A benign review of a malignant past

The shifting feasts of consulting

This was my third outing of the week after church on Sunday and the office on Tuesday. I had a rescheduled appointment from December that I attended yesterday. It was my usual biannual checkup, which has shifted from the April/October cycle to a January/July cycle in three years.

Once I realised, I would not be able to attend the early December appointment because I would be out of the country, I called to postpone the appointment and reschedule it to mid-January. I ensure I never miss my hospital appointments or consultations as it deprives others of time and audience with scarce medical personnel.

A miscommunication between us some 18 months ago meant I never received my expected scheduling for May, and we fell into a June/December cycle that only happened once. Besides rescheduling, I was promptly given a prescription to make up for the additional time.

Let’s keep to what we discussed

For this consultation, I had a few issues to discuss, the main one being the unfortunate mismanagement of information that I should not have received until I had met the consultant involved in that area of investigation and diagnosis. The computerisation of personal medical records meant that a certain diagnosis ended up in my clinic notes that the person I met should have redacted before forwarding to my doctor and I.

Blog - The note that crept in

The sinking feeling of reading a diagnosis of adenocarcinoma of prostate over a week before my scheduled appointment with the consultant urologist was as earth-shattering as it was a humbling reminder of one’s mortality. When I remonstrated with the doctor, he offered to redact the diagnosis, but what good was bolting the doors after the horses had bolted?

Meeting with the chief consultant of the team that had assumed my care for over a decade and she for about 8 years, she immediately understood the issue.

She said she would raise an incident with the multidisciplinary teams to ensure that they are aware of what information gets passed to the patient; that it is centred on their particular consultations; and that the more interested patients can assess seemingly hidden interdepartmental communications to read the chatter pertaining to them.

A malignant test of the benign

For me, what I learnt was the difference between the definition of malignant to the layperson and the medical establishment. When I read malignant adenocarcinoma of the prostate in interdepartmental communications, I read it as a qualifier of the type of cancer, something rampaging and very likely to cause death.

To the medical eye, malignant always means cancer regardless of stage or metastasis. The absence of cancer in the presence of a growth or tumour will be considered benign. [Medical News Today: What are the different types of tumour?]

My consultant patiently explained the terms fully to enhance my understanding. Other issues in my notes were from the perspective of the person I saw. Any similarities would suggest a lazy engagement, as situations and circumstances do change between visits.

All good and nice

We discussed the readings of my blood tests, and the need for new assays, though this time without a urine sample and at the end of my allotted time with a medical student present, I was handed on to the phlebotomist who had no problem drawing three vials of blood before I was sent on my way to collect my renewed prescription and I made my way home.

In all, the consultation was pleasant, and the typical readings were within normal range, it is likely I have lost a centimetre in height, and the physiotherapy to address issues in my spine will not commence until all the other medical issues are resolved.

Making new blood stories

Necking on the arm

“You are the vampire on duty today?” She laughed and called me cheeky, this being after I had seen my consultant for my biannual consultation which passed quite without event. Though I did fill in a survey for the registrar that saw me, who I did meet on my last visit, nothing memorable stands out from our conversation and it probably was the shortest engagement I have had in years.

Given the opportunity to ask questions, I had no inclination at all, beyond the cheerful greetings and recognition at the reception, the weighing-in, height measurement, and blood pressure readings were a rather perfunctory exercise.

Our man the hands like shovels was nowhere to be seen as I drank as much water as I could ingest through the night into the morning to ensure when the needle was coming for the vein, there was something to give. After giving up a urine sample, I sat and waited to be called into the treatment room where the nurse was taking blood for testing.

Cheeky and Swiss cheese arms

Presenting my left arm, she felt for a vein and then punctured my skin, I watched every action without being squeamish, but nothing came, it was dry and unyielding, and it was not Nicholas doing it. Then as she suggested trying my right arm, I could see a vein presenting quite boldly as I completed her statement about if she could not draw blood, “You’ll sink your fangs into me?”, I retorted.

