Ending hormone therapy after Radiotherapy

User

Posted 29 Oct 2018 at 12:41

Alan,

Hope all goes well with the PSA test and the meeting with consultant. And also that you are ready to make your decision regarding the HT duration. There is so much conflicting information which doesn't help.

From your stats i wonder what your team are suggesting for the HT. Are they saying you will be on and off for life or that the 3 years will likely be enough? Our initial stats are similar although you are T2b if my memory serves me correctly ( no pun intended )

It makes me wonder for my own journey as i never once have thought i might have to go back on HT ( or have a holiday ).

I see Mr Angry, hello Iain, is aware that he is on a 'holiday' and his stats were very similar to mine with T3b. And we all seem to share the dreaded G9 ....

I see my consultant on 27th December , roughly a year after diagnosis and starting the HT, and about 4 1/2 months after the end of the RT. This is a question i will be asking - 'are you thinking that i am likely to go back on relatively soon'. I know they cant say but they must have opinions. If they think its likely then i will listen to my body a bit more about when i stop/start . If they are confident its just this one time then i will stick it out until they say so.

Iain,

Hi there, i'm keeping well. I have become a bit of a gym bunny ( not Gin - although that sounds good too ). And still aiming for a Tough Mudder next May....Had to buy loads of new clothes the other day as my old stuff was all too big. Costing me a bloody fortune this HT stuff, what with the gym membership and all.

Dark thoughts still there which the counselor is doing her best to control . And still have a bit if a preoccupation in my head with my early years. Cant seem to shake that at the moment.

But Hey Ho , we keep going don't we.

Again, Good luck to Alan and all those others in this shaky old boat we are all crammed into...

User

Posted 10 Dec 2018 at 08:33

Hi Mr Angry

I finished RT on 5th September and got my review on the 8th November. I was Gleason 9 T2c classed Aggressive hi grade PCa.

My PSA at review was 0.5 After a brief discussion with my oncologist she agreed with such good response to RT I could stop HT after 18 months. We discussed QoL and the results of clinical studies comparing 18 months Vs 3 years of HT, I am now on 4 monthly PSA tests for a year, so March, July and November 2019. They will be looking for any consistent rises in PSA, 3 in a row means my PCa is back. My last HT injection will be July 2019 which lasts 3 months until October.

So by my 68th birthday, 6 months after stopping HT I hope to be back to “normal” I will then be on 6 monthly PSA checks. This will be the most anxious time since diagnosed. Can I finish by saying not once did my Oncologist say she thought cutting my initially recommended 3 years HT to 18 months was not a good idea

User

Posted 10 Dec 2018 at 10:39

That’s great Alan . I started my journey Dec/Jan and from 26.7 to 0.2 I was also hoping for a reduction in the 2 years originally prescribed. But alas although all signs are good my consultant wants to stick with 2 years. I will have my fingers crossed for you to never need to go back on the dreaded HT.

Iain , also for you I hope your ‘holiday’ continues for many years.

we are in a tricky place being in the G9 club and I suspect that they expect to see us again at some time in the future. Well I hope to not see my consultant again for many years to come after my next in 6 months.

good luck guys.

Phil

User

Posted 10 Dec 2018 at 12:59

I suppose some people would think me foolish and selfish, stopping HT after 18 months instead of the initial term I was told of 3 years. Putting myself at risk of my PCa returning. My wife and I have discussed the implications at length and we agreed that not only the QoL is important, but I am what’s called a lifetime athlete, I competed at high level athletics for 20 years, then switched to cycling. At diagnosis in January is was at my peak fitness and was competing in veterans races. The HT and RT have stopped all that, but I hope to get reinvigorated after I get my Testosterone back. A little silly to take this risk, possibly, but I want to enjoy my remaining years, not just exist

User

Posted 10 Dec 2018 at 13:10

Hi Alan,

I understand fully your decision regarding the duration of the HT. i cant imagine having all those issues with fatigue and muscle wastage.

I , so far, have had no issues whatsoever physically with the Prostap. I do understand i am very lucky. Only this morning bumped into a friend who was on his way to get his Prostap injection and he has found he is getting quite severe muscle issues, and although he didn't say i think also fatigue.

