Tag: health

Bobs Bowel 13 – Chemo !!!


It’s 19th May, 2025 and I have an appointment with an oncologist. This is to discuss potential precautionary chemotherapy following my hemicolonectomy at the end of March.

I am introduced to Dr Mutheramalingam, known as Dr Ram.

He seems to have done his homework, as he tells me all about the various conditions that I am receiving treatment or surveillance for, including Prostate Cancer, Type 2 Diabetes, and possible Non-Alcoholic Fatty Liver Disease (NAFLD). And, of course, not to forget the main event, T3 N1b Colorectal adenocarcinoma, the reason I am in his office.

Dr Ram procedes to explain the situation i.e. the positive results of the surgery and that the scan prior to surgery had not shown any signs of cancer elsewhere.

Interestingly, he mentions that the lesion on my lung seems to have disappeared. This lesion was strongly suspected to be Prostate Cancer, and is the reason I have been on course of regular Prostap injections. We discussed the possibility of my no longer needing the injections but he wanted to defer that discussion to my Urology consultant.

Dr Ram then went on to describe my chemotherapy options, which appear to one of two.

  • Option 1:
    Combined tablet and chemo infusion over a period of three months
    This option comes with a range of potential side effects which also include damage to my liver which is already under surveilance due to the NAFLD.
    This treatment offers a potential 12% increase in my survival prognosis.
    The chemo infusion would be administered at the hospital and therefore require multiple trips to the Queen Alexandra hospital, parking fees, and the time spent during the infusion.
  • Option 2:
    Tablet only treatment over a period of six months
    This option also carries the full range of potential side effects with only a 10% increase in my survival prognosis.
    The tablets would be self administered at home,each two week cycle being 4 tablets twice a day, followed by one weeks rest. During the weeks rest I would have a blood test and a telephone consult prior to starting the next cycle.

It seemed to me that option 1 only giving an additional 2% and also introducing the risk of liver damage was not a good deal. Also, the regular visits to hospital for the chemo infusion was not very appealing, given the many medical appointments I have had since diagnosis of the tumour.

I have therefore opted for option 2, the self administed tablet only chemotherapy.

Bearing in mind the positive results from the surgery we, the medics and me, don’t know for sure if I have any cancer in my body. This chemo, being precautionary, may not actually buy me any more time.

Since that initial oncology meeting I have started the chemotherapy regime having been prescribed Capecitabine. I have just completed my third cycle.

Capecitabine comes with a whole range of potential side effects which include the following:
Appetite loss, Diarrhea, Vomiting, Nausea, Stomatitis, Abdominal pain, Fatigue, Weakness, Hand-foot syndrome, Oedema, Fever, Pain, Headache, Hair loss, Dermatitis, Indigestion, Shortness of breath, Eye irritation, and Myelosuppression.

So far, after nine weeks, I am only experiencing fatigue which manifests itself by me dropping off into a deep sleep with little or no warning, usually when sitting quietly reading of watching the TV. Thankfully, this does not happen while I am actively involved in something.

In the first week or so I did notice, thanks to my smart watch, that my heart rate was spiking quite high. That is I was hitting over 130 beats per minute with no apparent cause whereas prior to commencing the chemo it was rare for my heart rate to go over 80 bpm. I contacted the oncology department and they told me it was probably my body getting used to the chemo. Certainly, the spiking has reduced, both in frequency and magnitude.

So here I am, cycle three completed. What now?

Well, due to a family issue I have had to travel and will be away from the UK for three months. This means that continuing with the chemo is problematic. Because of the type of drug that Capecitabine is and the need for regular blood tests, they cannot prescribe sufficient doses in advance for me to continue the regime.

Apparently taking a short break from the chemo is OK but two to three months may be too long for me to restart when I am back in the UK.

So I am exploring getting access to the local medicare here in Australian so that I can then see a doctor and hopefully get prescriptions for Capecitabine and also the requisite blood tests. There is a reciprocal health insurance arrangement between the UK and Australia but this might just be too complicated to manage.

I have applied to join Medicare and I am hoping that having been previously been accepted it will be pretty much a rubber stamp exercise.

We shall see!

Bobs Bowel 12 – Home Again


After ten days in hospital, I was home, at last. And what a difference it makes.

