Tag: surgery

Taking The Edge Off


Merry Christmas to you all. And I truly mean that. I hope you have managed to have a great time, and that you have managed to stay healthy, despite Covids best efforts and those of the other seasonal diseases that tend to crop up at this time of the year.

Over past years Gerry and / or I have managed to contract one of the various bugs doing the rounds during the Christmas period. Being sick really does take the edge off things especially when it means not seeing the grandkids opening their presents.

However, an unexpected benefit of the precautions taken, during the Covid pandemic ,seemed to be a reduction in the number of these seasonal infections. Sadly, now that many of the precautions have been relaxed there are many bugs doing the rounds. And, of course, Gerry has gone down with the dreaded lurgy, yet again. I say yet again, as this must be the third bug she has contracted this year.

Usually we are scanning around for the culprit, hunting down patient zero, searching for the one that passed on their germs. However, this year there are several candidates.

On the Friday before Christmas we were visited by a friend who said her husband was suffering with something. On the Saturday, Christmas Eve and our 45th Wedding Anniversary, we were visited by our daughter Angie and her husband Jon. He was suffering with a sore throat, croaking well.

That brings us to Christmas Day itself. Our granddaughter Keeley was hosting us this year, and of course nobody wanted to call it off, but, Keeley and her eldest, were both suffering with their own lurgy variant. And we didn’t see her youngest as he was in bed all day doing battle with his own lurgy. Although we had a good time and the food was yummy, the day was a little subdued. The edge had definitely been taken off.

Obviously, the odds were not in our favour and Gerry started with a tickly, then sore, throat late on Monday, Boxing Day. And there we have it, multiple folks at which to point the finger of blame.

Our concern is, as always, that anytime Gerry contracts one of these coughy cold/flu things, it invariably travels down onto her chest and evolves into a chest infection. Earlier this year she had two such episodes resulting in three prescriptions of antibiotics.

This morning, wanting to get a jump on things, I started the marathon task of trying to get an appointment to see / speak to a doctor. To stand a chance of getting an appointment, you have to start calling Crookhorn Surgery at 08:00. I started calling on the dot, with the following results ……

75 Calls = Number of attempted calls when the line was engaged.
This is only possible when using a modern phone, hitting redial immediately the system drops the call. I can’t imagine what folks do that are still reliant on landline phones and those that aren’t au fait with modern technology.

7 Calls = Number of calls picked up by the automated system, where I had to listen, excitedly, to a message which informed me that they were busy and to call back later. At which point the call is cut leading to huge disappointment.

At 08:13, after some 82 redials, I managed to break through to join a queue where I was informed, regularly, that my wait time was one minute. After some time I actually spoke to a human. The net result, after just under 10 minutes, was that we had been triaged and informed that we would receive a call from a doctor by 13:00.

This is better than last time where we attempted to get through, and, after 40 minutes were informed that there were no more appointments that day and that we would have to call back the following morning.

The good news from this, is that we had received the call from the GP, who duly prescribed the antibiotics. At 10:21 I received a text from the pharmacy to say that the script was ready for collection. By 11:30 Gerry had taken her initial dose.

Obviously, this is an improvement over our previous experience. But it does not reflect well on the NHS. Covid regularly gets the blame for whatever ails the NHS. All I can say is that prior to 2019 we were able to get appointments fairly easily, that we actually got to see a doctor on almost every occasion. Since 2019, trying to phone for an appointment is a chore, which rarely results in a face to face appointment.

Today my wife was called by a doctor who prescribed antibiotics over the phone. He didn’t see my wife, didn’t take her temperature, didn’t listen to her chest / lungs. This is not the NHS service that we are used to. But it seems that we are going to have to accept this as the new norm.

My Prostate and Me – Part 8


My Prostate Operation Was Cancelled – After 3 + hours of waiting.