The punishment for my precociousness was subtle, as she put a folded gauze staunch on the first needle puncture and applied enough tape that it almost rounded my arm catching the hairiest parts of my arm in the process. I knew the peeling off would be gritted teeth and some agony if I could be man enough to do it today or allow it to wear off over days.

The right arm initially did not come to play, but soon enough it gave in before desperate measures were needed. I am always surprised at the darkness of the colour of blood as it feeds and fills the vials. In no time, 7 vials were filled with blood.

Could we be better armed?

Yet, between the Netherlands and the UK, I am still surprised at the difference in the art of phlebotomy. Dutch hospitals insert a needle attached to a tube that feeds the vials, whereas here, there is no flexibility between the needle and the vial, which means the patient can easily be irritated and bruised by holding the needle in place and the action of attaching each vial. I should not have to write a novella about my many experiences of having blood extracted.

How I wish the Theranos experiment of Elizabeth Holmes had worked where their dream was to be able to conduct all blood assays from a single drop. Then I could not get a drop from my finger when I tried a home test kit some months ago. I believe Theranos was a good idea long before the means and technology were available. Maybe in a century, blood tests would be as easy as having a light spectrum impacting on the skin like we have with smartwatch pulse oximetry that records peripheral oxygen saturation (SpO₂)

I received my prescription all sealed up only to realise when I got home that a second essential one has not been dispensed. The pharmacy was quite helpful in facilitating it and I shall pick it up tomorrow. The other parts of the day included an induction to volunteer as a welcomer to the cathedral. I have a bit of bedtime reading on church history to do.

Now, I think about it, how that I am always inspired to write something interesting about having blood taken for tests.

Waiting for veins so shy

Appearances always matter

Do not show it, even when I was at my most ill, my appearance was always sophisticated. The first impression my doctor will have of me will suggest this person is not ill. Appearances matter, always. And that was how I was kitted out for my biannual check-up at the hospital this morning.

I had hoped to see my long-term consultant, but I was seen by a registrar and not one of the many I have seen since I started attending this department. We had an easy conversation about my situation, the results of my last tests, a refill prescription, my general plans for the future and the arrangements for my next appointment as to whether I would prefer a telephone consultation or a face-to-face meeting.

A bloody blockage

He mooted extending my blood tests to an annual activity, but I was reticent, the highlight of the discussions do centre around the bloods apart from questions or other concerns I might have that would usually relate to tests and prospects in terms of treatments. He arranged for me to meet the departmental nurses to have blood taken, we nudged elbows and that was my consultation done until next April.

Two needle puncture wounds, one on each arm, later and there was no blood drawn. I might well take a dose of blood thinners, though Brian in his wisdom would suggest it’s because I do not drink enough water. The nurse, a burly man, six-foot and many more inches tall with hands that are hardly dainty but likely to be seen on a construction site was the same person who failed to draw blood that last time I was here.

Veins in hiding

It might have been an involuntary response on recognising him that sent my veins diving inward from the surface of my skin, they were indeed hiding and could not be sought, no matter how hard he tried. He put it down to dehydration and suggested I get a drink, though alcohol is prohibited. I submitted my drug prescription to the pharmacy and literally gulped down 500 millilitres of water with the hope that in 20 or so minutes, someone might be able to extract the elixir of life for the vampires.

On returning, he called another nurse to try and draw blood, this time on my right arm and a third puncture as if I was to become a colander. She teased and kneaded my arms to no avail; this was a case of waiting on veins that were too shy to show up. I don’t blame them.

They are good

So, I was sent to the blood lab, a room of expert phlebotomists I was told knew how to get blood out of stone if need be. I was to knock on their door even though there was a plain sign on the door advising not to knock on the door and ask for someone by name. They were expecting me, in a horror film wit would have been vampires licking their lips at the sight of another blood feast.

I sat down, he put on a tourniquet, inserted the hypodermic needle in my arm and there was blood filling the vial-syringes, all 4, one after the other and we were done. I guess there is ability that the departmental nurse did have to draw blood, but the phlebotomists had expertise. They are good. I picked up my prescription for another 6 months and I was on my way home.