To start with, home is much quieter. As I said in one of my previous posts, I didn’t realise just how noisy hospitals are, I think the staff become quite blasé  about their speech levels, they also don’t seem to worry about banging cupboard doors and trays around. And then there are the various bleeping machines measuring life signs, pumping fluids and inflating air beds.

On the subject of machines pumping fluids i.e. saline drips etc.  The nursing staff seem to be immune to the sounds of the various alarms emitted by those machines. For example, I was hooked up to a saline drip and my pump started beeping. Nobody came but, luckily, I was able to see the small display screen which was indicating air bubbles in the line. I’ve seen enough crime dramas to know that air injected into your veins doesn’t end well. So I had to press my help button and a nurse duly arrived to redo the connections.

Anyway, being home means I don’t have to contend with the noise anymore. Another positive for being home is being in your own bed. My first night home I got seven hours sleep. Amazing, considering I don’t think I had a decent night’s sleep all the time I was in the hospital.

Sad to say I wasn’t able to match that in the days that followed, typically only getting three to four hours each night according to my smart watch. Having consulted “Dr Google” it seems that lack of sleep is not unusual after significant surgery. Thankfully, my sleep patterns have, slowly, returned to normal.

Another big difference between hospital and home is the attitude of the staff versus friends and family. In hospital the staff, whilst caring for you, encourage you to get up and about. The want you to walk the corridors, go and have a shower, and so forth. Movement helps with the healing process and also helps get the digestive processes going. Apparently it also helps dissipate the gasses in the abdomen. These are the gasses used to inflate the abdomen during the laparscopic surgery. Once home I found that, family in particular, were very protective of me. Every time I moved, someone was asking am I all right, do I need something, when all I am doing is adjusting my seating position as my bum has gone numb.

I did find that, as predicted, I was quite tired and dozed during the day. But that wore off over a few days and I was soon able to help with meal preparation, despite my wife intercepting me at every opportunity.

Of course I had to be careful about what I attempted to lift, push or pull. The standard “boiling a kettle” to make a cup of tea for two was a definite no-no. However, I am beginning to question the advice I was given. I think the advice about lifting and bending etc. is somewhat generic and based on old surgical practices. That is to say, based on abdominal surgery, which involves being cut from stem to stern with massive intrusion to the  muscles. My surgery was robotic laparascopic, so I only had a few holes where the rods were inserted, so minimal intrusion to the abdominal muscles. Yes, there is a letter box cut below my belly button, where they extracted the tumour and colon after it was cut away. However, I felt no muscular tensions down there. Rather, all muscular sensation tended to be in the upper abdominal area.

The point I am  making is that I did not feel any kinds of pain, soreness, or any other sensations around the wound site’s while I was moving around. Obviously, I didn’t want to do anything extreme but was I being too cautious!

I was also told that I shouldn’t drive  for six weeks. Or, at least, until I was able to perform an emergency stop without any pain. Also I had to be able to make rapid turns of the steering wheel. What wasn’t clear was who decides that I am fit, and how do “they” decide?

With driving, there is always the question of insurance. I had read that you are supposed to inform your insurance company that you have had major abdominal surgery. However, my insurance company does not have that requirement, but recommend getting your doctor to write a letter stating that you are fit to drive.

Getting to see a doctor might be a bit of a challenge here in the UK at the moment. I am told I will have a meeting in surgical outpatients in five  to six weeks.  That would tally quite nicely, if it happens.

I did phone the colorectal team and was informed that the decision, of when to drive, was down to me. I was also advised to practice braking in my car whilst stationary on the drive. If I experienced any pain, that would be a good indicator that it was too soon.

Another positive aspect to being home was having proper meals, with more solid foods on the menu. During my time in hospital I transitioned from clear fluids, free fluids, nil by mouth, clear fluids, free fluids and finally on to low fibre meals. On discharge I was expecting to be given some dietary advice, but that didn’t happen. So left to my own devices I have pretty much reverted to my previous foods. I have had jacket potatoes and ate the crispy skins, had roast chicken pieces and ate the skins. Also my daughter cooked us a chicken curry, medium heat. Oh what a joy as these were all things I had to avoid, from the day my tumour was diagnosed, up to the day of the surgery.

A few days after discharge I received a call from the colorectal team. The purpose of which was to inform me of the histology findings.

