So at the end of my last post I had just escaped from the QA following my Brachytherapy procedure. This was to be a temporary escape as I had to present myself back at the hospital for a CAT scan.
So the following Monday I dutifully presented myself for scrutiny. Unfortunately it was organised chaos due to a lack of availability of notes. This is not the first time that my notes have not been available although it is more usual for them to not be available for an appointment that has been set up for weeks.
I did press the radiographer as to why it was necessary for my notes to be available when they knew that the scan was to confirm placement of the radioactive seeds in my prostate. I said that I assumed they knew where the prostate was and therefore where to target the scan.
She, very patiently, explained to me that having a scan 3 days after brachytherapy was not normal procedure. The norm is to have an MRI after about a month, so they needed to know if there were any other issues that they needed to be aware of. They did their best to find my notes, even going up to the ward to search on the assumption that they, my notes, were “in transit” due to the weekend.
My consultant must have foreseen this as he had provided me with an extension number on which he could be contacted, even though he was in surgery. I passed this number over to the radiographer and after a short chat with my consultant we were good to go.
So after nearly two hours pfaffing around I had my ten minutes of scanning and we were out of the hospital. Of course there is then a period of trepidation, waiting to hear if I was going to have to go back in for more seeds. As time passed I relaxed, no news is good news after all.
A month after the procedure I had the MRI. This was a much quicker visit than my previous MRI. I guess because this time they were only interested in checking the prostate itself and the immediate surrounding area.
Once again, there is that trepidatious period of time where you wait for the bad news phone call. And, once again, as time passed I relaxed.
The next check point in all this was to be a visit to the consultant preceded by a visit to the vampire clinic.
Which brings us up to date.
Last week I gave the blood sample required to check my PSA levels and yesterday I visited my consultant. After all the pleasantries, how is your bladder, how are your bowels, etc. etc. we eventually got round to the important business i.e. talking about my PSA.
Brilliant news !!
Prior to the brachytherapy my PSA was up at just over 13. Now my PSA reads just over 1. Which, in the words of my consultant means that the seeds are doing their job. My next check point will be in six months when I will have another blood test and another consult.
My thanks to Clotho, Lachesis and Atropos, the three fates (Moirai) for watching over me. I think they were watching over me last December when my operation was cancelled due to a lack of hospital beds. When I think about all the possibilities I am so, so glad that I have taken this path.
For those of you who are following this saga you will remember that my last post was shortly after attending hospital for surgery. That the surgery was cancelled due to a lack of availability of beds.
I think the fates intervened and the cancellation of the operation was a blessing in disguise. There were just too many risks with the operation and the potential impact to my lifestyle for the following year (at least) were just too much to consider.
So, surgery, which was always my first choice, has now been kicked into touch, and became the option of last resort.
Since December 2014 I have had follow-up appointments with Mr Wilkinson, my consultant. We have discussed fully, my reasons for not going ahead with the surgical option. As a result I was referred to an oncologist, Mr Nagar who talked me through the alternative radiotherapy options.
Given in the hospital radiotherapy department, as daily sessions from Monday–Friday, with a rest at the weekend. The course of treatment would last for just over 7 weeks.
Low-Dose Rate (LDR) Brachytherapy
This type of radiotherapy is sometimes called internal radiotherapy, implant therapy or seed implantation. This uses small, radioactive metal ‘seeds’ that are inserted into the tumour so that radiation is released slowly. The seeds are not removed but the radiation gradually fades away over about six months. There is no risk of it affecting other people.
So after a full and frank discussion with Mr Nagar I was left with a lot of thinking to do, along with more discussions with my wife. The net of this was that I decided that LDR Brachytherapy was the right treatment for me. The following images show the basics of the procedure.
And so it was back to Mr. Wilkinson who scheduled me for a Flow Rate Test. I mentioned that this was somewhat less than successful last time so he suggested that the fall back plan would be a visit to Urodynamics.
As preparation for the Flow Test I had to keep a diary, over three days, of how much liquid I took on board, the type of liquid (tea, beer, wine etc.) and how much pee I produced. On the day of the flow test I thought I would help things along by arriving at the hospital early and drinking lots of water. I spent nearly an hour walking the grounds sipping at my bottle of water. Twenty minutes before my appointment my bladder started to indicate that it would need emptying soon so I headed up to Urology. I let the receptionist know that I might have an urgent need to perform. I was directed to take a seat and to let her know when things became truly urgent. So I sat there and my bladder went to sleep.
