Surgery

Make mine a Merkel

by feurmann

Avid readers (such as all you lot) will remember I was booked for a sentinel lymph node biopsy in at the Peter Mac yesterday.

This went uneventfully, if rather lengthily. We were booked in for a 7 am arrival at Peter Mac, meaning a 6.15 departure from Burwood. (A general anaesthetic being involved, I had had to fast from midnight, which simplified the morning arrangements.) There was a surprising amount of traffic on the freeway at that time, but after winding our way down to a subterranean level of the PM multilevel car park, we were there pretty much on time.

PM is a very modern hospital. On arrival, one stands in front of a temperature check machine. If one satisfies its requirements, it dispenses a sticky label to denote one’s patient or visitor status. The lifts are fun too. On selecting the required floor from a touchpad, an automated voice intones “Car N” (or whatever it is). Once inside, no need to press buttons — the lift knows where it’s going. (Dad would have loved it!)

Mine was a two part procedure. In the first, I went to the day surgery department, was assigned a cubicle, put on a standard hospital gown, and packed my possessions into a few plastic bags (which remained in that cubicle). I was then guided to the nuclear medicine department for three injections with a radioactive substance. The purpose of these was to highlight any lymph nodes around the face and neck area to which the Merkel carcinoma had spread. The injections were administered in the skin between the eye and eyebrow, and were rather painful, of which I was forewarned. One of the staff kindly gave me her hand to squeeze at this point. I got a lot of congratulations on my bravery! (I bet they tell all the boys that.)

Then followed a couple of periods of lying on a gurney under some high tech machinery to see what lymph nodes were lighting up. Two goes at this were required because the radioactive stuff hadn’t worked its way around. (Apparently there is quite some individual variation as to how long this takes.) After pacing around the huge machine a few times, doing some stretching, and massaging the area where I had had the injections, they laid me down to try again. “I think we’ve got something!” someone said. An orderly helped me get up (about an hour in total on the gurney, I was pretty stiff) and onto a wheelchair, and he and I headed back to the day surgery area.

Here, when my number came up, I was transferred to a kind of mobile bed, thence to the anaesthetic room. Here I was asked for about the fourth time that morning my name, address, and date of birth. Satisfying these requirements, a team of two anaesthetists (!) and an anaesthetic nurse swarmed around me and knocked me out. I woke up minus one or more lymph nodes back in the cubicle. My beloved had been working away productively on her laptop all the while in the hospital’s Wellness Centre. I was offered a sandwich and a coffee, both of which I accepted gratefully. Then I whizzed home with my beloved in the RAV, arriving about nine hours after we had left that morning.

As anyone who has ever had an operation will recognise, this is a rather bare account. There were a few quite lengthy delays between the main events, mainly due to waiting around until various people were available, until the radioactive injections had done what they were supposed to do, and until my number came up on the surgical list. Everyone was very kind and kept us both informed as to what was going on. This morning the area in my neck where the surgeon had made the incision was quite swollen and a bit sore. I didn’t need any pain relief for this, though, and generally didn’t feel too bad. I will be having a further consult with the surgeon next week to discuss the biopsy results. At some point (I’m not sure exactly when) the radiation treatment will begin, to last about 5 weeks. I guess the particulars of this treatment will be guided by what the biopsy tells them. TBC!

You should have seen the other bloke

by feurmann

This morning I had a brief operation to remove a small growth on my upper left eyelid. (For some reason, the picture above is reversed; the shiner is definitely above my left eye.) The growth had been detected during my annual eye test. I hadn’t really noticed this; it was blocked by the upper frame of my glasses, and I couldn’t see it when I wasn’t wearing my specs! Anyway, the optometrist recommended that the growth be removed by an opthalmologist.

I saw the specialist to whom the optometrist had referred me, Dr L, last week. He said it probably wasn’t cancerous, but that pathology tests would confirm this. If it turned out to be, he would need to take out a bit more. (The plus side is, in that instance, my health fund would pay a rebate for the first operation!)

My original appointment at the eye clinic was for 10.45 this morning, but they rang about 9.15 and asked if I could come in earlier (they had had a cancellation). This suited me and my beloved, who was to drop me off there and pick me up afterwards. (This was necessary because I was to have a local anaesthetic and eye drops.) Anyway, we beetled off there about 9.30. After an extensive induction and history-taking (all of which had taken place at the earlier consult), an anaesthetist gave me a local and some other shot to reduce any anxiety I might have, and Dr L speedily removed the growth in the clinic’s theatre.

