Whereas December 2020 had been a month dominated by questions, January 2021 was when I started to get some answers. Given the low bar set by 2020, it shouldn’t take much for 2021 to be a better year. And, for me, 2021 started delivering the goods as early as January 6th. So, Happy New Year to me.

Hopefully everyone else also managed some Happiness, in their respective New Years.

For a couple of months, now, I’ve been seeking an answer to the question as to whether a metastasis can make metastases of its own. Basically, can a secondary tumour create more tumours?

As I mentioned in my November post, at that time, the outcome of this question was too close to call:

I’ve now got three different answers from three experts:

  1. Yes
  2. No
  3. Dunno

But on 6th January 2021, I got my call from my oncologist at Musgrove Park Hospital. And he cast the deciding vote…

No.

No they can’t…!

The tumours that have been cropping up during my various recurrences have all spawned from the original disease. That being the primary tumour that had grown in my colon. To put it another way, and as recorded in the oncologist’s notes from the meeting:

We also talked about the risk of further secondaries, which would most likely be secondaries from micrometastatic disease from the time of the original tumour, prior to primary resection rather than necessarily secondaries arising from liver metastases.

[And it’s sentences like that, which ruin the Yoast SEO readability stats on a post like this. How can someone so highly educated hate the poor, innocent full stop so much?!]

As you might have noticed, there’s a discrepancy in the way I’m describing the outcome of all this, compared to the notes from the oncologist. While I’m coming across as if it’s cut and dried, the oncologist has a definite, don’t count your chickens, vibe going on. But that’s only because you don’t speak ‘oncologist’…!

I mean, sure, there have been some mouse studies which suggested that secondaries can new make secondaries, but what do mice know? If they were smart enough to be worth listening to, they wouldn’t be used as lab animals.

[Poor mice!]
We might not like to think about it, but we owe a lot to these creatures.
Image by Tibor Janosi Mozes from Pixabay

Anyway, there has been no proof that secondaries can makes other secondaries in humans. This isn’t to say that such a thing is impossible, just that it hasn’t been seen. And given how hard it’s being looked for, that’s good enough for me.

While I had the oncologist, I asked whether or not surgery was still the ‘gold standard’ for treating cancer. The reason I asked this, was that I’d had a conversation with an Australian doctor on Quora, who insisted that surgery was old hat. And that SABR was the coolest kid in town. Given how often I sing the praises of surgery, on Quora, I thought I’d better check.

The oncologist insisted that surgery does, indeed, remain the gold standard. Indeed, he even introduced me to a new expression, which reemphasised the medical profession’s stance on surgery:

Heal with steel

Isn’t that great?! It even rhymes! Everything’s better when it rhymes…

The oncologist also decided that, if I wasn’t having an immediate surgery, I might as well have my regular scans. He booked me in for a MRI scan on Monday 25th and a CT scan on Thursday 28th January 2021. He’d then sort out an appointment with me, to discuss the results, for some time in February.

All in all, a great meeting. The only thing he hadn’t been able to do, was offer an update on how the liver surgeon was faring.

But I learned more on that front, the very next day…

I received an email from the liver surgeon’s private secretary, seeking to introduce me to a different surgeon. This left me feeling conflicted. On the one hand, I didn’t want to abandon my existing surgeon, if he was going to get better soon. On the other hand, I don’t want to leave my tumour untreated, if my existing surgeon was going to be out of action for too long.

The difficulty, of course, was in what constituted: ‘soon’, and; ‘too long’.

After a bit of back and forth, I learned two things:

  1. My existing surgeon was going to remain out of action for some months
  2. It was my existing surgeon who had recommended this new guy

Given that I was already struggling with depression, I said I’d go with the new guy.

But felt pretty rotten about doing so.

And this turned out to be tipping point that got me to make contact with my therapist. Thankfully it turned out that she was available, and willing to see me, so my first session was booked for the 15th January 2021.

