So far so good (part xix)

And the results from the MRI scan are in. Actually, they came in back on the 7th, but family birthdays, bonfire night, and the normal daily madness somehow got in the way of me reporting it.

Essentially the MRI showed that the infection that tracks out from the leak in my bowel is much better, but that my left kidney is still a bit dilated (indicating that it’s still not draining properly). However, the overall appearance of the tissues in my pelvis showed “considerable improvement”. Which I thought was both pretty positive and slightly worrying at the same time. I mean, I thought we’d sorted all that kidney stuff, right?

Apparently, not necessarily.

The next step from the surgeons perspective was to examine the join under anaesthetic to better assess the join and the healing. Apparently each mode of diagnostic (physical, X-ray, MRI, endoscope) provides different but complimentary information.

And so I was booked for an endoscopic examination under general anaesthetic; the appointment for that came through for the 15th. Except when I actually got there, there was some disagreement over whether or not I was meant to be having a general anaesthetic or not, and whether it was for a colonoscopy or a sigmoidoscopy. Which wasn’t very reassuring.

In the end it turned out to be a sigmoidoscopy, under a general, not just to examine the join, but also to perform curettage on the wound tract. This is where the granulation tissue that forms in the wound as part of the healing is removed by scraping. It sounds pretty grim (and I guess the need for the anaesthetic confirms that) but it apparently promotes better and faster healing.

They also ran some blood tests on me too, and they at least show that there are no issues with my kidney function – despite the dilation. However, it’s likely that some time with a urologist is lurking in my (fairly near) future too.

So far so good (part xviii)

On Thursday of last week I had another follow-up examination by my surgeon. In the grand scheme of things, I seem to be doing pretty well, but he was keen to check on how the healing was progressing, and whether the inflammation was remaining in abeyance or not. At the same time he wanted to check to see if my kidney was continuing to function normally after the removal of my stent.

And so I was scheduled for an MRI scan. Which to my surprise was arranged for Monday of this week.

The scan was without any contrast dyes (so no need for a canular!) and involved three main components – a high resolution scan of the pelvis, and lower resolution scan of my kidneys, and (a new one!) some sort of scan of my diaphragm while I was breathing normally.

I never did find out what that last one was actually used for, but it’s the first time I’ve been in an MRI scanner and actually felt the entire motorised bed assembly jumping from side to side in the magnetic field – so they must have really cranked the power up for that one.

And now I wait to see what my surgeon and his radiographer think of the pictures. I should hear from them in the next week or so.

Marie Curie would have loved this

So, on Tuesday I was scanned.

There were two procedures, a CT scan and an MRI scan. From a purely geeky perspective, the whole process was quite interesting. I’d read up on the technologies in advance, so I knew roughly what the kit would look like, how it worked, and thought I knew what was going to happen. Of course, they still managed to spring a few surprises.

They did the CT scan first. This is basically a series of x-rays, but rather than producing a traditional xray image, they take many slices through you, saving the data into a computer so they can reconstruct various 3D images later. In my case, they were using it to image me from the neck to the thighs, basically looking for secondary cancers. The most likely locations for those would be bladder, liver and kidneys, though it can also show up in the lungs, bones, etc. Anything showing up in any of those would probably be fairly bad news.

To make the best possible image of my digestive tract, I had to drink a litre of what can only be described as “gloop”. Fine from a taste perspective (faint lemon flavour) but the consistency was such that each mouthful provoked a gag reflex. I had an hour to drink it all, and somehow managed it without being sick. Although they never mentioned it, I suspect that it would have been barium sulphate in some sort of suspension. In addition, they put a cannula into my arm to allow them to administer a contrast agent into my bloodstream (iodine solution?) while I was in the machine. This should help them to see any unusual concentrations of blood vessels, which would probably also indicate more tumours. For once I managed not to faint, despite the needle being amongst the biggest I’ve seen so far.

The scanning process itself was trivial: lie on a table, which then rises up, and pulls you through the circular (rotating) x-ray source and sensor array. The operator then controls your position within the scanner, allowing them to image to their hearts content. Oh yes, and they control the pump which flushes the iodine into your blood stream. According to the nurse I “might taste a slight metallic tang, and feel a little flushed” when they did that. In practice, I felt sharp heat at the point of injection, which then flowed through the arm into the heart and all over my body before finally settling (most disconcertingly) as a very hot feeling in my buttocks. All in all, extremely strange, and somewhat unpleasant.

At this point I was glad to have the cannula removed, and move on to the MRI scanner…

Which turns out to need no special preparation, and is another donut shaped device with a motorised bed arrangement. Except this time the tunnel is much longer, but smaller in diameter; there was only just room for me to fit into the tunnel of the scanner – my shoulders were touching both sides of the tunnel. It’s obvious why when you know that magnetic force diminishes according to the inverse square rule; smaller devices will need less power to generate the same field in the center of the tunnel, and presumably cost a lot less to buy and run. Still, I can imagine patients who are in there for a long time would find it very unpleasant. Fortunately since they only wanted to image my pelvis, my head was poking out the far end of the machine, so not as bad for me.

Since these things generate truly amazing levels of magnetic field (the one I was in can go as far as 3 Tesla!) you have to be very careful not to have anything ferrous on or in you – as otherwise it would be dragged around with huge speed and force – think “projectile injuries”. They machines are also very loud – 100+ dB apparently. The noise is from the coils of the electromagnet, which make a lot of noise as they change the polarities, so they give you a set of sound-deadening earphones, through which they can talk to you and play music to keep you amused while they get on with looking at your insides.

In my case, they made a big fuss of asking me what music I’d like to listen to, only for them to not actually have anything that I really fancied. Turns out not to matter much – we settled on some Phil Collins, only for me to discover that I couldn’t even hear it over the buzzing and clacking from the machine anyway!

One thing that I did wonder about during my 20 minutes in the machine was how you got a really big person into it. I’m definitely a bit of a fatty, but nowhere even near the size of some of the people we are starting to see in the UK, who must live on the most dreadful diets to achieve their dimensions. On subsequently asking about this, it turns out that apparently the “super-size me” patients are sent to the local vetinary college where there is an MRI scanner specifically designed for treating horses! If that didn’t provide the impetus to go on a diet I’m not sure what would…

Anyway, the results of the scans and the biopsies they took earlier should all be with the consultants now (they operate as a multidisciplinary team for diagnosis and initial treatment planning) so I expect to be called in after they all meet on Tuesday morning, at which point I’ll know the worst, and what they plan to do about it.

Frankly I’ve passed the point of worrying any more; I’ve had a couple of very bad nights imagining the worst. I’ve come to terms with the fact that beyond being positive there’s very little I can do to affect the outcome, so I just want them to get on with whatever they can do to help me.

Lightning strikes twice

Yesterday I was diagnosed with bowel cancer. No news on how bad it is yet; they’re growing cultures from the biopsies now, and I’m booked for a full body CT & a lower body MRI on Tuesday next week. That will tell us if its already out and spreading, and how bad the base tumor is respectively. Prognosis varies wildly depending on the current state of the tumor, but the only treatment is (fairly major) surgery along with optional supporting chemotherapy and radio therapy. Realistically I’ve a fortnight of waiting while they gather information and build my treatment plan, but at that point things should shift into overdrive. Its likely I’ll be in surgery within 30 days, and recovery from that will take 3 months or more.

We’re not even over my wifes brush with breast cancer yet. Sometimes life is a bitch. But the alternatives are not acceptable. We beat this thing once; we can and will beat it again.