it’s the tooth, the whole tooth and nothing but the tooth.

It starts back in September just days before we go on holiday.  I crack a filling.  My dentist is on holiday, so the choice is wait a few weeks or see the locum.  I choose the latter.  It’s like a scene with the mad dentist from Little Shop of Horrors.  He’s almost most standing in the chair as he drills out the old filling.  It takes a week or so for the ache in my right jaw to go.

And now it’s back.  From my ear to my chin.  Codeine does nothing to alleviate the pain and I manage to get an emergency appointment with my own dentist, who’s now looking tanned and relaxed.  It turns out to be an abscess.  There’s a dead tooth sitting above it.  The very one I had filled.  It’ll have to come out, but not yet.

The warfarin is the problem.  He wants to wait 4-5 weeks so that I can see my GP and sort out a plan for coming off the warfarin while he pulls the tooth.  I’ve never had a tooth abscess before – my sympathies to all those who have – but I have dealt with pain and discomfort before.  A dental abscess would certainly make it into my top 10 list of things to make my eyes water.  He prescribes a course of antibiotics; “once they kick in you should feel more comfortable”. 

I don’t think I’ve had a tooth out since school days – laughing gas, a nice sleep and a bloody hanky.  Now it’s local anaesthetic.  So I’ll be awake.  When I get home I google tooth extraction and immediately wish I hadn’t.  The web is full of gruesome images of bleeding gums.  So don’t search for that particular topic if you’re in anyway squeamish.

It gets worse under the heading ‘things that can go wrong’.  It can take 8 hours for the mouth to stop bleeding.  I could swallow the tooth if the dentist is clumsy and drops it.  I didn’t check if my dentist is prone to dropping things.  I give up at this stage; I just don’t want to know any more.

Next day at the gym I’m just settling down to a session on the exercise bike when one of the nurses asks how I am.  I mention the toothache.  She looks at me as if I’ve done something very rude in a place where you shouldn’t do rude things.  Before I know it, I’m off the bike and sitting on a chair in the middle of the room.  People are watching.  I think she’s going to give me a detention, but she gives me a cup of tea instead.  It turns out that exercise and dental abscesses do not mix (especially while on antibiotics).  Exercise increases pressure on the abscess (through various nerve pathways running up from the abdomen) and there’s a risk that the abscess will spread from the jawbone to other part of the skull and ultimately, the brain.

Assuming the antibiotics kill off the infection I can come back next week.  Oh no I can’t.  I’m having a flu jab a few hours before the next gym class.  Flu jab and exercise is also a no-no.  The needle can damage the tendons in the upper arm so they need to heal for 24 hours before being put under any pressure.  It’s frustrating but it is also reassuring.  These people have my interests at heart.

I visit my GP for a plan of action; he looks up from his computer screen when I enter the consulting room.  “I haven’t seen you since you went to Australia.  How are you?”  I can’t imagine many GPs remembering that one of their patients went on holiday 6 months ago.  I explain about the abscess.  There’s a sucking of teeth and a hint of a frown;  “It’s very difficult to stop bleeding from the mouth.”  My INR is currently 3.1; “It needs to be 1”.  INR gives a measure of how quickly or slowly blood clots.  A normal person (i.e. someone not taking warfarin, or any other anti-coagulants) will have an INR of 1.  My current reading suggests my blood will take 3.1 times longer to clot than the norm, which is not ideal when having a tooth out.

Tooth day is eventually scheduled for 4th December.  I can stop taking warfarin 5 days before that.  My GP suggests a blood test on the morning of the appointment, before I see the dentist, just to make sure that my INR has indeed dropped enough to make the tooth removal safe.  He also prescribes another course of antibiotics;  “you’ve got a long wait.  We don’t want it tuning nasty.”  No – we don’t.  I just want the tooth out and whatever it is they do to abscesses, done.  I do not want it going walkabout.  A visit from the tooth fairy would be in order though.  I don’t know what the going rate for tooth fairy visits is these days, but I’m sure someone will enlighten me.

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if the nurse comes in …. part 4. this time she does!

But not straight away.

