Sheep and Stress

Out for a walk near my house, I came across a sheep in the hedge at the side of a small field. Nothing too unusual I thought, sheep always try to get out of the field they are in. I carried on down the lane, it was a fine sunny day and this was one my first walks out in the fresh air after weeks of bronchitis.

I had suffered from a terrible cough for three weeks and then this had been replaced by a sore and wheezy chest. It felt like very bad asthma, my breathing tubes were still inflamed by the virus. Although the sun shone, the wind was keen and I pulled my hood up to keep my face warm. It was lovely to see the new grass in the fields, the ewes and their lambs grazing, catkins hanging from the hazel trees, wild snowdrops and daffodils in the hedgerows and queen bumblebees active after their hibernation ready to establish nests. With tomorrow being the Vernal Equinox, it certainly felt like the height of Spring.

Since the discovery of my lump, some five months ago, I have been suffering from very high stress. Getting the all clear two weeks ago in my first general CT scan post-surgery was a huge milestone, especially as the oncologist had told me that she expected it to show a recurrence. But long-term stress doesn’t just switch off like a light-bulb. I felt enormous relief, then complete exhaustion. And my stress symptoms persisted. I felt sluggish, restless, anxious and often had difficulty sleeping. Stress hormones were still coursing around my body. Then I would sleep for ten hours and wake feeling completely burnt out and depressed. I had what is called a stress hangover. And I hadn’t touched a drop.

The treatment for this condition is gentle exercise, good food, talking through your troubles and gentle distractions that take you into a different mental and emotional space. My ability to follow the first of these was somewhat undermined by the bronchitis, but I could pursue the others. T has continued to be a great help and support. Despite her own persistent cough, she made me healthy soup and we laughed at Shaun the Sheep videos together. And slowly the problem has eased.

On my return up the lane I saw that the sheep was still in the same place in the hedge. That is strange I thought, and I entered the field to investigate. As I approached I saw that the sheep was stuck, held tightly by several briars that were strung across its back and latched into its wool. The sheep was panting and began to buck against the briars. As I got closer it began to buck harder, loosening one of the briars. I picked up a sturdy stick and prised the briar from her wool. She bucked again, the other briar snapped and she was free. The ewe ran off across the field bleating, the broken briar dragging behind and a little black lamb trotting at her side. 

Well done my little white cells

An epidemic of swine flu has been spreading across Europe this winter. It seems to have been particularly pronounced in Ukraine, where 3000 people a week were being hospitalised and over 300 people have died. Unfortunately in recent weeks it has spread to this island and over 20 people have died here thus far. Swine flu is a particularly virulent strain of flu (H1N1) which is strong enough to kill the young and healthy. This flu last hit us in the epidemic of 2009 when over 250,000 people died from it worldwide. It doesn’t come from pigs, but is similar in its structure to a virus that affects pigs. You don’t get it from eating bacon and sausages.

I know only too well what it feels like as I’ve had this flu for the past two weeks. It began in the normal way, with a headache and sore throat. Then it quickly escalated to a sinus infection and a chest infection. My chest became very sore and I had frequent coughing fits that couldn’t be soothed. I took Paracetamol, Sudafed and Benylin. My chest got so bad I was heading towards a bottle a day habit. I was feverish, my joints were aching, I felt exhausted and listless. I couldn’t concentrate, my eyes and forehead throbbed. Added to that was the diarrhoea. Without doubt it has been one of the worst doses I’ve ever had.

After the 2009 epidemic the UK stockpiled a drug called Tamiflu.  This drug inhibits the spread of the virus through the body. But it must be taken within the first two days of the virus appearing and has some significant side effects. In practice most people are very unlikely to recognise that they have something out of the ordinary within this time period. The £500 million cost of this stockpile has undoubtedly benefited Roche, the drug manufacturer, but probably not the rest of us too much. The seasonal flu vaccine does offer some protection from this strain, apparently you still get infected but you don’t get quite so ill with it.

