Why I have been silent!

[David House]

Some, though not too many I guess, might have noticed I have been missing for a few months.
There is a good reason for this. I have had quite a lot on my mind. I should by now be enjoying my new house on the beach in Cebu. Its finished, and has been for a few months but we cannot yet return. Maybe we can in around 3 months from now, but maybe we will not be able to then.........or ever. Our business is in the process of being sold and we should be house hunting, but even that has had to be postponed until things become clearer.
So what is the problem? Well if you really want to know visit my blog at:-
http://david-atthecrossroads.blogspot.com/ and it will explain all.
Those who do, please let me know what you think.

[Steve.r]

OMG David! I certainly will be wishing for a sucessful outcome. I can't imagine how you must be feeling right now. Be sure that anyone who reads your blog will be wishing you only good thoughts. Take care of yourself, keep dreaming of your home on the beach. Please keep us updated.

Steve

[Doc Alan]

I'm a relative newcomer here, but I've read your blog and share what Steve has just said to you. I really can't fault what you have said on your blog.
It can be hard for people to find the right words in these circumstances, but,no matter how many replies you get, you can be sure that all those who read your thread will sympathise and wish you all the best :xxgrinning--00xx3:

[Florge]

xoxoxoxoxo...

my husband and i will be praying for you david...

[nigel]

Focus on the outcome that you want, and feel how good it's going to feel, I believe in Law Of Attraction me...:)

[maria_and_matt]

So sorry to hear this, stay positive please will be saying a prayer for you.

Maria, Phil and Matthew

[liane]

I have read your blog and I am sorry to hear about this David.
We will be praying for you and I hope things get better.

[fred]

Sorry to hear about this news David..You must be shattered.
We have a situation here too.. One of my workers here (2 years service) was complaining about an upper back problem so we sent him for an X ray 2 weeks ago..As the X ray was unclear we sent him for a CT scan.. The scan shows a large mass in his left lung..His wife hasn't told him yet as she is scared to.. Im sending him to Cebu next week for a biopsy but I have a feeling that it may be too late..
Its gonna cost me a nice few bob but when I see his young kids there is no way I will abandon this family now..
He`s 42. Really tough situation ..


I was talking to an Aussie about this and he says he will live longer if he remains ignorant..Stay positive was the message.
Apparently aboriginal leaders would point an animal bone at perfectly healthy members of the tribe and condemn them..Seems as these "condemned" would simply walk off and die.. They simply worried themselves to death..

Stay positive and perhaps your luck may begin to change..
Dont give in.
Regards,
Fred.

[David House]

Thanks for the replies and good wishes guys. I am most certainly staying positive and fully intend to make the very best of everything, for however long it lasts. Right now I don't know how long that is, but thats' the same for all of us, although in my case I probably have rather more reason to be concerned.
I don't agree with the advice offered about it being better to remain ignorant. If an early diagnosis is made then action can be taken which will stop the progression and enable a pretty normal life. If ignored it will spread in time and your life will be cut short. I am still waiting to know if mine has been found early enough.
The whole point of sharing this is to encourage guys to be aware of the warning signs and not to ignore them, which is so easy to do. Until just a few months ago I was convinced I would live for ever. Sure, I had had a few aches and pains, and more night time loo visits than when I was 20, but most people found it hard to believe I was 65. So did I!
I don't want to frighten anyone. I just want them to not ignore things which might be considered as the normal consequence of ageing, both by them and their doctor. Insist on getting it fully checked.

[keithAngel]

Hi David long time no see its 15 months since we had such a pleasant evening at Dionnes bar.

I dont know exactly what you mean by the NHS rules but if your house is ready then your only 18 hours away from the uk and if your care program allows I would spend as much time in it as you can and look in to the possabilities there to at Cebu Doctors etc Folowing your dream is always going to add rather than subtract from your life if not in time then in Quality

I wish you and Connie all the very best and welcome to the coffin dodgers club:xxgrinning--00xx3:

[David House]

Hi Keith

Thanks for your good wishes and I very much hope to enjoy lots more good evenings in Diones's bar. For those who don't know it I thoroughly recommend it as a really pleasant venue on Mactan Island, Cebu. Largely populated by ex pats it is not at all a "girly" bar but serves really nice, western style food and has a live band on Saturday nights. The band are relaxed and friendly and encourage "guest" singers to come up and join them. As Connie has spent 3 years in a band herself, and is now gigging regularly here in the UK on her own, this is a way for her to keep up to date with new songs etc.