(If you don’t know what I’m on about you might like to read if the nurse comes in we’re doomed, July 7th 2012)

We see the Professor of Clinical Oncology.  He’s our favourite.  Compassionate, a good listener, a patient explainer of all things medical.  And to the point, no messing about; “your scan is clear”.  With those four words the stress of the past week just rolls away.  We’ve been through this so many times now – it never gets any easier.  In the time between having a scan and getting the results we go into some sort of emotional meltdown.  Annie still finds it possible to speak and be civil, but I’m withdrawn and brittle.  As if I’ll break at the slightest thing.

It looks as if the sums are now on my side.  But sums have a nasty habit of making 2+2=5.  The prof has explained this all before but it’s worth another listen; “in the case of bowel cancer, if it is going to return, it will do so – for around 90% of patients – in the first 2 years.  After that, the likelihood of a recurrence is very much reduced.”  So – get past 2 years and you’ve a good chance of surviving the disease.

“But”, cautions the prof “you’re a reminder that this doesn’t always quite work out.”   My cancer returned 4 years and 3 months after first diagnosis.  Which is unusual.  And it’s this that makes these appointments so difficult for Annie and me.  It’s now 3 years and 7 months since the cancer returned.  So while most people this far down the line might be starting to think they’re out of the woods and can treat scans as routine, we treat them with more respect – we know that it can still come back, even this late in the day. But the prof is relaxed about my progress; “I’m very pleased about where you are as far as cancer’s concerned”.  And if he’s pleased then we should be too.

He asks about my general health; I tell him about my aches and pains – particularly around my stomach.  I say ‘stomach’ – sometimes it’s the entire internal plumbing system.  I also point out that I’m aware it may be stress and all in my mind or a reaction to the various heart pills I have to take.  He listens patiently, then gives me a thorough physical examination.

He puts it all down to the after-effects of surgery; “you’ve had a lot of work done down there and, frankly, your bowel is never going to work as well as it did before.  It will cause you aches and pains from time to time”.  This is my version of what he said – he didn’t put it quite like this.  His explanation was far more graphic and used language that might cause those of a nervous disposition to faint.

So where to next?  He’s not sure.  Rather than see an oncologist in 6 months time, “it might be time to hand you over to the Nurses’ Continuity Group”.  He leaves the room for a moment and comes back with a nurse.  Annie and I exchange a glance (ha .. so a nurse did come in after all).  It seems someone making my sort of progress would, in future, be seen by a specialist cancer nurse; but given my history they may need to defer this for another 6 months.  They’ll have a think about it and let me know.  The prof makes his exit and leaves us to get to know the nurse.

I tell her that I’m glad she didn’t come in at the beginning; she asks why.  I explain about the ‘angel of death’ – a game we play to ease the tension while we wait.  If the oncologist comes into the room on his own, then it’s probably going to be OK.  But if a nurse comes in as well, then it means bad news.  “You’re the 3rd person that’s said this in the past couple of weeks.  We’re going to have to think about how we do this”.

We have a general chat, exchange contact details and then head home.  And that’s it over and done with.  Six months of uncertainty and a week of high tension, distilled in a half hour consultation.

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road to nowhere – take 2

My experiment is in danger of failing.  About 10 minutes from the gym I’m considering turning back.  I feel unwell – stomach pains and light-headedness.  Something is not right.  If I miss the session, I won’t know if exercise affects my arrhythmia.  It also strikes me that if I do go to the gym and have another arrhythmia I still won’t know if it’s down to exercise – it could be something to do with whatever’s making me feel unwell (or a combination of that and the exercise).  Designing an experiment is hard work; no wonder it took so long to find the Higgs-Boson particle.  I ponder on this for a while.  In the end I decide to carry on – if I’m going to be unwell while exercising, this gym is a good place to be.

We gather in the foyer while exercise instructions, clipboards and pens are handed out and oxygen stats are taken.  My heart rate is 71bpm but my O2 is 88%.  This is not good – it should be at least 95%.  What on earth is causing this?  I know I’m feeling anxious; I have stomach pains and I have my scan tomorrow.  The previously discovered abdominal hotspot is weighing heavily on my mind.  I just hope it’s not weighing heavily in my stomach.

