Men's things XXV: Prostate cancer under control

Gathering my thoughts

There are many things to be grateful for: life, health, relationships, friendships, hope, faith, and the love that conquers all.

It's now been over a year ago that I began the twenty sessions of hypofractionated external beam radiotherapy for prostate cancer, the aftermath of which includes an extended time of monitoring and care. [NHS England: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (PDF) 25 pages.]

After meeting with the multidisciplinary team in March, in conversation, I was to be seen again in 4 months, but the letter to my doctor indicated 5 months. But I received no appointments, so I had to consult the oncology department secretary about it.

It took her just over three weeks to respond. That was after I placed a phone call to her number and left a message that got a nurse to call and plan to be seen within three weeks.

Reviewing the process

Any appointment would have required first doing a serum prostate-specific antigen (PSA) test and getting the results before the appointment, and the secretary gave me just 6 working days to my next appointment to get that done.

Thankfully, for my Monday appointment, my GP surgery invited me on Thursday to provide a blood sample, and I was able to access the result on the NHS app last night.

I was concerned because the PSA results from February 2024 and the 5 test results altogether have fluctuated in ways that if I had not taken decisive action to act on the possible presence of prostate cancer by urging my doctor to be engaged, responsive, and proactive, the malignancy would have continued untouched to a seriously life-threatening situation.

This is because, in early February 2024, the PSA was borderline high at 3.5, then 7 weeks later at the end of March 2024, it had risen to 4.0 and needing further investigation, that started with a Digital Rectal Examination (DRE), through a multiparametric MRI (mpMRI) scan in April 2024, an ultrasound-guided transperineal biopsy of the prostate gland in May 2024, and a stage-2 prostate cancer diagnosis in June 2024 with the recommendation that I undergo active treatment.

Making your decisions towards the best outcomes

In July 2024, I made the choice between a radical prostatectomy and radical radiotherapy, opting for the latter, though on seeking a helpful opinion from Prostate Cancer UK, the nurse thought it was better to opt for active surveillance or watchful waiting.

I was not going to wait to watch what a clear diagnosis of cancer was going to do in my body, and worry myself silly about what I could have done on the back end of having this knowledge. That was the last time I called Prostate Cancer UK, because having come this far, I needed encouragement and support, not dissuasion.

As I prepared for radiotherapy, we had another PSA test at the end of August 2024, and it had fallen to 2.0. That sneaky thing could have been a dangerous signal to abandon treatment, as the reading had fallen below the danger zone into the normal range. However, that did not mean the cancer had suddenly disappeared. Either way, I was going through with the radiotherapy.

This began on the 12^th of September 2024 for every weekday until the 9^th of October 2024, and I worked through it, even as the side effects of chronic fatigue and bladder issues took hold. A month after treatment, I took an extended sick leave that lasted just under 2 months, spending most of that time with Brian, caring for me in Cape Town.

After treatment monitoring and beyond

When I went for my first post-treatment checkup in early April 2025, the PSA test I took, the previous week at the end of March, read 2.6 and this was the cause of my concern and it led me to question the reliability of the PSA test as an indicator of reduced prostate agitation, especially after radiotherapy, but then I also realised that the period of recuperation could be long, as exemplified in my strength, and voice.

My reckoning was that if the PSA result did not fall at my next appointment, I would request a second mpMRI scan. I am glad to say that on my receipt of the results last night, that might not be necessary as the PSA has fallen to 1.3 micrograms per litre (µg/L).

However, for my meeting on Monday, I am on alpha blockers since that regulates prostate function, since October last year, and I might be on that for some time, and I have had two episodes of epididymitis in May and August. We might have to discuss the hows and whys of that.

Apart from the occasional insomnia, the fluctuations in my voice, irregular occurrences of fatigue, and some restlessness that besets me at various times, I am doing quite well and happy with the improvements, grateful for the support from many people who have helped me through interesting times.

When I am presented with the opportunity, I talk about men’s things, the need for us to be conscious of the health of our bladders, bowels, prostates, testicles, and sexual organs. These things matter, and catching anything going awry early is of the utmost importance.

Here’s to life and living. Thank you.

References

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things - XXIV - A presentation

Blog - Men's things - Prostate Cancer blogs

The ordeal of another Microsoft certification test

Sorely tested to the testicles

By the time I clicked on the submit button, I was all shook up in an Elvis Presley kind of way. I had no time for filling out feedback forms, I had been stripped of every dignity and confidence suggesting passing this Microsoft test, I was expecting some bad news.