Blessed is the day with all its troubles

The day started slowly

Going from my telephone consultation last Wednesday, it had been arranged that I visit the hospital today to see a phlebotomist and pick up my prescription. It was an afternoon appointment and I had decided I would take the day off.

Waking up a little later than usual, I went for my morning walk and returned home for another nap. At noon, I made what you could term breakfast and soon after called an Uber cab to take me to the hospital. Much as I had considered walking the 6 or so kilometres to the hospital, a headache was not giving me the pleasure of the feat.

Not here nor there

In what was a test of temperament and attitude also quite unusual for my consultant, when I checked in at the pharmacy, my prescription had not been submitted for preparation and it was even suggested I return on another day to collect it. Much as I was having none of it, the pharmacist took the initiative to put things in motion.

At the outpatient’s reception, I was directed to the waiting area for the blood room. We do have a good natter when I visit and she immediately chased up my prescription, altogether, I was assured I can pick it up after the bloods. At least, I was sure the prescription will be correct.

When I was invited to give blood, the phlebotomist could find no recent requests on the computer. There was a pending request from 2018, I think that was when the computer system could not be accessed, and the requirements were written down. No one went back to synchronise the record of activities.

Fixed through communication

The last fulfilled request was in October 2019, which left me wondering about what happened to the vampire conference donations of April 2020. As my consultant had the results for our conversation last week, I guess what is required is a bit more housekeeping to match the blood work requests with the fulfilment of the orders.

Returning to the receptionist, she phoned up the nurses and got the blood requirements straightened out, entered in the computer system and I returned to the waiting room, waiting to be called in again. This time the order was in for just 3 vials of blood, when I usually give 5 or 7 vials. I was not complaining, I could not even see a vein and it required a bit of jiggery-pokery with the needle to get the blood flowing out.

With humour and honour

Before that, I was asked to give a urine sample, on my way in I had only seen the female toilet and telling the nurse, she said, any of the toilets will do. Not that other patients in the waiting room would allow that to happen, as a chorus of voices pointed out the male toilets. The much older man quipped about my having a sex change and I cupped my breast, shock, mirth, and laughter arrived as contortions on the faces of the others. I guess we could all do with a bit of humour.

All done, I picked up my prescription, walked to the Manchester Super Store on Cheetham Hill to get some fresh fruit before boarding the tram back to Manchester Piccadilly and settling for some fresh air in the village garden. Looking at my watch, it was already 5:00 PM, the day had gone but not as eventful as Brian had his, tough and resilient, smiling through it all. I hope he has a good night’s rest. My poor dear, for his good heart, is on for a wonderful blessing. Love him to the stars and beyond.

Grateful for the generosity of time, service, and hospitality

Never forget to be thankful

It crossed my mind that for the many acts of generosity I have recently experienced, I have not properly acknowledged and paid gratitude. A few weeks before, having acknowledged my hospital and shortly after my original consultant in Amsterdam and my current consultant in Manchester on Twitter, they both sent their greetings.

In our exchanges, I promised to visit my old consultant in Amsterdam after this Coronavirus pandemic was over to thank him for the decade after we first met. My consultant here then informed me that I would not be meeting her, this time, but the consultation would be done over the phone in early April, a few weeks ahead of the scheduled appointment.

I am grateful for their professional care, the confidence they all have exuded in attending to the critical and general issues to do with my health, I feel I have always been well cared for.

Calling me on the phone

When the call came in early April, we went over results of the consultation in October, checking what might have changed in health and life, both would be registered as considerably improved. Beyond that, they arranged for me to visit the hospital for a phlebotomy and at the same time pick up my prescription. Much consideration had been given to ensure we have a separate area from the common blood room for the blood tests.

On my visit, there were a few administrative issues which would have required going to the common blood room, but the nursing staff ensured that would not be the case, they worked to ensure the arrangement they had made with us was kept, without my insisting on it. They recognised they some might be anxious about being in crowded places in a hospital.