I’m losing all sense of proportion.  Well – to a degree.  Life is short, life is precious, don’t waste it.  I get that.  When I’m at the hospital surrounded by sick people, that message is writ large in the front of my brain in capital letters – my very own personal heads-up display.  (This message will also be powerfully reinforced in the gym foyer in a few moments time).  But the longer I survive cancer, the easier it becomes to lose sight of the big picture and so get stuck in the trivial.  It probably is just stomach-ache.

There should be three staff on duty but two are missing.  An announcement – the class will finish early today because of a shortage of staff.  One is at a funeral for someone from the Wednesday morning class.  The other is at a funeral for someone from the Thursday morning class.  This news is greeted with silent acceptance; I’m shocked – and then wonder if someone’s going to make a joke about Friday’s class.  But no one does.

I choose the exercise bike to start with.  The cardio-nurse is on duty and stops by my machine to ask how I am.  I explain about the stomach, the light-headedness, the O2 stats.  “Did you eat enough before you came?”  Yes, I think so.  She’s puzzled and tells me to take it easy.  They’ll check my stats at the end of the session.

I ask her about the arrhythmia and explain about last week.  “Whenever someone tells me about arrhythmia I always ask what they were doing in the 24 to 48 hours before”.  Hmm, interesting.  I was gardening the day before.  “Doing what?”  Moving some pots around.  “Heavy pots?”  One was very heavy.  “The exercise might have put the lid on the tin, but I’ll bet it was the lifting the day before that was the trigger.”

She explains it all in terms of speed limiters; “you know – on lorries.”  The bisoprolol sets a steady heart rate (speed limit), which can be over-ridden if necessary (foot down or over-exertion).  With the foot off the gas the speed/heart rate falls back down to its previous level.  So far, so good.  I tell her that this is the first time anyone’s explained the nature of beta-blockers to me in this sort of way.  I’ve heard the bio-chemical explanation before (whoosh – sound of adrenoceptor blocking agents going over my head) and I’ve heard about some of the side effects – tiredness, sleeplessness, low blood pressure…. – but no-one’s mentioned HGV engine limiting systems before.  She just shrugs; “I’ve been doing this for 25 years”.

I ask why there’s a time gap between the trigger and arrhythmia.  She puts it down to the bisoprolol.  “It’s a problems with all beta-blockers.”   The drug can cause a delay in the transmission of electrical impulses in the heart.  So the effects of over-exertion will be felt some time later.  I’m still pedalling away as we speak and getting more and more breathless – not ideal for conversing – so leave it at that.  But there are questions still to be answered.  I don’t pretend to understand all of what she says but I like where it’s going.

After the exercise bike I manage a go on the cross-trainer.  I get it right this time (rotate pedals forwards) and as I settle into it I come over all Mo Farrah-ish.  I can hear Vangelis¹ in my head – and my own personal chariot is on fire.  I could be out in the desert (on a Horse with no name) or loping through the Kenyan highlands (no suitable music comes to mind) and I realise that I really, really, like this.  I suddenly get running.  I understand human evolution; I’ve come down from the trees and I’m now chasing after food.  Or perhaps fleeing a lion.  Is it too late, at 66, to take up the marathon?   When we finish the class my O2 has risen to 95%.  So that’s a relief.

I’m tired when I get home and doss on the sofa with a cup of tea and a flapjack.  (By comparison, when I got home last week I was bouncing round the kitchen on an endorphin high).  My plans for a light supper are almost scuppered – Annie’s made one of her special (cardio-alert) apple and blackberry crumbles with a frightening amount of butter and sugar in the topping.  But it would be churlish to turn it down.

And so to the big question; what happened next?

Nothing.  Zilch.  Diddly squat.  In the context of last week, this is a ‘good thing’.   The Gods of Arrhythmia chose not to come.  Although if they read the bit about the 24-48 hour delay, they may just decide to put in an appearance tomorrow.

