Cancer 12
Posted on March 2, 2023 Leave a Comment
I am in hospital again today, this time for an echocardiogram. I think the anaesthetist is a little worried about my heart. There are two key aspects to consider beyond heart rate and blood pressure, both of which are controlled by drugs (OK, my blood pressure is a little high, bt not ridiculously so). The other two aspects of importance are my ejection fraction and my arrhythmia.
My arrhythmia is under control. Since I had a cardioversion in September 2020 I have not had a problem. The cardioversion is a wonderful tool. Basically it involves stopping the arrhythmic heart and starting it up again, hoping that it will be in rhythm. There is no real difference between this and turning a computer off and on again to make it work; and just like with the computer, it usually works. It was invented by scientists in the USSR and involves sending several thousand volts through the system – bu tI have described it in an earlier post. The danger is that the operation may make my heart go out of rhythm again, so I may need another cardioversion.
The other problem, the ejection fraction, relates to the rate at which the heart pumps blood through the heart. More precisely, the ejection fraction (EF) formula equals the amount of blood pumped out of the ventricle with each contraction (stroke volume, SV) divided by the end-diastolic volume (EDV), the total amount of blood in the ventricle. To express this as a percentage it is multiplied by 100, ie: EF=(SD/EDV)100. The normal ejection fraction in males is from the mid-50s to 70s%.
My ejection fraction when I first got heart failure was less than 30%, or ‘severely abnormal’. At the last measurement in 2021, it had increased to nearly normal, just over 50%. This is what is being measured today. As I have been taking the drugs, not drinking and generally had a reasonable diet, I am hopeful that it will be reasonably normal. I should know later on.
Later on.
Nothing really to report, except that the echocardiogram went smoothly. The person who administered it did not have the analyses so could only report that from the pictures the heart looked like it was functioning reasonably well. Hardly decisive, but indicative of a positive result.
While I passed my 60th birthday only three days ago I am fairly confident that despite my dodgy heart I am fitter than many people who go through this kind of surgery. I can (probably) still beat most people at arm wrestling if anyone wants a go; though I cannot do my old party trick of bending and breaking a six inch nail with my bare hands. To be honest, I haven’t tried it for decades. Perhaps I should.
Cancer 14
Posted on February 27, 2023 Leave a Comment
We all criticise social media for its triviality, its nonsense, its ridiculous videos, and so on, yet most of us get involved in one way or another, through Facebook, LinkedIn, Instagram, or all those others that I may or may not have heard of but don’t know what they do or how they work. I am rather a Luddite, though I use Facebook, and have accounts elsewhere.
I am never sure about Facebook. I enjoy flicking through the ‘pages’ (is that what they are called?) and looking at the news or what people are saying on the groups I am affiliated with such as Dull Men, Stiff Little Fingers, The Clash, Joy Division, old pictures of local places and something to do with Viz. It has nothing to do with work. I use LinkedIn occasionally for work purposes, or I pretend to. Twitter I don’t really understand. I am not sure why it exists. It is the same with Instagram. I set up an account but never use it. I am very glad that when I grew up the Internet did not exist, let alone social media. I was far happier digging holes, damming the local stream, making treehouses, forts and dens and replaying aspects of World War Two and other wars with either pretend guns (with friends) or real stones (with rival gangs).
Nevertheless I have found social media to be very helpful during this period of cancer, both mine and my sister’s. People have been universally supportive. I have had messages, both public and private, from all over the world. Yes, people used cliched phrases, but that is because those are the phrases that work, and there are only so many ways you can say things. Perhaps we shouldn’t call them cliched because of the negative connotations of that word. They are supportive statements. It is good to hear from people.
I have had stories of other people’s cancer, usually positive ones about how they are now clear of cancer and have lived for many years. Of course, no one is going to tell me that they know people who died of my kind of cancer. I appreciate honesty and openness, but not many people are willing to go that far!
Then there is this blog. I am currently writing my book about applied narrative psychology (I finished my penultimate draft today!), which is all about the ways we use stories in everyday life, not only to keep civilisation going but to deal with the problems we face. It is good timing. Writing this blog, this narrative, is cathartic. It helps me control my thoughts and emotions. Without it I would be a little bit worse than I am in terms of emotional distress and confusion. There is plenty of evidence that telling stories and writing stories helps people’s health. It is a way of focusing thoughts and feelings, it forces you to spend time on thinking through how you are feeling.
In the end, while social media is a terrible invention, it has its positive side.
Cancer 10
Posted on February 26, 2023 1 Comment
My sister died yesterday. It was cancer. She was 63 years old. It is good that our parents are not around to see both children with cancer.