Gifts and swifts

The nurses were interested in my FFP2 respirator mask and asked where I got it from. I noticed I had a more sophisticated mask than what they were wearing. They had plain surgical masks that would offer no little protection from the Coronavirus. Whilst I was waiting to be attended to, I was the only one in the waiting room and I was offered a cup of tea.

Blog - Masking all attempts at convenience

A nurse on finding out how much I had paid for my respirator, was aghast, that we went away and brought me a couple of surgical masks that I could have as spares if needed. Quite helpful and generous they were in time, care, concern and service.

Picking up my 6-month prescription, the paperwork shows the order was put in on the second, filled in and packaged on the sixth even though I was not expected to pick it up until the fourteenth. The pharmacist had my bag of medicine in my hands within two minutes.

Despite the few difficulties during the day, in all, I have much to be grateful for, the NHS, the people who staff it, the consideration and care by everyone I met. I had to make a note of thanks and gratitude for it all.

Masking all attempts at convenience

Preparation and depilation

And so, came my biannual visit to the hospital, one of the excuses you needed to be out and about. The usual consultation that heralded such visits had been conducted by phone two weeks ago as my consultant had informed me early last month on Twitter that this would be the case in view of the then developing Coronavirus pandemic.

The specialist nurse brought my scheduled visit forward 8 days to allow for phlebotomy whilst registering an update for my prescription to be collected at the same time. A separate room had been assigned from the blood work as some other patients had expressed concerns about being on large communal spaces in a hospital.

For my visit, I acquired an FFP2 (N95) respirator mask and to ensure it was close-fitting, I had to shave my whole beard, and I included my head, to return to the look I last had in January before I donned my Corona chic. I planned to get the tram, but the modified timetable did not give indications of transport to meet my prompt arrival at the hospital, so I took a black cab taxi instead.

Just keep calm anyway

On arrival, I got a hand sanitiser from the dispensary before I was met by a gatekeeper at the main entrance who I gave my appointment card to pointing out my scheduled appointment, but he flipped through the pages and pointed out a date from 2015. I held my breath as I remonstrated, I handed you the correct page with my appointment, why are you nosing around?

Indeed, I had arrived early for many reasons including the need to keep my blood pressure normal as it does shoot up if my arrival is delayed and I am anxious about making it on time. I offered to sit out until he was ready to let me in according to his arbitrary concept of promptness, but he ushered me in.

Pricks like Jagger

At the reception, I was informed the phlebotomist had not arrived yet, that it was better for me to collect my pre-ordered prescription first, which I did and then returned to wait for the phlebotomist. He was as tall as trees and definitely did not move like Jagger probably because he was Nick rather than Mick. I then had to wait because of the administrative issue of obtaining the required blood tests from a computer system he apparently had no access to.

When I was called in, neither of my veins on the right or left arm was ready to yield any blood. He asked if I had ever had blood drawn from my neck. God, not today, not ever. He stepped out to get another phlebotomist, she successfully filled one and a half vials before it ceased, moving the needle around a bit with attendant discomfort, and new vials inserted without much luck, eventually, 5 vials were satiated with my life fluids and labelled up for analysis.

Shopping and hoping

I was fortunate, I did not leave the hospital looking like Swiss cheese. As a detour before going home, I decided to go by the ethnic Manchester Superstore, which was about 2 kilometres away, the directions took me through parks and back roads until I reached familiar surroundings. I stocked up on the essentials and waited just under 20 minutes for the tram back home. By which time, the sufferance of the mask had exceeded any comfortable feeling, leaving indentations on my face.

What I could do with a nap after a few useful calls. The morning and the evening will have become my own interesting Tuesday.

A reprieve and a celebration of goodwill

The signposts are appointments

The year in almost a decade now has been signposted by my visits to see my hospital consultants first in Amsterdam, then in Wrexham, London and now Manchester.