Well, it’s taken me a while to get my thoughts together after what turned out to be a really stressful morning. Truth be told, I had probably been stressing for quite a few days but had not realised……
As I said in my previous post, we had been requested to arrive thirty minutes earlier than the 07:00 originally planned. This was, supposedly, so that I could have my pre-operation meet with the surgeon and anaesthetist. So my wife and I dutifully presented ourselves at 06:30 in Theatre Admissions and were, almost immediately, shown through to a consultation room.
A nurse arrived, wrote out a luggage tag for my small holdall, and attached a fancier version to my wrist. So far all was moving along quite nicely. Next she started taking / checking my details and very soon I began to wonder what the point of the pre-operation assessment was since all the questions were repeats of Wednesday afternoons interrogation. My doubts further increased when she informed me that she didn’t have my blood details nor my ECG results both of which were part of the Wednesday session.

Already somewhat stressed, in anticipation of the forthcoming procedure, I was beginning to get a little terse. Not just that, but I was also beginning to wonder if they knew what I was in for. A thought that was reinforced a few minutes later when I was invited to get changed. Some of you will remember from my previous visit, for the template biopsy, that I had been given a gown which was way too small and couldn’t be secured. In an attempt to prevent the same indignity I asked for a larger gown. Yet again I was offered a small size. It was obvious that it wouldn’t even fit across my shoulders, let alone do up at the back. Almost grudgingly I was offered a “bariatric” gown. I muttered “whatever that is ” under my breath. Obviously not under enough, as I was informed “oh they are huge !!! “.
As she handed me my bell tent I was asked “what is it you are having done? ” I replied “my Prostate!! “. “Then you should take everything off!!” she informed me.

With that I was left to change. The gown had enough room in it to hold a small disco but at least I could fasten it up. And, best of all, my new dressing gown was of sufficient length to reach the lovely sage green pressure stockings I was sporting. This new vision of sartorial loveliness was finished off by my new suede moccasin style slippers. Now, properly attired, I returned to sit with my wife in the consultation room.

There then ensued a, seemingly, long wait. In truth it was probably only minutes but eventually the anaesthetist arrived and after he had confirmed my details, and repeated many of the questions from Wednesday afternoon, and from earlier this very morning, he ran through what the order of play would be.

For the first time the duration of the operation was mentioned. I had been under the impression that this was to be a two hour procedure. Nope, this was to be four to five hours in duration. Suddenly the first penny, of a whole bag full, dropped and the true magnitude of this operation began to sink in. Five hours!!! He also mentioned that it was possible that the robotic basis of the operation could switch to full open surgery should any problems arise. This had always lurked at the back of my mind and, to be honest, that is where I kept it filed. That is, until the session with the surgeon.

Fast forward a few minutes….

Mr. Wilkinson talked us through the operation and thoroughly explained risks. How little I knew. Over the last couple of years I have reviewed the implications of having this operation and thought that I was pretty well versed. Trouble is, I had been focusing on the post operative time frame. I had not paid too much attention to the detail of the surgery itself.

He, Mr Wilkinson, listed the various risks involved with a radical prostatectomy, starting with how difficult it was going to be to find the little sucker. Especially given the route taken during keyhole surgery, in through the abdomen then turn due south and head for the pelvic zone.

Add to that the fact that the robot has fixed length (but short) arms. I know some folks who are like that when it comes to buying their round in the pub. Next up was the proximity of the prostate to my bladder which introduces a risk of damage over and above the urinary incontinence which is to be expected. Moving swiftly on, next on the list is the proximity to the bowel.

New news here was that the prostate could be stuck to the bowel and that this could have been caused by, if not caused by then exacerbated by, the biopsies I had as part of the original diagnosis and active surveillance regime. At no time was it ever explained to me that the biopsies, TRUS or Template, could have negative impact on future surgery. Apparently during the prostate operation they mighty have to peel the bowel away from the prostate. The biopsies could contribute to any adhesion between the bowel wall and my prostate and the act of separation could cause damage that would have to be repaired. If such damage occurred it would require a colostomy to allow the repair to heal. Obviously, once the repair was healed there would have to be another operation to undo the colostomy. My four to six weeks recovery period suddenly looked to be extending with the possibility of the further surgery and recovery period.

