Great news!

Nick, the chap in the bed next to me at the NHS hospital who I struck up a friendship with has just sent me a text message to tell me that completely out of the blue he is to be released home tomorrow. Which is really good news indeed, as like me, he was going slightly stir-crazy.

We’ve arranged that I’ll give him a call early next week with a view to me popping around to see him for a coffee and a chat. He’s promised me a run in his Ford Mustang when he’s well enough to drive again, but I suspect for now we’re going to have to settle for more mundane pastimes. If nothing else it will be nice just to see him back in his own home rather than in hospital.

“Spam, lovely Spam, wonderful Spam.”

SPAM is a tinned meat product, that judging from its longevity, must be enjoyed by some people. Spam on the other hand is universally hated, and apparently now accounts for over 95% of all email that is sent, or in excess of 200 billion emails a day. 80% of those are sent by one of only 200 or so spammers around the world. As a result of this the IT industry wastes an inordinate amount of time, money and resources filtering out the vast majority of this rubbish before it ever reaches the end-users of most email systems. The former became associated with the latter by way of a 1970’s sketch from Monty Pythons Flying Circus.

Why do I mention this? Well, for historical reasons, I run my own mailserver here at home. This has advantages and disadvantages. The main disadvantage is that setting one up is quite complex, and getting it exactly right is essential, otherwise you can easily set up what is known as an open relay, which allows anyone to send email using your email server – and the people who would quickly take advantage of this are spammers. A faster way to get your ISP connection terminated is probably hard to find.

The advantage for me was that it was the only way I could provide economic email for my family while I was using the IBM-supplied broadband package. Now that I have switched to my own ISP the need is not so pressing, but we’d all need to change our personal email addresses, and update the many people who use them. So it’s just easier for me to keep running the system, especially as it’s been a completely trouble-free experience for the last 3 or 4 years.

Except when I went to collect my personal email this morning, rather than the 2 or 3 emails I’d normally expect I found well over a hundred emails, all of which were spam, advertising the types of products that I’d mostly rather not even know about, let alone take advantage of. I have to take quite enough drugs already thanks – no need for any more, especially from unknown, unverifiable sources.

Why the sudden increase? Well, to be honest, it’s partly my own fault. I set up a secure email server that can’t be used to relay email, but I didn’t make any effort to make it particularly resilient to someone who wanted to harvest my email addresses and then target them with spam. And we’ve been flying under the radar ever since. Except it looks like someone has lowered the radar; they’ve obviously scanned my IP address, found an email server, tried to use it as a open relay (and failed) and then rather than moving on, have worked out the email addresses that my server supports, and put them onto a large number of mailing lists. Gee, thanks a lot.

So my job this afternoon is to significantly upgrade the configuration on my email server to ensure that I filter out all the spam that is starting to arrive. After all, its bad enough that I should see some of this rubbish, let alone have it being sent to my wife and daughters too.

UPDATE:

Well, as seems to often be the way at the moment, I didn’t mange to get started on this when I expected. But when I did get around to it (mid-evening instead) I was surprised just how much work has been put into my mailserver (postfix) to make it trivial to harden. The server is incredibly modular, with open interfaces that make it easy to hook up to external “helper” applications. By installing a couple of extra packages using the Ubuntu package management system I was then able to make about 20 lines of changes to my postfix configuration files that should stop almost all the spam that I’ve been receiving. The only slight concern is that I may have hardened the server to the point where I occasionally discard some good email too – something to watch out for.

But so far so good; I still pass the open relay checkers on the web, and appear to be successfully sending and receiving normal emails. Just no sign of any more spam. Which I am currently interpreting as being a good thing.

Lots (and lots!) more drugs

Tuesday was the first day of my first cycle of chemotherapy.

I’m scheduled to have eight of these three-week cycles, which basically consist of taking a cocktail of drugs to kill off any remaining cancer cells. Unfortunately they also kill off normal cells too, just not as effectively as they kill cancer cells. But to do their job properly on the cancer cells they do tend to make you feel pretty ill too. As expected, there is a very long list of side-effects, and at the moment I seem to be steadily exploring most of them – hence the delay in writing this post!

Still, there is no point complaining about it – it’s got to be done, as it halves the chance of the cancer spreading elsewhere in my body, and that’s too important an advantage to turn down, no matter how unpleasant the treatment may be.