I wonder if they will ever find out what the causes of the side effects are ? Would be fascinating and i do hope they are doing this research. As i said i haven't got any physical issues and have indeed lost weight. But.....i have suffered very badly mentally ( like Mr Angry did ) and also got the ED like most . But even then i still have libido.

You and your wife have made your decision and i wish you the very best of luck.

I don't think my wife would want me to take any risks, i fact she has already told me to do whatever the consultant says ( i.e. 2 years on the injections) . Interesting that your consultant has agreed to the 18 months , mine was adamant it was for 2 years.

Phil

User

Posted 10 Dec 2018 at 13:26

Hi Alan.

We all go through life making decisions and we all make them for our own reasons.

Good luck and let us know when you win your first race

Bob

Edited by member 10 Dec 2018 at 13:49 | Reason: Not specified

User

Posted 10 Dec 2018 at 13:30

Originally Posted by: Online Community Member

Absolutely not selfish or foolish, Alan. It's your life, and your decision to make. 100%. If the HT is resulting in serious side-effects for you, then quality of life is a very important consideration, particularly when weighed against the likely small increased risk of recurrence that may result.

You need to do what's right for you and your family. It doesn't matter what anyone else thinks!

Cheers,

Chris

User

Posted 10 Dec 2018 at 15:42

It isn't selfish at all. John hated everything about being on bicalutimide - the man boobs, the changing body shape, loss of libido, it was affecting his rugby and his gym / cycling. He stopped after 6 months. He has also said that he will never go back onto HT although when it comes to it, he will no doubt accept the inevitable.

They already know what causes the side effects, it is the depletion of testosterone so the male body begins to feminises. Basically, your body goes through the same process as an adolescent girl ... hips widen, you lay down layers of fat in preparation for future pregnancy and breast feeding, your metabolism is more like a woman, muscle tone is lost and tendons / ligaments become more stretchy.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 10 Dec 2018 at 16:17

Hi Lyn , What future pregnancy ....my wife will kill me !!!

i understand that it’s the loss of testosterone, but it must be more complicated than that. It would be good to understand why some men get different side effects to others . For instance my lack of physical side effects. Maybe I sailed through adolescence, and to be honest I don’t recall my time as an adolescent. Either because of my upbringing/ life at the time or is their a biological difference that makes a difference???

phil

User

Posted 10 Dec 2018 at 16:49

Why do men lose their libido with no testosterone, yet women can have a high libido with very low testosterone? I find all of this talk so scary , and even Lyn’s comment about John. Whilst externally I may seem calm and collected , I’m terrified of my rollercoaster changing course again in the very near future. It’s inevitable T4 G9 N1 and psa approaching or over 100 ( I find out just before Xmas ). Simply don’t know whether I want to exist or have QOL and it seems both isn’t an option. I guess pain is the biggest persuader at the end of the day :-((

User

Posted 10 Dec 2018 at 22:24

Originally Posted by: Online Community Member

I have posted this before but hopefully it will reassure:

http://www.ascopost.com/issues/april-15-2013/similar-outcomes-for-18-vs-36-months-of-androgen-blockade-in-high-risk-prostate-cancer-treated-with-radiation/

Edited by member 12 Dec 2018 at 07:19 | Reason: Not specified

User

Posted 11 Dec 2018 at 18:38

interesting... if I were seeing my consultant again soon I would mention this.

i wonder if time counted from end of radiotherapy is relevant or time from start if HT ???

i certainly will ask my consultant when I see him in 6 months if I can come off at 18 months .

Phil

User

Posted 11 Dec 2018 at 20:07

Originally Posted by: Online Community Member

interesting... if I were seeing my consultant again soon I would mention this.

i wonder if time counted from end of radiotherapy is relevant or time from start if HT ???

i certainly will ask my consultant when I see him in 6 months if I can come off at 18 months .

Phil

phil, my Oncologist counts HT from first injection. So any micro cellular cancer cells that were around the prostate would have been subjected to 18 months of HT. Although my post RT PSA was 0.5 I am aware that the HT could be keeping any residual PCa suppressed I guess I won’t know the real PSA level until 6 months after stopping HT. I want to take the chance of living a “normal “ life if possible but I assured my wife I would accept going back on HT if I get the dreaded 3 rises in a row

Edited by member 11 Dec 2018 at 20:13 | Reason: Not specified

User

Posted 11 Dec 2018 at 20:18

yep I think they all do but I wonder if for instance you have treatment very early then they could count from then. Some men for various reasons wait for 6-7 months for treatment but then are counted from start of HT ...

