Cancer Update: Third Quarterly Check
Posted by Andrew | Filed under Cancer Diary, General, Gripes, Living in Korea
Things seem to be proceeding in a satisfactory fashion… but once I sat down and started writing, this blog suddenly became unexpectedly long!
After visiting Daegu again last Tuesday, I made sure to text Professor Kim on the Friday morning reminding him about letting me know the results as soon as possible – and reminded him again by text the following Monday morning (just in case, you understand). He very kindly obliged a short while later with his usual reassuring “nothing to worry about” response.
However, as if a mere text message (from the Male Professor Kim) were not enough, his locum last Tuesday, (the female) Professor Kim actually called me yesterday (Tuesday) lunch time to pass on the news. Which surprised me, firstly because I tend to receive very few calls on my cell phone at any time, and secondly precisely because of that exact time, as it would otherwise (probably) be one of those annoying advertorial-type robotised calls from the phone service provider (in this case, LG), which has been a regular irritation ever since I first signed up with them. Unfortunately I have (after fifteen long years here) still not learned enough Korean to understand what their automated calls are actually about, so they remain a noisy, jangling and rather pointless mystery. I realise that this is Korea (where English is not the native language), but surely, by now, there is a sufficient quorum of native English speakers to justify at least a minimal English language service?
We might now ask the question: where to from here on? As this is the third of four quarterly blood tests, the last will be in February and will include a (hopefully final) CT scan to give a visualisation of any otherwise undetected neoplasms. Not sure right now how frequently after that it will be necessary to keep checking, but rest assured that despite a constant feeling of tiredness (due to having to hit the bathroom several times each night), I am feeling well, with only the odd twinge of still-unsettled fatty tissues resulting from the operation itself to remind me that it ever happened… and starting to think about what I will be doing next year.
Looking back over the previous twelve or thirteen months, the remarkable thing has been how painless the detection, treatment, removal and convalescence have been in the course of all this. Using the robot for a laparoscopic procedure avoided a lot of the tissue damage that would have resulted from a more conventional (i.e. open) abdominal technique, and hence faster recovery and much less post-operative pain. There is no doubt in my mind, however, that I would have been much happier remaining in my previous job than having to find and secure a new one. This would have made the immediate post-operative period much less stressful – not to mention less expensive.
Something does need to be said, however, about the reactions of other people to the process, as my rapid recovery may have made them think that everything was normal. I assure you that this is not the case; although I may appear to be walking around in my typical manner, it is simply not possible to lose a foot of irreplaceable large intestine and not experience adverse effects. That part of the body is largely responsible for the removal of water from your solid wastes (as digestion is largely focused in the stomach and small intestine), and removing it compromises this function. This means that you need some kind of pharmaceutical intervention – the Lopmin capsules – to slow down the natural process of peristalsis and increase the residence time of food in the gut, thereby allowing it to remove water to a more normal consistency of stools. Alas, perhaps, my gut seems to be quite sensitive to Lopmin and the result of this is that I have made a habit of coming off the treatment temporarily at weekends to allow it all to pass out, as even the most minimal daily quantity still seems to be slightly too much, resulting in a regular ‘plug’ of drier material which is difficult to void at first. Having said that, the feeling afterwards is wonderful, but you do start to feel somewhat bloated by the mid-week…
Part of the reason for this is that the differing lumen diameters at the two joined ends make voiding (and retention) more difficult than they were originally. The part of the gut removed was that which (under normal circumstances) is perhaps less involved with desiccation and more with storage prior to voiding. This meant that semi-liquid digested food would otherwise be difficult to contain until at least some of the storage function could be restored – but to achieve that, the narrow lumen in the upper part of the anastomosis (the point where the upper and lower ends were joined) has to expand sufficiently, and the simplest way to achieve that, it seems, is to relax the smooth muscle in the gut wall so that the wall itself can expand to accomodate what needs to be, er, retained. It is no exaggeration to say that without Lopmin, retention would be impossible and I would always have to be a short dash from the nearest rest room; I kid you not. So that bloated feeling does at least give some reassurance that you are not going to shed a stinky load in a public place at five seconds’ notice, which was much how it was immediately after the operation. For this reason, I am also hanging on to my small supply of adult diapers…
All of which has meant that another regime of health management has had to be incorporated into my lifestyle. It is not hugely taxing, as in reality it amounts to little more than acquiring a few additional minor habits, but one’s social life is affected by all of this, and diet also. For example, I would not wish to be out every Friday or Saturday night because nowadays I am using this time to allow the release of several days’ stools, meaning that I have to stay at home for convenience; likewise, it is not a good idea to eat too much because what goes down must, eventually, come out, and one may become rather bloated by midweek without some attention to what one is eating. Finally, it is worth remembering that there is something of a moratorium on alcohol consumption with a view to avoiding the retardation of the healing process, at least for the first post-operative year.
The impression has come upon me that my apparent wellness has demonstrably been misleading to onlookers, who think that I am fully recovered and able to resume everything one hundred per cent. right now, but this is far from the truth. For example, I have been told that it would be helpful to lose weight, and I cannot do this if people constantly insist on offering me food. Sugar in particular is known as the primary fuel of cancer, and it has been proving difficult to transition to a more suitably ketogenic diet; the environment here does not seem to support it – indeed, from a sugar-avoidance point of view, Korea is getting worse due to a rise in the presence of franchised, Westernised-style restaurants, coffee shops and other places like the Paris Baguette and Tous les Jours-style bakeries. Professor Kim’s original admonition to avoid carbohydrate and err towards more animal protein has one unfortunate aspect, in that it requires spending more on food at a time when my salary is being squeezed by things like paying for my own accommodation, and repayment of the operation (and other associated) costs. Whic I think is also slowly tapping this job on the head!
At work, the offerings at the restaurants are essentially for younger people who need a lot of energy for their daily exercise, and hence there is a lot of carbohydrate available in the form mainly of rice. I am not saying that there is anything bad about the rice, as it makes the other food easier to eat, but it is a kind of food to avoid most of the time if a recurrence of the cancer is to be avoided, for reasons which have been discussed here previously. Anything alcoholic (other than, say, wine) necessarily tends to have associated sugar components if only to make the alcohol more palatable, so this should really be avoided, too. Even the beverages we have in our office are essentially laced with sugar and sweet creamers, as they come in sticks and the ones without sugar are virtually undrinkable. It is for this reason that I recently purchased a new coffee maker (as the old one was truly dying the death), as strong black coffee is actually a good thing – especially when you stagger out of bed of a weekday morning. Maintaining a low-carbohydrate diet is proving unexpectedly difficult, however.
All of which is making me think that a situation like last year would be much better – same style of employment, housing and diet – but that would mean losing this job and (probably) relocating to a new city, too. The bottom line, however, is that the expense of changing my diet (and other elements of lifestyle) would be far easier if I did not have to lose so much each month on renting my apartment, something which is almost unheard of among foreign English teachers in Korea. So we come to the run-up to Christmas this year with something of a quandary – stay in the current job and lose money on rent which would otherwise be helpful for my diet, or give it up and find something more suitable.
Decisions, decisions…