 


¹ Vangelis; composer of theme music for 1981 film, Chariots of Fire.  Also used at the 2012 Olympic Games opening ceremony.  And any footage of someone running in slow-motion.
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road to nowhere

I walk down the road to nowhere for precisely 6 minutes.  Not ‘approximately’ – give or take a bit – but 6 minutes to the second.  This is not a stroll, a walk in the park with time to stand and stare; I’m on a mission.  This is science.

Walking by oneself can be a strange thing to do, often engendering a sense of self-consciousness, that doesn’t seem to happen when travelling, say, by car.  I recall that in a previous life I would sometimes walk to work.  Nods to people passing the other way would often be unacknowledged – as if lone walkers are objects of suspicion.  When I walked the dog the complete opposite would be true.  Strangers would smile, sometimes stopping to chat if the dog was being particularly cute (he could turn on the charm if he thought a treat might be forthcoming – much like his owner).  It’s as if the dog legitimised walking alone.

But I’m not alone, I’m being observed.

I had assumed that when the gym I mentioned in my previous post said that I’d need to do a 6-minute walk test to check my base level of fitness, I’d be doing this on a treadmill, wired up to various monitors.  The sort of thing you see in television programmes about people being wired up to machines while they pound away going nowhere in particular – except perhaps backwards if their concentration should slip.

But no – I’m having a real walk.  The main room in the gym is 25 metres from corner to corner, across the diagonal.  My job is to cross the room, backwards and forwards until called upon to stop.  At a given signal I set off at a brisk pace.  A nurse calls out as each minute passes.  On this signal another nurse hurries alongside me and without breaking my stride, slips an oxiometer onto my finger, thereby catching my oxygen saturation and heart rate as I walk.  All very low-tech but effective just the same.

I begin by counting laps to relieve the monotony, but the time goes surprisingly quickly and with the added challenge of sticking my finger out every so often without causing injury to myself or the nurse walking alongside, I soon lose count.  And then I’m done.  I actually enjoyed it – the sensation of walking in this way.  I mention this to the nurses and try to relate it to walking through the Milton Keynes shopping centre – which might well take 6 minutes or so.  But far less enjoyable.  “That’s because this floor is sprung – the shopping centre is solid marble which hurts your feet”.  Solid marble flooring?  The pension funds which financed the building of the shopping centre must have been pretty flush at the time.

After checking my blood pressure and heart rate I’m free to join the class, which has now assembled in the equipment room.

I’ve never been to a modern gym – the last one I set foot in had men in tights sporting waxed handlebar moustaches and brycleemed hair, lifting dumbbells and tossing Indian Clubs.  (I jest but you get my drift).

I am baffled by some of the equipment.  I choose an exercise bike (familiar), rowing machine (soon get the hang of it) a cross (or elliptical) trainer (a what?? – my co-ordination is rubbish and I begin the session by rotating the pedals backwards) and my bête noir – the treadmill.  Two large buttons immediately catch my eye – a tortoise (-) and a rabbit (+).  Hmm.  I give old rabbit (bear with me) a tentative press and then have to grab hold of the handles to stop myself flying backwards.  Apparently you’re not supposed to stand on the treadmill when you touch the rabbit.  After a few minutes of switching between tortoise and rabbit I get the hang of it.  But I don’t like it.  (Annie subsequently points out to me that it should be a hare not a rabbit – it looks like a rabbit to me).

After a warming down exercise we all sit around for a session of bicep curls and tricep extensions using a large rubber band.  I’m given a green one, which indicates average fitness.  I notice one red one (macho – or ‘I could be in a real gym’) and a beige one (oh dear – serious heart/lung problems).  We all then have a nice cup of tea while our heart rate and oxygen levels are measured.  My O2 is 97%, which is good, and my heart rate is 82bpm, which is OK having just spent an hour or so exercising.  I think I’m going to enjoy coming here.

And then Life does that thing that I find really annoying; you’re bumbling along, head down, not causing any mischief or discomfort to anyone else – just minding your own business – and as you turn a corner, Life sticks a foot out and you fall flat on your face.

It’s about 8pm; we’re enjoying a sociable evening watching a programme about Australian art – Dan (Annie’s youngest, home on an all too short visit from Oz while he waits for a visa to go back for a second year), Annie and myself.  There’s a knock on a metaphorical door; the Gods of Arrhythmia have come to call – and they’re not happy.