I had Brachy first then radiotherapy finishing beginning of August after diagnosis in January.

Fairly quick but not the quickest by any means.

so anyway, my timeline is 2 years from start ....

Phil

User

Posted 25 Dec 2018 at 19:15

I finished my 20 fractions on 7th September this year, now soon to be 4 months ago.

Side effects seemed to clear up ok, but today, 25th December, i have a recurrance of mucous discharge fron the anus.

Im a bit concerned why this should all of a sudden start now, as i have not seen this for 2 months. Is this something that can come back after this time? should i bother my oncologist or cancer nurse?

Thanks for reading

Alan

User

Posted 25 Dec 2018 at 19:43

For some men, it doesn’t even start until a year or more after the RT. You might find it happens sporadically for the next few years, or it could happen for the rest of your life.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 26 Dec 2018 at 11:04

I still have this periodically having finished SRT in April 2017. I had a sigmoidoscopy in September and it showed radiation proctitis.

My oncologist told me that mucous discharge can happen.

It’s very unpredictable, doesn’t happen all the time, just occasionally.

Ido4

User

Posted 04 Jan 2019 at 12:36

Dear Pallance, dear all

I have just come back from seeing my counsellor and one of the questions that came up was about the emotional impact of HT and how much it contributes to my current state of mind. Next week is the post-RT appointment with the consultant at which one of the areas to discuss will be HT, its effects (both on the cancer and the rest of the person) and how long to remain on it.

My "journey" started last Spring with a PSA score from the doc of 141, then meeting a consultant with a strong finger and a stronger line in gloom (doing the equivalent of a car mechanic sucking their teeth and saying "I'm not sure is the engine will last long mate, a couple of years at best"), then to hospital scans / biopsy etc giving scores of G9 / T4N0M0 and a more hopeful consultant (different one to the first), to courses of HT (bica then prostap) then external beam RT course in Autumn. So far PSA has reduced in-line with expectations (although I'm waiting nervously for the results of the blood test done for the appointment next week).

Emotionally I have been in a bad place at times. Not to the extent of doing anything silly. Just very very sad. Some of this is down to the situation and my own circumstances. For example, consultation with the gloomy consultant gave quite a shock; I feel guilty as hell about the possibility of dying and leaving my wife alone (I even wonder if getting PC was my fault / should have gone to doc's earlier, and so on and so on); the RT was physically quite draining (almost back to normal now). However I find myself very weepy at times (in the shower, at my desk, right now ...) in ways that feel not wholly caused by the situation.

So, I wonder how much is due to HT. I'm not wanting to stop the HT quickly as my understanding is that it helps fight the cancer better (at least in the medium term - for example,18 months is better than 6 months). But I'm not comfortable with the weepiness. Actually I hate it - it's embarrassing in public (e.g. last week in Mary Poppins), not easy to control, it feels rubbish, and so on.

I read lots of the threads on these boards with interest (I read far more than I post) and this seemed a good one to get others views on their personal experiences of HT and the emotional roller-coaster.

So guys, fill me in: am I weird (probably, but that's another story), or is it the HT (in part?, wholly?). Does it improve with time? should I ask about other HT options? Could it be that there's an emotional thing from the RT ? Should I stop watching films with sad bits?

Steve

User

Posted 04 Jan 2019 at 13:34

Good post Steve, I had my second 3 month prostap jab yesterday and although it's freezing I've no heating on I'm sat watching TV in a T shirt because the hot flushes are unbelievable today, like I've got my own in built Central Heating System.

I'm currently on chemo so supposed to keep warm but burning up after yesterdays jab although my temperature is spot on 36.5..

What's your PSA now after the HT and RT? Have they told you how long the HT will last, 2 or 3 years seems to be the gist of it.

How were you after the RT and how long did it take to get back to feeling "normal"?

