patient.

Should Patients Be in Charge of Choosing a Treatment Plan?

Doctors who care for prostate cancer patients are sensitive to the limitations listed above. And they realize there are other problems as well. The first is that doctors have a major conflict of interest. They are paid to carry out only one type of therapy, surgery or radiation. As a result, they are reticent to give forceful treatment recommendations. How many times have patients heard from their doctor, “You need to be the one who decides"?
Second, predicting the seriousness of a patient’s cancer is impaired by prostate cancer’s extremely slow-growing nature.
It takes a decade for the impact of a treatment decision to be realized. Predictions are further impaired by the elderly profile of prostate cancer patients. Mortality from old age is often a bigger risk than the cancer itself. Lastly, in the context of this mild, slow-growing cancer, the impact of treatment on quality-of-life—things like impotence or incontinence—may be greater than the impact on survival.
Who is better positioned to balance quality-of-life priorities with survival than the patient?

Knowing Your Stage

Participating in the treatment selection process is therefore unavoidable for prostate cancer patients. Selection of treatment revolves around the cancer’s stage, the patient’s age, and his quality-of-life objectives. As a result, knowing the cancer’s stage is crucial:
  • It reduces the number of therapeutic options and avoids the need to sift through vast amounts of unessential information.
  • It improves patient-doctor communication. Doctors can skip over basic explanations about stage and jump right to a comparative discussion about the most commonly used treatments for that individual’s specific stage.
  • It is the best way to obtain an accurate perspective of the cancer’s risk and the urgency (or the lack thereof) for more aggressive treatment (see below).

The Five Stages of Blue

There are five major stages of prostate cancer—Sky, Teal, Azure, Indigo, Royal—each containing three subtypes termed Low, Basic and High, for a total of 15 levels. The first three stages, Sky, Teal, and Azure are very similar to the standard risk categories of Low, Intermediate, and High-Risk diseases which were developed by Anthony D’Amico of Harvard Medical School.
Indigo and Royal represent relapsed and advanced prostate cancer, respectively. There are a number of other staging systems, but they all have shortcomings. Only the Stages of Blue represent the full spectrum of prostate cancer.

The Risk of Dying From Prostate Cancer

One of the greatest benefits of staging is that it provides insight into the disease’s seriousness, which is one of the most important factors in determining optimal treatment. Treatment intensity should be commensurate with the disease’s aggressiveness. Mild cancers deserve mild treatment. Aggressive cancers require aggressive therapy.
Enduring treatment-related side effects is unacceptable if the cancer is mild, whereas more side effects can be accepted when life-threatening disease is present. Table 1 shows how much the risk of mortality varies between stages.
Table 1: Risk of Dying Per Stage
Stage of Blue
Degree of Treatment Intensity Recommended
Risk of Dying
% of Newly-Diagnosed per Stage
Sky
None
<1%
50%
Teal
Moderate
2%
30%
Azure
Maximal
5%
10%
Indigo
Mod. To Max.
<50%
0%
Royal
Maximal
>50%
10%
Important Note: The table above shows that the degree of treatment intensity recommended for 80 percent of men who are newly-diagnosed (Sky and Teal) is either moderate or none.

The Timing of Mortality From Prostate Cancer                                                  

Prostate cancer behaves very differently from other cancers, especially in how slowly it grows. For example, mortality from lung cancer or pancreatic cancer may occur within the first year of diagnosis. Our familiarity with these terrible types of cancer explains why the word “cancer” causes so much consternation. Cancer, we think, equates with imminent death. But look how the statistics in Table 2 show how differently prostate cancer behaves.
Table 2: Survival Rates for Newly-Diagnosed Prostate Cancer

Survival Rate
Original Date of Diagnosis
5 Year
99%
2012
10 Year
98%
2007
15 Year
94%
2002
More than 15 years 
86%
Late 1990s
Consider that survival rates can only be determined by the passage of time; 10-year mortality can only be calculated in men who were diagnosed back in 2007, and by today’s standards, treatment back then was antiquated. Therefore, the survival statistics that rely on older technology might not represent the prospects of a patient undergoing treatment today. Survival rates will continue to get better with time, and, if anything, men with slow-growing prostate cancer have time.