It was 57 questions in 100 minutes, I barely had 90 seconds to spare at the end. Then, I rarely mark questions for review, my first answer or gut feel response is usually my final answer, no point scraping over sores left by finding out that you’re not as sure as you thought you were.

It is just over three weeks ago that I passed another test with barely a week of preparation.

The preparation never ends

I had painstakingly gone through the theoretical stuff for this one, and attended courses from both Udemy and Coursera, I could even run the latter at 1.5x and keep up with what was being said. Practice, practice tests, even AI producing flashcards for revision. It could easily have been 48 hours of serious study in just over 2 weeks.

What other tips I could get from people who had passed or failed the test were best viewed from Reddit, everything filled the spectrum from a full gloat to despondency at multiple attempts without success. You had to feel bad for them and there was a moment I thought I would be returning as a glutton for punishment in a few days to revisit the site of my drubbing.

My initial plan was to try for Tuesday, but I had a health progress meeting in the afternoon. It wasn’t until Wednesday afternoon that I decided I had done enough, and I booked the test for Friday with hardly any leeway for postponing or rescheduling the test.

Time is not as kind

One new feature of the test is the open book facility, useful for getting exact details, but it could be a time-consuming trap when looking for ideas or processes. I fixated on the documentation section where I needed to and pored through the search results page for clues before clicking on links to dig further. It is helpful, but time suddenly plays like an hourglass; given girth to let the sand through without constraint.

The most important thing is not to panic, get to the direct question asked then walk back to the scenario or setting presented, especially when you are running out of time. Things click better when you know what you are looking for having had a glimpse of the suggested answers.

When the final screen came up, I had not done that well in one section and did much better than average in the three other sections. The most important thing, I had exceeded the passing score, I passed. Amid the shaking and trembling, as I tried to catch my breath, I signed out, collected the printout and called Brian. What a relief and well, it is preparations in earnest for the next certification test.

Men's things - XXII

The post-radiotherapy situation

Three months ago today, I rang the end-of-treatment bell in the radiotherapy department of Christie Hospital. Twenty weekdays of hypofractionated radiotherapy administered to the cancerous parts of my prostate gland had begun to take its toll.

These three side effects that took hold started with chronic fatigue quite early in the treatment, then insomnia, and uncomfortable bladder issues increasing the difficulty in passing urine along with sometimes stabbing and sharp pains in the urethra. The fatigue affecting my energy levels seriously impacted my natural voice which regularly fades into a tired sounding voice belying other issues.

As I have reported, my recuperation continues apace. Though I worked through the treatment and for a month thereafter, the side effects of radiotherapy had become such that I needed to totally take time off to rest, recover, and recuperate while availing myself of essential care, help, and support of my partner, Brian.

Some side effects persist, the main one around the bladder and urinary functions is managed with medication, I feel stronger and able, but I need to manage wisely my return to normalcy as it is becoming obvious that these things take time.

Take heed and test

At any opportunity especially with young and middle-aged black men, I talk about prostate health, the need for checkups and the essential work of removing stigma and embarrassment from talking about men’s things. Things around the male reproductive system that crudely and culturally define manhood, manliness, masculinity, or virility.

Any black man over 45 should be aware and conversant with their prostate health as statistically, 1 in 4 black men will encounter prostate cancer in their lifetime. The risk is heightened if your mother or sister has had breast cancer or if your father or brother has had prostate cancer. [Prostate Cancer UK: Black men and prostate cancer]

This matter should not be trifled with, if caught early you have many options for treatment and cure. What would be unfortunate is to find that prostate cancer has spread and metastasized and there is little that medical intervention can do.

Prostate enlargement or inflammation may not be indicative of cancer, but every occurrence of what is called benign prostate hyperplasia needs to be checked out. [NHS: Benign Prostate Enlargement]

Early action helps prompt intervention

You can easily determine if your prostate has problems by running the IPSS Calculator. The International Prostate Symptom Score (IPSS) is a somewhat subjective assessment of your bladder and urinary health since the prostate gland is a muscular switch that sits beneath the bladder, surrounding the urinary tract as it exits the bladder and controlling urinary and ejaculatory flows.

Regardless of the IPSS score, it might be useful in persuading your medical team to conduct a Prostate-specific antigen (PSA) test. In my case, adverse readings on other blood tests and the fact that I am in the above 45 cohort became the impetus for requesting a PSA test in early February 2024. [NHS: PSA test]

The PSA test result would determine if other investigations and interventions are necessary. Again, in my case, we caught it early, addressed the options, and commenced effective treatment, and I am on the way to full recovery.