I had had to fast this morning, so was glad to have a couple of cups of tea afterwards — they didn’t run to real coffee — and a sandwich. The only real holdup came when exiting the practice.

The building is situated on sloping land, with a small concreted area of outside the front door, clearly intended for short-term pickups and dropoffs. There is a narrow driveway running downhill to the right of the building, which leads to the practice car park. Because of the slope of the land, however, patients entering the practice from the car park need to climb quite a steep metal staircase, which has a right angle bend in it. The nurse therefore directed me to tell my beloved to park on the concreted area outside the front door, so I could exit without going down the staircase to the car park. (I had a patch over the left eye at this stage, and was still feeling the effects of the anaesthetic. These things would have affected my depth perception and so on.)

The problem with this sound advice was that there was already a car parked on the concreted area outside the front entrance. My beloved therefore went down the driveway, heading for the car park. She couldn’t even park there, however, because she was blocked by a truck making a delivery! Regardless, the nurse was adamant I couldn’t walk down the staircase, even with assistance. Of course they couldn’t have prevented me if I’d insisted, as I was on the verge of doing. (I just wanted to get out of there at this stage.) Anyway, my beloved drove around the block and parked behind the illegally parked car. I resisted the urge to let down its tyres as I made my exit. (Had I had my wits about me, I would have keyed one of its doors — I was pretty cross that its owner was being so selfish.)

Anyway, all is done now. My beloved reckons I look as if I’ve been in a fight, I’ve resisted giving way to my anti-social urges, and am being waited on like Lord Muck. For a while I even looked like the Whitmont Man!

Mr B sees it through

by feurmann

[Apologies — I have corrected the first sentence to remove various solecisms. Some changes further down are too trivial to mention. So no need to read further if you’ve already read it.]

Yesterday I went with my beloved to see Michael B, the surgeon who carried out the hernia operation . This follow-up consult was one week after the operation had been carried out. Mr B pronounced himself satisfied with how everything was looking. My main question was “When I can go back to exercise classes?”. He thought another couple of weeks’ recuperation should do it .

Just before Michael came in, the nurse removed the dressing that had been put on the wound after the operation. This dressing was transparent, allowing any bleeding or anything else undesirable to be identified. According to the notes with which we were supplied on discharge, this dressing could be left in place, absent any leaking, oozing, or other indications of the wound not healing. We had seen no reason to change it, however. (Several spare dressings had been included in the sample bag I took home on discharge.)

Before yesterday’s consult, I had imagined the dressing being ripped off in enthusiastic Nurse Ratched style, perhaps preceded by a bracing “This won’t hurt a bit!”. However, it was just gently peeled off, with zero discomfort. I was lying on an examination couch, with my shirt and jacket pulled up a bit, so I couldn’t see exactly what the nurse was doing. On our way out my beloved and I asked ourselves “Did she put another one on?”. I checked when we got home — she hadn’t. But the wound still seems dry, and neither tender nor inflamed .

A few stitches are holding the edges of the wound together. These stitches will just dissolve by themselves, so there is nothing further to be removed. Because I seem to be healing well, a second consult date wasn’t set. Of course I can ring and report any problems or complications that might ensue. Based on how things have gone so far, however, I am not expecting any.

Hospital admissions are bit more protracted, in Victoria at least, because of a compulsory temperature check, a digital form to be filled out on one’s phone, and other CoVID19 business at the point of entry. Even with these extra steps, we were in and out in less than half an hour. This period is the maximum for which Knox Private Hospital provides free parking: after this, their meter is on. Anyway, we must just have snuck under the wire — yay!

Yesterday’s visit featured another freebie: there was no charge for yesterday’s consult. I am not expecting any other charge to be forthcoming. Before we booked in for the procedure, I had requested a financial quote from the practice. According to this, Mr B’s, the assisting surgeon’s, and the anaesthetist’s fees were all to be sent direct to our health insurance fund. This seems to have happened exactly as promised. So, apart from a few dollars for some anti-inflammatories and analgesics with which I was supplied on discharge, the procedure cost has cost nothing.

We won’t (fingers crossed) have to pay anything for the costs for my overnight hospital stay, either. The hospital cover of our health insurance features a $500 excess. The hospital cover year runs from May to April. (Just to make things difficult, the extras cover corresponds to the financial year.) From May to April, the first two hospital admissions for either of us cost $250 a throw. Any subsequent admissions in that period come after the excess has been paid, and are therefore not charged.

