32) A Gentleman’s Falafel

I managed to escape the weekend without serious illness, although I can’t really say I feel any better, but I certainly feel no worse.  The side effects, and list of things to avoid, because of the antibiotics, were somewhat worse than the symptoms of the UTI.  No eating within 2 hours either side of taking them led to a rolling around the bed, in the middle of the night, belly ache, that eventually subsided with a home made cocktail of milk, Nexium, Endone, Zantac, and a packet of Quick Ease.  I’ve dispensed plenty of antibiotics in my time with the warning they may cause gastrointestinal upset.  In fact, I’ve even argued plenty of times, with patients, that the side effects of their particular antibiotic may actually be worse than just sitting out the infection and letting their immune system sort it out itself.  My friend Rachel and I even got called “fucking knob-sacks” by a particularly Neanderthal like male specimen who thought he needed some for his sore throat, that we had clinically deduced would likely not make much of a difference to his symptoms.  Off he went effing and blinding, dragging his knuckles across the floor on his way out, threatening to punch my lights out.  The first patient of the day on a public holiday in the urgent care centre.  Imagine how the rest of the shift went, with such a sterling candidate first up.  I think I was at that point I realised I needed a change of scene at work.  When a punch in the face, and the consequent rest of the day off, seems more enticing than suffering the carnage that the rest of the day would bring.

I’ve not really taken too many antibiotics myself.  The nurse in me knows that my innate defence systems will mop up most infections without them, and it’s only in particularly serious ones you may need antibiotics.  In the UK, antimicrobial stewardship is taken very seriously.  Frequently treating mild infections has contributed to resistant organisms.  We face a potential future of not being able to treat some infections.  There are already multi-resistant organisms lurking around the world that are not affected by any antibiotic known to humanity.  It portends a step back in time, to when losing a family member to communicable disease was the norm.  I now have a resistant infection myself, therefore having a vested interest.  The infection is sensitive to two antibiotics only.  I am taking one, the other one can only be taken intravenously, and therefore necessitates some sort of hospital input and substantive cost.  Also 11% of patients who receive it go deaf.  Permanently.  I’m not suggesting this is likely to happen to me, but just illustrating the potential that it will happen to someone.  What a can of worms to open on a Monday morning.  I should add that if the docs thought I was in particular danger they would have admitted me to hospital for treatment.  A lot of illnesses have the potential to be very serious.  I’ve just got to be vigilant, that’s all.

I think the point I was getting along to, was that I was surprised to fall victim to the sour belly, early hour, bed dance that occurred.  Wifey, typically, just took the piss.  I was feeling pretty rough, and we know how the early hours bring out the most dark thoughts.  Things that you would usually brush off as ridiculous somehow getting a foothold in your mind, and then gaining traction, spreading to suggest the ludicrous as true.  Working potential problems of the next day into Herculean tasks, which in reality are a massive anticlimax, and were not worth the consequent stress and missed sleep.  Back on point, the pain I had was pretty bad, I’d put it at a 5 or 6/10.  Pain is generally suffer-able, as long as we know why we have it.  It’s a lot easier to manage, when we know we are not about to have a perforated appendix, a heart attack, dissected major vessel, twisted and dying bowel, or blood clot stuck in your lungs.  As it was Sunday morning around 3am, there is little by way of doctor review other than the emergency department.  I knew I was doing alright, but did mention to wifey, that perhaps I would need to attend there in a couple of hours, if things had not settled down.  Cue Carte-Blanche of ridicule from wifey.  She was even going on about it to some friends we saw on Sunday morning whilst walking the dog.  Clearly after my miraculous recovery.

As long as I keep cracking down the tummy tablets, it’s only a mild queasy hangover belly.  So I continue on.  One of the things that I forgot to mention was that I’m not allowed to have caffeine whilst taking these pills, as I may get an arrhythmia, they say.  So I make my morning walk to the local cafe, where today, I sit nursing a chai latte.  I don’t even know what it is.  I understand that chai is tea, and that’s where it ends.  I sit sipping on the sickly, sweet beverage, feeling slightly bohemian, avante-garde even, still unsure what’s in it, furtively checking my pulse, just in case.  If my mid twenties self could see me now, he’d be choking on his breakfast cider.

