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.

Happy Thanksgiving


Here’s hoping that the many friends and colleagues that I have in the US have a brilliant Thanksgiving. Enjoy the food, the drink, but most of all enjoy socialising with your friends and family.

Have Fun !!

Oh, and I also thank you for the respite, brief that it is, brought about by the dramatic reduction in email traffic aimed at my in basket.

Limousin, France – Day 9


Day 9 turned out to be a bit of a mixed bag. One of our happy band of travellers wanted to send an email a family member based in the US. The email had been written but, due to the fact that the gite was pretty much a dead zone for wifi and mobile technology, we decided to take a trip to MacDonalds.  Normally you couldn’t get me to within a mile of one of their establishments. Leastways not without a lot of wailing, gnashing of teeth and not an insignificant amount of kicking and screaming.It’s not that i don’t like burgers, it’s more that I don’t like the way they are served to you. Wrapped or boxed and slowly going soggy in their own steam. Best commercial burger I ever had was from Fuddruckers in Austin, Texas. fuddAnyway, I digress.

So we trundled off to our nearest McDonalds as they have free WiFi and so that we didn’t feel guilty we actually sat inside and purchased coffee. However, the coffee was as awful as I remember and so was the WiFi coverage. The laptop containing the email could not even see the McDonalds WiFi and would not connect. My Blackberry could see the “see” McDonalds WiFi but also would not connect.  My wife had her iPad with her and that could “see” and connect to McDonalds WiFi. Isn’t technology wonderful. Three devices but no way to get the data onto the device that could talk to the outside world. In the end, after nearly an hour, it was decided that when we returned to the gite, the email would be transcribed to the iPad and then we would make another foray to McDonalds.RONALD MCDONALD

So our slightly subdued band of travellers headed off for their second visit to Limoges. There are lots of things to see in Limoges. One of the things I like about France in general is that they don’t just leave blank walls on buildings. They don’t leave them to crumble or fall foul to the vandal graffiti artist.  I don’t have anything against graffiti in general, just the mindless desecration perpetrated by those who just leave their name or a pretty poor caricature of a penis. In fact I see some graffiti as a perfectly valid and useful art form. In France they turn blank walls into  huge canvasses to provide street scenes, country views or truly humorous cartoons.

Église Saint Michel Des Lions, Limoges, Limousin, France

Église Saint Michel Des Lions, Limoges, Limousin, France

Here in Limoges, with the Église Saint Michel Des Lions as a back drop, the end of  a building has been painted not only to extend the street view but also to provide one with a voyeuristic insight on what may be going on behind closed, or in this case open, shutters.

The Voyeurs View - Limoges, France

The Voyeurs View – Limoges, France

Everywhere you walk in Limoges there are reminders of the past.

Limoges, France

Limoges, France

With differing architectural styles jostling for attention.

Limoges, France

Limoges, France

It is with that in mind that we have chosen to explore one of the most famous areas of Limoges, the Quartier de la Boucherie, the Butchers Quarter. In the 14th century this district was inhabited by families belonging to the brotherhood of the butchers and many of the original half-timbered buildings remain. Although few, if any, have the same purpose as you can see in the next picture….

Hot Rocks Boutique - Limoges, France

Hot Rocks Boutique – Limoges, France

The old doorways give evidence to our ancestors diminutive height and at times the old buildings seem to resemble a jumbled stack of packing cases …

Quartier de la Boucherie - Limoges, France

Quartier de la Boucherie – Limoges, France

Every now and then as we explored we would stumble across a real gem.

CHAPELLE SAINT-AURÉLIEN

Chapelle Saint-Aurelien – Limoges, France

 

Chapelle Saint-Aurelien - Limoges, France

Chapelle Saint-Aurelien – Limoges, France

On almost every street there is something to draw your attention…

street_detail

Limoges, France

Be it old, ancient ……

street_detail2

Just Chillin’, Rue du Canal – Limoges, France

….. or modern …

street_detail3

Mask – Limoges, France

Walking the lanes of  the “Quartier de la Boucherie” made us a tad peckish so we took lunch on a terrace overlooking the Central Market building.

Central Market - Limoges, France

Central Market – Limoges, France

The market, built-in the 19th century, was designed using a mix of materials, including iron, glass and ceramics. The result is this beautiful building with Eiffel-inspired architecture (or so I read somewhere). Just round the corner from here is Place Saint Michel, a pleasant square adjacent to the church.

Église Saint Michel Des Lions - Limoges, France

Église Saint Michel Des Lions – Limoges, France

Place Saint Michel as well as providing access to the church has a number of shops and cafe’s. Of immediate interest was the Belgian chocolate shop.

Place Saint Michel - Limoges, France

Place Saint Michel – Limoges, France

However, we all agreed that we could each of spent several hundreds of Euros in “Comptoir Famille”. This establishment sells some very stylish items for the home. It is a good job that our vehicle was stuffed to the gunnels on our journey into France and wasn’t getting any lighter during our stay and i was rather taken with a rustic wooden storage / display unit.

So we dragged ourselves away from the delights of Place Saint Michel and headed over to Limoges Cathedral (Cathédrale Saint-Étienne de Limoges), an impressive gothic building started in 1273 and only finished in 1888 when the nave was connected to the bell tower.

cathedral

Cathédrale Saint-Étienne de Limoges – Limoge, France

Makes you wonder why the bell tower was not built as an integral part of the main building. There is much to see inside the cathedral. The following photo shows an ornate gallery. Sadly all of the statues have been damaged, their heads are missing.

Detail inside Cathédrale Saint-Étienne de Limoges - Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges – Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges – Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges – Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges - Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges – Limoges, France

Detail inside Cathédrale Saint-Étienne de Limoges - Limoges, France

Musée municipal de l’Evêché & Cathédrale Saint-Étienne de Limoges – Limoges, France

There are some beautiful gardens in the cathedral grounds….

Cathedral Gardens - Limoges, France

Cathedral Gardens – Limoges, France

Cathedral Gardens - Limoges, France

Cathedral Gardens – Limoges, France

Limoges is also home to the Musee de la Resistance which is just a short walk from the cathedral. As with Oradour, I found walking through this museum quite moving.  The exhibits set the part played by the people of Limoges into the proper war-time context.  Great focus is always given to the capital cities such as Paris .This museum puts the records straight. And again, as with Oradour, I found myself leaving the museum with an underlying feeling of anger towards the politicians who took all of europe and most of the world to war.

By the time we left the museum it was time to look for a place to eat. Our day was completed by a really nice meal provided by Restaurant “La Maison des Saveurs”

 

Limousin, France – Day 8


Eighth day of our vacation based at the La Porcherie gite. I think we are getting into the swing of this holiday lark.

Yet another nice day, weatherwise so we decided to go explore Landes Pierre du Mas.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

Once again the pond impressed with its quiet beauty.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

It’s refreshing to be able to visit such places and to have them to yourself.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

Not just the tranquility of the pond and the paths around its perimeter but also the beauty of the heather illuminating the mound.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

Just a few feet of elevation makes all the difference and changes your perspectives.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

There were many brightly coloured lizards here, but they were much to fast for me to photograph, so you will just have to take my word for it.

Pierres du Mas, Limousin, France

Pierres du Mas, Limousin, France

Even the lichens and moss, covering the rocks, has an inherent beauty. Providing a subdued contrast to the vibrant floral display of the heather.

Pierre_du_mas7

Pierres du Mas, Limousin, France

 

Pierre_du_mas8

Pierres du Mas, Limousin, France

We had taken some stale bread to the pond, hoping to entice the fish to put in an appearance. We were out of luck, the suitably softened crusts floated across the pond, driven by the gentle afternoon breeze. Apparently of no interest to the fish. However, it did prove to be attractive to a large crow who performed some impressive aerobatics and a fair emulation of a fish eagle plucking soggy bread from the surface of the pond.

Crafty crow plucking bread from the surface of the pond - Pierres du Mas, Limousin, France

Crafty crow plucking bread from the surface of the pond – Pierres du Mas, Limousin, France

The fresh air and exercise set us up nicely for the BBQ planned for our evening meal. The only fly in that particular ointment was the bottle of wine that we opened to wash it down. It was so decidedly bad that I tipped it away, the only bad wine of the whole holiday.

 

View From The Conservatory


I was relaxing, reading, in the conservatory, immersed in the latest  Tarzan adventure, when I felt that I was being watched. I looked around to discover that my neighbours cat had taken up position, outside looking in. Perhaps it too was enjoying Edgar Rice Burroughs description of the latest exploits of  Jad-bal-ja,  the golden lion, trained by Tarzan.

Spy Cat

Spy Cat