Once the flu virus has spread through your body there is little you can do other than keep warm, keep hydrated and take things like Paracetamol, Sudafed and Benylin, to manage the symptoms. Over the past week I’ve also taken a course of antibiotics but they haven’t had any discernable effect. This confirms that the problem is viral and the bug will have to run its course. Thankfully, during the past day or so my immune system appears to have been gaining the upper hand, as I have had periods when my symptoms have subsided and it feels like I am getting better. But I also know that I must be careful as deep down some vestiges of the swine are still there.

The greatest boost to my recovery came today when I heard that the CT scan I had last Thursday was all clear of cancer. I’m over the moon and deeply relieved. I was dreading the result of this scan. Because last month the Oncologist told me that she thought that this scan was ‘likely’ to show a recurrence, as the pathology report had shown that some cancer cells had been left behind by the surgeon. She even gave me a leaflet about the chemotherapy drug that she was expecting to put me on.

I can only conclude that my immune system is doing extremely well. It has killed off all the cancer cells that were left behind when my tumour was removed. It has repaired all the cells that were damaged during my abdominal surgery. And now it is sorting out the swine flu bug that has already killed hundreds of healthy people across Europe. Well done my little white cells.

The Wilderness

John the Baptist managed forty days and forty nights. We would have liked longer, but our bargain break only promised three. We were, however, located in the magnificent Nephin Wilderness: 27,000 acres of mountain, forestry and bog in North Mayo entirely preserved for nature. The principle behind this unique designation was that nature rather than humans would mould the development of this landscape over the coming decades. Visitors were welcome to experience the Nephin Wilderness as long as they used the land sensitively and left no trace.

Mindful of these principles, we picked a good hotel on the coast near Achill Island and went for walks into the wilderness each day. The weather was changeable: bright sunshine and blue skies interspersed with showers of rain and sleet. This produced some fantastic vistas of changing light as we walked along old drover’s trails and turf-cutters paths across the bog. The mountains had a sprinkling of snow on the tops and hardy black-faced sheep peered at us as we passed. We were able to take an informed interest in their heads, eyes and legs, having recent viewed the excellent hill-farming documentary ‘Addicted to Sheep’.

We ate well at the hotel breakfast buffet and pocketed snacks to munch during the day. We had home-made bread and wild honey; as no locusts were available, we took sausages. The first day we walked some eight miles and the second we went seven. I found that my post-operative body could manage these distances okay. The only trouble for me was a sore knee, a flare up from an old injury. T managed the walks without any problems.

Our hotel was blessed with an award-winning restaurant run by a very inventive chef who only used locally sourced ingredients. The restaurant also made all their own bread and each day there would be three or four different types to try. Our wild walks meant that we tucked into the very fine food on offer most heartily. The first evening we became so stuffed that we had to go for a walk down to the village and back to be able to sleep.

Unfortunately, there has been a sting in the tail. At the end of the week the hotel became full of families on half-term break, with kids running everywhere. The very next day we went down with a dose. Our return journey became an ordeal of coughing and sneezing. And since then we have been suffering in bed. It’s proving to be a bad dose of the flu.

Lent

I was delighted to get the call that told me my bone scan was all clear of cancer. Thankfully the torture of waiting for the result was over quickly. At first I was deeply relieved. Then I felt euphoric. Not long after I began to feel tired. The next day I felt run down. And this exhaustion persisted.

I had received the appointment letter several weeks ahead of the bone scan. I tried to keep doing things one day at a time and not to focus on this impending event. But my stress built up inexorably. This was intensified by the knowledge that there could be no way back from a positive result in the scan.

Over the past twenty years, I’ve regularly had aches in my lower back due to a worn disc I acquired during my younger days of running up and down mountains carrying a rucksack. In my youth I thought this was all good clean fun, and if someone had told me then that I would suffer in later life because of it I would have laughed. However, during the past couple of weeks when my back and pelvis were sore my mind began to tell me that this pain was something more than just the worn disc. These thoughts often seemed to happen when I was lying in bed at night. It was all too easy to believe that the pain was the cancer eating away at my bones.

All my fears seemed to be confirmed when I was asked by the nurse when I attended for the bone scan - had I noticed any pain in my joints and bones in recent weeks? I reluctantly answered yes. She noted my response and moved on to the next question. I gulped and my heart sank.