Booking that appointment seemed to act as a catalyst for me, and I was finally able to start clearing down all the things that had been building up over the last couple of months. I got back to writing my blog posts on a regular basis. I forced myself back onto a diet. Hell, I even contacted my doctor’s surgery to see if they were ever going to give me the results of the knee X-Ray I’d had back in November.

The doctor’s surgery got back to me with an appointment with their resident physiotherapist, for Monday 18th January 2021. I was quite keen to hear what the physio had to say, because my knee was definitely not right. And it didn’t seem to be improving on its own.

The knee is a complicated structure at the best of times…
Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”.

So, come the 15th January 2021, come my first Zoom call with the therapist. I’ve got to say, when it comes to therapy, a Zoom call just isn’t the same as a face to face meeting. Some things work well over Zoom, like business meetings. But therapy? It’s just not as good.

That said, it was a damn sight better than nothing!

As ever, the first session didn’t achieve much other than to establish the basics. Even so, I found myself feeling a bit more hopeful after the session. And I had another meeting booked in for the following Friday, so things were moving forward. Overall, it felt like the issues concerning my depression were in hand.

Sadly, during Monday 18th’s meeting with the physio, came the first real setback of January 2021.

The X-Ray revealed that I have osteoarthritis in my left knee.

And that’s really bad news, for me.

While it’s true that my diet’s going quite nicely, I’m not doing anything in terms of exercise. And, in my experience, to effectively lose weight, I need to diet and exercise. But what I was finding was that even a three mile walk, at a moderate pace, was causing so much pain in my knee that I could barely move for the following couple of days.

Traditionally, when I start a diet, I do a fast three mile walk, every day, for a month. After which I look to move on to more intense forms of exercise, typically hockey and/or cycling.

For me, now, and moving forward with my arthritic knee, cycling remains fine. Hockey, however, is very much not fine.

And a life without hockey, for me, would be a jolt. To put this into context, let me refer back to a post I wrote about a year ago: Is A Bucket List A Good Idea?

In that post, I revealed that I have exactly two items on my Bucket List.

The second one being, to play hockey for Wales.

In a veteran’s team!

I’m not suggesting that, at the age of 50, I’m going to force my way on to a team filled with twenty-somethings. What I had been hoping was that, at the age of 50, I could find a place on the Wales over-50s team. Or, at 55, some room on the over-55s team. Etc…

Part of my Bucket List post asked: what if you make a list but then find out that ill health prevents you completing it? Well, here I am! And I accept that the ‘ill health’ I was referring to, was aimed at cancer-related issues. But, from a mental health perspective, I’m not sure depression cares to focus on such distinctions.

At the end of the Bucket list post, I concluded that, on balance, I thought that a sensible bucket list for cancer patients was worth it. And I stand by that. But I would like to take this opportunity to reiterate why it’s important to be sure that you want to make a bucket list, before drawing one up.

Because this genuinely doesn’t feel nice.

However, I still have a plan…

There must be an age when the majority of the Welsh hockey players have had knee replacement surgery. So, I shall find out what age group that is, be it over 75s, or over 80s, etc. I’ll then aim to have my knee replacement surgery just before I hit the relevant age. After that it’s just a case of going to the trials, dazzling the selectors, and playing hockey for Wales.

Simple!

One day, you will be mine, my preciousssss…

Despite the weakness of this plan, and to my genuine surprise, learning that my hockey playing days were suddenly behind me, didn’t push me into deep depression.

I know! I’m as shocked as you are. My therapist certainly seemed quite surprised when we talked about it that Friday.

Unfortunately, I think I know the reason…

Due to the COVID lockdown, there’s no hockey at the moment. And, in the back of my mind, I’m pretty sure that I will be able to play hockey, really.

Essentially, I’m living in denial!

Which is fine, because it means I can put off having to deal with this horror show until a later date. Something that definitely works for the me of the present. Clearly, future me is going to have to deal with this at some point. But, then: sod future me. He should have thought of that earlier…!