It starts with a few ectopics and I leave it a while; my heart rate fluctuates on each beat – 60, 90, 115, 125, 80, 60, 100 …. and so on.  I take the pill-in-the-pocket and settle down to wait.  After about an hour the ectopics cease, but my heart rate stabilizes at 125bpm.  Odd.  It should be lower.

I go to bed but no change.  I hate this feeling; like an old car brought to a sudden standstill.  I’m in neutral – I’m going nowhere, but the accelerator is stuck to the floor and the engine’s racing – screaming – and bits are starting to fall off (the imagined car, not me).

We pass an anxious night; although the pill-in-the-pocket has brought the heart back to a regular rhythm, it hasn’t lowered the rate.  It’s been over two years since I’ve been tachycardic for more than a few hours.  Last Christmas, I had an episode where the heart stayed at about 130bpm for about an hour or so before the p-i-p kicked in and things went back to normal.  Since then these high rates have been no more than blips – a couple of minutes at most before reverting to ectopic episodes that oscillate between 60 and 90 bpm.  I had begun to think that perhaps I was free of the tachycardia; I’d even gone as far as thinking that I might be able to reduce the p-i-p dosage if I was simply dealing with abnormal rhythms around the normal range.  Not yet, clearly.

Annie’s worried – she wants me to go to A&E.  I’m reluctant; I have no chest pains, breathlessness or symptoms of any sort other than a racing heart rate.  I reassure her that the drugs will do the trick, although my confidence is somewhat shaken – this is the first time the p-i-p has failed to reduce my heart rate.

At 7.00am when I take my morning dose of bisoprolol, I’m still struck on 120bpm.  By around 8.15 the bisoprolol has kicked in and my heart rate finally drops to 70 bpm.  I feel like a zombie and it takes me the rest of the day to recover.  And now as I sit and write this, some 24 hours later, my resting heart rate a high(ish) 87bpm.

I don’t get it.  If it was to do with the gym session, why did it take around 6 hours for the arrhythmia to occur?  And why, when the heart rate finally went back into a regular rhythm, did it do so at such a high rate?  A few weeks ago, I was wondering whether singing might prompt an arrhythmia.  Last week I had an impromptu rehearsal with my friend Neil.  I’d gone to help him with a recording project, but we were unable to finish it so we had a singsong instead.  No problems afterwards.

Following lung surgery I was diagnosed with Atrial Flutter and subsequently treated via Catheter Ablation in June 2011.  Although the Flutter was deemed ‘cured’, arrhythmias continued and I was subsequently diagnosed with Paroxysmal Atrial Fibrillation. Paroxysmal simply means ‘random – of no known cause’.  So perhaps I’m looking for a rational explanation when there isn’t one.  That’s something I find hard though – I am by nature, inquisitive.  Maybe this particular road really is going nowhere.

I have to go to the gym again.  There is so much evidence supporting the role of exercise in heart and lung rehabilitation.  I’ll change one variable though; I was hungry when I got home from the gym so I ended up eating more than usual at our evening meal.  So, next week – post-exercise snack and portion control.  And we’ll see what happens.

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With a song in my heart

During my visit to Birmingham last week, I mentioned that I’d heard about singing as therapy for damaged or diseased lungs.  The consultant was very positive about the whole idea.

Here’s the thing; to sing well, you need good breath control.  Good breath control comes from lungs that work properly.  Sing and your lungs get better.  And as your lungs improve your singing becomes easier.  A virtuous circle.

But what happens if you can’t sing (properly) and your lungs are damaged?  Can rehabilitation of the lungs help a dodgy voice?  This, I am about to find out.

In the dark days just before the lung resection, when I worried about the consequences of being deficient to the tune of one lung, I happened to read about a man who had his left lung removed and then went on to become a successful triathlete.  In what seems like a bizarre tale from late night TV but is really a testament to the amazing wonder that is the human body, the right lung, over a period of years, grew larger – expanded – and filled the cavity left by surgery.