My visit today for which I took the day off started easy. My Uber ride to the hospital was without event, arriving with about 5 minutes to spare. I do worry about the rides because of the concern about getting to the hospital late has added more millimetres of mercury to my blood pressure readings as to put it in the danger zone.

Up and down and just about right

I booked in at reception and within minutes of my sitting down, a nurse I had not seen before called me in for the initial checks, weight, up a bit, height, down a bit, blood pressure, good, a bit can be improved upon.

After that, I met with a registrar who seemed to have swotted up on my notes before asking a few questions about how I felt. It seemed to me that my concerns about memory in terms of shortness and loss of it at certain times for which I had the HAND test last year had become something to do with my moods.

Moods are not memories

I had to immediately correct the impression, the medication I have been on for 8 years now, might cause cognitive impairment, that impairment is neither psychological nor psychiatric. Then the issue of folic acid deficiency anaemia, the counts are still low and this might need stronger medication than can be bought over the counter. My GP will be instructed to that effect.

The reason I was back for consultation within three months was to review my drug regime, a topic that had come up for the past two years. At my last appointment, I was given four choices to review. One that would have changed my drug regime from single-pill daily to twice a day, I ruled out, but I did have concerns about hepatic and cardiovascular side-effects, whatever is lactic acidosis and the dreaded lipodystrophy.

The registrar assured me that there would be stricter and frequency monitoring considering my medical history, however, we could postpone this activity for another three months.

Giving back wealth and experience

Through our discussions, as I had mentioned the many consultants I had met in that department over the last 3 years, we touched on the activities of the retired head of department who is out in Myanmar working for a foundation proving acute healthcare services in the region. He showed me his blog which makes interesting and revelatory reading, especially when comparing the advances in the West to the issues in less developed countries.

Blog – Greenshoots Foundation – Dr Ed Wilkins

This is after 27 years of being an NHS consultant, he has retired to work in environments that would tax people half his age and he seems to be having a time of his life. Very inspiring.

I had a new drug prescription made before I went for phlebotomy, where the queue was 40 deep until 10 were called off to be fed to vampires in another consulting room, the waiting time was close to 60 minutes. When I did have 6 vials drawn, I returned home and went to bed. Until September comes.

Keeping my blood pressure normal

Will Uber help my blood pressure?

My biannual check-up came up again yesterday, and it is interesting that much as the same things happen, each episode is a story in its own right. First, I needed to ensure my hospital card and medical journal where I record significant milestones were in my pocket and for a 10:00 AM, the job of getting there had to go to Uber.

Much as I gave myself enough time, the Uber driver not only took a circulatory route to the hospital, I was again afraid that by the time I had my blood pressure taken before seeing the consultant, it would be reading at levels brought on by anxiety as in the case of my last two visits. Literally, through the ride, he was chatting on his handsfree phone as I sat beside him, not an activity that prepares you for a high rating.

In any case, I kept calm, arrived with 7 minutes to spare before my scheduled appointment and sat in the waiting area expecting to be called to take a few measurements of my height; as if that would change, my weight; which does change frequently and my blood pressure; which read within the normal scales.

The nurse who tended to me was a slightly older man who I was seeing for the first time, he had made a career transition from a driving instructor to nursing, quite unusual but interesting.

The bloody tales are good

When the consultant called me in, she who had taken over the department from the consultant who retired last year and was involved in some charity work in Myanmar, I reckoned we had not seen each other for about 18 months. When we first met, I had done my research about her, seen most of her recent seminar and conference presentations and determined how she had come about her foreign name.

In her consulting room was a quiet student doctor that I tried to involve and engage in the conversation. I am freely aggregable to having students sit in on my consultations, considering others allowed that for the expertise and treatments I now enjoy.

We started with the pleasantries before reading the runes of my bloods, the tests were done six months before, the counts good, the loads good too, then kidney, liver and cardiovascular functions looking good too. That niggling issue with Vitamin B12 and folic acid deficiency anaemia was still there, improved, but not yet the acceptable region.