It can be a strange relationship, that between siblings. I would not dream to judge other people’s relationships. All are similar, all different, but ours was one of both closeness and distance. There is a natural bond between two people who emerged into the world from the same womb, a bond built throughout childhood at the same time as being battered by the experiences of the same two people who spend most of their childhood not getting on very well (I still have the scar to prove it. See below). We generally got on better in adulthood, partly because we were adults, and mainly because we lived in different houses. We sometimes went a long time without seeing each other, but when we met it was as though no time had passed. Many times I have been exasperated by her, by something she did or something she didn’t do. No doubt I exasperated her too, but there was never a real fall out. Perhaps there is no reason to have a fall out when you are both close and distant anyway.
She was 3 years 6 months older than me. She said she liked being an only child and was annoyed when I turned up. Perhaps what she said was true, that our father always wanted a boy and was glad when I turned up. I never saw that. I thought he treated us equally, though I think I spent a lot more time playing with him than she did. I put that down to boys prefer playing with boys. After all, she didn’t like football, cricket, digging holes or building treehouses in the garden. She had an old chicken shed as a Wendy house for what I remember as a short time, then it became mine. I was to move it seven times to various parts of the garden. My finest memory of it being a Wendy House was getting my sister to open the door and I threw a bunch of nettles at her bare legs. She was stung quite well/badly (depending on your point of view). I was a good little brother. Some time previously (probably years) she had locked me in a rabbit hutch.
We had a big garden, getting on for an acre, which had a quarry, a field, and lots of trees, along with the vegetable garden, lawn, etc. I know we were privileged in that respect compared with other children (though there wasn’t much money around), and I have always looked back on my childhood in a positive manner. We were fed and sheltered, we had an annual holiday, and we were looked after. I was happy, I dug holes and climbed trees, made dams and rode my bike, all the things that boys did before the internet and computers were so sadly invented. My life was busy, generally positive, and provides great memories. The worst thing was having hand me downs from my sister, girly clothes, girly bikes (until I got my own racing bike at 11).
My sister had the same opportunities, the same space, but as an adult looked back in a generally negative way about her childhood. I have never understood why. Perhaps she wanted to be a boy.
She did have responsibility for looking after me on many occasions. She took me to school, which was a good long walk each way including one busy (for a village) road. In the holidays when both parents were at work she was meant to look after me. My strongest memory is that she would never let me in the house, keeping the doors locked and forcing me and my friends to play utside all day. What a shame. It was sometimes a game to try and break in. My scar arose from me trying to open the front door and my sister trying to close it. Unfortunately I was pushing on the glass (she should have told me not to. She was responsible for me. I was a child. How was I to know? ahem….), which broke and a piece took a big chunk out of my wrist. I stared at it, this great gouge, and suddenly the blood started splurting out. I didn’t wait for a response from my sister, but ran about 500 metres to my friend’s house, where his Mum sorted me out. I don’t remember, but surely my sister must have been nice to me for at least a little while after that. I still bear that scar.
We did share a lot of things. We occasionally went on bike rides together (I would go round in circles waiting for her to struggle up hills). We occasionally played together in the garden. She twisted her knee badly when we were playing in the field behind the house and ended up in plaster for weeks. We certainly spent a lot of time together on the back seats of the various cars we went in on holiday to Scotland and the Lake District (We all have selective memories. Who wants remember a week on a beach in Blackpool?). We sometimes even spoke to each other civilly and played games.
On the whole I thought our relationship was normal, presumably because I didn’t really see that many relationships between brothers and sisters. Those of my (male) friends who had sisters tended to ignore them when we were together.
Yesterday I was in a state of shock. My insides were turned inside out, my emotions in turmoil, and my thoughts confused. Today is better. The shock has worn off. We were expecting her to die. Now she has died. My recollections are mixed. Good memories, bad memories, indifferent elements. Why would I want to change anything? She was my sister, and that’s normal, I assume.
Cancer 9
Posted on February 23, 2023 Leave a Comment
0727. Today the treatment has a beginning. This afternoon is the pre-op. I will be meeting again with the surgeon and with the nurse, and then have an appointment with the anaesthetist, who may want to test my fitness. Hopefully I am fit enough. The wait is notoriously long. I am going in early to order that, and then write my book in the medical school, where fortunately I can park all day as I work in the medical school.
1057. After spending 20 minutes in the queue for the pharmacy, with the sign indicating a 1 hr 10 min wait for picking up, I was told that my drugs were not in stock. There is a benefit to this. My pre-paid certificate ran out a few days ago, and I don’t become age eligible for free prescriptions until Monday (presents to the usual address please!), so at least I saved a tenner or what ever they cost, though it does mean I will have to drive back to Derby which will probably cost more than a tenner. And that is a good example of Tory economics!
1105. If I am having to hang around all day getting border then you, my dear reader, can also go through something similar reading this. I am now sitting in the cafe of the Medical School in the hospital. I am fortunate in having this sanctuary away from all those sick people! My intention is to spend the next couple of hours reading my book before I have to go for the pre-op appointment. Blog writing is a great avoidance strategy. I am on the boring part of the book, rewriting and editing. It seems to take forever with no visible gain. At least when writing the first draft you can watch the word count gradually go up, 10,000 words, 20,000 words, and feel you are achieving something. At the editing stage it also involves realising how bad the writing is. OK, get on with it.