I’m doing this part of my treatment privately using the private healthcare that I get as part of my benefits package for working with IBM. This means a switch from the local NHS hospital to my local private hospital (also in Portsmouth). Apparently I could have had the treatments in my own home if I’d wanted, but frankly (a) I don’t see the point, and (b) I’d rather partition the treatment away from my home life. An Englishman’s home is his castle after all, and I really don’t want to associate my bedroom with IV lines, injections and blood-taking.

The contrast between the private and NHS hospitals is interesting – the private hospital is much more comfortable. Single room with a flat-screen TV, ensuite bathroom, carpeting, pictures on the walls, nice food (with a wine-list!) etc – it could be a hotel room from anywhere in the world, apart from the plumbed in oxygen and suction, and the standard electric hospital bed. But on talking to the nurses, it turns out that if I’d had my operation (and subsequent problems) in the private hospital, they would have put me in an ambulance and transferred me to the NHS anyway, as they are not set up to deal with those more major kinds of long-term illness. Which is interesting, as it clearly implies that the business model of the current private healthcare providers is centered around the easy (and hence cheaper) procedures, leaving the hard and expensive ones to the NHS. And they divest themselves of anything that subsequently turns into a hard and expensive procedure, passing it on the NHS to put right. Maybe that’s an overly harsh view, but it certainly seems to fit the evidence, and makes me wonder if by cherry-picking where I have my different treatments I’m contributing to ongoing funding issues for the NHS in some fashion.

But I digress (blame the drugs!).

The appointment was for 10am, but my daughter also had an appointment with her orthodontist at 10:10am, so my wife (acting as taxi for the day) dropped me off at 9:30am before taking “J” to get her new braces fitted, then back to school, before rejoining me. Checking in was easy, and I was happily ensconced in my hotel-come-hospital room within a few minutes. Tea and biscuits turned up almost immediately (though the biscuits were nicer in the NHS!) as did a friendly doctor to draw some blood and insert my cannular. Regular readers will know these are a problem for me, and this was no exception. But we managed it, and he also drew the blood he needed through the cannular too, so no need for a second set of needles.

I then went on a glucose IV while we waited to see if my blood results were good enough to allow me to undergo the treatment. The OK turned up in the form of the chemotherapy medicine mixed into a half litre of IV saline, and a some anti-emetic and steroid injections designed to help me cope with the shock of the main medicine. Those were injected first (through the port in the cannular) before the glucose was swapped out for the main course of IV medicine, and then it was a simple case of waiting the two hours or so for the IV to feed in.

In my case, the first side-effect made itself known towards the end of the two hours, with the arm they were feeding the IV into becoming extremely tender, slightly swollen, with signs of a rash forming. The chemotherapy medicine is clearly not nice stuff.

Once all the chemotherapy was pumped in it was then a simple matter of flushing the tubes and my veins through with about 10 minutes worth of glucose IV before I was allowed to go home. By this time my arm was sufficiently painful that it was uncomfortable to even wear my fleece. I can see that it’s going to be important to swap arms as the cycles progress to avoid things like collapsed veins.

And since then I’ve just been trying to keep ahead of the side-effects. So far I’ve had: the pain in the arm, much worse than normal tiredness, headaches, nausea, increased stoma output (resulting in slight dehydration), loss of appetite, peripheral neuropathy (pain in the finger tips), pain when initially starting to chew anything, and difficulty with swallowing anything cold, including water – which isn’t helping with the keeping myself hydrated game. Drinking 2.5 litres of warm water isn’t fun. The worst of the lot however, has been the hiccoughs which seem to come and go of their own volition, in addition to whenever I’ve eaten or drunk anything. The last attack came on just as I was getting ready for bed last night, and didn’t really stop until around 4am, by which point I was so exhausted I was beyond caring.

Still, from reading all the various leaflets (what else is there to do at 4am?!), I’ve barely scratched the surface of some of the possible side-effects. One that sounded particularly unpleasant was a tightening of the larynx, which apparently makes it feel like you’re choking. The leaflet notes (with marvellous understatement) that this can be particularly distressing for the patient! So I’m considering myself lucky so far

Alarmed!

It ended up taking most of Friday to finally get back to my prior state of equilibrium. As I mentioned, I had a quick look into pill reminder systems, but most of them seem to be rather expensive and much larger (more bulky) than expected which meant that I’d probably end up not carrying them around with me. So nice idea, but probably not very practical for me. I need something less intrusive that I will carry with me all the time.

