I forget where we are up to sometimes, with my tangential ramblings. As far as I remember, I had just changed roles at work, had bloods and an MRI, and needed to go back to the urologist. So, I’m back at hospital by the sea, to see Dr Professional the urologist. He tells me the only way to find out for certain is to have a biopsy of my prostate. He offers me a trans-rectal ultra sound biopsy (TRUS), not until he had offered me another dis-pleasurable finger up the bum. He was obviously more used to it than super GP. His was more Trident than Exocet, so much so that I suggested he might want to take his rings off next time. Of course, I offered him my thanks, but I drew the line at congratulating him this time.
Australia is actually at the forefront of prostate cancer diagnosis. This fella, Dr Grummet, explains why in an expert way.
He is a urologist. If anyone has dealings with prostate cancer, in your friends and relatives, this is worth a read. If you only landed here to laugh at my misfortune, then you may give it a miss.
In a nutshell, Dr Grummet suggests that a TRUS is archaic and barbaric in modern society. The main reason being that a TRUS attacks the prostate via your anal canal. That’s right. Up your chocolate starfish. With, you guessed it. Lube. I actually saw one of these done when I was a student nurse 20 years ago. I sat there chatting away to this poor geezer about the relative merits of a midfield diamond for England in the 1998 World Cup finals, whilst a couple of haggard looking doctors poked around his nether tunnel with a some sort of implement that I am sure I’d seen before in the Sex Museum in Amsterdam. A cross between a magicians wand and the Starship Enterprise, coupled with a sophisticated mini nailing gun. With a condom on. That didn’t really fit. Kinda of like a skeleton with a stiffy wearing a French tickler. No sedation for the poor bloke, him wincing every now and then in time with the click click of the nail gun/biopsy needle. One thing I remember them saying is he had a chance of Sepsis because of this procedure. I didn’t really know what sepsis was back then, but it didn’t sound too clever.
Sepsis is becoming a bit trendier these days as it hits the headlines more and more. It’s not a new phenomenon, but there are various strategies around to raise awareness and hopefully save someone’s life. Sepsis is essentially the bodies reaction to bacteria that gets in to your blood stream. As you fight the infection, there is a massive inflammatory response, which kind of has the potential to cascade out of control and kill you, usually from multi-organ failure. It is this response that makes it likely to occur in young fit people, as well as the elderly and the already compromised, and hence that is why it is a a hot topic.
In the UK, I think, could be wrong, but I seem to remember that patients are offered a TRUS on the NHS if you have a raised PSA +/- a lump discovered after the index finger Exocet. If anything shows up on that, they will do an MRI, and then possibly another more targeted biopsy. Hard to believe, but the Australians are actually more civilised than that. We do the MRI first! Saves us pain, saves us dying of sepsis, and saves us from feeling great because our biopsy was negative, but in reality, the samples taken just happened to miss the cancer, and landed in the good bit. If you are not offered an MRI before a biopsy, I would strongly recommend that you at least ask the question. The NHS is great, but cost and resource management, and more recently, poor funding, is bound to have some effect. Worst case scenario is they say no. In that case, look into going private, just for the scan, then go back. MRI does nothing to hurt you, unless you are carrying a significant amount of embedded shrapnel, it runs on magnets and witchcraft, or something.
So Dr Grummet suggests the blood poisoning risk to be around 2%. I have heard from other sources, it may be less than that. However, I didn’t fancy taking the risk. Yeah, OK, I might have cancer, and that cancer might kill me, but if there is potentially a 1 in 50 chance I could die there and then from trying to find out, well I’ll think I’ll pass. So I told Dr Professional that I’m not up for it. I know what I eat, and drink, and therefore can hazard a guess what badness exists in my colon. Badness that belongs with the shite and stink of the sigmoid, and can’t be helped by a truckload of Inner Health Plus, and a liberal application of blue Toilet Duck. Badness that is not happily floating round my bloodstream like a ship full of pillaging Vikings, causing mayhem.
Another thing that Australia do is offer a trans-perineal biopsy (TPPB). This is done via your perineum, your tint, if you remember earlier entries. Tint bum, tint balls, it’s the bit in between. This is much safer, firstly for the doctors, because the patient is under the general anaesthesia, and is essentially dead to the world. They can feel free to stick as many needles in you as they like, with no danger patient squealing and kicking them in the face. OK, not for that reason. It is much safer for the patient, as there is no risk of blood poisoning. Yes there’s an anaesthetic. There’s a slight risk from that, but hey, people take the same drugs on a Saturday night in the Valley, so having them in hospital with a consultant anaesthetist and all the gear to bring you back from the brink is relatively safe.
“I’ll go for the TPPB, please”
“HBTS, doesn’t have the equipment for that yet”
“I have it in my private rooms, you can come and see me there”
“Oh. How much is it?”
“Around $6-7000. But we do have a wine list, and a choice of gown colour.”
He sent me away to think about it, and told me to come back in 6 weeks.
We have to take responsibility for our own health. The medical team are usually fantastic, but are sometimes hampered by policy or resources. I was left with a choice of “archaic and barbaric” and free, or modern and safe, but expensive. I’m a nurse. I’m more left than right. I’m of the opinion that health, education and the like should be equal and available to all. A level playing field. An equal start. I don’t mind paying more tax, as long it is utilised appropriately. As a nurse, I strongly feel that I should be using the same service that I advocate for my patients. Consider the message sent if all the nurses go private, and the teachers will only educate their own children in private schools? This is right for me. However, freedom, in my opinion, trumps equality. Freedom to choose, so I concede that other people do what they feel is best for themselves and their loved ones. The point I am making, is that when faced with choices, sometimes, there are more than at first glance.
Take a nice restaurant menu. It may have, say five dishes on there. Whilst you could exercise your right to choose here, this is an example of when you shouldn’t look for the hidden option. In any half decent restaurant, the chef, when they formulate the menu, has thoughtfully considered what flavours mix with each other, what produce is available, what time of year, and various other factors. They release the menu. If you decide to go off piste by asking for the lobster bisque from the lizard egg and scallop slop, heaped on your railway sleeper chips from the steak and Jenga, then you A) Look like an un-pleasable pretentious tool, but more importantly, B) Piss off the chef, and leave yourself open to the inclusion of some home-made cheese as he gives your bisque a final stir with the end of his knob. Although, I’m not knocking anyone’s freedom to choose. Just do it at your peril.
Health choices are different. Look for more options. Help yourself. Ask people. The UK, these days, has cancer nurse helplines. You can just phone up for a chat. What a wonderful service. The internet, if you stick to the official cancer sites, provides fantastic information. Most people know a nurse, a midwife, a paramedic, someone in the health service. We can help direct you to what you need. We can ask a person that knows. Talk about things.
I figured that if anyone in our area had the equipment for a TPPB, it was Super Hospital. A quick phone call proved this to be the case. I went to see Super GP and got her to send a referral to them, and a few weeks later I was booked up any ready to go.