Saturday night and a glass of red!

Back on the treatment trail, will it work? I most definitely hope so!!

The RT treatment was quite straight forward, strip down to tee shirt and shorts and up onto a couch amid high-tech gubbins to be carefully wedged into place so that the radiographers could line up their x-ray machine on one of my tattoo marks.  I was told "DON'T MOVE" while the operators went and hid a a lead shielded room.  The machine clicked and hummed while the timer counted down, more clicks and the humming stopped, staff appeared from their dugout, realigned the  machine, ordered "DON'T MOVE" and disappeared again.  When the third dot had been zapped treatment was over until the same time next day and so on for the rest of the week.  Because my treatment slot was 11:20 it made a serious hole in the day so with a bit of pleading and eyelash fluttering I managed to chat the young lady programming appointments to slot me in at the beginning of the day, so on the Monday of week two I had an early start to get back up to Inverness but it was worth it to have the rest of  the day to myself.
Because of the travelling involved while I was undergoing treatment I was accommodated in an NHS flat at the hospital from Monday through Friday and home over the weekend.  Knowing that as the therapy progressed its effect on me would be more and more tiring so I had resolved to make the best use of these early weeks.
My mountain bike was in the back of the car so after my therapy session I was away.  Culloden Battlefield (National Trust coffee shop), along the Caledonian Canal from the basin at Clachnaharry (nice little pub) past Bught Park (cafe in the Floral Hall) to Dochgarroch (small cafe).  These trips out on the bike along with walks into town and browsing through the books in Waterstones (coffee shop), or spending hours looking through Leaky's huge stock of second hand books (coffee shop) kept me occupied and gave me some exercise.  The last two weeks of treatment were beginning to take a toll on me, the accumulated doses of radiation were making me very tired.  Now after treatment I would manage a short walk or ride, back for a shower and then read or sit out in the sun, after lunch I would sleep or read, dinner, perhaps some TV, a shower and bed.  The days were becoming a blur and the end of therapy was a bit of an anticlimax, a final session on the Friday morning, say my goodbyes to the radiography team, back to my room to pack up, load the car and away back to sunny Fort William.

Self indulgent? I don't care!

This cancer stuff is a cathartic process for me, so a wee glass of red and keep going!

Back to Raigmore and time for the catheter to come out; oh joy!  Back to life without having a bag of warm piss strapped to my leg!  Mind you, it did have the odd benefit, I could go for hours before I needed to think about looking for a convenient spot to drain off the plumbing system!  However, now that the 'main drain' had been removed, to ensure that my urethra didn't start to close up again I had the pleasure of having to 'self catheterise' once a day for a month.  A bit of DIY treatment!  The Specialist Urology Nurse sorted out a pack of catheters for me, gave me the instruction book (with DVD) and asked if I was happy about what I was required to do.  I told him I could think of nothing more thrilling than sticking a plastic rod up my dick and into my bladder every day for a month!  At least it was in my own hands so to speak, and wouldn't need the ministrations of the District Nurse.  I certainly didn't want to go through the problems of another stricture.

A month later and catheters all done!!!  a further two months and another PSA reading, still rising, definitely not a good sign.  Three more months, another test, another increase, a week or so later and an appointment to see my urologist dropped through the door.  Another journey to Inverness and a long discussion with my urologist about what was going on with my innards.  "Well it looks as though some cancerous cells have invaded the tissue beyond the prostate margin; hence the rise in your PSA level, I've organised for you to see an oncologist to discuss further treatment, I think we (meaning me) will be looking at radiotherapy".  Having gone through surgery and its associated side effect I was willing to do what ever else was necessary to effect a cure (if a cure was going to be possible!).  The oncology consultant explained in great detail what the proposed treatment would entail.  I would require six weeks of therapy, one session per day Monday through Friday, each session lasting around twenty minutes, but before starting I would require an MRI scan.  Now that my prostate was no more they would need to pinpoint where to focus the x-ray beam.  From data taken during the scan it gave three points where tiny black dots were tattooed, one on each hip and one dead centre on the pubis, these dots were aiming marks for the radiographers when setting up the machinery to zap me.
On May 30th 2005, just over a year after the prostatectomy operation I started my six weeks of radiotherapy.