Men's Things Blogs

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Men's things - XX

Insist and be insistent

Some encounters with the medical establishment can be unbelievably sublime and others exhibit inertia and obduracy, you might find pulling teeth a greater pleasure to enjoy. Here I was trying to get a sick note that I was told was easily obtainable and assured would be ready on Monday only to meet with a bureaucratic reluctance to fulfil what clearly everyone concerned knows is needed.

As with these things, I insisted against their prevarication, eventually someone cottoned on the idea that I was here for new excuses or postponements, something had to be done and so they sought out a late shift doctor and somehow found a stache of ‘Statement of Fitness for Work’ forms to be annotated and initialled by the doctor.

Their first attempt was clumsy, signing me totally off activities and the hospital stamp was upside-down. My reaction brought a reconsideration, and they did it properly with the caveats I wanted. It was an easy enough job with the will and opportunity to do it, hardly an encumbrance, this is a hospital, for crying out loud.

Just that spike is all you need

As I was chatting to a doctor, I also felt I could ask about the last two blood tests conducted a fortnight before my first radiotherapy session, my glimpse of the blood form indicated both the Prostate-antigen specific (PSA) and testosterone levels. I could not find the results anywhere as they were not communicated to my GP.

My PSA had fallen to within normal levels and testosterone was reading levels on the low side of the normal range. There must have been some other indicators in earlier blood tests to suggest I did not need hormone therapy before radiotherapy as testosterone has never been in the cachet of tests I have done before.

If I had not unilaterally pursued the need to recalibrate readings from my blood tests in February towards remediation by intervention, we would never have been on this track to discover prostate cancer and it might have been seething and growing undercover, but for that spike in my PSA in March that forced an investigation.

Do the graft on your bloodwork

It is no doubt incumbent that anyone with a modicum of literacy must take immediate interest and seek to understand what the results of blood tests are whether they fall in the normal ranges for your demographic and where they do not, ask questions and be unrelenting until this is explained in the simplest of terms. Err towards interventionism than otherwise, cancer is not something you wait and see grow like a wild weed in your body.

Demand answers and seek a second or even third opinion, speak with experts and learn all you can to be sure you are getting the best treatment towards the most beneficial outcomes. If you must go private and have the means to do so, do not count the cost and end up paying a costlier price.

The goal is the best outcomes

It took 7 months to get from my first request for a blood test to where the prostate cancer is being effectively treated with radiotherapy. I will cover in more detail sometime in the future, why I opted for radical radiotherapy over a radical prostatectomy. It was about the post-treatment quality of life more than anything else.

If anything, and for about 15 years, I have learnt and understood that your biggest advocate for the best outcomes when engaging the medical community is you, your voice, your initiative, your instigation, and your relentlessness. You are the centre of your diagnostic, prognostic, and therapeutic options. Remember, it is always your body first before it is their Guinea pig, that premise is non-negotiable.

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Men's things - XI

Generational medicine involves talking

It is one of those unspoken things that even became the butt of a joke and some rather frank talk, though, I am not laughing now. Along the way, I have not acknowledged certain conditions that have appeared in the family, that medicine would consider factors indicative of a predilection to that condition.

This area of generational medical history is somewhat more developed in female medicine, like if breast cancer has been diagnosed in one member of the family with any degree of consanguinity, other females are advised to undergo tests and attend to a regular monitoring of their health to catch issues early. Some females even take radical precautionary measures if genetics suggest a susceptibility.

Reluctantly, it was during an eye test a few years ago that I volunteered the information that someone else in the family had glaucoma. I did not and do not, but that information alone meant from that time on, my eye tests were free on the NHS. When the patriarch did attribute certain chronic health issues to the prostate, I found myself dismissing the concern as that of a hypochondriac. [Refer to the first sentence of this blog, for the context.]

The cancer you can see

Prostate cancer is now an issue to deal with but differently from when I first had cancer some 15 years ago. Then with Kaposi’s sarcoma, I saw it appearing for almost a year like the slight irritation of Athlete’s foot that did not respond to any fungal treatments and then a discolouration that I ignored even as others where noticing that my health was beginning to deteriorate. I just put a brave face on things and continued as I always did.

