Steer for the deep waters only

Robert Day's thoughts on his photography, his writing and his business

Mr. Prostate

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Note: of necessity, this post will deal with fairly intimate personal and medical matters. But if you are a male over the age of fifty, or know a male over the age of fifty who you care about, I’d encourage you to read on.

After I got back from Hay, it wasn’t that long before I got a potentially nasty reminder about the progress of Time’s Winged Chariot. I began to notice some discolouration in what General Jack D. Ripper in Kubrick’s Dr. Strangelove would have called one of his “vital bodily fluids”. I wasn’t in any pain, and I sort of assumed that this was probably the result of some sort of infection – I was feeling possibly one degree under the weather and was running a slight temperature – and it did clear up of its own accord after about ten days.

But two things happened after it cleared up. First, I became aware that my ability to produce a strong flow of urine had improved, which was a bit of a surprise because I hadn’t been aware of any problem in that area up until then. First it was OK, but then it got better. That’s a bit interesting.

Then I got a phone call from my doctor, asking me to go in to talk because my regular blood tests as a part of normal health screening had now shown up two successive PSA readings that were higher than normal. PSA – Prostate-Specific Antigen – is a protein produced by the prostate gland. Elevated levels of it can indicate a problem of some sort. Whilst the assumption that may be jumped to is that by ‘problem’ we mean ‘prostate cancer’, that is literally just an assumption. Statistically, 75% of high PSA readings are due to other causes. But 25% are not, and that’s too high a number to ignore.

So within a couple of days, I was having the conversation with my doctor, and he was telling me that he would be writing to the local hospital to refer me. What was really very heartening was that because of that 25% risk, the process would be fast-tracked and I should expect an appointment within two weeks.

It was actually closer to ten days from consultation to appointment; the letter itself arrived virtually by the next post. So it was that I had to make the journey to Leicester General Hospital, on the other side of the city to where I live.

The first appointment was fine; I saw a registrar (second-line consultant) who talked about case history (no previous history of prostate cancer in the family) and carried out a physical examination to check for any signs of testicular cancer (all clear); then he said that he’d still like to refer me to the consultant for a biopsy and endoscopy.

Again, everything moved fairly quickly, and soon I was going back to the General for the biopsy. For first-timers, this is the procedure that causes the most concern, because the process involves the surgeon using the endoscope to enter the body via the rectum and then penetrating the rectal wall to then snip small portions off the prostate gland itself. The process is done under local anaesthetic, and although there are no nerve endings in the prostate itself – one reason why for years prostate cancer was something that went undiagnosed until it was too late – if you start prodding it, you will feel something. I personally felt that the sensation was akin to that of using a hand-held stapler, and the pain was not as bad as having dental root canal work – except that the surgeon takes twelve samples during the process. I was also given a prophylactic antibiotic before the process, because (obviously) the route of entry is through possibly the most potentially infectious site in the body. In fact, the worst effects I had were nausea and dizziness from the antibiotic – oh, and the effects on my bowel of the invasiveness of the procedure.

I was told to expect results within two weeks and I would be called for a follow-up appointment. In fact, I never received the appointment; the first thing I knew was that I had a phone call from the hospital saying that I’d missed my follow-up. When I said I’d never received any appointment, which is why I’d missed it, I had a new appointment made there and then; again, for not too far away into the future. I assumed that this was going to be for a consultation with results.

Instead, when the confirmation letter arrived, I found that this was actually going to be for bladder endoscopy. Now, as a part of the Government’s “24-hour NHS” programme, this appointment was actually set for a Sunday morning, so off I went.

I saw the same consultant, who delivered the good news that the biopsies were all negative. Then we started the endoscopy. The camera – more accurately, the fibre-optic probe – is inserted through the urethra, this time with no anaesthetic; still not as unpleasant as a root canal, but certainly more so than the biopsy, especially as the end of the probe moves through the various sphincters that control urine flow. A few minute’s observation satisfied the consultant that there was nothing untoward to be seen; the camera was withdrawn, and it was “Thank you and goodbye” – the consultant was off through the door before I had time to gather any thoughts, leaving his assistants – two nurses, one male and the other female, to help me clean myself up and recover my composure. (Forget about my dignity. That went out of the window at the first consultation. And in any case, this is a bit like working on the production line at a chocolate factory, where they say you can eat as many chocolates as you like, secure in the knowledge that by the end of the first week, you’ll be sick of the sight of chocolate; you’ve got nothing that the health professionals haven’t seen before, and in any case, anticipation of the procedure tends to mean that impressing the ladies [amend as appropriate depending on your personal preferences] is pretty low on your body’s internal agenda and your physical manifestations respond accordingly…)