Firstly, the tumour removed was confirmed to be a carcinoma “something or other”. She did say, but I promptly forgot the name. Anyway, they took the tumour with good margins which were found to be clear of cancerous cells. So good news.

Secondly, they took out sixty five lymph nodes, of which two were found to have cancerous cells. Again, good news, but followed up with a precautionary offer of a consult with an oncologist.  Heavy emphasis on the “precautionary” statement.

So it is likely I will have some chemo. What form that will take I have yet to discover.

In the future, after five to six weeks I should have a Surgical Outpatients appointment.  Six months down the road I should have a virtual (telephone) consult to see how I am fairing. At the twelve month point I will probably be invited in for a colonoscopy. It is also anticipated that I will have an annual CT scan for the next five years.

So watch this space, for future developments.

Bobs Bowel 10 – The Big Day


Finally, the big day has arrived. Today is the day I am to have  my tumour removed.

I’m due at the hospital at 06:30. I have been told that I am the only patient on the list, so I am hoping that means first into theatre. No hanging around.

So my next post will be after my procedure when I am compos mentis again.

It’s funny how it seems to have taken a while to get to this point, but in reality, it has been just over three months, from diagnosis to surgery.

If all goes to plan, I’ll be in theatre for about three hours. Then, after time in recovery, I should be on the ward in time for tea. Although I doubt I’ll be in any fit state to eat and who knows what diet I’m going to be on.

I’ll see you on the other side.

Bobs Bowel 9 – A Grand Day Out


Not so much a day out, more an afternoons tour of the hospital as today I have three appointments.

First up is an ECG. Making sure that my ticker is still ticking. No specific time for this, I just had to turn up and present myself at reception. I arrived at about 11:45 and was seen just after 12:00, which gave me time to find the venue for the next appointment.

This session, at 13:00, is with the Stoma Nurse. Although a stoma isn’t planned, this appointment is to talk me through the what ifs. Also to mark where the stoma could/should be if the surgeons deem one is necessary. Although the colonoscopy and subsequent CT Colonography show the tumour hasn’t spread my internal physiology could present other problems. The surgeons won’t know until they get inside and start rooting around.

So the stoma nurse explained all the why’s and wherefores of how a stoma is formed. She then had me lay on an examination couch while she felt my abdominal muscles and ultimately marked the primary site for a stoma on my right hand side but also marked a secondary site on the left side. Viewed from the front I now have a face on my belly with my navel as the nose. I was toying with the idea of drawing on some ears but various folks have deemed that a bad idea.

Having had the spots drawn on I was then shown how a colostomy bag should be affixed to my belly. She demonstrated how to fix the bag on, how to seal it and also how to empty it. And then it was my turn. To prove that I had been listening I had to apply a bag over one of the spots on my belly. Having passed that test I was told to keep the bag on for the rest of the day. “To see if I had a reaction to the adhesive”. To be honest I actuall forgot I had it on, until I went to bed, by which time I was to tired to mess with it. So I slept with it still on. The following day I found out how good that adhesive was. It was not an easy job getting it off.

The final part of my stoma education took the form of a kind of homework. I was given a number of bags to practice with. A couple of them had some kind of tablet in them to which I was supposed to add water. The tablets, when mixed with water, form a sludge of the same consistency as wallpaper paste. This was intended for me to practice emptying a bag. Needless to say, I failed in this task. And it is too late now.

After an hour or so in stoma class I was sent up to E Level to meet with a doctor for my formal preop interview. She went through many of the same questions that had been asked at each of my previous appointments. In this day and age, with the technology available, you would think that all staff in the hospital would have access to all of this information. Still, all the questions and drawing some more blood, and taking my blood pressure, took another hour.

I was eventually released to go home at just on 17:00.

An interesting point is that none of the folks that we visited knew when my operation was to take place !!! This, despite the fact that I had been informed the previous week.

So, my procedure is due to take place 31st March, 2025

Bobs Bowel 8 – Bloods


Whilst I don’t yet have a date for my surgery, the NHS is keeping me on my toes. I recently had to make a trip to the hospital to hand over some more of my blood.

I knew they would want to check to see if the iron infusion had done the trick. So I already had that appointment in my calendar.

However, a telephone call out of the blue informed me that they wanted more blood. Apparently they needed to check my liver function and also to ensure that my blood is clotting correctly.