1248. I managed to finish off another chapter (and by finish I do not mean finish, but completed the latest, penultimate, stage). A couple of things. I am now in the ‘restaurant’, where the main meals are pie and chips or curry. I had curry as being the lesser of two evils (if you know me you will know that I don’t mean that. Give me pie any day. I am just trying to be good). I don’t know why hospitals aren’t compelled to just sell healthy food, given that diet is a key indicator of health. Many of the staff turn up with their own food, boxes of salad, sandwiches and the like. I have also noticed that, despite the rule that they should be worn, fewer people are wearing masks. I haven’t yet been asked about wearing one. In the past I just say ‘I am exempt’. While I want to say ‘I am exempt because I am following the science that indicates masks have no effect on the transmission of viruses’, I should say, ‘I am exempt because I have heart failure, cancer, and lungs battered by previous experience of pneumonia and pleurisy.’ Back to the book. This is exciting isn’t it?
1836. I am back home. It is over. The pre-op lasted over two and a half hours, but it was mostly positive. Good rapport with the nurse. My heart is not bad, my lungs are fine. My blood pressure is a little high but I knew that. My weight is, ahem, and my BMI is more than 20. They even managed to take some blood, which has been difficult since I have had heart failure. The 30 day mortality risk after the operation is 1.48%. The main anaesthetic drug will be diamorphine, injected into my back. I will have overnight pulse oximetry to check my blood oxygen levels, but it showed 97% today, which is good. I need to go back to the hospital tomorrow with the results of the oximetry test, and then again next week for my prescription. The day before my operation I have to fast and take some high carb drinks. I then need to take tablets to induce the emptying of my bowels before I arrive at the hospital at 7am on the big day. Now I am going to spend the evening doing nothing of importance.
Cancer 11
Posted on February 23, 2023 Leave a Comment
I generally have an optimistic starry-eyed view of the world, where my cancer will be cured, but today has been one of those days where it has been difficult to keep staring at the stars. Last night I spent too long on or near the toilet , with my abdominal cramps worse than normal, and blood oozing and spurting – I hope you are not eating. There should be some good toilet humour in this, but I am not in the mood. Let me know if you think of any good jokes. It is not particularly painful, but it is worrying that it is getting worse, ie that the malignant tumour is increasing in size and narrowing my colon, so making it difficult to get things past it.
I telephoned the cancer nurses to let them know what was happening. They have put me on a low fibre diet (where at least I can eat white bread, meat, fish and eggs) to help ensure the safe passage of looser stools.
My second worry over the last few days has been that my operation may be postponed because of the junior doctors’ strike. I hope it won’t be. I asked the nurse if there was any information. She checked with her manager and we should know sometime towards the end of next week, which is a week too long for me.
The stress of the day meant that we completely forgot that my niece was taking me out for my birthday afternoon tea today, She phoned me 15 minutes after the due time, and we got there half an hour late, extremely apologetic. This never happens. We are early people. Tell us to be somewhere at 1100 and we will be there at 1030 and think we are just in time. Stress has profound effects on behaviour.
Whenever I worry I inevitably think things will go wrong, that my cancer has spread so that it cannot be easily controlled, that it is in my lymphs, in my liver, in my kidneys. I feel it everywhere. OK, I know this is my neuroticism but neuroticism is real so my feelings are real (even when I know they may not be – see, even here I can only say may not be rather than are not).
These are the times when I reflect on my life and wonder whether it has been of some value, I mean subjective value. We can’t all be Einstein, Gorbachev or Churchill. Do I think it has been in some sense worthwhile? I start to think in existential terms, with the ideas of being and becoming and absurdity to the forefront. In the end I know that objectively no life has value. A few atoms bonded together in a weak, floppy body, ever-changing for a few rotations of a minor star around a minor planet until it dissolves into the earth. None of it matters. Yet of course it does; it matters to ourselves in some absurd manner. It matters that we have achieved things, that people like or respect us, that we have in some minor way contributed to the world. These things give life some meaning. As Sartre would have it, a sense of becoming rather than just being. Albert Camus would conclude that while life is absurd, the meaning we put on it is important, and so we should not commit suicide (see The Myth of Sisyphus for a fuller explanation) . Thanks Albert, I was not thinking of committing suicide just yet, no matter that parts of my body might want to.
Sorry that I have been negative again. The key thing is that I just want this operation over and done with. Inside I am under stress, but my self is aware that the chances are that Western medical science can destroy my cancer and make me reasonably well again (apart from my heart failure, my pinned big toe, my outsized belly, my flat feet, my alopecia and my perennially broken shoulder).
Dr Nigel Hunt 