Tuesday, 19 April 2016

Expert Opinion

This week I have attended consultations with an oncologist who specialises in kidney cancer and a surgeon who specialises in gastro-intestinal procedures. Over an intensive few days I have learnt a good deal about my situation. It has been very difficult news to absorb and go forward with.

The oncologist told me that I was at high risk of a further recurrence and that the most likely place for this was at the site where the tumour had been removed in December, because a small amount of cells had been left behind there. I asked what sort of time-scale might this be expected to happen in. She told me that the cancer I had was very unpredictable, it could be soon or it could be measured in years. I asked her if there were any drugs that could impede or stop the recurrence. She said that despite much research no drug had yet been found that worked to prevent Renal Cell Carcinoma recurring. In all the double-blind studies thus far people who were taking the placebo (a sugar pill) had better outcomes than those who were on the drugs that were being tested. At the end of the consultation she told me that I would be given CT scans at three monthly intervals to check whether any recurrence was present and wished me well.

The surgeon told me that the tumour that was removed in December had been attached to the rear wall of my abdomen and had abutted onto my duodenum (the funnel shaped tube that loops to join your stomach to your intestines). The surgeon had removed surface tissue and scraped both of these structures as much as he felt it was safe to do so. He told me that if there was a recurrence at this site, complex and demanding surgery would be required. This would probably mean the removal of my duodenum, part of the pancreas and bile duct and then the re-routing of my digestive system. This procedure was pioneered by a surgeon called Whipple in 1935, but until relatively recently was done rarely because of the high death rates of patients during surgery. He told me that these days this procedure was only done in specialist centres and because of this death rates during surgery had now come down to under 5%. The only good thing I learned was that there was a specialist centre for this surgery at the Mater Hospital in Belfast.

Now I know in some detail what might happen to me on my journey ahead. It is undeniably heavy knowledge and it is proving very hard to absorb. But I’ve always thought that it is better to ask questions and find out what is involved in any situation because your mind can build greater fear around the unknown. Despite what I have learned this week I still believe this. Knowing is a form of empowerment, however daunting your challenge appears, because you gain resources that you didn’t have before.

My last scan was six weeks ago and I am now around halfway to my next one. And at this last scan there was no sign of any recurrence. I can only hope and pray that I get the same result at the next one. Keep the faith.

Sunday, 3 April 2016

When in Rome

We are just back from a trip to Rome. We were based in Fiuggi, a medieval town 50 miles southwest of the city that became a spa after Pope Boniface was cured of kidney stones by water from a nearby spring in the 14th century. We drank the waters and walked the steep alleyways and flights of steps up to the old town on a hilltop some 500 feet above our hotel. The alleys were decorated with pot plants, washing hung from balconies and people sat on their doorsteps or leant out of windows talking. One of the alleyways was called Baciodonne, as it was only really wide enough for one person and you would be close enough to kiss someone coming the other way.

Fiuggi Alta was mainly populated by the old. In the cobbled square in front of the Commune you might see a couple of wizened fellas chatting, or a woman going home from the market with shopping but the young seemed to be absent. During siesta time you would see no-one, perhaps only a stray dog. The hilltop art deco Grand Hotel was closed and its ornate pink facade was crumbling.  The lower town was full of hotels where people came to get away from Rome and take the waters.

It was a one and a half hours by bus into Rome on traffic laden roads. Easter was warm and very crowded. On many street corners there were armed police. At all major churches there were army detachments. Scanners and metal detectors had also been erected; it was just like airport security, only the queues were longer.  

Rome is a visually spectacular city. The ancient Romans established the massive scale of the buildings and subsequent generations have sought to outdo them. Walking from the Colosseum through the Forum you come to the enormous and ugly white marble palace that honours Vittorio Emmanuel the first king of unified Italy. St Peter’s Basilica atop the huge steps above the vast square that runs down to the Tiber affects a similar grandiosity.

My favourite building is the Pantheon, a domed Roman temple that was later adopted as a church virtually unchanged. There is a large hole in the centre of the dome that shafts of light come through to illuminate the statues of gods (now saints) that were placed in niches around the base of the dome. Rain also comes through the hole in the dome but there is neat ancient drainage, water accumulates and drains through slots that are disguised in the pattern of the floor.

My favourite visit was to the Capuchin crypt where the bones of 4000 deceased friars were arranged in designs that covered the walls and ceilings of a series of rooms. The recurring motifs for the arrangements of bones were flowers and stars. You went from a room full of skulls, to one full of pelvises and then to another full of leg bones. It is a striking and sobering experience; the message is that life is short and death is ever present – something I am only too well aware of.  

My last visit to Rome had been over 30 years ago. It now seemed so much more crowded, with huge groups of tourists being led by flag waving guides around all the attractions. As Rome is built in a river basin and surrounded by hills, the air quality is terrible; my asthma really troubled me. At the end of each busy day in the city I found myself longing for the relative peace and calm of Fiuggi.