Other Staging Systems Are Incomplete

When men ask their doctors, “What stage am I?” they are usually unaware that there are multiple different staging systems in use. Let’s briefly review the other staging systems:
  1. Clinical staging (A, B, C, and D) relates specifically to how the prostate feels on a digital rectal exam (DRE). This system was developed before PSA was invented and is used by surgeons to determine if the performance of a radical prostatectomy is acceptable (See Table 3).
  2. Pathologic staging relates to the extent of the cancer determined by surgery or by a biopsy.
  3. TNM Staging incorporates the information from both 1 and 2 as well as the information obtained from bone scans or CT scans.
  4. Risk category staging, which divides newly diagnosed men into low, intermediate, and high-risk categories, uses information from 1 and 2 plus the PSA level.
Table 3: Clinical Stage (DRE Stage)
Stage
Description
T1:
Tumor that cannot be felt at all by DRE
T2:
Tumor confined within the prostate
T2a: Tumor in < 50% of one lobe
T2b: Tumor in > 50% of one lobe but not both lobes
T2c: Tumor felt in both lobes
T3:
Tumor that extends through the prostate capsule
T3a: Extracapsular extension
T3b: Tumor that invades seminal vesicle(s) 
T4:
Tumor that invades the rectum or bladder













Components of the Stages of Blue

The Stage of Blue system utilizes all the other staging systems (1, 2, 3 and 4 listed above), plus it incorporates information about whether previous surgery or radiation has been performed.
  • Digital rectal exam: Normal vs. nodule vs. mass  
  • Gleason score: 6 vs. 7 vs. 8-10
  • PSA: <10 vs. 10-20 vs. over 20
  • Biopsy cores: Few vs. a moderate amount vs. many
  • Previous therapy: Yes vs. no
  • Imaging: Extent of disease, whether it is in lymph nodes or bones
You can determine your stage online at the PCRI website by answering a short question quiz at stagingprostatecancer.org.

What’s Wrong With the Risk-Category Staging System?

The risk-category staging system, which is constituted by the top three components in the bulleted list above, doesn’t include many of the important new staging factors that further enhance the accuracy of staging:
  • Multiparametric-MRI findings
  • The percentage of biopsy-cores that contain cancer
  • PET scan information
On top of that, the risk-category system doesn’t include men who have relapsed disease, men with hormone resistance, or men with metastases in the bones.

Once You Know Your Stage, Which Treatment Is Best?

The main value of knowing one’s stage is that it allows patients and doctors to zero in on the most sensible treatment options. In the remainder of this article, some stage-specific treatment options are presented for each of the stages.
Sky
Since Sky (Low-Risk) is a relatively harmless entity, and since we now know that Gleason 6 never metastasizes, labeling it a “cancer” is a complete misnomer. Ideally, Sky would be named as a benign tumor rather than a cancer. Therefore, all of the three variations of Sky, (Low, Basic and High)are managed with active surveillance. The biggest risk for men in Sky is the failure to detect occult higher-grade disease. So diligent scanning with multiparametric MRI at an experienced cancer center is prudent.
Teal
Teal (Intermediate-Risk) is a low-grade condition with excellent long-term survival prospects. However, most men require treatment. The exception is Low-Teal, for which active surveillance is acceptable. To qualify as Low-Teal the Gleason must be 3+4=7, not 4+3=7, the amount of Grade 4 in the biopsy must be less than 20 percent, only 3 or fewer biopsy cores can contain cancer, no core can be more than 50 percent replaced with cancer, and the rest of the finding must be like Sky.
Basic-Teal has more cores containing cancer than Low-Teal, but still fewer than 50 present. Men with Basic-Teal are reasonable candidates for single agent therapy with almost any of the modern treatment alternatives, including seed implants, IMRT, Proton therapy, SBRT, hormone therapy, and surgery.
High-Teal encompasses any set of criteria for a Teal patient that does not fit into Low or BasicHigh-Teal is more aggressive and should be treated with combination therapy that includes IMRT, seeds, and a four-to-six-month course of hormone therapy.
Azure
Azure (High-Risk) also contains three subtypes. Low-Azure is Gleason 4+4=8 with two or fewer positive biopsy cores, no biopsy core more than 50% involved with cancer, and all other factors like Sky. Men with Low-Azure are treated the same way as High-Teal.
Basic-Azure is the most common type of Azure and represents anything in the Azure category that fails to meet the criteria of Low or HighBasic-Azureis treated with radiation, seeds, and hormone therapy for 18 months.
High-Azure is defined as one or more of the following: PSA over 40, Gleason 9 or 10, more than 50 percent biopsy cores, or cancer in the seminal vesicles or pelvic nodes. High-Azure is treated the same as Basic-Azure, though possibly with the addition of Zytiga, Xtandi, or Taxotere.
Indigo
Indigo is defined as a cancer relapse after surgery or radiation. Whether Indigo is Low, Basic or High is determined by the likelihood of cancer spread into the pelvic nodes. Low-Indigo means the risk is low. To qualify as Low-Indigo, the PSA has to be < 0.5 after previous surgery or < 5.0 after previous radiation. Also, the PSA doubling time must be > 8 months.  In addition, the original Stage of Blue prior to surgery or radiation had to have been Sky or Teal. Treatment for Low-Indigo may consist of radiation (after previous surgery) or salvage cryotherapy (after previous radiation).
Basic-Indigo means that scans and pathology findings show no metastasized cells (known as mets), but the favorable criteria cited above for Low-Indigo are unmet. In other words, one or more of a variety of factors suggest that microscopic pelvic mets are more likely to be present. For Basic-Indigo, aggressive combination therapy with radiation to the pelvic nodes and hormonal therapy should be used.
High-Indigo means mets are proven to exist in the pelvic lymph nodes. The treatment of High-Indigo is the same as Basic-Indigo except that additional therapy with Zytiga, Xtandi, or Taxotere can be considered.
Royal
Men in Royal either have hormonal-resistance (a rising PSA with low testosterone) or metastases beyond or outside of the pelvic nodes (or both). Low-Royal is “pure” hormone resistance without any detectable metastases. These men almost always have small amounts of metastatic disease but it may be impossible to detect with standard bone or CT scans. New, more powerful PET scans such as Axumin, PSMA, or Carbon 11 may be required to find the metastases. Once the metastases are located, treatment will be the same as Basic-Royal.
Basic-Royal is the unequivocal presence of metastatic disease (outside the pelvis) but the total number of metastases is five or less. Treatment for Basic-Royal is a combination of SBRT or IMRT to all sites of known disease, Provenge immunotherapy, plus Zytiga or Xtandi.
High-Royal means that more than five metastases have been detected. SBRT or IMRT with so many metastases is usually not practical. When the disease is not rapidly progressive or painful, treatment should consist of Provenge followed by Zytiga or Xtandi. Painful or rapidly progressive disease should be treated with Taxotere.