At my allotted appointment time I was called through to another waiting area asked to sit, offered tea and told to shout when I was ready to do the test. My bladder snoozed on. It was perhaps another thirty minutes before my bladder woke up. So I looked for the nurse. No sign. Well she said to shout so I did. After all I didn’t want to waste this opportunity. Thankfully the nurse appeared and we dashed to the flow test equipment. Basically it looks something like this….
After successfully performing I was given a quick ultrasound check to see what was left in my bladder and there it was, job done. Although I had a second appointment set for a visit to Urodynamics it was deemed not to be necessary and was cancelled. Instead a new appointment with the consultant, Mr Hodgson, was set.
Time flew by and once again I presented myself for the scheduled appointment with Mr Hodgson. Sadly, not for the first time, there was a distinct lack of notes. At least the computer was working this time and he was able to access my notes that way. However, what was missing was the flow rate test results. Two sets of print outs were found from that date and I had to choose the chart from my test. Thankfully the graphs were very different and I could easily identify mine.
The results were deemed good and I was informed that I would need another rectal (digital) exam as well as having my prostate vital statistics taken.
So there I was again, trousers round my ankles, up on the couch, laid on my side with my knees under my chin. Different room but the scenery hadn’t changed just a blank wall painted in that neutral paint that all hospitals seem to choose.
First up was the rectal (digital) exam and for the first time since this whole process began I actually felt some discomfort, though not for very long. This was followed by an Ultrasound Scan during which measurements were taken of my prostate. These help to determine the shape and mass of the prostate and would be used during the Brachytherapy procedure.
Soon the scan was finished and I was back in the vertical plane. I almost had my trousers secured when I was informed that some of the data from the scan had not been saved. So it was trolleys round the ankles again, back on the couch and staring once again at the blandly painted wall. This time the scan image was saved and once fully dressed we were back to discussing the procedure and timing.
Apparently hospitals don’t keep a cupboard full of these things around and the seeds have to be procured. I wondered if they went to Suttons, Fothergills or perhaps our local garden center to obtain the seeds. I did not vocalise these thoughts. They implant 80 – 100 Iodine 125 seeds @ £30.00 each. That’s dearer than a packet of Impatiens seeds.
When my consultation was over I had to visit with the nurse for nasal & groin swabs. She was less than amused when I suggested that I had saved the NHS money by using one swab for both areas. Either she’d had a humour bypass or had heard it all before.
On 13th May I presented myself for my Pre-Op Assessment and was duly measured, weighed and gave up a blood sample.
Before I knew it a date had been set for the procedure, May 15th. This was sooner than anticipated and I will admit to going through a moment of panic.
On the day I presented myself at reception and was shown through to a consulting room. I was measured and weighed again, blood pressure taken and given some premeds, antibiotics etc.. I was visited by the anaesthetic and the consultant and signed the consent forms after having everything explained to me. Thankfully, this time, the wait was not very long between these consultations and being taken through to theatre.
Preparation for the procedure was a surreal experience, what with me being dressed in the wonderful hospital smock and stockings, also the jokey disposition of the theatre staff. We were actually having a good time and that was before I had any anaesthetic.
It was about this time that I started to misbehave. As usual they inserted a canula, except that they had two goes at that. Then they informed me that I was due to have an epidural, which had not been discussed previously. At the same time they administered something through the canula that they said would make me feel like I had consumed a couple of G & Ts. I remember feeling a little woozy and then nothing more until came to in the recovery area.
I was subsequently informed that the anaesthetists assistant tried on two occasions to set up the epidural. They are supposed to see spinal fluid come out of the needle and on each occasion I wouldn’t give any up. The anaesthetist then took over and tried herself, three more times, and still I wouldn’t give any fluid. At this point they decided that they would give up on the epidural and put me under with a general anaesthetic (GA). Once they had me under, and the procedure was underway, that’s when I really began to misbehave. I decided to vomit.
From what I have heard vomiting whilst under a GA is not good. This required the use of dyna-rod and a vacuum cleaner to clear out my tubes and the upper reaches of my lungs.
As a result of this the procedure took much longer than the estimated two hours which would be normal. A further consequence was that I had to stay in hospital overnight, when I had expected to go home, and I was wheeled up to a ward where I was connected to an oxygen supply with attached humidifier. This was so that they could monitor me and make sure that I hadn’t inhaled any of my stomach contents and didn’t suffer an infection.