Then, it became a painful weeping sore, at which point, it is was stupidity that took hold, I could weather this problem, I thought. Just bandage up the foot and walk, it was bearable enough until it became unbearable. When I finally went to see my doctor, if there was any alarm in her voice, she was as measured as she could be, as she said, “This is serious, I need to refer you.”

She probably had seen many presentations of late cases like mine before, her urgency coupled with care and understanding without any judgement, condescension, or condemnation was very helpful in accepting the seriousness of my condition. I could feel the cancer, I could see it too, it was utterly dreadful and thankfully something could be done about it.

Appreciating the graveness of my condition was exemplified in the statement of my consultant, just two weeks later. “We can treat this,” he said, “but it depends on how your body can take the treatment.” He continued. “If you can tolerate the treatment, you’ll be fine, if not, you probably have five weeks.” Five weeks! Life could have ended before the end of 2009.

A different prospect presents

With prostate cancer, everything is internal, the biopsies would suggest cancer has been detected very early and again something can be done about it. Apart from the results of the Prostate-Specific Antigen (PSA) test that led to the Digital Rectal Examination (DRE) suggesting an enlarged prostate and so, a multiparametric Magnetic Resonance Imaging (mpMRI) scan, and consequently an ultrasound-guided transperineal prostate biopsy, these are all internal medical indicators, I feel fine and well.

The weight of this situation is inferred in many other ways, as being added to the National Cancer Registry with a diagnosis and the initial prospect of treatment options that on the face of it have no particularly pleasant outcomes.

The invisibility of this invasion on my particularities and what might portend has me in a dalliance of disbelief and anxiety. I am steeling myself, not with substance abuse, but with the encouragement of the Word of God.

It is probably a kind of delayed shock too; I am here with my partner, and it is difficult to bring up the subject in the first instance and then begin to assess the situation. Yet, we must face up to what we intend the outcomes to be, first with myself and then together. It feels like we are hardly anywhere there.

Why I am writing about this

Any health condition is difficult to talk or write about, especially among men and even more so when it comes to men’s things. Black men are too macho for such talk.

I took the PSA test as an add-on blood test in trying to address an anaemic situation that I had tracked through two previous sets of results that were indicative of a deficiency in vitamin B12, iron, or folate (vitamin B9).

Years ago, I had folic acid deficiency anaemia and knowing that it is essential in binding other vital vitamins and minerals for good health, I wanted my doctor to address it, this has given rise to a series of Men’s things blogs.

One alarming statistic is, 1 in 4 black men will get prostate cancer in their lifetime. [Prostate Cancer UK], I don’t know if 1 in 100 or even 1 in 1,000 black men get the basic PSA test to forestall any indication of prostate activity for medical intervention. I reproduce the information from the Prostate Cancer UK website below:

You may also be more likely to get prostate cancer as a Black man if:

• you are aged 45 or over – and your risk increases as you get older
• your father or brother has had it
• your mother or sister has had breast cancer.

As for my journey, I already have a diagnosis and will avail myself of all medical expertise available strengthened by faith whatever the situation. We never quit living and living well.

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Telling new tales again in blood

Just for the blood

I winced in nearly excruciating pain as the phlebotomist tried to extract 10 vials of blood from my veins and was most assuredly doing it from a muscle or tissue in my arm. The flow had stopped early and the wriggle room she found was a bruising stab with push and ease to fill the vials with blood.

This was the most ever that had been extracted for tests since I attended a follow-up consultation for my biannual checkups. In my discussion with the consultant registrar who saw me on Wednesday morning, I presented all my concerns with the results I had been getting for the past 8 months to determine any trends to address issues early.

Before giving blood, I was asked for a urine sample, the colour was richly white wine yellow and not too bad a bouquet, as I explained to the nurse to account for the fact that I had a prostate biopsy a few weeks ago, and this might affect the quality of the urine sample. It was however the most painful blood clinic I ever attended.

Even when they could not find blood and I had been punctured to the effect that I could pass for Swiss cheese, pain was never a component of that experience as this was, the comforting just-a-scratch statement before you are stabbed with a hypodermic needle was replaced with the phrase, ‘almost done’ and there were still 5 vials to go. It was her poor technique and nothing to do with me having latent or actual belonephobia, which could easily induce the fear of medical procedures if I remember the staple gun sound of the biopsy procedure.

Turning up and turning out

However, the day started slowing with what was a night of not enough sleep and as I planned my journey to the hospital, I decided on an easier ride that took me through backroads I have walked many times but never plied in a vehicle. The driver was the first of many who complimented me. The desire to present a sunny disposition regardless of the circumstances remains one I enjoy.

