Floodgates

The penultimate scan, prior to commencing treatment, was a CT scan on my chest, abdomen and pelvic region. Not too time consuming and nothing sinister to worry about. Except maybe the injection of dye, which is used to improve image quality. Except also, the insertion of the canula through which the dye is injected.

During my limited time as a season ticket holder at Southampton General Hospital, I have already made numerous visits, many of which I have recounted in these posts, What I have not mentioned previously, is that frequently, when you turn up for your appointment, you are asked if you mind having a student present or perhaps a trainee carrying out part of the procedure.

I always say yes. How else are the next generation of doctors and nurses etc. going to gain experience? It’s never been a problem to me. Well, except for the two occasions when it has been a problem.

The first time was when I was having my blood sampled and an overenthusiastic trainee, despite my bulging veins, had difficulty in inserting a needle into me. So much so that one attempt resulted in the needle being bent. “Too much iron in my blood”, I quipped. This was ignored by my tormentor as she moved to my other side and prepared to launch an attack on my other arm.

Fortunately, the qualified nurse/mentor stepped in at this point and deftly inserted the needle and extracted the samples with such expertise that I barely noticed. Thus saving the trainee from further embarrassment and me, I might add selfishly, from sustaining further damage.

The second time as you may have guessed by now, was when I was being prepared for the CT scan. “Hello. My name is ******, I’m a trainee and I wonder if you would mind if I inserted the canula for you?”.

“Not at all”, I replied, trying to suppress the memory of a needle being bent against my arm. Not that I was able to suppress it for long. I have a very prominent vein situated in the crook of my right arm. It is almost as if it was put there specifically for people collecting blood samples or for the insertion of a canula. Needless to say, the trainee homed in on it straight away.

In the space of a nano second, the needle was in my arm and then out of my arm, followed by a great arc of my blood making its way across the room. “Oh no!” cried the trainee.

“What are you doing?” demanded her experienced colleague.

“You’ve opened the floodgates now. Could this be life threatening?”, I asked. I was doing nothing to alleviate the situation, as I watched this fountain of an essential part of me, exit my right arm.

Well, life threatening or not, the flow of blood was quickly stemmed and the expert, in almost the same way as in the previous incident, stepped in and inserted the canula into my other arm, which still had blood left in it. It was hardly noticeable. I could not help but wonder, how many cases of projectile bleeding there might be between leaving the level of trainee and arriving at the level of expert.

The scan then proceeded without further complication. Just one to go before starting my treatment.

Sleight of Hand

When I signed up for the Pivotal Boost clinical trial I was given a letter to take to my GP’s surgery. As I had to pass the surgery, I delivered the letter on my way home. The receptionist made a copy and returned the original. The letter specified which drug I should be prescribed to begin my hormone therapy, which was an antiandrogen to be taken daily for four weeks, starting after my final scan. Also listed were three different drugs together with the annual cost for each one. It seems that the GP would choose which one I should be prescribed (a decision I hoped would not be made on cost). An injection would be given periodically and indefinitely, commencing one week after the antiandrogens.

After about a week, I phoned the surgery to ask if my prescription was ready for collection. “What prescription?” was the reply from the receptionist.

“For my hormone therapy,” I informed her.

“What hormone therapy?” she asked.

“For my cancer treatment”, said I.

There then followed a discussion as to the whereabouts of my prescription, and/or the letter from the hospital. It seems it or they had vanished. Fortunately, as I still had the original, I was able to return to the surgery and they took another copy, assuring me that all would be well and I could collect the prescription in a few days.

As it happened, I had an appointment booked with the practice nurse for the following day for immunisation against pneumonia. After having the injection, I mentioned to the nurse that I was having problems with my prescription. “Wait there a moment”, she instructed as she left the room. She returned just a minute or two later waving a prescription in her hand. It was dated the 20th February the date that I had first taken the letter into the surgery. For almost two weeks it had been missing and suddenly, not missing at all. How come? Sleight of Hand perhaps.

Options

When the specialist nurse told me I had prostate cancer she advised me of the options I would be given. I could have no treatment, which involved “watching and waiting”. Basically just letting things develop before taking any action. Or, I could choose to have surgery, which would entail removal of the prostate gland. Finally, I could opt to have a combination of hormone therapy and radiotherapy. I was given information on all of the options so that I could make myself familiar with the processes before having further meetings with the consultants.