Since the scan result I’ve been treating the tiredness by cutting down on what I do each day. I’ve been meeting friends for coffee and going for walks in the fresh air and reading and doing a little writing; but not much else. I’ve also booked a wee break with T in the West of Ireland next week.

The war against cancer is an ultra-marathon. And to be able to win this war you have to remain strong and healthy throughout. The bone scan was an important victory, but the fight continues. In a couple of weeks time I will have a general CT scan which will check if there are any traces of cancer elsewhere in my body. I feel reasonably well at present, but you never know.

I’ve also been reading about what you can do to boost your immune system. It seems that despite much research there is no definitive evidence that there is any one thing that is of proven benefit (i.e. Vitamin C, Echinacea, Garlic, etc). The conclusions lead in entirely the opposite direction. To stop doing things that harm our immune system is the most important. So: not smoking, not drinking alcohol, not being overweight, not failing to take regular exercise, not missing a night’s sleep, not eating a balanced diet, not being stressed, and so on.

Given the intensity of our contemporary lifestyles these modifications are very hard to do. Wouldn’t it be so much easier to keep the unhealthy lifestyle and to take some magic bullet that would fix these problems? I wish it could be so, but unfortunately that doesn’t work. It looks like I’m going to be doing Lent for the long-term.

The Bone Scan

I didn’t think I had anything in common with Alexander Litvinenko. After all, I wasn’t a Russian émigré and I didn’t take tea with members of the KGB. However, yesterday I was injected with a radioactive substance at the City Hospital. Thankfully this was not Polonium 210, but a small amount of a radioactive isotope that would help identify whether the cancer had spread to my bones.

The procedure happened in two stages. First, a radiographer inserted a butterfly needle into a vein in my arm (much like when you have blood taken for a test). But here the tube from the butterfly needle was attached to two syringes: one was clear plastic (as normal) the other was metal with a glass face. The radioactive isotope was in the metal syringe and there were only two millilitres of it. The normal syringe was full of saline. Both of these syringes were bit by bit injected into my arm.

After this I was given a time for my scan: it was two and a half hours later. Until then I was free to go and didn’t have to stay in the hospital. Because of the radioactivity in my body, there were some precautions I had to observe for the next 24 hours. I was advised to drink plenty of fluids; to empty my bladder frequently; and to flush the toilet twice each time I went. I was also advised to avoid close contact with children.

I expected to feel odd. I didn’t. I asked T if I was glowing green. I wasn’t. I thought my pee might be a different colour. It wasn’t. Strangely enough, I soon became used to wandering around Belfast with radioactivity coursing through my body. We went to a coffee shop for lunch, the Central Library and a jewellers before returning.

Back at the hospital I was ushered into a secure area with radiation warning symbols on the door. The triangular warning symbol was also on the door of the toilet next to the little waiting room. Then I was taken in for the bone scan.  Like other scans, I had to take off anything metal. But I didn’t have to undress and wear a gown. I lay on a narrow bed with my arms beside me. The radiologist strapped me firmly onto this bed and I was told not to move. The scanner consisted of a tunnel between two large panels above and below. I was drawn between them on the moving bed. Then the bed was raised up towards the upper panel. I saw that there was a cross marked on its surface. The bed stopped about an inch away. The cross was right between my eyes. I then remembered the name of the scanner, which I had glimpsed on the way in, it was ‘Hawkeye Four’. I closed my eyes and began to pray.

The bone scan took about thirty minutes. I was drawn very slowly on the bed between the two panels. There was no breathing in and out, like a CT scan. There was no horrible noise, like a MRI scan. Physically, it was the most undemanding of all the scans I had been given. Mentally and emotionally, it has been the hardest.

After the injection, the radioactive material circulated and became temporarily absorbed into my bones, giving off gamma rays. The scanner was taking pictures of the gamma rays from head to toe. In a normal scan these rays would be evenly distributed across your body. Concentrations of gamma rays are called ‘hot spots’, these indicate cancer, infection or bone damage.

So I am again waiting for results. And given the potential seriousness of the outcome, the wait is agonising. 