John

User

Posted 04 Jan 2019 at 13:39

Steve

i wont go through my journey but ours has been very similar. i had very strong emotional instability in the first 4 months of Triptorelin HT. in some ways i also felt a little guilty as my wife had been ”encouraging” me to get a PSA check for 6 months since we heard my brother was diagnosed Gleason 3:4 T2c

The 20 fractions of RT involved a lot of time travelling, waiting around and expense. But the end justified the pain

I finished RT on the 7th Sept and waited the standard 8 weeks to see my Oncologist. We had a full and frank discussion on HT and QoL.

My PSA on diagnosis was 38, then 6 just before my RT after 3 months on Triptorelin, then 0.5 8 weeks after RT

I had read numerous papers on 18month vs 36month HT and the outcome is there is less than 5% risk on taking the lesser period. Now every person and their PCa is different and differing %ages on the effectivness of 18 vs 36 are published by different researchers, but the variance is negligable.

My Oncologist agreed that taking my QoL needs into consideration and the fact i had responded so well to HT and RT she agreed 18 months posed no significant danger to me

Since my post RT review in November, i get 4 monthly PSA checks for a year, what this means to me is that 3 significant increases in a row means my PCa may have returned, if so then I would of course go straight back on HT for the rest of my life probably.

I started Triptorelin April 2018, so my last injection will be July this year, which will run out October 2019

I am of course aware that Triptorelin will have supressed my PSA and the real proof of my ”cure” [remission?] will come in a PSA test April 2020 when my testosterone will have recovered, probably as much as its going to at age 66

Steve, good luck with your post RT review, the 8 weeks wait are a very nervous time. You should never feel guilty about getting PCa my friend. My emotional issues have resolved after my review and I am on Fluoxetine a mild anti depressant, that is also an ssri that helps with hot flushes.

User

Posted 04 Jan 2019 at 13:46

John

when i had really bad hot flushes my oncolgist reccommended Cyproterone Acetate tablets as the most effective treatment and this certainly helped me initially, but i dont need them any more as my hot flushes have diminished in intensity. I find that hot flushes are more intense just after a Triptorelin jab and slowly ease as the weeks go by. Im due my 4th Triptorelin in 2 weeks and am preparing myself! I have 2 more Injections to go, April then July for my final, as im stopping HT after 18 months [see my teply to Steve]

User

Posted 04 Jan 2019 at 14:27

Hi Steve, I just get back from seeing my counselor today too , and she is requesting permission for more sessions ( I've had 16 so far). This is far in excess of the normal cancer diagnosis number, which is around 4. This is due for me to the HT dragging up some bad stuff from an 'interesting' childhood. Its an interesting journey to say the least.

Is it my past , the present , my future or most likely a combination of all three that is causing me the biggest head ache. All I do know is its very hard to get through as I thought all this childhood stuff was dead and buried.

I do know that my emotions are all over the place at the moment. But my counselor says she thinks my emotions may have been suppressed during childhood and so i have to deal with these 'normal' emotions I've not had before.

All too much for my poor intellect to deal with .....

I don't think much has been made of on here about the mental effect of the HT although i am sure it is different for all of us. I have the depression, anxiety and insomnia and the bringing back of old memories, which is likely linked to the depression. But.... i am lucky not to get any physical effects from the HT or the RT , so I have to count my blessings. Oh of course i forgot the PCa .... hopefully it is now gone forever - fingers crossed, that's a bonus which not everyone gets and i appreciate that.

I have started using anti-depressants (Mirtazapine) which also really helps with the insomnia. Maybe something to discuss with your counselor and doctor.

From what i heard , especially from Mr Angry, now departed from this forum, who i shared some similarities in our childhood with, was that after finishing the HT it does eventually get better. He told me to hang in there, and that is what I am trying to do. I have till October now for the my last injection (Prostap) and I will have a damn party when the effects wear off.....

My counselor said to me today that if i feel like crying then I should cry. Not so easy at work or in a cinema though but i get the meaning. We have to accept these heightened emotions as much as we can without the aid of pills if we can. I am on min. dose for the Mirtazapine and don't want to up the dose if i can help it.

One thing i do is try to distract myself and keep busy. I still work full time and have started back at the gym and running and have entered a Tough Mudder in May. I think making plans for the future helps too so your brain realises that there is a future ahead, may be a different future to the one you planned but it is there.

And lastly, you are not weird. Well , i suppose we all are in a way ....

Good luck Steve, pm me if you wish.