I was also told that I would need to have a urine flow test on my next visit which meant I had to hold on to my pee for a few hours beforehand. Something that has not been so easy in recent times although until now I have not had any mishaps.

Consultations

Within days I received a letter informing me I had appointments with two consultants on the same morning. The first was to discuss surgery and the second to discuss radiotherapy etc. There would be time in between for me to have my urine flow test.

On the morning of the appointments I arrived early at the hospital, had a coffee at Costa and then popped into M+S to buy a litre bottle of water. I needed a full bladder for the pee test. I then proceeded to the outpatients’ waiting room, where I put on my headphones, got out my Kindle and relaxed while also drinking plenty of water. Mentally preparing myself for what was about to come. Life could hardly be much better. Could it?

My first appointment was running late when I was called in. This one was to take me through my condition and discuss the option for surgery. I listened intently to what was being said to me but the more I heard, the less likely it seemed that I would take this option. If the guy had been a salesman, he would have been talking himself out of a deal. However, I did not have to make a decision yet and I still had to hear about the alternatives.

On leaving the consultation room, I immediately went to check in for my next appointment, only to be told that my name had already been called. I was told not to worry and within a minute or two the doctor called for me again. No worries indeed.

Following the introductions, I asked the doctor, “not wishing to be rude but will you be trying to sell me this treatment? does your budget rely on a certain amount of people having treatment?” The doctor looked a bit shocked but assured me that was not the case. My reason for asking was that in the information pack given to me previously, was an invitation to take part in a clinical trial and I was seriously considering it.

During the discussion that followed, there was a knock at the door and the doctor had to leave to attend to something else. She apologised, telling me she should not be long and then she was gone. I went back to reading my Kindle.

Probably no more than five minutes passed before the doctor returned. More apologies were made, discussions resumed and then I felt the urge to pee. Nowadays, when I get that urge, it’s not exactly an early warning. More of a demand for instant action. Whatever was said to me in that room after that moment was lost on me. I remembered none of it. All I could do was concentrate on not pissing myself.

After what seemed an eternity, the meeting was over. I asked the doctor if she could notify the specialist nurse that I was here for the flow test and that the situation was quite urgent. Fortunately for me, the nurse was close by as was the room for the test and both flowing and testing could begin. Not a moment too soon. Were they taking the piss? Maybe.

The pee test result was fine and was followed by an ultrasound scan to see what was left in my bladder. Not much, I was relieved to hear. I was free to leave. By the time I got home I realised that I could remember everything about the surgery option and very little about the radiotherapy and/or clinical trial option. I had lost my focus and had little choice but to phone the hospital and ask for another appointment. No problem, they said and I was given an appointment for the following week. I guess they are used to this sort of thing.

Consultion Take 2

During the intervening days, having decided againsy surgery, I re-read all of the literature I had on Hormone Therapy and Radiotherapy plus the clinical trial, which is known as Pivotal Boost. I took the precaution of writing down any questions I had in readiness for the appointment.

It all went very well this time and I made the decision there and then to take part in the trial. The decision is not binding and should I change my mind, I can opt out without it having an adverse effect on the treatment I then receive. I will be allocated to a group randomly to determine which specific treatment I get and in the meantime, I have to have yet more scans.

Diagnosis

The day finally arrived to visit the hospital to find out exactly what was wrong. All I knew up until then was my prostate was enlarged. It could be benign or not be benign.

The information was given to me by a specialist nurse. The same one who had previously inserted a camera into my penis and a finger into my backside. Mercifully, not both at the same time. She explained the state of the cancer and what it meant in terms of types of treatment available to me. Assuring me that the intention would be to cure it.

I have a grade 2 cancer with a score of 7 (3+4) on the Gleason Score. It was mostly still contained within the prostate but there was a small section which was close to spreading and so it is classed as Locally Advanced. Not exactly a death sentence but not really a cause for celebration.

I was given a large and comprehensive information pack covering diagnosis, treatment, help and support. I will be doing a lot of reading and research in the coming weeks.

Next stop, appointments with two consultants on the same day to discuss the treatments available to me.