Continuing on with the inherent risks of this surgery, let’s not forget that during the procedure I would be tilted head down by approximately 30 degrees. This would cause my innards to slop towards my head, thereby putting pressure on my heart and lungs. Apparently this is a negative thing.

The coup de grace was  the underlying small print of robotic surgery, if they ran into any difficulties, i.e. the Da Vinci machines short arms couldn’t reach, they would revert to the good old fashioned procedure and open me up from stem to stern.

Bottom line for me was that, due to my 18.5 stone (259lb) weight, the risk factors were double the norm.

This operation, and the potential ramifications, was taking on mammoth proportions. And now, the anxiety I was already feeling, was ratcheting up to whole new levels. I really was beginning to feel that I was making a big mistake. But, despite my misgivings I still signed the consent forms.

You may well ask “Why?” Why proceed when I was obviously having doubts.

I can offer no sensible answer. Guilt, Fear, Not wanting to let anyone / everyone / myself down.

After Mr Wilkinson left, my wife said “I fully expected you to refuse to sign that “.

Her statement just added to my anxiety and it was at this point that the anaesthetist returned to ask if I would agree to an epidural. As there was the possibility of my robotic surgery converting to full open surgery he thought it might be a good idea to give me an epidural to help with the pain management.

It was then that I experienced what I can only describe as a “crisis “. It wasn’t that I was crying, there was no wailing and gnashing of teeth, just that my mind was in total turmoil. I was in a flat spin. I really don’t know if I was coherent but I do think I was borderline having a panic attack. I couldn’t answer him. I tried to explain that I was seriously thinking that I shouldn’t go ahead with the surgery. He sat there patiently until I regained my self control and eventually I informed him that he should go ahead with the epidural.

So I was still going ahead. I think that I probably convinced myself that it was normal to have doubts and that I was probably magnifying the issues out of all proportion.

At around 09:00, my wife, took herself off to work and I went to sit with the other surgical victims where I waited for nearly an hour. During this time I was brought a cup of tablets, my antibiotics, anti vomiting, anti anti everything etc etc. And a small cup of water to wash them all down. This was the only drink I had since 05:30. The nurse that delivered them said something that I didn’t quite catch but when I asked she apologised for the long wait and informed me that there was meeting underway to discuss if my operation was to proceed as there was an issue regarding availability of a bed for me after my operation.

Around 10:00 Mr Wilkinson arrived and took me off to a consultation room. He explained that my operation had been delayed due to the beds issue. That he and the other consultant, Mr Solomon, had decided at around 09:30 that the operation was a no go. At around 10:00 the management had given permission for the operation to proceed but by then this was considered to be way too late. The operating list for Friday was morning only, such a late start would mean changing members of the surgical team mid operation and a probable finish time around 17:00. Adding to the risks previously outlined and putting the surgical team under the clock, more so than they would normally be. All in all, not good for the patient, Me! And not good for them.

To say that I was relieved would be an understatement. I had a long chat with Mr Wilkinson about my earlier “crisis” and whether surgery was the right option for me. The net of this was that the reschedule of my operation would be deferred until after Christmas.

To be quite honest,my wife and I are taking this time to rethink if this is the right way to go. Right now it doesn’t seem that surgery is for me.

I think, fate was on my side, that this operation was never meant to be.

My Prostate And Me – Part 4


So, It’s been a while, almost exactly a year. Had a fairly intense conversation with a close friend last night. The intensity was about Steve  Jobs and Apple, not my prostate, but that’s another story. Anyway during our conflab I was berated for not adding anything to my blog. In essence he was telling me off for leaving my story on another cliff edge.

As it happens I am approaching another significant milestone on this journey and by the time I finish this we’ll be at another cliff edge.

So here we go.

