Related Medical History
Following 12 exciting years in the British Army, some 6 1/2 if which were on active service in South East Asia, I came to Oz with my wife and three young children to start life anew. I had been relatively free of sickness during military service, apart from duodenal ulcers, Dengue fever and the usual injuries one seems to acquire on operational duties. Anyhow, at this juncture, I considered it prudent to leave the army. I’d had enough of military service in that era, where politics took precedence over military necessity and personnel safety and besides, the warm climes of Australia beckoned. We made the move in 1970, settling in Sydney.
Much later, in 1995, I lost my right kidney due to an adenocarcinoma, oncocytic variant, nuclear grade 11. Immediately following that operation and without leaving hospital, I underwent a transurethral resection of the prostate (TURP), as I was then unable to urinate without the help of catheters, of which I had three or four. Benign prostate enlargement was identified as the cause of my problem
As if to confirm my propensity for excessive tissue growth - in 1992 I also had most of my thyroid removed along with a huge benign tumour– and I was having regular check-ups to catch any metastasis or other abnormal growth.
In 1999 I had a dysplastic compound naevous growth, described on biopsy as a probable, malignant melanoma, removed from my back, and later, a malignant carcinoma, too. Two additional carcinoma growths were removed from my back in 2004.
In 2000, after a bout of severe bronchitis, a nodule was identified in the right upper lobe of my lung and yet another, in the right lobe of my liver. My then doctor, a really charming, sincere and concerned chap - the old variety family doctor we don’t see much of these days - immediately diagnosed secondary cancer and suggested that I probably had 12 months in which to get my personal affairs in order. But to confirm his diagnosis, fortunately, he sent me to an oncologist, who turned out to be a quiet, shrewd and cautious chap, who would not commit to any such diagnosis without further, intensive analysis.
It was during this period that he went off overseas and a much younger oncologist filled in. His first move was to send me to see a thoracic surgeon at a Sydney private Hospital. Now this chest specialist, a delightful lad, immediately and with further tests, pronounced secondary cancer in my left lung and offered to operate on my lung within two days. He said he wouldn’t know how much of my lung he would have to remove until he opened me up. I then asked “But what about my liver?” to which he replied “I don’t do livers”.
“So where is the logic in that?” I asked as he obviously didn’t get my drift. “If you say I have secondary cancer in my lung it stands to reason that I also have secondary cancer in my liver. So what is the point of surgery on my lung when it seems probable that cancer has spread elsewhere, possibly to other places yet undiscovered? “Ah, yes, you have a point there” he replied. Enough said - I walked out.
Would it be cynical of me to think that this chap was more interested in filling in allocated hospital theatre time than he was in my health and welfare? You decide…
A week or so later, my regular oncologist returned and, having explored all the clinical possibilities, he still could not commit himself to a diagnosis of cancer, preferring instead, to play the waiting game, with regular scans. The intention being to see if the ‘nodules’ in the lung and liver increased in size or number over coming months.
My wife and I felt very comfortable with both him and his advice, and concurred.
Anyhow, the ultimate finding, after 12 months, was that both nodules had remained constant in their respective size and no new ones were evidenced. A diagnosis of ‘probable’ haemangioma was given. I continue to have regular scans and these nodules are still present, but unchanged, so the diagnosis appears valid.
An interesting aside to this saga was that on the chance that the prognosis would turn unfavorable my wife and I had planned a six month visit to the UK. primarily to visit old haunts and say a silent farewell to family and friends. We decided to continue with those plans and ultimately spent a very happy and worthwhile ten months, based in London and staying at our daughter-in-laws’ family property in Kensington.
During our visit we determined that being semi-retired, Queensland had far more attraction for us than New South Wales - and that I could still follow my interests and conduct my activities from there just as easily as in Sydney - so we made plans to move north on our return to Sydney. Hence, since 2001 we have lived on the coast just a few clicks north of Brisbane, where the weather is superb one day – and perfect the next. I should add though, that we have the worst drought on record at present.
I digress. So let’s get back to my clinical stuff.
In 2003, I underwent surgery; left combined approach tympanoplasty and myringoplasty, to remove a benign tumour, a Cholestiatoma, deep inside my left ear, resulting in a total loss of hearing in that ear. (Yes! They keep on growing, don’t they?)
I mention all of the above ‘stuff’ only to demonstrate my propensity for growing these little nasties over the years and to illustrate further why I might be better mentally conditioned, more so than most people anyhow, to face the “big C” with grit and determination and to attack it head on, and in my own way.
There was a time when whatever the man in the white coat said or recommended, I listened to and complied with unquestioning. Isn’t that the way we were brought up in the thirties and forties? I well remember my family doctors’ words being the law in my home. But with my growing experience over the years I soon came to realize the limits of modern medicine and so to, its practioners. I then began following the mantra of being responsible for my own health and body.
And now we are getting closer to my current situation.