Regarding the NHS issue, this is really important and I invite the input of anyone with direct experience. My understanding is that once you have spent more than 3 consecutive months out of the UK you lose the right to free NHS treatment, other than for emergencies. This applies irrespective of whether your NI payments have all been made, have a UK residence and pay UK taxes. We can of course, fly back and forth, every 3 months but that gets expensive and was not what was planned. We planned to spend October through to April/May in Cebu and the summer in the UK. However if I need regular treatment, or even monitoring, then I want it done by the NHS and may have no choice.

David

[Steve.r]

I remember when I was an expat (saudi for 2 years) I paid a nominal payment to NI which allowed me to have all the benefits of the NHS. I went to the local tax office to arrange this. This was about 20 years ago though, so might have changed by now. hth

Steve

[fred]

We can of course, fly back and forth, every 3 months but that gets expensive and was not what was planned.David you are entitled to use the NHS as long as you decide to resume your residency in the UK after having lived abroad.



(from the NHS website)

Are you taking up or resuming permanent residence in the UK?



Under the current Regulations, anyone who is taking up or resuming permanent residence in the UK is entitled to free National Health Service (NHS) hospital treatment in England. If your intention is to live permanently in the UK you will be exempt from hospital charges from the date of your arrival in the country but you should expect to be asked to prove your intention and that you are legally entitled to live here. This exemption applies to your spouse, civil partner and children (under the age of 16, or 19 if in further education) if they are living here with you on a permanent basis.
http://www.dh.gov.uk/en/Healthcare/E...able/DH_074376 (http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/Browsable/DH_074376)

[Piamed]

Hi David

I'm incredibly sorry to hear what you are going through. I happy that you are mai ntaining a positive disposition and am really hoping that the cancer has not spread. You are certaininlyt in our thoughts/prayers.

all the best!

Toks

[Arthur Little]

Being of the same vintage as you, David, I'm all too aware of how easy it is to be "wise after the event" ... by confusing the symptoms you've described, with the vague aches & pains [and other conditions] normally associated with the ageing process. After all, when life seems good in every other respect, who really wants to even contemplate the prospect of one's own mortality? :rolleyes:

It's often said that "a trouble shared, is a trouble halved" ... and you are to be commended for your frankness in relation to the diagnosis - in the hope that others will learn from your experience. As has already been mentioned, it is always difficult to find the right words to express to someone in your situation, but please be assured of our thoughts and prayers as you await further test results. :xxgrinning--00xx3:

[Gavanddal]

David you are entitled to use the NHS as long as you decide to resume your residency in the UK after having lived abroad.



(from the NHS website)

Are you taking up or resuming permanent residence in the UK?



Under the current Regulations, anyone who is taking up or resuming permanent residence in the UK is entitled to free National Health Service (NHS) hospital treatment in England. If your intention is to live permanently in the UK you will be exempt from hospital charges from the date of your arrival in the country but you should expect to be asked to prove your intention and that you are legally entitled to live here. This exemption applies to your spouse, civil partner and children (under the age of 16, or 19 if in further education) if they are living here with you on a permanent basis.
http://www.dh.gov.uk/en/Healthcare/E...able/DH_074376 (http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/Browsable/DH_074376)

As far as I can see this is only relevant to EU members coming to live here. It states clearly in a separate section that free NHS treatment is "residency based" i.e. only valid whilst you are living here.

If you were of retirement age and claiming a pension in the Phils then trying to get NHS treatment would be hard. If you were below pensionable age and kept an address in the UK you could probably get away with still receiving NHS treatment by being perceived as still being resident in the UK.

Who decides where you're resident? If you cut all ties with the UK then clearly you're no longer resident. Seems best to keep a foot in both camps.

[joebloggs]

good luck david

:NoNo:

[David House]

It is my current understanding that you must be permanently resident in the UK and returning ex pats must be here for 12 months before they will get NHS treatment for free again. Whilst it used to be the case that maintaining a UK home, as we will, would probably be sufficient not to draw attention to the fact that we were spending time in the Philippines things have changed. My doctor told me that Local Primary Care Trusts are now required to return to the centre files for anyone with whom they have not had contact for 3 months. I presume he means anyone who has an open and active treatment programme underway, otherwise that would include a lot of perfectly fit people! The UK border agency computers are also soon to be able to monitor all entries and exits and match them against NHS records so hiding your situation will become pretty difficult.
Whether this is fair or not is another question, but that is how I understand it. I am though seeking guidance on the issue to determine what steps I can take to mitigate the effect.
As far as I can see this is only relevant to EU members coming to live here. It states clearly in a separate section that free NHS treatment is "residency based" i.e. only valid whilst you are living here.

If you were of retirement age and claiming a pension in the Phils then trying to get NHS treatment would be hard. If you were below pensionable age and kept an address in the UK you could probably get away with still receiving NHS treatment by being perceived as still being resident in the UK.