Consultations

Just before Christmas I had a meet with my consultant. Well one of them, seems I have three and they are not as entertaining as the Three Stooges, must be the subject matter. Anyway they take it in turns to see me.

I duly present myself at Urology Reception and after a short wait in the “General” waiting area we are ushered through to sit in a holding pattern outside the consultation rooms. I have been here a few times now and the wall opposite the seats isn’t getting any more interesting. Pride of place is given to a cross-sectional view of the male anatomy.

Urology Care Foundation - Urology A-Z - Ureterocele www.urologyhealth.org
Urology Care Foundation – Urology A-Z – Ureterocele – http://www.urologyhealth.org

I’m not sure if this image is the one I get to stare at, but it’s a close match. I keep expecting some hints on the prime cuts and interesting ways to cook them.

I digress.

So, seated in the consultation room, I am informed that the Template Biopsy hasn’t disclosed any new frightening discoveries. In fact this latest biopsy pretty much supports the findings of the original TRUS (Trans Rectal Ultra Sound)(See Part 1 above). Basically my cancer is quite small, isn’t raging doesn’t on the face of it appear to be life threatening. In my words we are effectively back at square one. That is, the situation is the same as it was around 18 months before.

Relief

 

Obviously, I was quite relieved and commented to the consultant that I had fully expected to have to make a decision following the biopsy results. He was quite interested to know what my decision was going to be. I explained that I would probably have opted for the operation, prostate removal. My reasons being that I would be able to fall back on radiotherapy if the cancer reappeared. Once you have had radiotherapy surgery really isn’t an option.

Lecture

The consultants response to this was to give me a fairly forceful lecture on the possible side effects to the surgical option. Urine leakage and erectile dysfunction being the two headline leaders. He hammered home what a life changing thing incontinence can be and that I shouldn’t go into surgery lightly. For a surgeon he was doing a good job of selling radiotherapy to me. He then went on to explain to me what a difficult operation it is to remove the prostate.

Apparently my weight was a big consideration here and it was at this point he asked me to stand up so he could lift my shirt and demonstrate. He explained that for keyhole surgery, even though this isn’t abdominal surgery, the entry point is through the abdomen. Having entered the belly they then have to turn due south and head deep into the pelvic region. He pointed out that as I was a big lad, with a significant “food baby”, the journey through my entrails would be a long one. That he wouldn’t just have to negotiate his way past all the tubing but would probably have to burrow through extra fat. A new twist was that for the operation I would be tilted head down, meaning that all my fat encrusted viscera would slop up towards my lungs to press against my diaphragm. Wasn’t this a good thing I enquired, won’t this clear the way  and make the operation easier. Nope, this migration makes life difficult for the anaesthetist. Yards of tubing heading north makes it difficult to keep the lungs full of oxygen. After this I wasn’t sure if he was bigging up his role or trying to dissuade me from having the surgery.

After all he is a surgeon, isn’t that his raison d’être. To be fair he did pretty much say that himself, that he just wanted me to be clear that surgery is not the easy option, nor is it without risks. I suppose I could have suggested that he had misjudged his audience since I was pretty well read up on the subject. I don’t let anyone go rummaging around my insides without finding out what they are supposed to be doing and what the pros and cons are.

Carry On Regardless

So, having come to an understanding I opted to carry on with the Active Surveillance with a view to probably having a scan and/or another biopsy. I must have given the impression that I wasn’t wholly convinced by his lecture and he was rather keen that I see one of his colleagues for an alternative view. This I agreed to do and we shook hands and parted company.

Approximately a month later I had an appointment with consultant number three. We discussed the biopsy results, the options open to me and the pitfalls of the various treatments. Once again it was agreed that I should carry on with the Active Surveillance. Part of the Active Surveillance regime is the taking of bloods on a regular basis, every 3 to 4 months, to monitor PSA levels.

PSA is not viewed as an accurate indicator of  the presence of cancer but once diagnosis is confirmed the PSA can give an indication of change.