This operation was preceded by a couple of hospital admissions during this period, each for a Zoladex implant (albeit this is only a day procedure). The lady at the cashier’s at Knox Private, by whom I was interviewed at admission and at discharge, did try to charge me $250 both times. She readily demurred when I pointed out I had already had two hospital admissions since May. No, I’m not having anything else done, even for free! I do believe in being careful what you wish for.

Hernia op all done

by feurmann

Many of you will have found out, directly or indirectly, that my hernia operation went successfully yesterday.

I didn’t get much sleep last night. The wound made it difficult to push myself up the bed far enough so that my feet weren’t pressing against the end of the bed. Fortunately it was possible to raise the middle of the bed independently of the top section. This raised my knees a bit, which took a lot of pressure off the feet. By the time I fiddled around with this, however, I had woken up, so I had to go through all the business of sitting up again. Laughing was the worst thing for the wound — I had to press on the wound site to avoid straining it too much. (Of course, trying not to laugh at something that is bloody funny is next to impossible.)

I felt a lot better after breakfast this morning, and was able to get up, shower, and dress myself independently. (These always seem like major achievements after surgery!) Kudos to the nursing staff at Knox Private Hospital, who were kind and attentive. I was sent home with painkillers and anti-inflammatories, and strict instructions not to lift anything much, or strain the site in general. Today when I stand up, the wound is a bit painful. When sitting I can still feel it, but there is only a mild discomfort.

Fortunately I had taken in a few things with which entertain myself. Among these was Night letters, by Robert Dessaix. I hadn’t read this since it came out in 1996. It had a lot of extra resonances for me this time through. I gather it was written after his diagnosis as HIV positive. (Fortunately his Wikipedia entry only has a birthdate after his name, so I gather he is still with us.) Dessaix vividly describes how receiving a diagnosis of a serious medical condition throws one’s values and plans into disarray.

One of the nurses was interested in it. I tried to explain that the book purports to be a series of letters written by a character strongly resembling Robert Dessaix, who is travelling through Italy and Switzerland after receiving a life-changing diagnosis. Night letters is both an epistolary novel and a memoir, and a great example of both genres. It has some playful mock-academic apparatus in the form of a “translator’s” foreword, and three lots of end-notes. If this all sounds bit drearily post-modern, have no fear — the narrative pulse beats strongly throughout.

My tablet is running out of charge, so I am going to press “Publish”.

Didn’t see that coming!

by feurmann

Note to siblings: I have already alerted you to the main matter of this post.

This Friday, 8 October, I am booked in to have an operation to fix an inguinial hernia. This is quite unrelated to the cancer. I’m not sure how I developed the hernia — possibly through lifting weights that were a bit heavy for me. The weakness in the abdominal wall might have been there for quite a while. Anyway, it’s something that has gradually developed until the time has rolled around to do something about it. It is good to get it dealt with before it develops into something more serious, i.e. incarceration or strangulation, as set out in this Healthline article.

Naturally I checked with my oncologist before booking the surgery. He strongly encouraged me to have it. He said (words to this effect) “You’re very fit, you’ll breeze through it”. Having the hernia fixed will allow me to continue exercising, something of great importance to cancer patients (as for everyone). I sought a few other opinions as well, about the surgeon, and the technique he proposes to use. All these came back favourably as well. So I am as confident as I can be that the outcome will be positive.

After the open radical prostatectomy, this should be much less of a production. Having had the former operation unfortunately rules out keyhole surgery in this case. Hernias are still much easier to get at than prostates, lymph nodes, etc. I am scheduled to have the operation on Friday morning, and be in hospital overnight. I will have to take my music player in! I will also take in something a bit lighter to read than what I chose for the prostatectomy — Gödel, Escher, Bach, by Douglas Hofstedter. (It’s not every book that gets its own Wikipedia entry. Who was I trying to impress? Needless to say, three years later, including six months in lockdown, I still haven’t read it.)