And so, in the true spirit of innovative DIY, I sat down and worked out what I need. Which is a reminder to take my tablets, and an emergency supply of tablets, in case I should happen to be out of the house at the time. So the answer (for me) is to program my Blackberry to ring a series of irritating alarms when I need to take my tablets (because like geeks the world over, I carry my cellphone wherever I go) and a small metal mint box that is just big enough to take 1 dose of my 3 main tablets, and yet easily small enough to carry in my pocket with my loose change. And so far, so good. I’m carrying them with me all the time, being reminded to take the tablets, and actually doing so.

The only problem is that I will now have to admit that I’ve actually found a use for the Blackberry, which I find in all other ways to be a simply dreadful product.

Bad day

For the last few days I’ve been trying to reduce the amount of codine that I’m taking, cutting the dose from four tablets a day to only three, missing out the “lunchtime” tablet to give me a more alert afternoon. And that seems to have been working quite well, with me feeling more alert, but with no significant effect on my output.

But yesterday I managed to forget to take a complete set of tablets (ie, the leperomide and the codine) at “teatime” in addition to my planned codine reduction. The result was immediately noticeable, and as a consequence of that I’ve had a pretty rough time through last night and all of today. One of the side-effects has been that I’ve slept even more than I normally do (I’ve barely been awake!), so I’ve ended up taking my medicines at “unusual” times, which probably hasn’t helped me get the situation under control as quickly as I should have.

A check of my fluid chart showed that I was probably behind the curve both yesterday and today, which may help account for at least part of the reason why I’ve been feeling so ill, so I’ve had a concerted effort to drink as much water as possible, and that (and the medicines) seem to finally be helping me get back on top of the situation.

I can see I’m going to need to invest in some sort of simple “pill alarm” and something that I can carry a single dose of all my tablets in, that is small and light enough that I can carry everywhere, so I don’t ever repeat this exercise. Because it’s definitely not been fun.

Tuesday spent “tinkering”

Yesterday I decided it was time to work out exactly what is going on with my home server. This was one of those little jobs that I’d decided wouldn’t require much physical effort, and that could be picked up and put down again as required when I felt tired. In short, ideal for my current situation.

The main problem is that I have three large SATA drives in the server, that I want to run as a RAID 5 array, but the motherboard I am using (in common with almost all other mini-itx motherboards) only supports two SATA drives. Originally I tried to work around this by using a PATA to SATA converter, but found that it resulted in some odd errors and what appeared to be data loss. So I bought a PCI card with a pair of SATA ports, based around the SiL3124 chipset, to provide me with support for a total of four SATA drives. However, any drive connected to that PCI card started showing errors whenever the I/O rate went above some arbitrary level, making it completely unsuitable for inclusion in a RAID array.

So yesterday I replaced the SiL3124 PCI card with another based on the VIA VT6421, which provides 3 x SATA ports and an IDE port, and since I had the server in pieces, took the opportunity to add an IDE to Compact Flash adapter, along with an 8GB Compact Flash card.

My intention was to be able to install the operating system onto the Compact Flash card, and then use the 3 x SATA drives purely as a RAID 5 array for data storage. By installing the operating system onto the memory card (with no moving parts that wear out) I would minimise the chance of any failures, making the system more reliable. The RAID 5 array would provide redundancy for my data storage, allowing a drive to fail without impacting my data.

However, in the tradition of plans laid by mice and men, when I got everything updated, the drive connected to the new PCI card still exhibits strange I/O errors. And swapping the drives around still leads to errors only from the drive connected to the PCI card. Which leaves me with the frustrating conclusion that it’s probably something to do with the implementation of the PCI bus on the motherboard – which is not what I was hoping for.

This somewhat Frankensteinian server has worked well for the last couple of years, but I’m starting to think that given how much of my home now depends on it working smoothly, it may be sensible to actually buy a new server designed specifically for the task, rather than wasting precious time chasing down obscure hardware issues in my DIY creation. At the moment, this one looks just about perfect (apart from the price … gulp …) would allow me to reuse my existing drives, and can probably even be made to boot from my compact flash card still. Decisions, decisions!

Monday revisited

As predicted, Monday was a busy day and I managed to tick off some achievements, which felt really good. However, I seem to have been so busy (it’s all relative remember!) that I’ve not managed to post anything here for the last couple of days, so I thought I’d recap on what’s been going on.