As I stepped out of the vehicle when we got to the hospital, a nurse stopped me in my tracks too and with her compliments said words to the effect, “It is nice to see a gentleman take the time to dress up nicely.” It might be a hospital where we all come to a humbling of our humanity, but that should not mean the absence of humour, goodness, brightness, and something to put a smile on people’s faces. I think my mere appearance did as much for some.

More than miscellaneous

Having printed out my notes from that last visit that needed updating and corrections, we dealt with my health, my welfare, my social situation, the many questions I had, the opportunities for a new line of therapies I was not ready to assume until I had read up on the study. Strangely, medical decisions had been made to include this in our regimen even as Europe, Australia, and New Zealand, along with China and Japan did not have any participants in the cohort study. I had my misgivings.

As I asked for another serum folate check which determines whether I have a folic acid deficiency, another one could not be booked as there had to be a 90-day lapse from the last check in the hospital systems. I then realised that my general practice and the hospital shared the same blood laboratory. The hospital had visibility of all the results, whereas my general practice could only see the results of the tests they had ordered.

The integration and agglomeration of systems cannot come sooner, they need to be reading from the same set of data, not repeating tests to confirm situations. I sought and got an alignment of my pill regimes which had gone askew since 2018 but had me putting in a new prescription for one of them last month because my usual April – October consultations had drifted to November – May, and now is on a June – December biannual cycle.

It was a nice outing to the hospital, not much bruising in my arm and I caught up on much-needed sleep.

Drought in bladderland

You’ve seen it all before

I guess when it comes to health and medical issues you must forget to be embarrassed and face things with, well, an injection of humour.

When I was in hospital in late 2009, I needed to have a shower and I was in such dreadful pain being supervised by a nurse. She pulled the curtains to shield me, but in that state of sheer vulnerability, it meant nothing to me.

I simply told her, "In your job, you have seen so much that I do not care for what you see now", as I invited her to scrub my back and hose me down. We can be precious about the common things, when in the hospital, honesty, frankness, openness, and truth matter more than anything to get the right outcomes.

A drought in the bladder

So, this morning I got a call from a nurse at the GP surgery, we know each other, and she wanted a sample that I could not produce on demand. Well, after waking up and everything with the ablutions there is nothing to give.

As the conversation progressed, I asked if this could be medically induced, like cloud seeding the bladder, that sort of thing, you should never give the medical establishment those kinds of thoughts to work on.

For want of a better word, we agreed that I could visit when I am pressed and at the surgery, I’ll be given a container for it. Then, it might just need fear or terror to unwittingly wet yourself, why that surprises me when I once had juvenile enuresis is interesting. All they want to do is take the piss.

Blog - Childhood: Atọ̀ọlé (October 2010)

Men's things - I

Keeping an eye on it

When you get within a certain age range, you need to pay more attention to a few things, especially your health. I have attended talks, groups, discussions, seminars, and conversations about men’s health and ageing, these things interest me enough even if I do not seem to act on the much I have learnt.

I guess because I have usually had blood work done twice a year, I seem to be a bit conversant with health issues, my kidneys, my liver, bone health, and other indicators in the blood results that I chase up with medical personnel to have a handle on the issues when a result falls out of range.

One month on prescription folic acid and the folic acid deficiency anaemia is now a thing of the past, the last reading put it at borderline high when it was well below the minimum range hardly 7 weeks ago. The other things as red blood cell counts and thyroid activity we need to monitor over a longer time.

That erogenous zone of life

The elephant in the room, the prostate-specific antigen (PSA) test, that I have ignored and done nothing about for years. Friends report their experiences and I sometimes pretend not to be in the affected cohort. My GP even sent me messages inviting me to assess this facility, it is one of the more intimate men’s things that we find ourselves too coy to talk about.

Two blood tests later, in early February and late March, my GP called to have a chat and then immediately scheduled an appointment to have me felt up in a funny place. I duly attended and before I could draw a sharp breath, it was over.

Well, it is slightly enlarged but smooth, and a scan is needed just to be sure. This matter is important but we rarely want to attend to it, either out of fear or embarrassment, both of which can kill you if a situation could have been caught early, but left too late.

Deal with it early

After my many encounters with the medical establishment for all sorts of life-threatening conditions, this should be the easiest of matters to assess, review, and understand, and hopefully, after the scan, I might just lay my mind to rest, absent of any worry or anxiety.

