'Flu and me

Since I had a significant amount of radiation to my oesophagus and trachea, neither of these are quite what they once were. Radiation results in scarring and so the usual functions of these very important little tubes are somewhat impaired. In particular, I predictably get acid reflux if I bend over too quickly after eating (and at random other times), coughing often turns into small vomits, and I get chest infections every time I have the 'flu. The first two are because my oesophagus is less effective at keeping things down in my stomach, but the third is because my trachea is less effective at keeping phlegm up in my sinuses (and my cough reflex kicks in too late - I don't cough when the stuff is running down the back of my throat, but then get persistent coughs for weeks afterwards).

I also get the impression that my immune system is not what it once was (or perhaps it is just being in a different (and colder) country), which means I manage to pick up every 'flu that comes around and they knock me out for longer. When combined with the failure of my body to keep fluid out of my lungs, the result is that I've probably taken more antibiotics for chest infections in the last few years than the rest of my life's antibiotic consumption put together.

As antibiotic overuse is a very serious global issue, I am aware that I don't wish to be part of the problem, yet doctors keep telling me that they have no hesitation in prescribing such drugs in my case. After the latest iteration of 'flu plus chest infection, from which I am currently recovering, I am now even eligible for the 'flu shot each year here in the UK along with other vulnerable people such as the elderly, pregnant women and those with heart or lung conditions.

Clear again, and a discussion of scans

Yesterday I went back to the Western General Hospital for another follow-up appointment. All was well. The doctor even checked my legs this time (with all the poking and prodding I receive each time, no one has thought to do that before).

We talked about the possibility of another CT scan and three arguments were suggested as to why it wouldn't really be a good idea. First, it is more or less unnecessary after a certain period of time (though the Australian doctors thought two years, here they think one), and any relapse is likely to be signalled through clinical signs anyway (e.g. loss of appetite, difficulty swallowing, coughing up or passing blood, weight loss, lumps and bumps, difficulty breathing, and so on). Second, since I have already received the maximum amount of radiation they are ever going to give me (lest they damage my spine),* each scan adds a little more radiation to this (only a fraction of what I received in treatment, but there's no point pushing it). Third, and this was the point he elaborated the most, he believed that the more scans you have, the more anxious you become, since scans pick up more than cancers, so that every little dot becomes a reason for worry.

There was, of course, a fourth reason which he didn't mention: cost. It would be interesting to know the extent to which this was a factor in his recommendation. I don't think that in principle this is an unreasonable consideration as I don't think we ought to do everything possible to keep people alive. It is possible to over-invest in health. However, I don't know enough about the NHS and the UK budget to make any kind of informed decision about the relative investment in health here in the UK.

Nonetheless, at the end of the discussion, he agreed to arrange a scan prior to my next appointment in three months in order to mark the two year milestone.

Every now and then I struck afresh by how surprising it is to be here: (a) alive and (b) in Edinburgh** doing a PhD. Praise God!
*I can't remember if I ever mentioned on this blog the strange sensation I got a few weeks after the end of radiotherapy. For many months, whenever I walked for more than 5 minutes, my feet would tingle. I told my oncologist about this and he told me to nod my head. Being taken off-guard by the apparent nonsequitur of the request, I complied, only to find I could generate the same tingling sensation just by moving my head. He explained that the radiotherapy had started to affect my spinal column and so when I stretched it (through walking, or just nodding my head), then I felt that strange sensation. It was a little off-putting at the time, but on reflection, it showed that they had indeed given me the maximum dose of radiation. Earlier, the radiologist had referred to the real possibility of burning a hole in my oesophagus if they gave me a little bit more than I had.
**The image is a picture of my college in Edinburgh (the neo-Gothic towers in the middle of the photo) during a greener part of the year.