Who decides where you're resident? If you cut all ties with the UK then clearly you're no longer resident. Seems best to keep a foot in both camps.

[fred]

As far as I can see this is only relevant to EU members coming to live here.I am a British citizen. Does that mean Im not an "EU member"?

Under the current Regulations, anyone who is taking up or resuming permanent residence in the UK is entitled to free National Health Service

If your intention is to live permanently in the UK you will be exempt from hospital charges from the date of your arrival in the country

Once you are living here permanently(Which I am perfectly entitled to do)you will become ordinarily resident and the Regulations will cease to apply to you. Your spouse, civil partner and child will also be considered ordinarily resident if they are living permanently in the UK with you and have the right to do so. If they are not living permanently in the UK then the Regulations will apply and in order to be entitled to free hospital treatment they will have to meet one of the categories of exemption in their own right.



Seems pretty clear to me but your mileage may vary!!.

Cheers,

Fred.

[David House]

Thats right, but we intended to spilt our time 50:50 between the UK and our new house in Cebu and accepted that we would not be able to gain access to NHS treatment unless and until we became permanent UK residents again.
Now things have changed and I may well need regular treatments so the decision to go and spend longer than 3 months in Cebu needs to be re-examined. Nothing can really be decided until I know exactly what my prognosis is, and that may yet take some time.
I am a British citizen. Does that mean Im not an "EU member"?

Under the current Regulations, anyone who is taking up or resuming permanent residence in the UK is entitled to free National Health Service

Once you are living here permanently(Which I am perfectly entitled to do)you will become ordinarily resident and the Regulations will cease to apply to you. Your spouse, civil partner and child will also be considered ordinarily resident if they are living permanently in the UK with you and have the right to do so. If they are not living permanently in the UK then the Regulations will apply and in order to be entitled to free hospital treatment they will have to meet one of the categories of exemption in their own right.



Seems pretty clear to me but your mileage may vary!!.

Cheers,

Fred.

[fred]

David,

I quite understand your concerns and under the circumstances I think you have made the correct decision in changing your initial plans..
Best regards,

Fred.

[David House]

An update on the rules for obtaining NHS treatment. I spoke with the Department of Health, and then, on their recommendation with my local PCT.
It is confirmed that once you spend 3 months or more outside of the UK that free NHS treatment is withdrawn, other than for emergencies.
However I have been told that provided I can convince the NHS, on my return, I will once again become a permanent resident that this right will be re-instated. I was told that to qualify as "ordinarily resident" I would have to demonstrate that I would be in the UK for a minimum of 6 months. Proving intention will be the problem, so I will be discussing this with my care team at the appropriate time, which will not be until after my prognosis is known and my treatment plan determined.
I am to undergo an MRI scan tomorrow and expect to learn how things look early next week.

[Sim11UK]

All the very best for tomorrow. :xxgrinning--00xx3:

[David House]

I got my results yesterday and have summarised the last few days in my blog which can be read at http://david-atthecrossroads.blogspot.com/
It's pretty good news!

[liane]

I got my results yesterday and have summarised the last few days in my blog which can be read at http://david-atthecrossroads.blogspot.com/
It's pretty good news!

Well done, good news indeed David :xxgrinning--00xx3:

[Sim11UK]

Good to hear, I was wondering how you got on...Keep us posted. :)

[Doc Alan]

Thanks for updating us with your good news. You should not torment yourself with the thought, as expressed in your blog, that "it's pretty obvious that cancer was already there and was missed" - it may have been there but was almost certainly not missed by the pathologist, a doctor whose skill it is to examine the excised tissue under the microscope. It's more likely that it was genuinely not present in the original prostate tissue removed. Secondly, as you say, a PSA of 20 indicated "possible prostatic cancer". PSA means prostate specific antigen, not a specific prostate cancer marker.

[David House]

Thanks Alan.
Since writing that part of my blog I have been given more information. My PSA at the time of my TURPS was found to be only 2, so as a consequence no biopsy was done. It seems that the material removed during a TURPS is from the central part of the prostate, whereas the cancerous cells tend to be on the outside, thus making a biopsy irrelevant. I may well already have had the tumour, and it was incorrectly diagnosed as benign enlargement, as the PSA level is only an indicator and not a totally reliable test. We will never know and I certainly don't hold any grudges. My point really was to make people aware of these issues so that they can spot the warning signs.
Thanks for updating us with your good news. You should not torment yourself with the thought, as expressed in your blog, that "it's pretty obvious that cancer was already there and was missed" - it may have been there but was almost certainly not missed by the pathologist, a doctor whose skill it is to examine the excised tissue under the microscope. It's more likely that it was genuinely not present in the original prostate tissue removed. Secondly, as you say, a PSA of 20 indicated "possible prostatic cancer". PSA means prostate specific anntigen, not a specific prostate cancer marker.