A bit more on the cancer front

For the first couple of weeks back at home I was to have daily antibiotic injections in my belly; the District Nurse arrived to deliver the first 'jag' and after a bit of a chat with her and explaining what my job was she watched me draw up my dose of antibiotic and inject myself; satisfied that I could do the job it left her free of a patient for a while, she called in towards the end of the fortnight to see that all was going well, and then a week later to check up on my plumbing!  My catheter had to be examined to ensure there was no inflammation and that the bag contents were of a healthy colour and quantity.
The two weeks were soon over and I was back in hospital, thankfully just as a day patient, to be 'de-plumbed', bag gone, catheter out! Freedom!  Pee flow and colour was measured and recorded before I was allowed back into the outside world.  Hopefully that was it, quarterly visits to my GP for PSA tests and if all stable after a few readings it would be six monthly and than an annual event.  Oh were it that life was so simple!!

My first post op PSA test result seemed to bug my urologist, he said he was expecting the reading to be nearer zero and that I was to have the test repeated in a month.  A month later and the same result, but in the meantime another problem had occurred, my urine flow had become minimal and it was taking an age to void my bladder.  Two hours later I was on my way back into theatre!  The anastomosis scar tissue had virtually closed off my urethra seriously restricting urine flow.  One method of treatment is for the surgeon to insert a slightly tapered probe into the urethra and use it to 'stretch' the scar tissue back to a 'full flow' diameter; however my surgeon decided things were a bit too tight and chose to do a wee operation, this would entail using a knife to make a number of parallel cuts into the scar tissue within the urethra, inserting a catheter (again) and leaving it in place long enough for healing to take place around the tube, then, when the catheter is withdrawn, hopefully the urethra will not close up again (that's the theory anyway).
A day later and I was back on my way home with a brand new bag strapped to my leg and a prescription for some spare bags, antibiotics and pain killers.

A few weeks, another PSA test and again a slight increase in the score; not good!!

Forget Monday - knackered!

The weekend event was first class, a mountain bike enduro with around 300 competitors.  It was superb weather which helped to keep everyone happy, along with a first class catering trailer (The Billy Can) doing muesli, porridge, egg/bacon rolls etc.  Later in the day came a selection of burgers and a pasta dish with an excellent tomato sauce, and joy of joys real filter coffee!  The casualty count was quite light considering the difficulty of the technical sections, five on the Saturday with a couple of them off to hospital to get a further check out, and six on the Sunday mostly gravel rash or lacerations caused by trying to use their elbows to brake with (not a recommended method).  Ah well,  off to another bike event in a couple of weeks so we'll see what action that provides, hopefully quieter bunk room companions, the snoring varied in intensity but the 'blast' effects caused by a hot Rogan Josh made the windows rattle!

The weekend's going downhill!

Off to work at Innerleithen over the weekend, medical cover with Rescue Medics! well it helps keep me out of mischief!  A bit more of my cancer journey to follow on Monday when I get back plus a run down on the weekend's activities!

The show's over

A very fuzzy and gradual awakening with half heard voices then a more distinct "Hello, can you hear me?"

My eyes gradually focussed, a nurse came into view and said "That's it, your operation is all over, you're in intensive care for a little while, just rest and the surgeon will be along to see you shortly".  I think I drifted off in a morphine induced haze, then another voice prodding me into consciousness, "Your operation went very well, it took almost eight hours and their was a lot of work to separate the prostate margin and try to preserve the nerves and blood vessels, but we're all done now, get some rest and I'll see you in the morning".
I was about to drift off again when my ICU nurse came to tell me what some of the pipework sticking into and out of me was for, "Most important, that wee plastic thing you're clutching, any pain at all and you just have to press the button on the end, it will deliver a dose of morphine, the pipe under your nose is oxygen, and the other tube in your arm is feeding you, You've got a catheter up into your bladder so that we can measure your urine output and make sure you don't get dehydrated, now, as the man said, get some rest and I'll check on you later".