Wednesday, 29 August 2018

Prostate Cancer for Beginners

Prostate Cancer Basics

Whether you or someone you know has been recently diagnosed with prostate cancer or you are simply interested in learning more about this important disease, there are three key questions that need to be answered.

What Is the Prostate?

The prostate is a small, walnut-sized gland that exists only in men. It is situated just below the bladder and just in front of the rectum in the lower pelvis.
The bladder acts as a storage area for urine. When the bladder is emptied, the urine travels through a thin tube called the urethra to the penis and then out. The very beginning of the urethra as it leaves the bladder passes directly through the prostate. This fact accounts for why so many men with either prostate cancer or BPH (benign prostatic hyperplasia) develop trouble urinating. As the prostate enlarges, the urethra is pinched off, leaving a smaller tube to carry urine from the bladder to outside the body.
The prostate’s primary function is to produce much of the fluid that makes up semen. Semen acts to protect sperm as it makes its way out of the body.
The prostate is present from before birth and grows in response to male hormones such as testosterone. Blocking the production or effects of these hormones is one of the primary treatment options for prostate cancer.

What Is Cancer?

Cancer is most simply explained as cells in a certain part of the body that have started to grow in an out-of-control and unregulated fashion.
The human body is made up of billions of tiny units called cells. These are the smallest structures in the body that can be considered to be living. They can only be seen under high-powered microscopes. Cells normally go through a life cycle of growth, division, and death. When this occurs in an orderly fashion, cells are created and die in roughly equal numbers. They also normally stay confined to the area of the body in which they were meant to be.
Unfortunately, certain cells sometimes begin to multiply much faster than they die. When this happens, these abnormal cells squeeze out nearby normal cells. These abnormal cancerous cells can also spread outside of their original site in the body and spread to other areas. When cancer from one body site has spread to other areas of the body, the cancer can be said to have “metastasized". This is always an unfortunate occurrence as cancer that has spread is much harder to treat in general.
A cancer is named after its original site in the body. For example, prostate cancer, even if it were to spread to the bones or to the colon would still be called prostate cancer and not bone or colon cancer. This would more appropriately be called “prostate cancer with metastasis to the bone.”
All types of cancer are different. For example, prostate cancer is very different from lung cancer. The two are caused by different factors, diagnosed in different ways, and treated differently. Regardless of the type of cancer, the underlying problem is the unregulated and abnormal growth of the cells in that part of the body.

What Is Prostate Cancer?

Since cancer is the uncontrolled and abnormal growth of cells in a certain area of the body, prostate cancer is simply the uncontrolled and abnormal growth of cells in the prostate.
Some men have BPH (benign prostatic hyperplasia). This is often confused with prostate cancer. With BPH, prostate cells multiply faster than they should. This causes the prostate to enlarge and the patient to develop difficulty urinating. With prostate cancer, the cells not only multiply faster, but also behave abnormally by spreading outside of the prostate if not caught in time. BPH is not cancer but can show some of the same symptoms.
The prostate is made up of many different types of cells. The gland cells (those cells that actually work to produce the fluid that is released into the semen) however, are nearly always the cells that become cancerous. The technical medical term for cancer that arises from gland cells is adenocarcinoma. Thus, the technical term for prostate cancer is prostate (or prostatic) adenocarcinoma.
Early detectionprompt diagnosis, and effective treatment are the mainstays of good prostate cancer care.