Fortunately, before the full ramifications of the time paradox I had created could sink in, the fates of January 2021 started looking favourably upon me once more.

I was called in for a meeting with the new liver surgeon on Thursday 28th January 2021. A face to face meeting at the Bristol Royal Infirmary. Thankfully, it was a morning meeting, so I wouldn’t have to rearrange the CT scan, which was at 5:20pm at Musgrove, in Taunton. Thursday was shaping up to be a busy day…

And the meeting went well. Unlike my previous surgeries, which had been done through the private insurance system, this one would with the NHS. Fine by me. The only real benefit to the private system is that you tend to get your own room. And the main reason I want my own room, is so my snoring doesn’t keep the other people on the ward awake. I can only hope that everyone else will have remembered some ear defenders…!

I’ll certainly be taking some.

In fact the only deviation from expectation, from this meeting, was that it was likely to be an open surgery, instead of a keyhole procedure. To be honest, this has been coming for some time.

Whenever you have a surgery, there is always an element of ‘leakage’ from the operation site after the procedure. This leakage will be some combination of blood and serous fluid. It’s the exact same thing that happens with any external wound. Except, internally. Which means that the ‘leakage’ can’t dry up completely. Instead, the fluids thicken until they’re virtually indistinguishable from glue.

All of this makes sense, biologically. If you’ve had an internal injury, this thickened serous fluid holds everything safely in place and prevents further damage. From a surgical point of view, however, it’s a nightmare…

All of the organs become glued together, and need to be teased apart before surgery can start. Sometimes, this can’t be done without tearing the surrounding tissues. And given that this tumour is on the tip of lobe 2, just above the stomach, and pressed up against the diaphragm directly below the heart, things aren’t going to be easy.

Which means I’m almost certainly going to have open surgery. Something that will result in a six night stay in hospital, instead of the two nights I usually get away with for keyhole surgery.

My lunchtime companion during my visit to the BRI

Oh, and this surgery had provisionally been programmed for the week beginning the 22nd February 2021. Less than four weeks hence.

Which is why I was asked that, seeing as I was there, would I mind doing a pre-operative examination? It’d been booked in an hour’s time, and would take about an hour to complete…

Of course I didn’t mind. And a very thorough examination it was too. I was even given some homework! Which is to say; a small tree’s worth of literature to read. And some Omeprazole to take in the 24 hours before the surgery, to protect my stomach lining. Also some Preop and Fortisip drinks, to be taken in the run-up to the operation as well, presumably to boost my body’s nutrient levels.

The examination ended with an enquiry: seeing as I was there, would I mind having a meeting with an anaesthetist? It’d been booked in 90 minutes time, but would only take about 20 minutes…

Again, of course I didn’t mind. I just hoped that there wouldn’t be any more surprise meetings tacked on to the end of that one, otherwise I wasn’t going to make it back in time for my CT scan.

There wasn’t another meeting after the one with the anaesthetist, and the CT scan went without a hitch.

Likewise, the actual meeting with the anaethatist was very painless. When she’d seen how many similar operations I’d already had, she just quickly chatted me through things and sent me on my way. Hopefully giving her enough time to grab a cheeky coffee, or whatever she needed to help keep her going.

Both the hospitals I visited that day seemed to be under a lot of COVID pressure. Meaning all the personnel I met were really having to go some. Not that it showed in any of them. They were all as professional and diligent as they ever are. They just seemed… a bit frayed around the edges.

This seems a good time to offer my thanks to everyone at the NHS. To say that I can see the amazing job that you’re doing, and really appreciate you for it.

And, after a somewhat full-on Thursday, January 2021 ended at a more sedate pace with my third Friday meeting with my therapist.

It’s slow going, with these therapy sessions, but I think we’re starting to make progress. The reality is, though, that depression isn’t an easy fix. Something that I have to keep in mind to temper my expectations.

In hindsight, I think it’s fair to say that January 2021 took a completely unexpected turn for the better. Hopefully, February can follow through, deliver the surgery, and really get 2021 off to a flying start.