User

Posted 04 Jan 2019 at 23:26

You're not at all weird Steve. You’ve been diagnosed with cancer, put on a drug which stops testosterone production and been blasted with radiation.

These treatments are full on. What you describe is within the normal range of side effects for HT.

I have only experienced a couple of weepy times. Once when i was feeling really sorry for myself, worrying about my wife and family. The second time was when my boss was being extremely obtuse and trying to pressurise me.

I have had a few melt downs though when i get stressed. My wife has brought me back from the brink of refusing to attend family events at the last minute (the taxi is waiting outside and i suddenly feel I can’t go) when I felt things were on top of me.

I am taking sertraline to level these extremes out.

The guilt you describe about getting PC I feel that too.

I hope your post RT follow up goes well and that your PSA stays low.

Best of luck,

Ian

Ido4

User

Posted 06 Jan 2019 at 12:46

Hi John,

thanks for your post. Will get results on Tuesday of PSA. Last score (just after end of RT) was 0.96.

About RT: it went OK for first two weeks of RT but then things seemed to get harder and harder. By the end I was tired and sore (I had planned a celebratory trip to a football match at the end of RT but on the day could not get off the sofa - partly due to fatigue and partly due to lack of confidence in bowels / bladder). The recovery from there has been slow. For the first two / three weeks after the end I felt actually worse than before. After a bit of recovery I tried going back to gym / swimming just before xmas and over-did it - so, now just trying to get back to fitness gradually.

Good luck with the chemo (and hot flushes are a b***** aren't they?!).

Regards

Steve

Edited by member 07 Jan 2019 at 21:48 | Reason: correction to previous PSA score

User

Posted 06 Jan 2019 at 13:04

Hi Pallance

Many thanks for your reply and all the details - it's very useful and food for thought.

Regarding HT duration there's another aspect that I heard about at a recent support group meeting that you might have a view on (especially as you mention reading the papers about HT duration). We had a speaker from Yorkshire Cancer Research (Prof Norman Maitland) who - if I understood him correctly - said that there may be a benefit from "cycling" HT - for example 18 months on HT followed by a period (?? 6 months) off the HT and then repeating (18 months on, x months off). The theory behind it being that faced with a constant "block" from HT then the cancer may find alternative biological pathways; but if HT is cycled on and off then the cancer never gets to a stage where it tries to find an alternative pathway. This was on the basis of a recent paper he had seen (the Lancet in November ??? - but I can't find it online). It all sounds nice and plausible but I would like to read the report myself. I wondered if you might have come across it or anything similar?

Steve

User

Posted 06 Jan 2019 at 14:47

Hi Goalhanger

Many thanks for your reply. I read your post and I'm going : "counsellor suggesting extra sessions - check", "bad stuff from childhood - check", "is it the problems from the past, the present or the future? - check" - so what you write feels very relevant to where I am at the moment.

Repressing stuff from childhood is definitely something I have done and it's coming back in counselling. It's making me ask big questions like "who am I? am I the person I am now because I learnt this way and that way to deal with things as a kid?" It's explained a few things to me about why I am like I am - so on that score it is very useful. But it's also hard work! so it was good to have a break for 3 weeks over xmas. Whatever, the counselling feels useful and I'm very grateful for the sessions.

At the end of the month I start a mindfulness course that - hopefully - can be useful on the insomnia / thoughts going round and round side of things.

Good luck with the Tough Mudder prep (and totally agree about making plans for future). Thanks again

Steve

User

Posted 06 Jan 2019 at 15:57

Steve, it is called intermittent HT (or IHT) and is not new - we have members here who have been doing IHT for 10 years or more so you should find loads of threads on it.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 06 Jan 2019 at 16:11

Hi Ian

Thanks for the reassurance. I read yours and other replies last night and they really cheered me up.

Kind regards

Steve

User

Posted 07 Jan 2019 at 07:37

Hi Steve,

Be interesting to hear how you get on with the Mindfullness. My counselor and I discussed it and felt it wasn't for me.

Sometimes its a day to day thing sometimes i actually feel pretty good. Its a shifting sand thing .......

But now i'm in the same year as my last injection i do feel i have a target .

Good luck,

Phil

User

Posted 11 Jan 2019 at 15:15

Hi Alan,

As you are a competative sportsman i am hoping you can help ....

i’m not getting fatigue at all but after upping my gym a bit i’m finding i run out of energy before the end of my run. Doing a weights session then 30 mins on treadmill. Is that normal or something to do with the HT?