I managed to successfully walk my youngest daughter to school on Monday morning; according to Google maps, it’s 0.9miles following the route I took, and to be brutally honest, that was pretty near to my limit for an uninterrupted walk. For once I was absolutely delighted every time my daughter stopped to look at an interesting leaf, pretty flower, unusual bird, etc, as each diversion gave me a few seconds to catch my breath! And then having got to school not only was was it great to catch up with some of the other parents in the playground, but that also gave me a good 10 minutes rest before I started walking back home. Interestingly, the journey home was much easier than the journey to the school, perhaps because I was setting a slower pace than my daughter, and perhaps because the outward walk had already loosened up my muscles and joints a little. However, by the time I’d got home I was completely exhausted, and ended up going back to sleep. Plus ça change, plus c’est la même chose …

The stoma-care nurse called in to see me later in the afternoon, and we went through the whole check-up game, making sure that I was managing OK. She was also very helpful in setting up what amounts to a “standing-order” prescription for all the supplies that I need (custom-fitted ileostomy bags, adhesives, adhesive removers, skin-protector wipes etc) that will then be automatically delivered by courier over the next few months until I can get the ileostomy reversed.

And finally I drove down to Portsmouth and went back into hospital to visit one of the other patients who is still recovering from his treatments, who I’ve struck up a good friendship with. I took some beers in (to my surprise, the hospital don’t ban alcohol), and we ordered takeaway pizza from the local Dominos, which turned up at the front entrance in only about 10 minutes. Which made for a much more palatable evening meal than what would have been provided by the hospital!

It was very noticeable that having not seen him for some 10 days or so, he was looking much better. He’d put on some weight and built up some muscle tone, had much better colour, and generally looked much more healthy. He was also much more mobile and able to move more freely without assistance, which shows that he too is making good progress towards the day when the consultants will be able to send him home.

Sadly however, another patient that I recognised from my time in hospital had been readmitted yet again. He seems to be really struggling to get out and stay out of hospital. His first return was brought on by dehydration, but this time it transpires that he’s got a series of blood clots which have migrated to his lungs, so he’s now on a series of blood-thinning medication and close observation to ensure that the clots dissipate. Fingers crossed that the hospital can get him stable and back home again soon, and that (selfishly) I don’t run into such a series of problems.

Time flies, when you’re having … codine!

I can hardly believe it, but I’ve actually been home now for 11 days.

It doesn’t feel like 11 days at all. It seems like only yesterday that I was struggling to walk across the hospital car park as I started my journey home. I suspect that some of that is simply down to the fact that I’ve been too tired to do very much apart from sleep, probably helped by the relatively large dose of codine that I’m taking. And empty days that have nothing to show for them tend to blur together in my mind.

But if I look at my physical capabilities now, compared to that painfully slow walk across the hospital car park, I can immediately see the difference; I can walk (albeit slowly) several times as far without any significant concern. As an example of that, we took the kids out to the local YMCA centre where they were running an open day for children to try some activities as a precursor to possibly signing up to a summer camp later in the year. The place was absolutely heaving with people, with long queues for all the activities, and in the end I guess I was on my feet for nearly 2 hours. Admittedly, I was nearing my limits when we left, and needed to go to sleep as soon as we got home, but I was able to cope. So despite apparently having nothing to show for my time, I am making progress in my recuperation.

So my plan tomorrow is to raise the bar, and rather than just spending my time sleeping, trying to stretch myself just a little. With that in mind, I think I’m going to start walking the kids to school. I reckon its about 1500 meters door to door, which I ought to be able to manage without any major problems. And being a school governor, I figure I can I can always abuse my position a little, and recover with a coffee in the staffroom before walking home again

In fact, tomorrow is looking like a busy day, as not only am I planning that, but I have my home-visit from the stoma care nurses, and I’m going back to “my” ward in hospital to visit one of the other patients there, who I’ve struck up a really good friendship with. Add in some other little jobs I need to get ticked off tomorrow too, and it’s showing the promise of being a stand-out day in terms of achievements!

Oncology consultation

This afternoon I got a call from my oncologists secretary, offering me an appointment at short notice to discuss my results and options.

The outcome of that meeting is that I should have chemotherapy treatments designed to reduce the chance of the cancer reoccurring elsewhere in my body. The treatment will last 6 months, and be composed of eight 3-week cycles. Each cycle will involve a meeting with the oncologist, a set of blood tests (doesn’t everything?!), and an IV infusion of Oxaliplatin. I will then take a course of Capecitabine tablets for 2 weeks, and then have a weeks break before starting the next cycle.

