Cancer Update: Third Quarterly Check

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…

Third Quarterly Check: November

Here we go again…

A brief(ish) mention of my overnight trip back to Daegu for the third quarterly blood sampling to check that I am still non-cancerous… and how time flies! After some confusion about exactly when my (ahem) employer was going to permit me to take a day off, I got permission for Tuesday (today) and so went to work yesterday morning with a sports bag (black, of course) packed with bed wear and a second set of everything, made my way by taxi to the local train station, and… had to wait two hours because I was too late for the 6:15 train to East Daegu Station. What a surprise. Not.

Some time later (over two hours later, in fact) I was finally able to board the waiting Mugunghwa [1] train and make my leisurely way to my destination. Alas! The arrival time was 10:40 p.m. and I had been out of bed at 6:00 a.m., so the evening was to pass by slowly with me trying not to drop off, as I first had to make my way to my now-customary doss close to the University Dental School (and I knew about this because I stayed there the first time I wentto Daegu, because the new apartment, just across the road, was standing vacant), then went to see if my favourite small watering-hole-cum-eaterie was still closed, as it had been the last time I was there…

Imagine my surprise to discover that it had actually changed ownership, and the new incumbent had installed a huge, stainless steel booze dispenser with taps for not only Guinness and Indica, but also Lindemann’s Kriek (cherry ale)! A customer could simply refill their glass at a rate of 340 won for each liquid ounce. But I stuck resolutely to a small amount of vodka and tonic, which cost a mere 4,000 won and did not appear to be the cheapest (because the cheapest vodkas available in Korea resemble battery acid all too closely…). This was used to wash down a small plate of cheesy potato fries with a hot chili sauce, after which I went back to my room, thinking that 12:30 a.m. was still a bit late considering that an early awakening was necessary (even on a day off work) due to having a 9:30 a.m. appointment.

Back to the room, picked up two cans of Somersby and drank part of one after a shower… and woke up in agony later that morning, having absent-mindedly allowed myself to have a quick stretch, and forgetting that this usually results in a painful Achilles tendon… I lay on the bed cursing in agony until the pain subsided, but thereafter was hobbling around (I can still feel it now that I am back home). Morning ablutions and packing completed, I handed the room key back and wandered out into the morning sunlight.

I made my way to the hospital via the subway and didn’t have long to wait before seeing “another” Professor Kim (female this time) and she asked me how things have been, and I responded that there seemed to be no problems other than occasional twinges from the robot’s entry wounds, and she said that this was normal. They also said that some time before the end of the first post-operative year, they would like me to a second CT scan, and of course, this immediately creates issues, as I have a job that I am expected to do and have to travel between towns each time there is a check-up, and the cost of this also adds up. So I will have to get back to my original Prof. Kim about that to arrange a time.

Interview concluded, I paid for my tests, got the receipt and went to the open phlebotomy parlour, waited my turn and put out my left arm for the attentions of Dracula (actually a young female phlebotomist). I had to strip off a number of items of clothing beforehand, as the November weather had been getting to me and I was now wearing an extra layer or two, then put them back on again a few minutes later. There must be a more efficient way of doing this!

Then I paid another visit to Jamie, my former manager, who was in attendance in her office down the road even though there were no lessons on a Tuesday, and gave her an update about how things were going in Jinju over a small cup of warm tangerine tea. The university buildings were very quiet, as usual, and our conversation was punctuated only by the brief presence of a maintenance technician (I would never refer to such a person as an ‘engineer’ like they do here) to reload the photocopier with a new toner cartridge, plus a small number of phone calls. Then I said goodbye, and returned to the subway to get back to East Daegu Station.

As luck would have it, there was a KTX going south and due to arrive in only a few minutes. The problem? The girl behind the ticket counter had quite a strong accent and I had difficulty hearing her over the counter, but we eventually understood each other and I grabbed my ticket and quickly made my way down to platform 7, and was soon on my way. Without even time to grab anything to eat or drink. But I got back to Jinju, grabbed a taxi home, picked up some more allergy pills on the way and made my way back to the apartment.

Anyway, I arrived back feeling rather tired – not a lot of sleep the last couple of days – but lessons are basically finished for the duration and much of what remains is merely paperwork, which will occupy the rest of my time this week. The second CT scan will have to wait until next month. Perhaps. Possibly. Maybe. We’ll see what happens – the results of the blood tests should be available soon.

1: “Mugunghwa” meaning, we are told, “Rose of Sharon”. Sounds a strange name for a flower for a country in East Asia, but who am I to comment?