Over the last few weeks I have had so many needles inserted I beginning to think I’m in an episode of Hancocks Half Hour, namely the Blood Donor.

Other Medical Matters


Although the tumour in my colon is trying to hog the limelight we have found time to deal with other medical matters.

Gerry’s Clinic Appointment

First up my wife had an appointment at St Mary’s Community Health Campus in Portsmouth. The appointment was made back in December and was scheduled for 13:00 20th February. We arrived twenty minutes early. As per our last visit there was no one in reception.

Reception @ St Mary’s – Unmanned @ 13:15 Thursday 20/2/2025

So nobody to register the fact that we have arrived or to inform the clinician.

While sitting twiddling our thumbs I was reading the various notices one of which caught my eye. It was directed at deaf patients, advising them to go to reception who would advise the clinician of their presence as they may not hear their name being called. Brilliant, if there had been a receptionist.

This lack of receptionist became an issue for us as we still had not been called by 13:20. So I can’t speak to anyone and having wandered around to see if our clinician was present I decided to phone the hospital.

Amazingly, someone answered the phone almost immediately. I explained our situation. Her first comment was that all appointments had been cancelled. Of course I challenged this, asking when and how patients had been informed.

In the meantime she is sifting through my wifes notes from her last appointment. Informing me that there was nothing about a follow-up appointment, no record on the system, no indication that a notification had been sent out.

We were able to tell her that the clinician had, at the last appointment, written the appointment details on the original invitation letter.

We were promised that an incident was being raised and that we would be contacted to discuss it further

The net of this was that we had had a wasted journey, 14 mile round trip, as well as having to pay for parking.

Fibroscan

Later this same day I had a totally different experience. At short notice I was invited to attend the Hepatology Department for a Fibroscan. I have these every six months or so since I was diagnosed with NAFLD (Non Alcoholic Fatty Liver Disease).

If you have never had one of these it is probably simplest of scans. It is a form of ultrasound and the sensation for the patient is that it feels like someone has flicked you on your side.

So, just before 16:00, I presented myself at the department reception. Yes it was manned!! Hardly had my bum hit the seat in the waiting area than I was called through to the treatment room. A few minutes later, after being scanned, I was on my way out of the hospital.

Gerry’s Clinic Appointment – Follow Up

The following day we received a call from the clinic supervisor. She was very apologetic and put our experience down to human error. Nothing like stating the obvious but they were doing something, and quickly.

So we have a new appointment set for next week.

We also discussed the lack of receptionist. Obviously the receptionist is entitled to a lunch break but there should be some form of cover. Especially when there are active clinics underway. If no receptionist then there should be some better signage giving useful information like telephone numbers to be called.

If I didn’t have a smart phone with access to the internet I would have been stuffed.

Bobs Bowel 7 – Outpatients Anaesthetics


Thursday 13th February, and another appointment. Once again, at the Queen Alexandra Hospital. I’ll soon have my own allocated parking space if my visits carry on at this rate.

This time my appointment is with an anaesthetist in the Outpatients department.

My appointment was at 10:00, and right on the button, I was whisked away for some observations. I had my blood pressure, weight, and height measured, again. I was also given an ECG.  And then it was back to the waiting room where I had time to make friends, playing peek-a-boo with a toddler.

After a short while my name was called by the anaesthetist wearing an amazing pair of electric blue shoes.

After the usual pleasantries she revealed that we had met before. Ten years ago, when I went in for the brachytherapy treatment for my prostate. She was the anaesthetist who drew the short straw for my procedure. As a patient I was not very cooperative, not on purpose. With me sat on the table in theatre she attempted to give me an epidural. Three times!! My body just refused to play ball, would not give up my spinal fluid so no further attempts were made.

Once the procedure was underway it was time for me to misbehave again. I unconciously decided to vomit. She unfortunately had to deal with that, and call in Dynarod to suck out my tubes.

I apologised to her as in my head I was to blame, having had rather a lot of cheese as my last meal the night  before the procedure. Nobody told me that they tilted you head down to insert the nuclear seeds. She showed me the copious notes taken following that little episode but she was quite magnanimous. Noting my, as yet undiagnosed, type 2 diabetes which apparently can have the effect of slowing down your stomach process, causing “pooling” which in turn can cause regurgitation.

After reminiscing about old times we got down to the business in hand. We had the inevitable chat about my health in general and specifically focussing on weight, fitness and diet.