You have to know, to know, that once you are over 45 and black, the statistics can be scary, but do not become a tragic statistic, make that appointment, have those checkups, know the situation or at least have the knowledge to face up to it and have it dealt with promptly.

“1 in 4 Black men will get prostate cancer in their lifetime. Black men are more likely to get prostate cancer than other men, who have a 1 in 8 chance of getting prostate cancer.” Prostate Cancer UK

Men’s things are also about life and well-being, better the finger now than a scalpel blade later.

Reference

Prostate Cancer UK: Black men and prostate cancer

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Read and analyse the bloody tales and trends

Above range readings

Earlier this month, I contacted my GP (doctor) to discuss the results of tests I took in November when some indicators gave me cause for concern. Usually, I would wait for my next biannual checkup and visit with a range of questions and analyses of trends I want explained in essential layman’s detail to my understanding.

Especially now that every single result is posted to a personal portal from which you assess the test results against the expected normal ranges and the trends over a period. Two measurements stood out in the blood tests I took in November, the Mean corpuscular haemoglobin (MCH), measured in picograms per red blood cell [pg] with a normal range of 27 to 33, and the Mean corpuscular volume (MCV), measured in femtolitres [fL] (10^-15) with a normal range of 80 to 98, and it is a measure of the average volume of a red blood corpuscle or red blood cell.

When they measure above the normal range, this might be indicative of a form of anaemia related to iron, folate, or Vitamin B12 deficiency, and since I once had folate deficiency anaemia, I wanted this addressed before other issues resulted from it.

Even more detail

My GP invited me to the surgery for a complete set of blood tests where each of the indicators would be checked and I was ready to pursue better outcomes by looking the trend between November and February to urge immediate action.

On reviewing the new results, the MCV had returned within the normal range, but the MCH remained the same reading as before, a note from the assessor suggested no further action was required, I begged to differ and consequently we had a conversation today about those results.

What made the difference this time was serum levels were read for ferritin pertaining to iron, which was normal, Vitamin B12 was also within range, but the folate was well below range. I had already been taking vitamin and folic acid supplements from over the counter, however, I felt a stronger prescription was needed.

The prescription matters

I picked up my prescription from the pharmacy and when I opened the pack, the comparison between over-the-counter medication and the prescription was astounding, I would never have been able to get back into the normal range with the supplements and just my diet. The over-the- counter medication has a dosage of one tablet daily with a strength of 400µg, the strength of the daily dose of folic acid is 500mg, meaning I would have had to take 12 and a half tablets of the non-prescription medication to have any prospect of righting the folate deficiency.

For all that I have written, the main takeaway from me to anyone who takes good consideration of their health is to read to understand every test result you get. Ask questions where things are not clear. Fully pursue any concerns you might have, and seek a second opinion if you are unsure, uncertain, or unhappy.

Always follow through

The NHS is in the process of implementing Martha’s Rule, a set of protocols that would ensure that concerns about a patient’s deteriorating condition are subject to rapid review when raised. It would not be enough to just get assurances or be fobbed off by superciliousness, someone would have to attend the situation and arrive at a conclusion with commensurate action to address the emerging or emergency.

Hence my advice to read the bloody tales and ensure someone is addressing anything that falls out of the normal ranges with alacrity, consideration, and professionalism. In my case, we’ll have another review in a few weeks.

Back for the biannuals

Tell me about this

It was a week ago that I made it out to Crumpsall for my biannual medical with sheaves of printed-out medical results to get a better understanding of and explanation of the medical terms of obfuscation and intrigue.

This time, I met the lead consultant who was quite amenable to my inquiries, explaining in great detail the somewhat confusing or misunderstood terms whilst allaying my fears about other issues.

Critically, it was the result of the MRI scan I had in early October, the reading suggests that nothing is wrong with my bones, but my back muscles do need strengthening with physiotherapy, whenever I can get access to that service.

It flows better with drinking water

As was drinking water from the time that I woke up, my veins easily presented for phlebotomy, though that might well be dependent on the nurse doing it. I doubt the nurse with height and hands that would leave him comparable to the Nephilim would have succeeded, no matter what he might have tried.

Now, the results of the blood tests are posted for viewing immediately after they are available, the portal also offers trends on a graphical scale for you to note gradual or sudden changes to the readings observed.