Sometimes I forget what I have already covered in the blog.  Perhaps the chai is hampering my writing.  So what happens next?  Well, I am in a results limbo land. They’ve chopped out the bits with the cancer in.  I have my pathology.  The pathology is the report from the laboratories when they looked at my parts under the microscope.  The benefit of the newly launched governmental MyHealth database.  I’m not sure if they should be making cancer pathology available to the public before they see a doctor about it, but hey, that’s what it facilitates.  You can get the sack for looking that up at work, but now there’s no need, as it’s all there for even folks with no medical background to jump on Dr Google and potentially ruin their lives.  I have the pathology, my discharge summary, all my CT’s and PET scans etc.  It makes for interesting reading, If you have an inkling of what it means.  Otherwise, one would imagine that it just sows seeds of worry and misery.  Anyway, there is a collection of my sexy parts listed on my pathology.  Now no longer sexy, in fact probably a bit rotten and past their best one would imagine, festering in a jar somewhere.  That begins a tangential thought.  Who now is the lucky owner of my sexy parts?  I must have relinquished ownership when I consented to surgery,  but what if they prove to have some value?  Think along the lines of musk from a deers arse, or ambergris, both highly prized by perfume manufacturers.  A lump of this whale shit washed up on the beach in Wales, and the canny crap gatherer who found it, sold it at auction for $20000.  I can say with some certainty that my seminal vesicles have similar rare aromatic properties.  Perhaps it will just take a few more years of human evolution to become a base for perfume.

So they took prostate, seminal vesicles, and some surrounding tissue.   A nice person in the laboratory elected to carve the meat, and examined the shavings.  When you add it all together, they left quite a substantial hole.  Because I’m a bit odd, I’m going to do the math…Click, click, scribble, scribble, tap tap…..  Approximately 0.00000000000000002 the size of Halleys Comet apparently.  That is to say, 70 cubic centimeters, which is around the size of a standard chicken egg.  Or two golf balls.  Well fancy that.  I laid an egg.  They found the cancer lurking within.  Not one but two.  The size of chickpeas.  All that effort for a couple of bloody peas!  Six hours of top quality doctors, plus a robot, delving around to locate some malevolent legumes.  A bit of prostatic hummous,  a gentleman’s falafel.  They chopped a bit out around the edges- the surgical margins, which were clear.  There was a little bit of less well received news on there.  There was an element of extra-prostatic extension, and something called perineural invasion. The edge of your prostate is actually not that well defined.  Kind of fluffy, as a cloud.  My cancer had spread to the fluffy edges, but not to the tissue beyond that. The nerves function like highways, and so any cancer will try to take the path of least resistance -along the nerves, so perineural invasion is not uncommon.  Now the problems that these unpopular items bring, is that extra-prostatic extension means a higher chance of recurrence, and the same, to a lesser extent, with the nerve invasion. The same nerves that the docs left in there to make the flag of fun rise.  Which incidentally, if you are wondering, is not even at half mast as yet.  So much for Extra-Vascular Cock Man.  Essentially Vermicular Cock Man would be more appropriate.  It is only weeks since the surgery, let’s hope that the extra little bundle of vessels down there is working it’s dark, meaty magic.  I go back to see the surgeons in six weeks or so.  They have to have a PSA test before they can tell you if you are cured or not.  They can’t do this too soon, as they need to wait for things to settle after the operation.  Only prostate cells emit PSA.  If your PSA is zero after your operation, that’s good, you are cured (as much a a cancer patient is cured- there’s always the worry it’ll return).  If it’s higher than zero, then somewhere in your system are some prostate cells- with a likelihood they could be cancerous, as the prostate itself is in a jar in the lab. Or the bin. Or in a secret government experiment or something.

I await my appointment for that, to see if radiotherapy awaits in 2019.

falafel_man3

One thought on “32) A Gentleman’s Falafel

  1. Sorry to hear what a shitty weekend it was, but glad you survived it without major incident. Think you’re getting the same approach from Wifey as I’d get from mine. Gentle with patients, tuff love for family. Keep on trucking you two.. You’re both amazing and we love you.

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