I mentioned this to the cardiothoracic surgeon who was mulling over whether or not to go ahead with the operation.  He laughed; not in a funny ha ha or ‘that’s amazing, well I’m blowed…’ kind of way, but with a cruel and dismissive, ‘that’s about the most ridiculous thing I’ve ever heard’ type of put down; must be a pretty slow triathlon.”

I’ve since learnt to ignore negative comments from doctors; and let’s make no mistake – some are negative.  Perhaps unwittingly.  I guess that if they concentrate on the microscopic, it’s hard sometimes to see the whole organism.

So even though my new best friend in Birmingham tells all his patients with paralysed vocal cords that they won’t sing again, I take no offence; he can’t mean me.  I decide to investigate singing therapy.

Google quickly takes me to the Royal Brompton Hospital in London, which provides singing therapy for people with severe lung disease.  With great success, apparently.  Too far away though.  A few clicks later and I fetch up at the home page of the British Lung Foundation.  I discover, to my great surprise, that there’s an exercise class for people like me right here in my hometown.  But no ordinary exercise class.  This is not the village hall and ‘jumpers for goalposts’ stuff.  This is state of the art equipment, supervised by qualified healthcare personnel.  You can’t go near the equipment without someone checking your vital signs.  And – they’re even in the process of setting up a singing therapy group.

The key to the door of this palace of dreams is via a referral from the cardiology department at the local hospital or GP.  Hang on a minute; I’m a patient of said cardiology department.  And my GP has encouraged me to exercise to keep the fibrosis at bay.  I’m about to call Annie and go off on a rant as to why no one mentioned this to me before – I could have been doing this years ago ….. when my eye is drawn to the Blogroll on the right-hand side of this webpage.  Just about where you are now.  There it is – a link to the BLF website.  I’ve clearly been here before.  This is embarrassing.

No matter; having suitably chastised myself, I go along for a look round and begin the process of joining.  It’ll take a few weeks; referral, assessment, a 6 minute walk test and then hopefully I’ll be good to go.  In response to a question from the nurse on duty, I happen to mention a recent late night visit from the Gods of Arrhythmia; she’s a bit concerned.  Perhaps I should go to A&E?  Noooooo.

I understand the concern of healthcare staff, but I’ve lived with this for 3 years now.  The pill-in-the-pocket¹ deals with it in a very short time.  If I should get accompanying chest pains, then I’ll go to the hospital like a shot.

A couple of days ago I went to see my friend Neil (mandolin player in Fat Freddy’s Cat) for a jam session.  For those who are not musically inclined, we do not sit around labouring over fruit-based preserves, but make music instead.  It’s the first time I’ve done this in over a year.  My fingers are sore from lack of practice but my new(ish) guitar (second-hand last summer) sounds good and I manage to sing a few songs.  We resolve to ‘do it again’.

That night, around 1.00am I sense the familiar change in rhythm that signals an ectopic episode.  Then my heart races to 125bpm before dropping down to 80.  I leave it for a couple of minutes but it drops out of rhythm again so I take the pills and go to sleep.  This is the first tachycardic² episode this year.  The previous one was at Christmas.  I’ve had a few arrhythmias of late – episodes of ectopic heartbeats during the night – but none where my heart rate has risen above 100bpm.  Until now.

I recall that something like this has happened before.  I mention it to my live-in mathematician; co-incidence?  Possibly – possibly not.  Checking back in my diary I discover that we had two rehearsals last summer and then played a gig.  Each of these events was followed by an arrhythmia.  So that’s now four serious attempts at making music and four tachycadic arrhythmias.

She-who-dances-with-equations comes off the fence; this is no coincidence; “were you nervous?”  Yes I guess I was.  “adrenalin rush?”  A surge of adrenalin can certainly elevate heart rate.  But why would it happen a few hours later and not at the time? Singing is strenuous – I have to take a break after a couple of songs.  But nothing like as strenuous as shifting a cubic metre of gravel from the front of my house to the back, which I did last week.  It took 30 wheelbarrow loads – and a couple of days to accomplish – but apart from sore arms and shoulders, I felt no ill-effects.