I was given a thorough but gentle arse kicking. Likening preparing for the operation to an athlete preparing for the olympics. Apparently the procedure will last about four hours and, although I will be unconcious laid out on the table, for my body it will be akin to running against Usain Bolt. So, as she put it, I need to be in the best possible shape to deal with the procedure but also the fitter I am the faster I will recover.

Exercise and weight loss are the order of the day, supplemented by plenty of practice with my spirometer. She wants me to up my daily walking. That shouldn’t be hard since it is negligible at the moment.

We also talked about diet with regard to my diabetes which can have a negative impact on my post op recovery. And right there is where I get into trouble.

In general the medics extol the benefits of a balanced diet, with plenty of fruit, vegetables, nuts, seeds and so forth. Quite often promoted as the mediterranean diet. Below is a typical chart promoting a balance diet. All stuff that I like.

Due to the location of my tumour which is partially blocking my bowel I have been advised to stay on a low residue diet which conflicts with the idea of a balanced diet. Which in turn also conflicts with a diabetic friendly diet.

What that means is that the only food that I can eat from the green zone is carrots which have been peeled and cooked until they are soft. I can have cucumber but I have to peel it and scoop out the seeds. From the yellow zone I cannot eat any of the wholegrain items. I can have potatoes cooked without their skins and not shown I can have white bread, rice and pasta.

Hang on a bit, actually, for my diabetes I should not be eating any quantity of carbohydrates as this gets turned into sugar, bad for diabetics. So between the diabetes and my tumour everything in the yellow zone is pretty much a no-no.

Things do get a little better when we look at that strange pink zone. I can eat the tinned tuna, chicken, fish, eggs, and mince. Although my tumour says no to fish skin and bones like you might get with sardines and pilchards. Meat is fine but no gristly bits, no bacon rind etc.

And on to the blue zone where I am allowed small amounts of cheese and milk.

And so, I am resigned to eating a mainly protein diet, not quite leaping into the full carnivor diet. Supplemented by squidgy overcooked root vegetables.

As if meal preparation wasn’t already difficult enough.

Ah well, as the anaesthetist says, it is only for a few weeks.

Sad to say, I still don’t have a date for my op.

Bobs Bowel 6 – Iron Intravenous Infusion


Monday 10th February and, as I stated in my last post, although I don’t have a date for the surgery the NHS is hell bent on keeping me busy.

Following my colonoscopy I was informed that I was borderline anaemic and that I would need an Iron Infusion before my surgery.

Today is the day and my appointment was scheduled for 10:00. However, my iron prescription has not arrived.

So, sitting waiting. It is 10:30 !

It’s now 11:10, and after much searching, the nurses, three of them, have managed to cannulate me. Apparently, my veins were playing hide and seek. Not helped by my not having had a drink before arriving in hospital.

I did make a cup of tea, but traffic news indicated problems, so we left early. My tea is still sitting on the kitchen counter.

I am now hooked up to the iron  juice,

and literally, it has just entered my arm.

The infusion should take about an hour.

Job done in just under an hour. I’ve been unplugged, given a cup of coffee and an egg mayo butty. Thirty minutes to check there are no ill effects.

Thirty minutes was up. Took my blood pressure, blood gas, and temperature. All good. The canula was removed, and I was discharged.

It’s now 13:30 and I’m sitting in the hospital cafeteria having a proper coffee. I’m killing some time before heading up to visit a friend of mine who has been a patient here for the last few days.

As for me, I have go and get a blood test in two weeks to see if the iron juice has done its job.

More later ….

Bobs Bowel 5 – Surgery School


Monday 3rd February and the preparations for my impending surgery continue apace. The latest adventure was a two hour class at Surgery School.

I know the NHS is constantly strapped for cash but putting me through a crash course in surgery doesn’t exactly fill me with confidence that my outcome will be positive.

Of course the aim is not for me to carry out DIY surgery. No this session was all about preparing me for surgery and getting me as fit as possible both for the procedure and the recovery period after.

Getting fitter, they say, will help reduce the risks associated with the surgery. Risks such as chest infection, blood clots, kidney problems, wound infection / healing.