Changing Perspectives

And so it was I found myself once again at the QA, being given an opportunity to brush up my male anatomy and finally sitting in one of the consultation rooms. No consultant this time as I was seeing the Nurse Specialist. She talked me through my history and pointed out that my PSA levels had gone up. Previous readings had plateaued but the general trend was up. Her advice, based on 18 years of experience, and taking into account my age, she was of the opinion that it was time to take action. This was a contrast to the position taken by the consultants who were prepared to let me continue with the Active Surveillance. We kicked the subject around and it was agreed that I should go for a MRI scan and that I should then see the consultant to discuss the results.

MRI

If it’s good for nothing else, prostate cancer is introducing me to some new life experiences. TRUS, Template Biopsy and now an MRI. Everyone that I have spoken to, that has had an MRI, have said that they didn’t enjoy the experience. I wouldn’t say that I enjoyed it either but I didn’t actively dislike it either. I did, however, find it interesting. It’s noisy and a bit claustrophobic especially when you are my size. As your lower extremities disappear into the centre of the doughnut the hole begins to look a bit small. And when the table moves further in and your belly and chest further fill the available, visible, free space I suspect that the experience is similar to sausage meat being transported towards the sausage skin waiting on the tube at the outlet on the mincer. Another interesting thing I noticed was that as the MRI is clacking and clanking away the muscles in my left leg started to move in time with the noises. Not twitches as such, just a slight pull. Similarly, my wedding ring was also pulsing in time. These sensations varied with the tone of the MRI. Eventually it was all over and I left the QA to await the call to go and discuss the results.

Decision Time

Time moves on very quickly when you aren’t keeping an eye on it. Before I knew it I was back at the QA staring at that same wall with the same diagrams and posters. Still no recipes. And then into the consultation room.

Much to my surprise he told me that the results were really quite good. That is the MRI showed quite low levels of cancerous cells and that these cells do not appear to have moved onto other areas. All in all the MRI was pretty much repeating what the Template and TRUS biopsies had shown before. The only fly in the ointment was the steady upward trend of the PSA which didn’t seem to be echoing what the scan and biopsies were saying. Once upon a time doctors told you what was going to happen and then got on with it. In these PC times it’s all about patient choice. The trouble is the patient is necessary best qualified to make the decisions. Even if they have all the facts in front of the. And that’s the dilemma that i was confronted with.

I had the diagnostic results all laid out before me. I had all the options for treatment defined. I just had to make a decision.Anyone who knows me will know that I can’t make a decision when I’m in a restaurant with menu in hand. And then it doesn’t really have life changing implications if I make the wrong decision. Here there was no truly wrong decision to be made but the implications were momentous.

Decision Time

In the end I decided to go away and think on it. Subconsciously I probably knew what my decision was, but mentally I wasn’t ready to say it. I pondered for several weeks and then contacted the QA and told them to put me on the waiting list for surgery. The consultant had told me it would probably be a couple of months before I got a surgical appointment so I was looking at December / January.

Appointments & Disappointments

A couple of weeks ago, on a Tuesday, I got a call informing me that my appointment had been made. It was for the following Friday. Three days notice.  Unfortunately I had other plans. The proposed day of the op we were due to go away over night and a week later we were heading up to Merseyside for a few days to spend time with family. Hotels had been booked and paid for and I wasn’t prepared to pass on those. The young lady tried to persuade me otherwise, telling me that “it’s really important that I had this operation”.

I wondered who she thought she was talking to. Wondered why she might think that I didn’t know the importance of the surgery. After all, I’m the one carrying the infected walnut around inside me. I’m the one going through the various biopsies, scans and blood tests. I’m the one who is being nagged by various family members to get on and have it done. She did, does, sound very young.

So, disappointed, she said she would call me again when they had another appointment for me. And that call came yesterday.

I have a busy week, next week. Monday I meet with the consultant. Wednesday I go for my pre-op meeting to see if  I am fit to have the op. and Friday at 07:00 I have to present myself at Theatre reception.

I’ll let you know how I get on.

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