The consultant’s behaviour came as no surprise to me, as I’ve had quite a bit of professional contact with consultants in the past; they are dedicated individuals who are very focussed indeed on the condition they’ve specialised in; the patient is merely the conveyance that brings interesting cases to them. Once I’d proved to have nothing abnormal to be detected, I was of no more interest to the consultant and he was on to the next case. And I was fine with that. The consultant was personable enough before the procedure, and (just) polite enough afterwards. I took the immediate evaporation of his interest in me as a sign that he was a consultant of considerable experience and keen interest in his specialism, and that’s just what I’d want if things had turned out differently.

In retrospect, the worst thing about that visit was what happened next. Leicester General hospital is an old, sprawling establishment that has been added to a lot over the years; and as a result, I got lost trying to find my way out! I’d taken my sister’s advice to go and use the hospital restaurant for at the very least a hot drink to steady myself after the procedure; and it was in leaving the restaurant, which was off the direct route I’d followed from entrance to consulting suite, that I took a wrong turning. I then proceeded to wander around the hospital for a good thirty minutes, as the signage left a fair amount to be desired. What was more, with it being a Sunday, not all the out-patents’ departments were open, so some of the places I’d walked through on previous appointments were all locked and in darkness. I swear I walked past one bloke who was sat waiting twice…

Again, I had been supposed to attend a follow-up clinic a couple of weeks later, but never got an appointment letter, just a copy of the letter to my GP to say “Mr Day failed to attend my clinic on (date) and so I shall treat him as having discharged himself; but please note the results of his examination were…” I have to say that I did make a couple of telephone calls to complain about the tone of that letter when I had not received any letter or telephone call to tell me about that appointment; but that’s about the only complaint what I’ve got.

Britain’s NHS is the subject of massive political debate, both here and overseas. It is far from perfect in too many areas. It has to make compromises in decisions about funding and the allocation of resources. There are numerous instances of people who have legitimate cause to complain about the treatment they’ve received from the NHS. And it has to be said that the current Government’s long-term plans for the NHS are unclear about their direction of travel and the sort of NHS they want to see in the future. Many people do not trust the current Government with the NHS. Others believe that it needs to be swept away and replaced with a different model. Of course, the problem with that is how to get there from here. If we changed to a model based, say, on personal insurance paid over a working life, how do you continue to fund the treatment of those who won’t have time to pay sufficient into an insurance scheme before they need the services of the NHS, possibly in a very big way? Also, such schemes, especially those provided by employers, assume that you will stay with the same employer for a long period. Oddly, the people who advocate that system the most are often those who applaud the end of “the jobs for life culture” and promote the ideas of people – usually far further down the jobs ladder than themselves – having “portfolio careers”, or employers enjoying the “flexibility” to resize their workforces to match demand and supply (usually downwards). A moment’s thought will show that these are mutually exclusive objectives; but the politicians who make these sort of pronouncements work in the hope that no-one will ever notice that their ideas never join up.

And my experience of the insurance industry is that they will often try their hardest to avoid paying out on a claim. Anecdotal evidence I hear from the USA talks a lot about arguments with insurance companies over just what conditions are or are not covered by any particular policy, or at what point the insurance cover runs out.

All I can say is that I am glad that on this occasion, I was dealt with quickly, (mainly) efficiently, and with no other consideration other than getting me in front of a knowledgeable healthcare professional for a diagnosis. And my regular healthcare monitoring will be keeping an eye on this problem in future. This is what I pay my tax for, and given the seriousness of the situation if the diagnosis had not been so favourable, on balance I’m pleased that I do.

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Written by robertday154

October 16, 2017 at 10:43 pm

Posted in Uncategorized

One Response

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  1. I enjoy the personal nature of your blog, Robert, your candor and the pleasure of sharing your company. Glad the end result of all this testing was positive. I’ve reached the age when my health is a growing concern so your experiences struck home with me.

    Cliff Burns

    October 17, 2017 at 3:15 pm


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