[keithAngel]

Good oh David the beach calls :xxgrinning--00xx3:

[Doc Alan]

Thanks Alan.
Since writing that part of my blog I have been given more information. My PSA at the time of my TURPS was found to be only 2, so as a consequence no biopsy was done. It seems that the material removed during a TURPS is from the central part of the prostate, whereas the cancerous cells tend to be on the outside, thus making a biopsy irrelevant.... My point really was to make people aware of these issues so that they can spot the warning signs.

David, you are very well informed and you are right to make men aware of the symptoms. :xxgrinning--00xx3: The tissue removed at TURPS (transurethral resection of prostate) would in fact automatically be sent to the pathologist, but as you correctly say it is likely that tissue would genuinely not be cancerous. Needle core biopsies are taken from suspicious areas of the prostate and also examined microscopically, then given a "Gleason score" by the pathologist to indicate the grade of cancer. As you will understand it's not necessarily a simple matter of "cancer" or "no cancer". :NoNo:You will also know that cancer treatment is based on "multidisciplinary team" decisions (surgeon, oncologist, radiologist, pathologist, nurse specialist, and others), using the best evidence available for each individual patient:xxgrinning--00xx3:

[David House]

I have just updated my blog. The latest situation is as follows:-

I have now met with both the Oncology and Surgical teams to review what treatment options are available. I met the Oncologist at my local hospital. She is a lovely, empathetic lady, very informative and thorough. The radiotherapy would take place daily at Addenbrookes in Cambridge and last for seven weeks. Addenbrookes is 90 minutes from home but they have some kit there which enables the radiotherapy to be directed very accurately and avoids damaging other tissues. The treatment would be proceeded by 3 months of hormone reduction medication, to shrink the size of the prostate.
I met the Surgeon at Addenbrookes, which is also where the surgery would happen. This would be done using a robotic technique known as a "Da Vinci" machine. It is essentially keyhole surgery, less invasive, should avoid damaging other tissues and should make recovery quicker. I had read about these machines being used in the USA but was unaware that it was available here. It seems that the NHS now has 16 of them at various regional centres. The surgeons who use them need special training and I found out that they have all spent time in the USA receiving this and that surgeons from the USA have also been to Addenbrookes to assist in the familiarisation process. This is still major surgery but I count myself very lucky to have it available. The immediate side effects are unpleasant, involving a cathetor for a week or two but nothing I cannot cope with. The long term side effects are more important and most men will suffer some or all of them. They include incontinence, erectile disfunction (which may not be helped by blue pills!) and certain infertility.
The follow care on both options are similar. 6 weekly checks to start with, moving on to 3 monthly and ultimately to 6 monthly. These checks will monitor my PSA levels. It should drop to almost nothing after treatment. If it starts to rise again then it means that some cancerous cells have escaped and are growing elsewhere. That would be the worst news so these monitoring visits are going to be far from routine.
As it seems that 1 in 3 guys are not "cured" by either treatment and face the prospect of their cancer returning I am not out of the wood just yet, and may well be on the edge of a forest for the rest of my life.
Having reviewed both options very thoroughly I have decided to receive the surgery and will enter hospital on May 12th. Both seem to offer as good a result as the other but with the surgery there is always a backup option to receive radiotherapy to the area around the prostate capsule should any cancer be found there later. If I select radiotherapy as the initial treatment I cannot then have any more and surgical removal of such cells is not possible.
So now I know what my immediate future holds. I have other pressing decisions to do with my business and my retirement yet to make but at least this one is out of the way.
Thanks for reading. If you want to avoid all of this, then please do keep a good check on your own health.

If you want to read the whole story go to:- http://david-atthecrossroads.blogspot.com/

[Doc Alan]

If you want to avoid all of this, then please do keep a good check on your own health...


...as in my thread "What's up doc" which I ask everyone to read just once :xxgrinning--00xx3:
Thanks for sharing this information with us David, obviously everyone wishes you well. None of us actually know how we would respond when faced with a serious diagnosis such as yours, no matter how well informed we might be. Not everyone would wish to bother writing about their experiences. But I'm sure those who spend a short time reading your posts will gain useful insight. All best wishes to you :xxgrinning--00xx3:

[fred]

That is GREAT news David!! Hopefully you can soon get back to your original schedule here in paradise!

[aposhark]

Hi David,

I missed this thread but I would like to wish you all the best for the future :xxgrinning--00xx3: