Subscribe by RSS

Friday, 24 October 2014

Prostate postmortem

University Hospital Leipzig
So that's it done. Prostate out and on my feet again. Wait and see what happens next and whether the cancer cells have been banished or simply set sail for pastures new.

For once I'll keep this post fairly serious because some of you will face the same choices I have and maybe find it just as difficult to get the information you need. Without steady pushing for the past few months I'd have had the wrong kind of surgery.

If the tumour is confined to the prostate, as mine was, there are a bunch of treatment options, including surgery, radiation therapy and cryogenics. I was offered the first two and recommended surgery - "the gold standard", they said - because of two factors, my Gleason score and my PSA level.

Gleason score is a measure of how aggressive the cancer cells are, when examined after biopsy. Mine were 4+3 which is intermediate but tending towards get-it-out-sharpish before it spreads beyond the prostate, at which point surgery is no longer an option. My PSA level was 12.8, which is fairly high and a further trigger for action.

Once surgery is selected there are three options - open, laparoscopic or robot-assisted laparoscopic. Finding out which is best took me a while, because I was referred initially to a surgeon who, while highly regarded, practises only open surgery and had his own reasons for not briefing me fully. He was in the process of trying to persuade the Scottish Government to buy him a robot. At one point, when I was questioning him, he said he felt like Alex Salmond during the first televised debate.

At my request, he did refer me to a robot practitioner in England, Professor Prokar Dasgupta, but insisted that if I went robotic I would have to fund it fully myself. The inaccuracy of this statement only emerged after much more digging. He also referred me to just one, rather than the choice of several consultants that I'd asked for.

The Harley Street consultations went well and involved meetings with the surgeon, the anaesthetist, a continence nurse and a sexual function specialist, all of which cost me £750 before a scalpel was lifted. Total cost of this option would be around £27000, they told me, only £9500 of which went to the surgical team, the remainder being the cost of private hospital care for three days and nights in the world's most expensive city centre.

The specialist consultations were very helpful because two inevitable side-effects of prostatectomy are incontinence and impotence, either or both of which might not be temporary. During surgery, part of the sphincter muscle that controls the flow from the bladder is excised along with the prostate, so what remains needs to be retrained to do the job. This can take months and might not fully happen.

Impotence arises when two sets of nerves passing through the prostate to the penis are removed. So nowadays nerve-sparing may be attempted, provided the stage of the cancer allows and the surgeon has the necessary skills. This is where the robot comes into its own. A surgeon-operated robot is more precise than a surgeon alone, provides better vision of the site, more degrees of freedom than a human hand and no tremor.

A further improvement in recent years is "frozen sections" or intraoperative consultations. This means that excised tissue is sent to the lab for analysis during surgery to see if the cancer has been fully removed or more tissue needs to be cut. Without this technique the surgeon must err on the side of caution, which means less chance of nerve-sparing.

Hard scientific evidence for the superiority of the robot-assisted prostatectomy over laparoscopy is scarce, as large-scale randomised control trials have not, and will not now, be done - both for ethical reasons and because isolating the one variable of the robot is impossible. Softer evidence is mounting however and the surgeons who use the robots are convinced that they provide better outcomes in the trifecta of cancer removal, continence and potency. The superiority over open surgery, in the hands of an experienced surgeon, is well established.

But here is the problem for viewers in Scotland. Not only can you not get robot-assisted prostatectomy in our country but you can't get frozen sections anywhere in the UK. So after lots of research and talking to doctors, and with my robot-assisted, friends-and-family-funded surgery in Harley Street just five days away, I was offered two further options - laparoscopy in Edinburgh or robot-assisted laparoscopy with frozen sections, and the best chance of nerve-sparing by Professor Jens-Uwe Stolzenburg, in the University Hospital, Leipzig.

This option had been briefly mentioned very early by Forth Valley Health Service, but had sounded too far out to me, so I dismissed it. But in that final week two experienced NHS prostate surgeons, Alan McNeill in Edinburgh, on my request for an NHS second opinion, and Hasan Qasi in Glasgow, on his own initiative, having studied my notes and priorities, persuaded me independently that this was my best option.

I had less than a week to prepare for ten days away from home, work and internet, to organise travel and accommodation and to buy a German phrase-book. Which I left behind.

On the morning after our arrival in Leipzig I got a phone call from the director of Forth Valley Health Service asking how I wanted to be reimbursed for the £10,000 cost of the surgery and hospital care under Article 56, the EU directive on cross-border healthcare. On the day after the operation the surgeon told me he had spared both nerves. 

So far so good is the most you can say with any cancer. But at the moment I can say that. My Killearn GPs were fantastic as was Forth Valley Health Board. The surgery and aftercare at Leipzig were outstanding. My experiences of Gartnavel Hospital, to which I was initially referred, ranged from unhelpful through obstructive to incompetent.

This is the short version. There is more. If you'd like to ask me anything, please email ddblaneatgmail.com, replacing at with @ in the usual way.

And for regular readers whom prostates fail to fascinate, a few observations on hospital stays, in Leipzig or elsewhere. 

Rules of survival
1.  The only sane answer to Have your bowels moved today? is Yes. See 2.

2. You may be tempted to flirt with the most attractive nurse, but she is invariably the one that wields the enema. She will not see your best side.

3. Just because the mad bastard who bangs on the wall and sings Deutschland Uber Alles in the middle of the night is ill doesn't mean he's not a homicidal maniac. Do not complain. 

4. The sound that resembles a body being dragged along the corridor at three in the morning could well be. Go back to sleep.

5. When your hand accidentally brushes the ample bottom of the big nurse bent over shaving your belly, don't let it linger there. She has a sharp blade one inch from your genitals. Do the math.

Saturday, 18 October 2014

Another brick in the wall

The narrator is away. 

Welcome to our guest this week Gregor Steele. 

A couple of decades ago, having taken up residence in the TES  Scotland's comment pages, I felt that the world was    ready for a hilarious account of my teacher training year.  Maybe it was ready, but maybe what I wrote wasn't as         hilarious as I thought it was. 
Certainly, looking back on it (of course I kept it), there is a  lot that I would change.  Take the vignette of the first          science lesson that I ever taught. This tale of a voice not     used to being raised going squeaky at an inopportune         moment, of intrusive personal questions from teenage girls asked of a just-out-of-short-trousers pedagogue, of a boy   who looked like pre pubescent Kenneth Williams            auditioning for a part in "Carry on being a complete pain in the arse" includes the phrase, "foolishly heeding college     advice not to be sarcastic..."
I wouldn't write that now. It's not that I'm never sarcastic. It's more that I've seen pro-sarcasm, and having done so, feel well-warned away from trying even the amateur stuff.
I worked beside the World's Most Sarcastic Teacher. He was the one Pink Floyd wrote about in The Wall. Maybe.
"Can you tell me ma marks, sir?"
"No."
"How no?"
"Because you haven't got marks. You've got a mark. One. Out. Of. Thirty. Well done."
He was like this with all the kids. Some of his department members, passionate about their subject, were reduced to tears when they overheard  children say that they were avoiding it at S-Grade in case they got the WMST. 
The Tom and Jerry fantasy kicked in. I wanted to contrive the situation where he'd end up running, just so I could stick a frying pan in his path. 
I could hear the noise in my head. The only decision was whether I'd prefer if the frying pan ended up head-shaped, or his head ended up frying pan-shaped. It soon transpired that I didn't have to do this.
The World's Most Sarcastic Teacher had a knack of landing himself in it, and one of his redeeming features was that he was prepared to share his come-downs with the rest of us.
One day, a boy was idling in his Standard Science class, distracted by and distracting his classmates.
The WMST had tried to nag him into knuckling down but had failed. Time to turn the sarcasm up to 11.
"I'm going to put you somewhere, son, where you can do something that obviously you can only do by yourself."
"Whit?" 
(Sigh) 
"I'll give you a clue, son. It's a four letter word beginning with W and ending in K."
"Oh ya beauty...!"
"WORK, son! WORK!"






Monday, 13 October 2014

Guest bloggers wanted


I will be without internet access for a fortnight from tomorrow, for reasons that are known to my regular readers. 

This means I won't be able to keep you guys posted with the latest Friendly Encounters, and some of you will suffer withdrawal symptoms.

I am therefore looking for four light-hearted stories of 5-600 words each, just as soon as you creative people can write them. 

Email me please at ddblane@gmail.com 

Entries will be submitted to a judging panel. There will be prizes.

Sunday, 12 October 2014

Male bonding, Scottish style

Photo by Andrew Huff
"I feel I should give you a cuddle," Al says, stepping close as we're walking down the drive of his Bearsden house, after he's presented me with his MP3 player, packed with great rock tunes from way back. 

Only ancient Scottish instincts to avoid any physical contact that doesn't involve punches save us both, by making me do a swift body swerve. For thirty years Al and I have worked, trained and showered together, without touching each other once, even accidentally. There is no need to start now, my instincts feel, just because one of us has a life-threatening illness and impending surgery.

"Look after yourself in Leipzig," Al says, as we turn right along the drive headed for my car, which I've parked at the end to force myself to walk. Several months ago the doc had advised me to get fitter and lose weight, as this op is not an easy one for old, fat guys.

"Not that you're either of those," he had added tactfully, but too late.

"I'll be fine," I tell Al. "My main problem is I don't speak the language."

"I know only one sentence, which I'll tell you in a minute," he says. "Why are they taking your prostate out in German?"

"This guy Stolzenburg is one of the best," I say. "Trained a fair few UK surgeons. Been using the robots for years himself. Does frozen sections during the op, which show if he needs to cut out more."

"Take warm clothes with you," Al says. "Continental weather can get extreme. You know what a girl you are when it gets cold."

"Not at all," I say. "I just believe that losing toes to frostbite is a high price for feeling smug about global warming. That house of yours is the coldest place on earth. There are interstellar molecules warmer than the air in your living-room."

He shakes his head. "When you were a boy you had one coal fire to heat the whole house, right? And you weren't cold then, were you."

"I was bloody freezing," I say. "I used to huddle in front of a single electric bar before school, because the fire hadn't been lit yet. The bedrooms were sub-zero in winter, with frosted windows and sheep-skins piled on the beds. Sometimes the sheep were still inside them. Tough times, I can tell you."

I feel him moving closer again as we reach my car, so I punch his shoulder and step smartly around to the driving side. "Thanks for the tunes," I say. "They'll keep me cheerful. See you in three weeks."

"Kann ich einen Kuss haben," he says and I figure I'll look it up later, if I can remember.

Saturday, 11 October 2014

Pretty in pink

"That's Kelvin's old laboratory," I tell Rachel as we drive past, headed for the campus exit. "My son and I were in there last week, getting a tour of the Nanofabrication Centre

"You see all that pipework?" I add.

"What about it?" she says looking out the car window.

"That's for the services the Centre needs. Liquid nitrogen. Hot and cold running water. Tiny corn flakes for the nanobots' breakfast."

"You're gibbering," she says. "Get serious. What do you know about gay flamingos?"

"Mmm," I say, dredging the memory banks and coming up empty. "Nothing."

"See that's my point," she says. "You're a bottleneck."

"Did I miss the start of this chat?" I say, slowing for a young student in denim shorts who thinks earphones protect you from cars.

"Sorry," she says. "I was working through it in my head and you only got the end. The start was we need stories up faster on Three Minute Learning. We've got 200. We need 2000."  

"I can't write any faster," I say. "I got other clients."

"So we need more writers," she says. "Like me."

"What you going to write about?" I ask.

"Gay flamingos," she says, and the feeling I often get when Rachel talks to me - that my head's in a dark cave being squeezed by a giant hand - vanishes. 

"Got you," I say. "Makes sense now. What's the story?"

"Pair of gay flamingos at Edinburgh zoo have adopted a baby chick, after it was rejected by its straight parents," she says.

"Sounds good," I say pulling up on Wellington Street and getting her bag out the back of the car. "What's the development?"

"Same-sex animal pairs raising neglected babies is common," she says. "A zoo in Japan accidentally spent four years trying to get a pair of male hyenas to breed. A children’s book about a pair of male penguins who raised an egg is top of the banned book list in America."

"Great stuff," I say. "Go ahead and write it on the train."

"Which leaves in five minutes, so must dash," she says, reaching for a fashion item I hadn't noticed. "What do you think?" she says, holding it up. 

"It's a Harris Tweed handbag," I say.

"How did you know?" she says.

"Susan's sister got one for her birthday. But she's elegant. Why do you want one?"

"I figure Adam deserves better than blue jeans after a hard day in the fields," she says. "So geeky physicist is out and classy chick who's going places is in."

"You do look like a chick who's going places," I say.

"Because I have a fancy handbag?"

"Because you're running for a train."

Sunday, 5 October 2014

Women in uniform

It's usually females who confess to a thrill when they see members of the opposite sex in uniform. But admit it guys, there is something about a smart-looking woman in a fancy uniform, isn't there?

They certainly stir my strongest emotions. They're called fear and guilt. So when the six-foot lady constable on my step does not reach out and clap the cuffs on me, as soon as I open the door, I am mightily relieved, I can tell you.

"Do you know anything about smart water, sir?" she says, and I wonder why the law has come to my door to babble strange words from the delirium ward. Maybe she's one of those fancy-dress strippers and will rip her top off any minute. But it's not my birthday or anything, so I play for time in a way I've mastered down the years, when things don't make sense to me, by opening my mouth and letting a cavernous sound come forth. 

"Uhhhh," I say.

"It's a uniquely coded liquid you paint on your possessions," she says, but my brain still refuses to engage, so she hands me a piece of paper and as I read it a little light begins to dawn. 

I've often found this and not just recently. People talk to me in lectures or conversations and there's no flicker of understanding, but if I go away and read about it, things starts to make sense. I reckon there's a design fault in the human communication system. If people had speed limiters, like white vans do, so they could talk no faster than one word a second, then folk like me would have less trouble keeping up.

"Well this sounds very interesting," I tell the nice policeperson. "You give me a bottle of this stuff and I brush it into 'the nooks and crannies of my valuables'. Then if they're stolen you can identify them as mine under ultraviolet light." 

"Every householder in Scotland is getting a different bottle," she confirms with a smile. "You also get SmartWater stickers for your window which act as a powerful deterrent to burglars."

"That sounds great," I say. "So what do I paint it on?"

"Your valuables," she says and I have another blank moment. 

"I can't think of anything," I tell her.

"Your television," she says. 

"It's twenty years old," I say. 

"Your sound system."

"Same."

"Expensive clothes and shoes," she says and I shake my head.

"Paintings, gold, jewellery?" she says.

"Nope," I say.

She is clearly getting exasperated now and I'm getting worried. Last thing I want is to upset the law. 

"What is the most valuable thing in your entire house, sir?" she says and I get a flash of inspiration.

"Me!" I tell her. "Can I paint this stuff into my nooks and crannies to stop me getting stolen?"

She studies me with scorn, shakes her head and turns on her heel, and I have to tell you, guys, women in uniform look better to me when they're walking away.

Saturday, 4 October 2014

Old fossils

I have no idea why god created courgettes. Maybe it was his idea of a joke. "Hey listen guys, I'm going to make millions of slimy long green things on this planet called Earth. Then I'll create TV chefs and make them tell people they're edible. Watch this. It'll be a laugh."

Sure enough, 13.8 billion years later he's buggered off to the twilight zone or somewhere, but his joke's still going strong. Everybody's eating courgettes like there's no tomorrow. Except me. Even if you slap them on garlicked toast and call it bruschetta, they're still inedible lumps of semi-sentient slime. Would you eat slugs on toast? Course you wouldn't. 

So while Linda and my sis are getting outside some tasty-looking pizzas in Paperino's, which I'd declined because so much food at lunchtime would dull the razor sharpness of my brain in the afternoon and make me lose my train of thought at key moments ...

Where was I? Courgettes, pizzas, sis, Linda. Right. So I'm pushing the so-called food around my plate hoping the nice waiter, who'd organised a light veggy bite for me that wasn't on the menu, won't notice I'm not eating it, when Linda tells us a story about a one-liner of hers that went wrong.

Now I've heard similar tales from friends who are quick-witted and funny. Folk take offence sometimes at things they say. They don't see the funny side. And the older they are, the more likely they seem to be to get the hump instead of the joke.  

"Old folk don't like humour where somebody is the butt of the joke, according to recent research," I tell her. "Young folk do." 

A large forkful of calzone stalls halfway to her mouth, as her active brain gets to work on this new information. "I wonder if that's an effect of ageing that happens to all of us," she says. "Or a difference in the culture the older generation grew up in." 

"Exactly the question they're trying to answer now," I tell her.

"If we lived in China we'd get some respect," my sis says, getting on to one of her pet peeves. "Makes me mad the way people talk to me, now I'm not so young. The other day the boy in the computer shop was telling me how to install some software and he turns to the man beside me, who I don't even know, and says, 'You can explain it to her when you get home.'"

She seethes for a second, her fists clenching, then comes out with the strongest word in her vocabulary. "Cheeky little ... SHIT!"

"I pat her sympathetically on the shoulder, and she turns on me. "Don't you dare tell me to calm down, dear," she says.
     
"As if I would," I tell her, swallowing precisely those words and turning back to my green slime on toast.

"See, where you're going wrong is doing one-liners," I tell Linda. "Traditional jokes don't upset people. Guy walks into the doctor's, with a banana in one ear, a courgette in the other and a carrot up his nose. He says 'Give it to me straight doc, what's wrong?' 

"The doctor looks at him and says, 'You need to start eating more sensibly.'" 

Linda studies me like I'm a half-cooked courgette.  "That's not funny," she says.

"Maybe not but nobody's upset," I say. "One of the social skills you learn as you get older is how to spare people's feelings."

"So where are you going now?" she says, as I get up to leave.

"The Fossil Grove down in Victoria Park," I say. "We're writing a story about it. 330 million-year-old trees turned to stoneAmazing place. I remember seeing the fossils for the first time when I was young."  

"What age were you?" she says. 

"About 20," I say.

"Weren't they still trees then?" she says, and I realise my sage advice has fallen on deaf ears again.