All the jokes about how folic acid helps my maternal tissue along with returning to be served by the Bra Advisor at Marks and Spencer’s seemed to flow in the conversation to initial confusion and consequent laughter. We scheduled in a facility to get my full results electronically and apart from doing the blood yesterday, I also got the kit for bloods for my next appointment.

Besides that, there were questions about my love life and sex life, the former is non-existent whilst I search for someone and the latter, we all have needs.

A change of pills after 8 years is possible

During that discussion, we reviewed the situation with my HAND test which I had last year and the possibility that the drug regimen I have been on since May 2010 might have some contributory factors. New drugs also have become mainstream and there was a need to begin to consider switching to the newer drug therapies.

Whilst I have resisted the switch to generics, I was willing to review the options if provided with the information. I was given three options to research and we would select a course in three months’ time.

I was 12^th in the queue at the phlebotomists’ when on going in, I was told the computers were down and that I needed to return to the clinic to get a printout of the bloods to be taken.

More to the vials and the colours

It was there that I learnt from the nurse who tended to me earlier that the colour coding on the blood vials was pertaining to the kinds of additives or reagents that were added to the blood for testing purposes.

Certain reagents clotted the blood, others thinned it, then colouration and other reactions with the blood helped in the test selection for each sample of blood taken along with the timeframe within which the blood must be tested. If you need to know, I have provided a few links for you to review. [Geeky Medics – Blood Bottles Guide] [KCH Vacuette® Selection Chart – PDF] [UHB – Clinical Microbiology Tests]

In some ways. I am surprised that I was never that curious about what those colour codings meant, I was more concerned about the number of vials being drawn to sate the thirst of the vampires’ convention.

I returned to have my blood taken, picked up my 3-month prescription and that was my appointment done until I get an email for my results and possibly a letter from my General Practitioner (GP), that is what we call family doctors here to visit for a booster injection for Vitamin B12.

Pricked for new life stories

Acting on my mentality

Generally, I should make a mental note of when my next hospital appointment is. In fact, not only should I have made that note, I must prepare for it. My next appointment is in the third week of February.

Now, it is best to visit the phlebotomist two weeks prior to my appointment, ensuring the consultant gets to discuss the results of my blood tests at our meeting. It goes without saying that my mental note for my last appointment did not yield the appropriate action, when I finally found out, the appointment had passed, I was recalled for a new appointment, failing which I would have been taken off the patient list.

Lacking in some mentality

The lack of preparation for my last appointment meant we had no opportunity to discuss my blood work since it was done on the same day of my visit. I was to write to my consultant two weeks later to discuss the results, but the year crowded itself out on me. It can wait.

I chose today to visit the phlebotomist, got out the urine sample container and found myself turning the house upside-down looking for my blood card which lists the tests to be conducted and hence the number of vials of blood to be drawn.

All night, I wondered and disputed within myself as to what I might have done with that slip of paper until it occurred to me that the whole process had been computerised and my consultant had not really given me a blood card. He told me then, six months ago, I didn't need one, it was all on computer now. Phew!

Eschewing a wrong mentality

I was picked up by an Ethiopian Uber cab driver and as we talked about sickness, health, religion and abuse, he informed me of an Orthodox faith healer of whom he had observed healing miracles and as I made to step out of the cab at the hospital I was advised to consult the healer and forget these hospital visits.

I have been there before, I almost died trying all avenues to receive a miracle before I decided on the miracle of medicine. The process of unschooling ourselves from the carbuncles of cultural, traditional and religious errors of reason and living continues daily. Some things we know within ourselves are better left unsaid when entreated to channel our energies down a certain path.

Having the right mentality

The blood room was full, I picked a ticket numbered 61 when then tally display read 19, it was not as long a wait as I thought it would be. When I introduced myself to the phlebotomist, the computer did not have the detail gathered on one screen, she looped through screens until 7 vials were gathered in the dish. Another vampires’ convention, I quipped.

The blood was drawn in short order and soon I was out and back on my way home. In two weeks, another story of life would be told from the voice of the bloods.