I guess I was still well 'spaced out' as I don't remember pressing any buttons through the night and only began to surface when the ward lights were turned up and the blinds opened.  Morning ablutions consisted of a sponge down bed bath and a tooth brushing session.  Later in the day my consultant came to check on his handiwork and make sure his stitching hadn't unravelled.  He must have figured I was perking up because he took the oxygen off, and the feeding IV out.  At the evening meal I could manage some soup followed by ice cream.  My feeding improved somewhat on day two and by the end of day three only the wound drains and urine catheter were still in situ.  Day four and I'm due for a dressing change and drains out.  I knew what to expect.  Oh joy!  Externally you could see two plastic tubes coming through the skin at the lower end and either side of the neat line of stitches running down my lower abdomen, internally the drains were two perforated tubes left in the bottom of a deep surgical wound to allow exude which forms in the early stages of healing to drain out, if this not done these pockets of fluid can become infected causing problems for the healing process.
Basically the drains just have to be pulled out, not an exciting prospect!  Nurse puts one hand on my belly (to stop my insides coming out) grasps the outboard end, says "Are you ready?" "Go for it"  I said.  It felt as though a hedgehog was being pulled backwards out of me!  "Oh well done, only one more"  Another hedgehog hauled out and it was over.  One more day and I can have a shower, at least it was something to look forward to.

It wasn't long before I was shipped off to a small four bed ward to finish my recovery.  Reading, some TV and shuffling around the corridors with my catheter and bag of pee strapped to my leg.  In the day room I'd often get offered a cup of tea so I'd slurp it down and wait to see how long before my bag filled up some more.  Well it was a diversion from reading or daytime TV.

Ten days after being filleted I was discharged, I said my goodbyes, and clutching a fistful of medical notes and  instructions, and my clothes bag, pee bag was already strapped to my leg, I was off the the WRVS canteen to meet my daughter who had come up from Edinburgh and was going to drive me home.

Decision made....

Back at Raigmore in the consultant's office I gave him my decision to have surgery, I wanted the tumours out rather than nuked and still inside me!  We talked over the implications of the operation and I was interested in what the procedure would entail.   "An incision from umbilicus to pubis, separate the muscles to expose the urethra and prostate, then the delicate job of dissecting out and preserving the blood vessels and nerves supplying the penis, once that's done it's the excision of the prostate capsule, as the prostate surrounds the urethra that part goes along with the prostate, I then create a join between the two ends, close up and that should be it".  It sounded simple enough to me!!!
Prior to the operation I had to have various scans essentially to check that the cancer was confined to the prostate and had not metastasised, or spread, into surrounding tissue or bone structure.  The MRI was quite straight forward, a slow slide through a noisy tube.  The bone scan required me to have an intravenous injection beforehand, but it was a bit disconcerting to have to go to the nuclear medicine department for the jab!  A fancy syringe filled with some radioactive gunk which was squirted into my arm and was supposed to highlight any nasty bits which may have got into my skeletal system.  Time for a coffee while the gunk circulated then an immobile twenty minutes while the scanner did its thing.

All clear on the scans and three weeks later I was on the bus heading back to Inverness, bag packed and sort of mentally prepared for the following day in theatre.  This was it!  At least I thought it was, unfortunately that day wasn't over yet.  I arrived at the hospital ward, was booked in, shown to a bed and handed a regulation NHS 'fasten up the back' gown, the orders were put that on but don't fasten the back up (??).  Blood pressure, pulse and temperature were all duly recorded and I was handed a glass of clear, strange smelling liquid, "Drink that straight down and don't stray far from the lavatory" (??).  I quickly discovered why the gown wasn't to be fastened!!  The phrase 'the bottom has fallen out of my world' was suddenly reversed!!!  The drink was designed to completely clear my digestive system and boy did it work!

A restless night, then the following morning at the appointed hour a porter arrived to wheel me off the theatre......

To continue the cancer story...........