Another unexpected development has occurred, this one associated with my foray into the German language. My patient and good-humoured teacher Jörg told me on Friday that he now has a full-time job, starting in the middle of the month. He and I will finish up the two lessons remaining in the current block of ten. After that I will have to either find another teacher, or join a class. I am leaning towards the latter of these options, if I can find a class that is at about my level, and at a convenient time. (I was planning to have a break for a week or so in any case with the operation.) Of course I am happy for Jörg that he has a better position. I have come to look forward to the lessons, though, and it is a little sad that they will not be continuing after the next couple. We have developed something of a rapport, even after I corrected one of his corrections — something he took in good spirit! (As Mime says to Siegfried, in the opera of that name, “den Lehrer sein Knabe lehrt” — literally, “the teacher learns from the lad”.)

What’s been and what’s to come

by feurmann

Before the main part of the post, there is a small addition to the Resources page in the form of the NCI Dictionary of Cancer Terms .

We are now just a few weeks from Christmas. Those who know me will know this is my favourite time of year! (Not.) Still, it brings us to a sort-of review time for 2018.

The last twelve months has been one of numerous changes, and some milestones. I bought a new car, and we replaced some big-ticket things like the ducted cooling and the bed. The Blu-Ray recorder, and some electrical equipment, was also replaced. For the first time ever, my beloved moved to part-time employment. Most importantly, we are to celebrate our twenty-fifth wedding anniversary at the end of this year.

It has also been a huge twelve months or so health-wise. My treatment summary from November 2017 to now is the story of my cancer:

  • radical open prostatectomy
  • subsequent treatment with a physiologist specialising in continence
  • referred to a radiation oncologist, with whom I
    • had radiation therapy, with moderate success
  • then referred to a medical oncologist, with whom I
    • had androgen deprivation treatment and chemotherapy.

Of course the last of these is ongoing. However, being in remission is a great result for the treatments I have received under the care of Dr Parente and the staff of the oncology ward in Epworth Eastern. My GP has been terrific as well — someone I have been seeing for many years. Modern cancer treatment of course relies on adjunct modalities, and I feel my exercise physiologist (a recent referral) will become someone else I rely on.

My progress through these treatments has been one from specific to general, i.e. from treatments focusing on individual mets, to ones that are treating the whole body. This has been driven by the failure of the specific treatments to keep pace with the growth in the tumours.  I believe the progression in the treatments is also from ones with lower potential side effects to those with more potential side effects, but more efficacy. (Time, as ever, will tell.)

The chemotherapy  has been less of a big deal than I expected. I have dropped some social engagements in order to lessen the risk of opportunistic infection — something my immune system is less able to handle than usual. However, I haven’t wanted to become a recluse. So new year resolutions include doing a better job of keeping up with people, both individually and through groups like the local Cancer Survivors.

The chemotherapy is adjunct with androgen deprivation therapy. Their combination gives apparently an increase in efficacy of 10% in absolute terms, over either treatment singly. I started with the ADT some weeks before the beginning of the chemo, and I will continue with that as long as I remain in remission.

(On the subject of keeping up with people, we have been having a lovely time just recently having an old friend to stay for a couple of nights. She came down from Sydney for Die Meistersinger at the opera, which we all saw last night. Amazing! The second act was quite the most spectacular I have ever seen live. The orchestra played every bit as well as the Gewandhaus, whom we heard in the Leipzig Ring, and everyone acquitted themselves extremely well in the principal roles, especially Michael Kupfer-Radecky, the third singer to be engaged as Hans Sachs. And Warwick Fyfe as Beckmesser! Is there a better anywhere? Anyway, I hope that 2019 includes more Wagner as well as more socialising. Wagner’s beautiful libretto also gave me the latest candidate for my memoir title: How spring has to be.)

I need to do more to keep the remaining grey matter active next year, too. I think 2018 was the year of Karl Ove Knausgaard. (I have the final volume of his autobiographical novel sequence to finish off.) I feel that enrolling in a course would keep me at something better than if I were just doing it under my own steam. Some candidates include a couple of online masters programs in creative writing. Doing the internet course Modern Poetry over the last few weeks was great as well; it is very well-supported. Hearing the beautiful German in the Wagner last night, however, and even understanding bits of it, put this further up the batting order as something I could re-engage with.

I would also like to read through In Search of Lost Time again, with a group. Ever thought about it? Or even just wanted to see what the fuss is about? (For example, Maugham regarding it the greatest novel of the twentieth century.) I will do it via Skype, if required. So come on, all you wavering Proustians! Carpe the diem, grasp the literary nettle, and let’s get down to it. I can issue a portentous promise — your lives won’t be the same.