To this end the speakers were focusing on exercise and nutrition, the importance of a balanced diet. Unfortunately, my cancer is such that it is partially blocking my bowel. Because of this I am continuing on a low residue diet which means I cannot eat many of the “healthy” foods. No wholegrain breads, no high fibre vegetables such as onions, leeks, cabbages, and cauliflower. Also many of my favourite salad vegetables such as tomatoes, peppers, radishes, celery and baby corn are excluded. In addition to the low residue diet I am also on a course of laxative, Molaxole. To help keep things moving.

Thankfully I am not a smoker as that is definitely a no-no. Apparently smoking can have detrimental effects on ones ability to heal and also the well publicised impact on the respiratory system.

Similarly, drinking alcohol is frowned upon. My consumption in general has reduced dramatically over the last few years, to the point where I might only have a pint of beer or a glass of wine every week or two. Total abstinence won’t be an issue for me.

Preferably they like patients to totally abstain from drinking and smoking on the run up to surgery and offer help to those who need it.

And finally, that brings me to the contraption in the photo below. No it isn’t some kind of sex toy. This beast is an Incentive Spirometer.

Incentive Spirometer

All folks attending surgery school were given one of these. The purpose is to reduce the risk of lung complications following surgery.

Use of the incentive spirometer is part of the iCOUGH process a program implemented by hospitals nationally and internationally. The acronym ICOUGH stands for: Incentive Spirometry, Coughing and deep breathing, Oral care, Understanding, Getting out of bed at least three times daily, and Head-of-bed elevation. The program emphasizes deep breathing exercises to keep lungs healthy and prevent lung problems. Oral care, patient and family education, getting out of bed, and head-of-bed elevation are also important components of the program.

We were instructed to use this device three time per day prior to surgery, and every hour following surgery.

I still don’t have a date for the actual surgery but the medics are focussed on getting me fit and also preventing me from getting bored.

Bobs Bowel 4 – NHS Healthcare


After years of paying National Insurance there is no doubt I am getting my moneys worth from the NHS. After playing the poo sticks game I have had a Colonoscopy, CT Colonography, a session with a colo-rectal consultant and have been booked in to Surgery School.

My home phone seems like it is a hot line to the QA (Queen Alexandra Hospital).

Following the consult I received a text message informing me that a call had been booked by the Care Coordinator !!! No explanation of why. Obviously I could make a pretty goood guess. But I still had to confirm back to them that a call before midday on the 31st was acceptible. I also took the opportunity to ask what the call was about. The response was almost instantaneous. Lisa, the Care Coordinator from my GP Surgery, having seen various letters between the hospital and my GP, was making a courtesy call to see how I was doing with the ongoing investigations.

So Friday 31st arrived and it turns out that Lisa had very little information. I have since seen the letters that my GP was sent. Not very enlightening. So I brought Lisa up to speed, giving my history so far, up to and including my consult on Tuesday.

She in turn told me about the services that were available to me leading up to the surgery and what support they can provide after I return home. This includes councelling, assistance with obtaining benefits etc. After a very pleasant chat we agreed that she would call me on 28th February to see how I was going. Hopefully I will be home recuperating after the operation.

As I said my phone has been very busy. On Friday morning I missed a call from Julie, one of the colo-rectal nurses. She left a message inviting me to call her back. I returned her call and retaliated by leaving her a message in her voicemail. After one round of answer phone tennis she called me.

She asked if I had heard from the anaesthetist, which I had not. She told me that they had spotted that I was borderline anaemic and that I needed to be scheduled in for an iron infusion/transfusion!

Two weeks ago, the doctor that did my colonoscopy had told me about this. I had forgotten but I am glad that the anaesthetist is on the ball. Julie told me that I should probably expect to be contacted early next week, and that if I didn’t hear from them by Wednesday, to call her.

Later that day I received one of those neutral NHS appointment invitations. Informing me that an appointment has been made for 10:00 on Thursday 13th of February. What is this for? Is it for my iron infusion, or just a face to face with the anaesthetist? There is no information about what if anything I need to take with me. Nurse Julie told me I should arrange a lift for when I have the infusion just in case I’m not fit to drive after. There is nothing in this invite to clarify so I will have to call them on Monday.

One thing I will say for the NHS, once you are in the system they do look after you. So far, I have nothing but praise for the staff that I have been involved with. With the one exception, the CT Colonography, they have ensured that my experience thus far has been reasonably pleasant.