So what’s going on here?  When I sing on my own – no problem.  When I sing with others – heart b-b-b-beat.  Can it be that simple?  Can singing with other people trigger an arrhythmia?  In the interests of medical science, I need to do more research.  Which means more jam sessions and more gigs.  This sort of thing:

FF320

Unless the Gods of Arrhythmia are trying to tell me something.


¹ Flecanaide 150mg, to be taken as needed.
² Tachycardia; when the resting heart rate is above 100bpm
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raise or fold?

“I wish there was some quick fix I could offer you ….”  I’ve already guessed that there wouldn’t be.

We’re in Birmingham, at the Last Chance Saloon for voice ops.  The consultant is affable, asks questions and takes plenty of notes.  Then a squirt of something numbing up my right nostril and the camera’s on its way.  I make various sounds, which cause the vocal cords to move in particular ways.  When he plays the recording back I can see that the edge of the damaged cord is not straight when it meets its more mobile neighbour – there’s a slight bulge.  This means that the cords do not completely close, resulting in a croaky/rasping/breathy (take your pick) sound.   The bulge is the result of too much stuff having been injected.  No one’s fault.  Trauma during the procedure causes the cord to swell, so it’s nigh on impossible to predict where it will end up once the swelling has gone down.

There is only one surgical option – to undergo a difficult and risky operation (under a general anaesthetic) to try and REMOVE (yes – that’s right) some of the filling from my paralysed vocal cord.  There are no guarantees and it could make things worse.  I liken this to wobbly table syndrome; one leg is longer than the others so you take a bit off.  Chances are it’ll end up being shorter than the rest.

It’s all about chance.

My current reading is a Louis L’Amour novel – an old fashioned shoot’em up western.  The hero, a laconic loner is ‘a philosophisin’ on his predicament – surrounded by four baddies and nowhere to run.  All Louis L’Amour heroes tend to philosophise on their particular predicaments in the same way – by reference to games of chance.  Usually involving cards.  So there’s talk of percentages, knowing the odds and so on.  The hero only makes his move when he’s run the various scenarios through his head, skilfully predicting which way his opponents are going to react.  If only life were that simple.

With a bit of nudging, my predicament could be likened to a game of cards.  Do I take a chance and hope that an operation to remove some of the filling does not make things worse, or do I quit and live with what I have?

Where the analogy with games of chance falls down is that there are no percentages for this situation.  A deck of 52 cards can only be dealt a finite number of ways; a lot mind you, but a calculable number none the less.  Whilst there are only three outcomes for this new voice operation – it makes it better, it makes it worse or it stays the same – they’re not equally likely.  Indeed, they’re not quantifiable in any way whatsoever.

We can probably discount one of the outcomes; I think it reasonable to assume that another operation is very unlikely to leave things as they were before.  So we’re left with 2 outcomes – it’ll either make it better or it’ll make it worse.  But it’s still not going to be 50:50.  I can’t just toss a coin and say heads we do it, tails we don’t.

By the way – if you’re wondering what happened to the hero in the book – he’s rescued when one of the baddies turns out to be distant kin.  The odds have now changed from 1 against 4 to 2 against 3.  There’s a standoff while calculations are made as to how many of the bad guys will get shot if they attempt to shoot the good guys.  Having done the sums to the satisfaction of all parties, the bad guys decide not to risk it and ride away.

And so to my own standoff.  The consultant lays his cards on the table; “I always tell singers who have paralysed vocal cords that it’s unlikely they’ll sing again”.  But he’s willing to do the procedure to try and remove some of the filling if I wish.  There’s a lot to consider – he needs more information from Mr ENT in MK and I need to think about the  risks.  He’ll leave it to me to decide.

“It’s your call, stranger – raise or fold”.

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a hippocratic oaf?

I don’t usually bother with the local paper.  I can’t seem to stop its delivery and so it usually goes straight to recycling without even a cursory glance.  But today ….

Interspersed between the stories about muggings, the local MP visiting yet another primary school and Man with Van adverts, is a photograph of a face I recognise.  It takes me a while because the context is unfamiliar, the headline unexpected.  And shocking: ‘Hospital tells patients not to worry’.  It’s a bit like one of those big red buttons, which says ‘don’t press’.  Who can resist?  So worry I did.