Once again, I am grateful to the medical team that handles my care, from the receptionist who is always amiable and pleased to see me, we exchange copious pleasantries to the nurses who measure the vitals and then the consultants who extend beyond expertise to respectful humanising of their patients. I guess it is another meeting in six months.

Tested by many things

Just doing it

I decided not to beat myself up for the fact that July presented no prolific blogging activity even as I split the month between celebrating my partner’s birthday and holidaying, out of which I took the time for intensive study to do a Microsoft test.

After I did the AZ-900: Microsoft Azure Fundamentals entry-level test which I had been putting off for so long until early June, I began studying for the AZ-104: Microsoft Azure Administrator test, though this was not until I had completed all the course work on the Microsoft Learn website, even though I had handsomely passed the test. I did initially think I would finish that track before I travelled to Cape Town at the end of June.

Recovering self and purpose

Events and issues scuppered that plan, I lost my uncle, my contract was ending, and I was preparing for the trip to Cape Town to celebrate Brian’s birthday and spend the month together. The first few days left me slightly indisposed even as I discreetly planned for his birthday. Visiting Cape Town in the southern hemisphere’s winter might have me considering if I need the flu jab as we do take it for the winter in the northern hemisphere. Winter in Cape Town is like a mild spring to a summer day in Manchester, they are closer to the tropics than we are.

After his birthday, we did a few things, and moved accommodations and I found that I had some free time to do some study which required discipline and concentration as there was a lot of material to cover. Beyond the theory, there are the hands-on labs and then getting used to doing requisite tasks towards achieving goals or requirements borne out of typical case studies.

As I learnt and understood much more, I believed I had gained enough confidence, maybe folly to book the AZ-104 test in cape Town, a few days before my return to the UK. The more I thought I had covered everything, there was much more to do. A YouTube video signified the test in its current format with its current syllabus would change on the 28^th of July. I was now running against the clock to get it done.

Upset to messed up

I found some practice tests and subscribed to an annual membership of Whizlabs, this exposed some areas of serious weakness in my grasp of the concepts and the detail, that needed urgent addressing if I had any hope of scraping through the test. Progress in gaining the requisite understanding of the weak areas was slow.

The test was booked for Tuesday, the 26^th of July at the Prometric office in Cape Town, I checked in the shared workspace and was working towards taking the test at noon, when at 9:38 AM, I received an email from Prometric Vue, the test provider that they could not offer the test and I had to reschedule. Their scheduling system lagged the reality of what they intended, as I spent the next hour with an agent trying to sort it out. In the end, I had the test cancelled and booked a new test date for the next day at another Prometric test centre of the 4 in Cape Town.

The morning’s nonsense left me a bit messed up, I did a walk from the shared workspace home and back to clear my head before I could pore over the material towards the test the next day. Meanwhile, my Whizlabs profile got corrupted that I could not review test attempts and it was not working on my Android devices at all. Thankfully, the CEO contacted me to connect on LinkedIn and that gave me access to the technical team to provide a temporary account whilst they fixed the issue.

Facing up to it

On Wednesday morning, I had a niggling thought that I was about to undertake the test with the barest minimum grasp of the material. Yet, the truth is I had put in over 4 weeks of work along with my experience, and my confidence was taking a hit as Brian assured me that I will do well. At the test centre, I was met with both nonchalance and officialdom, both of which I put down to getting what you pay for in a different kind of setting. The test costs $55 in South Africa, £113 in the United Kingdom, and $165 in the United States. It would appear South Africa has the lowest cost, as most other African domains pay $80.

I was stripped of everything including my walking cane I had to ask if I would have been allowed to use a wheelchair. Then short of being patted down, I was asked to upturn my sleeves to see if I had secreted away cheat sheets of something. Heck! I have been doing vendor certifications since 1994 and this was the first time I was so violated. I surmised, it came with the territory and calmly went into the test room to begin the test some 15 minutes ahead of schedule.

Tested by the test

I did not get a hang of the interface when I was presented from the first question with case studies. I could click on the case study body and requirements but did not realise I had to click on the Question box at the top to return context to what I was to answer. I was close to panicking mode. When I eventually worked out how to do things, I had two case studies, with 9 questions and 32 minutes gone out of 90, with 45 questions to do.

Halfway through I scared myself into thinking I had already failed the test. With 10 minutes left, I had 12 questions to do, they were point-and-click multiple choice questions that I got done with 2 minutes to spare. I marked one question for review, answered that and could not wait to end my ordeal that when presented with the 54 questions to individually comment on each, I passed on the opportunity and closed the test.