Back in 2003, I began experiencing periods (maybe I shouldn’t use that word) when I would pass blood in my urine, commonly known as Frank Haematuria. This would occur quite spasmodically, and would range from just a little colour at the start of the flow to a full on flow of blood. My doctor sent me off to see an urologist. After giving me the digital rectal examination (DRE) and confirming an enlarged prostate, he expressed some concern and suggested an internal examination by way of a Cystoscopy and retrograde Pyelogram. This was done in August 2003, requiring an overnight stay in hospital. The finding was inconclusive in that nothing untoward was discovered. But neither was the cause for the bleeding found. He suggested we watch and wait for developments.
Charming!
Apart from irregular hemorrhaging, say 2 – 4 days, thrice yearly, nothing happened until Christmas 2005.
Nothing, that is, other than for the fact that my water-works had started playing up more than usual. Mind you, I had been living with that problem ever since my kidney was removed in 1995 though it had never bothered me. But now, it was becoming a nuisance. Typical symptoms included a slow start to the flow, especially when the need was urgent; reduced pressure more particularly after the mid flow point when it would slow to a simple ‘draining’ action, requiring urging of the muscles or external pressure on the perineum; and, if I wasn’t careful, dribbling after the event. Thankfully, I have not experienced the pain or particular discomfort in the renal tract area, as many others do.
I have, and still do, experienced some discomfort in the lower tummy area, where the prostate is located, when exercising, but it certainly doesn’t qualify as pain.
And so to the episode that will bring us up to date, as far as clinical history is concerned.
During Christmas 2005/6 I again experienced severe hemorrhaging over several days and taking into consideration my worsening water-works, decided to raise the issue again with my doctor and get a referral to another urologist. I say “another urologist” because I’ve always had the belief that the previous chap, in 2003, didn’t investigated my problem diligently enough, so another point of view was now required.
Subsequently, I found myself with a young, and as my wife says “very handsome” fellow whom I later found both candid and forthright in his deliberations and who seemed to grasp my situation very quickly. Following a digital rectal examination (DRE), which again confirmed an enlarged prostate, he ordered a blood test. This subsequently gave me a prostate specific antigen (PSA) result of 7.30, indicative of having cancer but not conclusively so.
As many will know, PSA is produced by both normal and cancerous cells. It can indicate prostate enlargement, infection, or inflammation. Some cancers don’t even produce an increased reading. In fact, one USA study I have read about concerned 500 men, each with an aggressive prostate cancer, of which 25% had no significant PSA reading. The medico’s do say however, that a high reading will give them an idea of the stage of growth of the cancer. It is also said to give an indication as to the likelihood of any spread of the cancer. Not sure that I’d want to know that. It might panic me into taking the surgical route.
However, more analysis needed to be done and on 5th May I went into day surgery for another internal examination. This included a Cystoscopy, retrograde Pyelogram and a biopsy of the prostate. For the latter, the prostate is approached through the anal wall and about 12 small samples are nicked from different areas of the prostate. Thankfully, I was in cloud cuckoo land at the time and didn’t feel a thing.
When the samples were examined 1 was a grade 7 and 3 were grade 9 on the Gleeson score. Grade 7 being half way between moderate and high and grade 9 being very high, indicating a very aggressive form of cancer, one hard to counteract. With this type of cancer the threat of metastasis having occurred already is considered highly probable, though it might be in microscopic form and therefore hard to detect.
The next cab off the rank was to be on the 15th May when I had an ultrasound of the urinary tract together with a CT scan, with IVP and tomography of the whole body to determine if cancer had entered the bones. Seemingly, if cancer does enter the bones the chance of recovery is very limited indeed. Fortunately, my scan’s proved to be negative, with no conclusive indicator of cancer in the bone structure.
After all this poking and prodding the outcome was that my urologist wasn’t prepared to operate to remove the prostate and the surrounding tissues in the belief that the cancer was too aggressive and the probability of it having spread, even wider than the surrounding tissue, was too high. To operate would therefore be futile. I was pleased to hear that as I had drawn that conclusion myself from my research and no way was I going under the scalpel anyway. Moreover, it confirmed that he was not surgery happy, as with some specialists who can’t wait for surgery time to come along.
We then discussed the limited options available to me after which he gave me his recommendation. This was for high dose Brachytherapy in concert with hormone treatment. There are two types of Brachytherapy, low dose and high dose. With high dose radioactive substance is placed in hollow needles which are inserting into the prostate. This method allows the radiation source to more directly target the problem area, the prostate, without affecting the nearby organs.
As for the hormone therapy this is used to counteract the cancer cells need for testosterone by blocking off the supply or reducing its efficacy. It sounds very simple but the reality is that, together with the stopping of your testosterone - which has its own major side effects - consuming large doses of deadly drugs can, in turn, seriously affect other organs, including the adrenal glands, the liver and the testicles, including there ultimate removal. So once you start the programme you continue to take one drug after the other, each to combat the combined affects of the earlier ones. That doesn’t sound too pretty to me. How about you?
Joke time:
A man elects to have a prostatectomy (removal of the prostate) and asks the surgeon to try to spare the nerves that produce an erection. Well, he goes into surgery and wakes up in the recovery room and sees his doctor.
Man: So how did it go?
Doctor: I’ve got good news and bad news.
Man: Give me the good news first.
Doctor: We were able to save the nerves.
Man: That’s great news! What’s the bad news?
Doctor: They’re under your pillow
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