The reason for this “don’t panic, don’t panic”¹ flap is the suspension of the colorectal surgeon who operated on me in 2006.  It would appear that he is the subject of complaints and legal action from a number of patients.  There is no detail about the nature of the complaints – the story apparently broke while we were in Australia; today’s article focuses on the fact that he is still drawing a full salary while having been suspended for two years.

I don’t know what the paper is more concerned about; the fact that he has been suspended or the fact that he is still drawing a salary.  And I don’t really know what I think about it either.

I had a very good relationship with him when I was being treated for the original tumour in my bowel.  No complaints, except for one thing.  He took a risk.  I know this because the Bag Lady (stoma nurse) told me; “he didn’t leave himself a safety net…..”

The original plan was for me to have a stoma – an opening on the right-hand side of my stomach so that my small intestine could drain into a bag while the surgery on my large intestine healed.  It’s a bit like by-passing the central heating system with a length of hosepipe, while a new radiator is fitted.  I would need to wear such a bag for about a year.

When I came round from the operation, there was no bag.  The tumour had been cut out and my internal pipework reconnected in such a way that the surgeon had deemed a stoma unnecessary.  Everything was hunky dory and I would be home within 5 days.  Two nights later, my stomach began to swell and I was in pain.  Five days later I had an emergency ileostomy; it appears the joint had burst.  I had blood poisoning and spent the next 10 days in intensive care.  It was 28 days before I was able to go home.  It was also 18 months before I had an operation to reverse the ileostomy and remove the bag.

It would be wrong of me to start thumping the table about this; I was overjoyed at the prospect of not having to deal with a stoma.  My initial reaction to the news that one would be necessary was along the lines of “oh well – it was worth a try”.  It was only later that I realised that this could have turned out far worse.  By then I was dealing with the day-to-day consequences of having a bag stuck to my stomach.  (Consequence No. 1 being that it didn’t always stick and leakage was a persistent problem).  It never really occurred to me that this was not a risk worth taking.  So I don’t think I’ll be calling Screwemm and Runn.  (Other personal injury lawyers are available).

The only surgeon I have ever really had doubts about was the one who removed the tumour on my lung.  Even now I wonder if the outcome (the collateral damage to heart and voice) might have been different if I’d waited a few weeks for the return from holiday of the (more senior) surgeon originally slated to perform the operation.  Possibly.  Probably?

We always knew that the position of the tumour meant that the operation would be difficult.  Afterwards, he put his hands up to the collateral damage with a big smile saying it was the only way of removing the tumour in its entirety.  However, he hadn’t.  Not only that – and this is the bit that still rankles with Annie – he knew he hadn’t and didn’t tell us.  We sat in his consulting room while he fobbed us off.   Annie knows about these things – 30-odd years of dealing with naughty boys (and girls) means she can spot a fobber a mile off.  And which is why, in the end, the radiotherapy was so invasive and debilitating.  It may or may not be significant that he has since failed to reply to any of the oncologist’s queries about the procedure and the outcome.

Hindsight is, of course, wonderful and ultimately a waste of time.  I cannot change the outcome for me.  And I cannot know that it would be different.  I can only say to others who might read this – if you find yourself in this position, question your doctor.   Check to see if they measure up to the original yardstick that all doctors are assumed to abide by.  According to wikipedia, while around 98% of American medical students swear some form of Hippocratic Oath, only 50% of British medical students do.

Here’s an extract;

“And I will use treatments for the benefit of the ill in accordance with my ability and my judgment, but from what is to their harm and injustice, I will keep them.”²

From what we’ve heard in the past few days about some NHS Trusts, it would be fair comment to argue that they’ve failed this particular test – particularly the latter part about harm and injustice.   The principles of the Hippocratic Oath surely have a wider relevance than the final year of a medical degree.

Just who is to blame for this state of affairs is a game politicians like to play.  In the grand scheme of things, I have little to complain about.  I’m still here.  Minus a few bits, perhaps, but still here.


¹ See Dad’s Army.
² Hippocrates (or one of his students) 5th Century BC.
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