So there I was stuck in hospital. Hungry, I hadn’t eaten for over twelve hours. Thirsty, no fluids other than a few sips of water prior to the procedure. Catheterised, for the procedure and for the duration of my observation. Sore throat due to the GA and subsequent rodding out and suction due to my vomiting session.
The nurses brought me a sandwich to alleviate the hunger. A cheese on wholemeal sandwich was the only choice and was so dry that it was very hard to swallow, especially kind to my sore throat …. NOT !!
This was only the beginning of the fun night. Did I mention that I was catheterised ? Through the night I was subjected to hourly obs. Just as I was drifting off to sleep along would come the nurse to take my temperature and my blood pressure. Then, just as I was drifting away again, she would come back and I would feel a pulling at my penis. This was specifically related to the brachytherapy and the catheter. She had to use a Geiger counter type device and scan the contents of bag attached to my catheter then along the length of the tube up to the old fella. Required to ensure that none of my seeds had escaped. Any found would need special handling for disposal. Seeds can escape from their implantation point and move around the body. Supposedly this is not harmful.
Saturday morning arrived and I felt a bit fresher after a strip wash and some breakfast. I was scheduled to go down for an X-ray but someone cancelled it which meant a new booking for later in the day. Hospitals are the most boring places to be when you are waiting to be released.
I was visited by the consultant who informed me that I would need to go for a scan on Monday. This was to ensure that the seeds were implanted in the right place and the right quantity. He also said I could have the catheter removed. Yippee !! His female assistant performed the removal saying “this might feel a little strange”. Decidedly unpleasant would have been my description. Mind you, after my first few pee’s following catheter removal I would have gladly had it back. The sensation is as close to burning as I can imagine and it seems like you can feel it all the way back to your bladder. Thankfully that sensation slowly faded away over the next couple of days.
The consultant also gave me a little blue card, which I have to carry for the next three years. This card informs people that I have “received a permanent radioactive iodine seed (Iodine – 125) implant to the prostate”. This is not because I glow in the dark, but the seeds will show up on various scanners and may even set off alarms at airports.
Back in the hospital, the consultant said he was happy for me to go home but that the final decision was down to the anaesthetist. And he wouldn’t give the go ahead until I had an X-ray.
Well it was nearly 16:00 when I was taken down for the X-ray and it was gone 17:00 before I was finally released. At this time I was given a box of Tamsulosin capsules.
Tamsulosin is used to relax the muscle around the Prostate which, not unexpected, can be a bit irritated following the implants. How would you feel after 80-100 foreign bodies were inserted about your person. Add to the facts that they are radioactive too. The irritation / inflammation can cause the Prostate to swell and constrict the urether making it difficult to pee.
So home I went. What a relief it was to get out of the hospital.
Yes, Thanks for the scary WTF moment this morning. I needed something to get my heart pumping …. NOT !!!
So there I am following this Dairycrest milk float through the QA hospital site when you, the Dairycrest driver, decided to pull into the bus stop lay by without indicating or braking. I carry on following the road and am just pulling alongside the milk float when you, the Dairycrest driver, pulled back out into the road, again with no indication.
Good job one of us was awake this morning as I avoided the collision that you, the Dairycrest driver, were intent on having.
That is why I award you, the Dairycrest driver, my Dickhead Of The Day award.
This award is normally reserved for Aqua Cars drivers, who have a total disregard for the highway code once the get on the QA site. However, they were somewhat scarce today so the award is yours.
Carillion are making money hand over fist with the contract that they negotiated with the QA authorities. I was told that the money they collect doesn’t even go into the hospital coffers, is just a contributor to Carillions £212m profits for 2011.
If that is true then it is obscene.
We, the great British taxpayer, who fund the NHS in general and the QA in particular. Most people don’t visit a hospital out of choice. It is usually because we have a health problem or to visit a friend or relative who has a health problem. Yet when we do have to visit a hospital we are fleeced.
Only this week I was talking with a neighbour, whose wife had been in the QA for six weeks pneumonia. He was paying over £8 pounds a day in parking charges.
That is criminal.
My wife works at the QA and she cannot afford to park on site as the parking charges exceed her pay which is why I take her to and from work each day. Yes she can use the staff Park and Ride but the car park on the hill is not very nice, especially during the winter when the paths and steps are icy.