After reading the Macmillan booklet and quizzing medics about options, the treatments on offer were; first of all, no treatment (monitoring only), sometimes called 'watchful waiting' this option is usually offered to older men or those not fit enough for treatments such as radiotherapy  or surgery and who have a slow-growing prostate cancer that is unlikely to affect their natural life span.  Active surveillance is a 'wait and see' process for low-grade early-stage prostate cancer, these cancers are usually very slow growing and may never cause any symptoms, for this reason some specialists advise waiting to see if there is any progression of the cancer before starting any treatment.  Radiotherapy uses a high power x-ray beam aimed at the tumour and is carried out over several weeks.  Surgery involves an operation known as a radical prostatectomy in which the complete prostate gland is removed.  Brachytherapy, also called internal radiotherapy, implant therapy or seed implantation is carried out by inserting small radioactive metal 'seeds' into the tumour so that radiation is released slowly over a period of time.  Hormonal therapy may be given on its own as a treatment or as an addition to radiotherapy, it may also be used at a later stage in prostate cancer progression, more of that later though.
The booklet I was given contains a lot more detail than is covered here and is only one of many produced by the Macmillan Cancer Support charity (www.macmillan.org.uk).

After some dark days, much reading, soul searching and talking with two friends in the medical profession I had come to a decision.  The fact that these two friends were surgeons may give a clue to the direction my treatment was heading.

mylife-bikerider

A bit of history!


In the beginning!!!.......In The beginning it was all down to an advert.  One evening sat watching some TV I saw a Highland Health Board information advert, "Don't die of embarrassment" it talked about 'men's problems', prostate and testicular cancer and the general age group affected.
Now I'm not a 'worrier', I rarely visit my GP and had no noticeable symptoms for either problem, even my one trip to the lavatory in the night was not unusual for a man of fifty eight!
However, I thought, I fit the age bracket and it's silly to ignore health checks, as the Health Board ad said, "Far too many men ignore things until it's too late".

I made an appointment and went to see what my GP thought about it all.

A few days later and I'm chatting to the man, "Well" he says, "A PSA (Prostate-Specific Antigen) test isn't all that satisfactory, there are many cases of false positive and false negative results, however, as you're here I'll give you the 'once over' I'll take some blood to test your PSA and do a DRE" (an eye watering digital rectal examination).
I have no problem with needles and watched as my dark red venous blood was drawn up into a vial to be sent to the haematology lab.  The next bit caused a little more concern!  "Just drop your pants and hop onto the bed, lay on your side and draw your knees up towards your chest" there was the ominous snap of latex gloves going on followed by a 'squidge' of KY Jelly.  "Relax" he says, easier said than done when a digit covered in cold gel is inserted into your rear end!!

"Everything feels ok" he says, "Your prostate is slightly enlarged but no more than usual for a man of your age, I'll see you again in a year and we'll check if there has been any change".
I walk from the surgery wondering if I really want to go through the experience of another DRE again even in a year's time!

2002, A year had gone by and a note in my diary reminded me that it was time to make another visit to my GP.  Should I ignore the note?  Should I go?  What the hell, I'd started the process a year ago, I ought to see it through.  Later that week I was back in the surgery waiting room reading and half listening for my name to be called out.  I read a few more pages of my book before the Tannoy clicks on to tell me to go to examination room 2.  The memory of the DRE had faded over the intervening months but resurfaced when told to drop my trousers and get up onto the examination couch!  The snap of the gloves, the gel, relax!  The post examination chat was far more relaxed than I had been while expecting 'the finger'.  However, I'm told that my PSA result was slightly higher and my prostate slightly larger but still felt OK and I should come back in six months.

November and I'm back to see my GP again.  I know the drill.  Trousers down, on the couch, gloves, gel, relax!  The chat this time is a little more serious.  "I can feel some hardness within the prostate I think I'll refer you to Urology at Raigmore (Highland Region's main hospital in Inverness) and we'll see what they have to say".
Concern began to set in as I trawl the internet and start to read up about prostate problems: The prostate gland (only found in men and is about the size of a walnut) sits just below the bladder and surrounds the urethra which carries urine from the bladder to the penis.  The gland is close to the wall of the rectum (back passage) and with a digital examination can be felt through the rectal wall.  The prostate produces a protein, Prostate-Specific Antigen (PSA) ans semen, a thick white fluid which mixes with sperm coming from the testes, the PSA turns the semen into a liquid.

Well I know where it is and I know what it does but what can go wrong with it?