Do you think i need an energy drink whilst working out or am i just trying too hard to improve?

I use protein and creatine shake afterwards.

Not gonna let this b****** HT take me down , hard enough having PCa without that.

thanks

Phil

User

Posted 11 Jan 2019 at 17:18

It is the HT - your body is feminising so muscle tone and strength / stamina will all be reduced. You may find slower allows for more, or shorter bursts work better - it isn’t about not being able to do things but you may have to lift lighter weights or run for shorter periods to be able to continue. Some PCUK research about 4 years ago showed that swimming worked well for men who very very debilitated by HT.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 12 Jan 2019 at 09:13

Thanks Lynn , Wasnt what i wanted to hear . i am gonna persevere with raising weights and running and try an energy drink during. Every thing else is OK so give ut a try .

Gotta try my best .

Phil

User

Posted 12 Jan 2019 at 10:04

Originally Posted by: Online Community Member

Hi Alan,

As you are a competative sportsman i am hoping you can help ....

Do you think i need an energy drink whilst working out or am i just trying too hard to improve?

I use protein and creatine shake afterwards.

Not gonna let this b****** HT take me down , hard enough having PCa without that.

thanks

Phil

Hi Phil, sorry for the delay in replying its been a hectic time since I’ve been retired I don’t know how I ever found enough time to hold down a job!

What Lynn has told you about the effects of the hormone therapy are of course correct, but regular structured exercise routines are well proven to be effective in combating the loss in muscle tone and fatigue caused by the HT. in fact all through my hormone therapy and radiotherapy I have exercised a minimum of six days a week and in discussions with my oncologist, specialist cancer nurse and the radiology team, all confirmed the beneficial effects of regular exercise

The problem with giving advice in a situation like yours is that everybody reacts to the hormone therapy and radiotherapy different and all our body chemistries and make up are very different in terms of age and weight and exercise experience.

Saying that there are of course standard guidelines that could help you. The first one I would say is do not try and exercise now to any pre-prostate cancer levels. You must listen to your body, if you have genuine tiredness then be happy with what you have achieved and plan to slowly increase your training load as your body and energy permits.

Personally and this is just me, I would not use supplements to achieve a training load when your body is telling you is too much. Despite saying that, recovery drinks are fine, in fact I use a protein shake, but only after a long hard ride to help my body repair the muscles. Drinking a balanced energy and electrolyte-based drink during exercise is okay, as long as you realise it is not to extend what you can do, but to look after your body whilst you are exercising

It is most helpful to keep a detailed log of all the training that you are doing and how you felt whilst completing it, this will help you to plan your progression in a structured and healthy way.

In my case before my cancer diagnosis I was cycling a minimum of 200 miles a week over some very arduous terrain and I was a very good Hill climber. Now I find I can just manage 100 to 120 miles a week but hills and headwinds sap my strength and I tend to look out for the weather and any courses that suit my current ability. Going cycling with my friends is very important to my mental well-being and this is something I have missed severely so I have found a way around that and I have bought an electrically assisted bike which means I can now rejoin them on the 60 mile group rides once a week. I have to put up with all the banter that I get from them and I love every minute of it.

Good luck with your training and remember do not push yourself beyond what is comfortable all of the time, occasionally pushing yourself beyond your limits is fine as long as it is only for short periods and you understand what you are doing it for

Alan🚴‍♂️

Edited by member 12 Jan 2019 at 10:24 | Reason: Bad grammar!

User

Posted 12 Jan 2019 at 18:34

Thanks Alan,

i will try with energy drink , going in the morning 😱.

Busy at the mo. will reply more later...and after i’ve been to the gym .......

thank you

Phil

User

Posted 13 Jan 2019 at 12:02

Hi Alan , Lynn.

Well went to gym this morning and made sure i drank plenty of water . Managed 30 mins run after gym workout and was fine . i did also drink while running so maybe i was a bit dehydrated last time. i even managed to add 0.5km to my distance.

Protein drink afterwards as well.

Good luck with your cycling Alan i know you cant wait for your last HT injection and get back to some kind of normality...

My last injection is October and i cant wait.

Cheers

Phil

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