The relief of passing

My heart beating at rates it should never reach, the test result came up and I had passed, not glowingly, one section required work, others were rated at average understanding and one at the level of very good. I would not deceive myself into thinking having passed by the skin of my teeth, I was through, I am going to study the material fully again and this would be necessary for the next stage AZ-305: Designing Microsoft Azure Infrastructure Solutions for the Microsoft Azure Solutions Architect Expert certification.

However, after this, I did give myself the time to do other things, especially with Brian and time to myself. There is a good feeling and sense of achievement, the quest to challenge oneself to ascertain, validate, and certify the knowledge and expertise one has gained. I suppose that is the pleasure one has in the work one does.

Looking at the azure skies of success

Passing the test

I have just returned from a Pearson Vue Computer-based testing centre which is just about a 25-minute walk from my home, and I am happy to say I passed the test I took.

Last month, I attended two 2-hour sessions of a Microsoft Azure Training Day: Azure Fundamentals, training day, it was the first time, I had the opportunity to follow the sessions fully. I had been thinking of getting certifications for the Microsoft Azure track for quite a while but could not get myself motivated enough to engage.

This time, after attending the training day which came with a free voucher for the AZ-900: Azure Fundamentals examination which I decided to use. The voucher was to expire at the end of June, I had the feeling I knew just about enough to pass the test, yet I could not afford to be over-confident.

Materials and practice

There is a lot of study material at my disposal, and this was one I did not think required instructor-led guidance like I required for my PRINCE2 and TOGAF certifications, in late 2019. The Microsoft Learn site is quite useful though it is mostly text-based interspersed with video snippets. I got to Level 7 and completed about 60% of the modules, but it was drudgery all through.

A better resource was John Savill’s AZ-900 Azure Fundamentals Certification Course of a library of YouTube videos of just over 9 hours of material. Thankfully, John has not entirely lost his English accent even if he has acquired some American mannerisms apart from the possibility of being distracted by his bulging biceps, the instructions, demonstrations, and whiteboard depictions are easy to follow to grasp the detail of the course.

I committed time to that, playing back elements that weren’t all that clear to me at first viewing and over 4 days, I had gone through the course enough to have some confidence that I will pass the test. After which I attempted two separate free mock tests and set out for the examination this morning.

Keeping up and current

Thinking about it, I did my first vendor certification just over 28 years ago, then, I acquired the Certified Netware Engineer certification after some weeks of self-study, having paid £140 for two volumes of study material. That was a lot of money for my 1994 salary, but that set my career off on an exciting, fulfilling and rewarding experience.

It is funny that I am still doing vendor certifications in my mid-50s, not that is matters that much, but the sense of self-affirmation and the confirmation of knowledge and understanding is a good fillip to proving you can still keep up with technologies and new developments. I love what I do, and I will continue to challenge myself as much as I intend to improve myself and remain relevant in my industry and career, for as long as I can.

As I left the test centre, I called Brian who constantly informs me that I am more than capable to meet any situation; I can’t distinguish between truth and bias, but I am always encouraged and motivated by him, then on getting home, I called my mum because we had discussed this and there was my concern that I might be tripped by the nuances of reading the context of US English with a British mindset. I got by and that is all that matters.

The vials of good news

Far along after the bloods

Long before we were caught in the throes of this pandemic and at a time when there was more freedom than we had stuff to do with it, at least a fortnight before each of my biannual medical check-ups, I would visit the phlebotomist to have blood taken in anticipation of discussing the results when I meet up with my consultant.

However, I cannot remember when I last did that, and the last three consultations have been by telephone conference with the inconvenient situation of reviewing the results of 6 months before. When I had a call over 2 weeks ago, I asked the nurse if she could provide me with an update once the results were ready and she kindly acquiesced to the request, even noting it in the update she sent to my General Practitioner (GP) and I.

Knowing it soon after the bloods

I find it strange that I have never met my GP who probably knows just about enough about me from the letters she gets if she reads them, or she just files them for reference when needed. My consultant however allows for a full flowing conversation about everything health, life, and much else.

The mail arrived in my post-box at the weekend, my CD4 count was at the highest it had ever been, I do not think I had that number at diagnosis almost 19 years ago. The other matters in the blood looked good too, and the cholesterol levels were improving, though I need to give it more attention. In general, I was given a rather clean bill of health and the likelihood that my next appointment in October would be face-to-face with my consultant. The times, they change.