If the prostate becomes enlarged it constricts the urethra and can cause difficulty or pain in passing urine, passing urine more frequently than usual (especially at night), and, though rarely, blood in the urine.  If you should notice any of these signs or symptoms consult your GP without delay.
Within a couple of weeks I had received an appointment to attend the Urology department at Raigmore.  This was the start of many visits to that establishment, initially to be 'digitally examined' by a urology registrar (with medical student in tow) and be told that I would be required to come back for a prostate biopsy to be done, and would I very much mind if the student had a search of my rear end!!  Well I guess trainee doctors have to learn their trade somewhere, so let it not be said that I stood in the way of education!
Back home and more internet searching to flesh out the bones of what the registrar had already told me.  A biopsy requires a small piece of tissue to be taken from the organ in question and sent to a laboratory to be tested; a prostate biopsy is done, as with a DRE, from within the confines of the 'back passage', a 'gun' is used to fire a hollow needle through the wall of the rectum and into the prostate; the needle withdraws removing a core of tissue which is sent for testing.
It seems a fairly simple procedure, not exactly comfortable but if it's necessary to have it done so be it.  A few more days and I'm back in Urology where a charming young lady doctor explained what was going to be done to me, and did I have any questions?  I naively said in jest "You won't miss will you".  "Oh no" she said "I'll be taking eight shots".  My eyes began to water at the thought!!
Fifteen minutes later having been handed one of those classic 'rear entry' hospital gowns to put on I was called into the minor procedures room; a gaggle, or whatever the collective noun is for medical students, waited in anticipation for what was to transpire.  I was asked if I minded them being there, but by that time I was on the couch with my backside exposed and beyond worrying, the canteen staff could have come to watch for all I cared!  The lovely lady doctor said "There will be some discomfort and some loud clicks but I won't take long".  A rather high pitched "Oh good" came from the top end of the couch.  The gun looked like a stainless steel Kalashnikov and felt like a surgical version of a field howitzer as it was inserted.  Relax I thought, she said it won't take long.  The gun went in, eyes widened, fists and teeth clenched.  A loud click as the howitzer fired, body jerked in spasm, buttocks clenched threatening to devour the gun.  "I know it's sore, just relax" she said, "It'll soon be over" (I'm sure she added under her breath "And give me my gun back").  First core sample taken, only seven more to go!  This is the original 'pain in the arse'!!  By number seven I thought the 'discomfort' would have brought tears to a glass eye!  Come on, 'man up' and grit your teeth, only one more to go.  Click, and that was it, eight shots spread through the area of the prostate where the scans had shown the 'nasty bits' to be.  Half an hour and a cup of tea later I was on my way home not really any the worse for wear, the necessary bit of 'discomfort' was over and I could sit and drive without any problem.
Around two weeks after 'the gun' procedure I received another appointment to discuss the biopsy findings.  The appointment took place in my consultant's office.  "Well" he said, "I'm afraid the result of your biopsy is positive and shows three small foci of Adenocarcinoma.  Basically it means that you have a malignant prostate cancer".

Although this thought had obviously gone through my mind hearing the actual words, "You have cancer", it was a bit of a gut churning moment.  The thought immediately springing up in my head was, how long have I got, weeks, months or what?  I gave myself a quick talking to and tried to calm down.  My consultant reassured me that as the problem had been caught in its early stages and the tumours were within the prostate margin treatment should be straightforward and successful, and did I have any questions?  Questions!!  My brain was in overdrive trying to come to terms with the whole idea of what I had been told, never mind trying to formulate questions.  My consultant was sympathetic to the problem and suggested that I took some time and read the booklet he handed me, Understanding Early Localised Prostate Cancer which was produced by Macmillan Cancer Support; it listed the various treatments available and explained their pros and cons.  He went on to suggest that as my situation was not immediately time critical I should take the booklet home, read, look on line and consider which treatment I felt would be most suitable for me.     The booklet listed a number of useful organisations, www.prostateuk.org, www.prostatescot.co.uk and the like; these groups provide a support network and forum where one can ask other sufferers what type of treatment they opted for, what side effects, recovery period etc.  I did find the forums useful to help build an overall picture but one has to apply a bit of filtering to pick out key points and then cross reference them by reading and questioning the medical professionals.