Apparently the bald statistics, based on tracking around 150,000 patients world-wide, are that if I were not to have any chemotherapy, the chance of the bowel cancer reoccuring elsewhere in my body would be approximately 40%. By taking the chemotherapy, the risk falls to approximately 20%. And those statistics are based on cases where the patients had between 4 and 10 infected lymph nodes, and were typically older and less healthy than me. So as I had only 4 infected lymph nodes, the expectation is that I should have better odds than those bare numbers imply.

But this is a pure game of numbers; and the only ones that matter are the end results for me – which will be either 0% or 100%. So the decision is made. I start the chemotherapy on the 28th of April. My last course of medication should be the 6th of October.

Sadly I won’t be able to have my ileostomy reversed before the end of the chemotherapy, and the closeness of the end of the chemotherapy to the LiveStrong Austin event that Mark Cathcart was suggesting I challenge myself with, may well put my participation in doubt. Which is… ahem … “frustrating”.

Finally, it’s not clear yet how this is going to affect my ability to get back to work. The best the oncologist could suggest was that these drugs affect everyone differently; some people are able to work almost normally, while others work part-time, and some are unable to work at all. His suggestion was that after the first couple of cycles I should have a reasonable idea of their affect on me, and hence what I’m going to be capable of doing while undergoing the treatment.

Which seems like code for “you need to suck it an see”. Which would be quite funny, except it makes planning how and when I can get back to work a whole lot more difficult. And I’m conscious that even the best of employers don’t have infinite patience, especially in the current economic climate…

Home PBX

Back in this post I mentioned that I was going to teach myself Asterisk, as part of a project to build a home PBX system. I thought it would be useful to outline what I’m trying to achieve, and why, before I start posting progress reports that might make little sense otherwise.

So, at the moment I have a single PSTN line into the house, which in addition to providing my phone service, also carries my ADSL service. Inside the house I have a series of extensions to various rooms, on which we currently have two old-fashioned wired telephones. Voicemail is provided at the exchange by our service provider. This works OK as far as it goes, but with five of us in the house, contention over the use of the one phone line is becoming an issue. In addition, despite being on the UK telephone preference service “opt-out” list, we still seem to get a lot of annoying cold-callers, mostly dialing in from abroad where UK legislation cannot affect them.

So, in an ideal world, my plan would be to initially add 2 more lines to the house using VoIP technology to alleviate the contention. Both would have geographic numbers associated with our local PSTN exchange, to allow me to nominally declare one inbound VoIP line for the children to share, and one for me to use primarily for when I’m working at home. However, outbound calls would make use of any of the available lines based on availability and a least cost routing algorithm.

I’d also replace the two wired telephones with several DECT handsets. My intent would be that each handset would operate independently of the others, and the system would support multiple parallel active calls. In addition, I would want to be able to conference together multiple handsets and/or multiple lines as needed.

Voicemail would be provided internally by the system, with individual accounts for each user, with messages forwarded to the user by email if required.

The system would also need to do time-based routing of incoming calls, so that after a specific time at night, all calls would go straight to voicemail, unless they come from a known and authorised number.

International callers, and callers with no CLI would always get trapped by the system and passed to an IVR system that would allow the caller to identify themselves. If they identify themselves as an authorised number then they would be passed on to the phones/voicemail, otherwise the call would be automatically terminated.

To create such a system I figure I need something like the following:

• My existing PSTN line
• 2 x geographic numbered VoIP lines
• Asterisk to handle the signalling, with a fairly complex configuration
• 1 x Linksys SPA3102 linking the PSTN line to Asterisk, and providing a fallback wired PSTN phone on one of its FXS ports
• A Polycom Kirk Wireless Server 300 to provide the interface between Asterisk and the DECT handsets
• A PoE injector to power the KWS300
• As many DECT handsets as eventually needed

However, the outlay on that is a little on the high side, and the learning curve very steep indeed before I’d get to a working phone system. So I propose to do this in two phases, and start with:

• 1 x PSTN line
• 2 x geographic numbered VoIP lines
• 1 x Quint package Siemens Gigaset S685IP

The Siemens Gigaset can handle some of my requirements out of the box, allowing me to get a basic working system up and running. It can also be interfaced to Asterisk, allowing me to start experimenting with Asterisk, before adding the SPA3102 and optionally upgrading the S685IP base station with the Kirk Wireless Server, reusing the handsets from the S685IP package as needed.

Well, it’s the current plan anyway