Old Pals

Phil and I became friends at school. We’ve been in close touch for over fifty years. After my first wife died in an accident I stayed with him and his wife Jean for several months until I could bear to go back to the house that we had just bought. I became the first visitor to the maternity ward after the birth of their son. And I helped Phil and son Nathan carry her coffin after Jean died of cancer almost three years ago.

Phil came over from England to stay with me this past week. He is a ranger in a National Park so we did plenty of walking and wildlife spotting. We walked around Castlewellan Lake and saw plenty of Little Grebe diving for food. At Corbet Lough we saw over forty yellow-billed Whooper Swans that had migrated here from the Arctic. Beyond the old harbour at Newcastle we saw six Black-throated Divers that had also migrated here from the frozen North. And strangely enough Phil was delighted to see plenty of our local Hooded Crows, a bird that is scarce in his part of England.

Phil is also very handy at DIY and helped me to change the dripping mixer tap in the kitchen, a job I wouldn’t have felt capable of doing on my own. He hacksawed off the old pipework, removed the old tap, attached two flexible links with compression joints to the new one and the job was done inside an hour. My role was that of the apprentice: handing him tools, shining the torch, filing the ends of the pipes and making the tea.

I also did all of the driving: picking Phil up at the City Airport, taking him around Co Down and delivering him back. It was the first time I had driven as far as Belfast. I managed it fine. Although I must admit I felt pretty tired after he had gone and slept for ten hours for several nights. Being so active every day was probably overdoing it a bit.

T has now returned from her own house, having gone back there to do some sorting out (amongst other things, the Xmas decorations were still up). We are back to our normal routines of eating, walking, worrying and sleeping. The appointment for the first of my scans, the bone scan, is coming up and my apprehension is rising.

On the positive side, I have been out of hospital for five weeks now. I’m eating regular meals and plenty of snacks too. I’ve been gaining about a kilo a week and have just returned to the weight I was before surgery. However, if I carried on at this rate of increase for a couple of months I would have a problem. I can complete an hour’s good walk without getting tired and do this most days. I continue to have pain in my belly, although this is diminishing, but I still need to take regular paracetamol. Overall, I imagine this is reasonable progress given what I have been through.

The Oncologist

It is five weeks since my surgery and a little over three weeks that I’ve been home, under the care of T. In many ways my progress has been good. I walk every day. Ten minutes was the most I could manage three weeks ago. Now I am able to go out walking for an hour, as long as I’m wrapped up well. The disturbances in my guts have largely settled and I can now eat reasonably normally. The pain of my belly wound diminishes slowly. It does intensify over each day and I require regular doses of paracetamol.

T is looking after me very well. She makes a healthy soup for lunch-time and a nourishing meal in the evening. I’ve also been sampling plenty of Xmas goodies and have put on around six pounds of the ten I lost whilst in hospital. At first I couldn’t get through the day without a nap in the afternoon. Now I do last through, but I usually conk out by 10pm. I’m managing to sleep fairly well, with very strange dreams, although I do take a sleeping pill.

T and I have just had our first meeting with the oncologist. They are a dour lot, who don’t pull any punches. We learnt that my tumour was six centimetres in diameter and weighed ninety four grammes. We learnt that it was graded three out of four on the aggressiveness scale. We learnt that the tumour was surrounded by a thin covering of fatty tissue, apart from at the surgical line of excision where three millimetres of tumour were exposed. We learnt that I would be given a CT scan and a bone scan in four weeks time, when my system had settled down after the surgery. We learnt that the oncologist expected me to need chemotherapy, as some sort of recurrence, most likely at the line of excision, was likely.

This prognosis has been hard to bear, particularly after the long, tough journey we had already taken. Whilst some sort of recurrence is thought to be likely, it is not yet a fact.  As far as I know, I am clear apart from three millimetres of cancer cells which have become exposed to my own immune system. I believe I’m recovering well and becoming a bit better each day. However, it is difficult not to feel each twinge in the right side of my abdomen as a symptom of tumour regrowth.

T has found it particularly hard. She has been signed off work for a month due to emotional exhaustion and stays in bed longer than I do in the mornings. We have our little routines and take things one day at a time. We limp along quietly, helping each other get by. It’s not easy. We try to do our best. And keep the faith.