It started with a piss

Part 1: Tom Pudding and the Todgercam™ Affair

Tom Pudding, Going Postal
Diagram showing a cystoscopy for a male
Cancer Research UK [CC BY-SA 4.0], via Wikimedia Commons
I don’t know why, but for me medical problems always seem to occur at the most inconvenient times possible, usually on a Saturday evening. And so it was one Saturday in late October 2019 when I first noticed that my usual pathetic dribble of pee was not its normal straw colour but a turbid, deep orange. ‘Funny,’ I remarked in my best Pete and Dud voice, maybe I hadn’t been drinking enough liquids and was dehydrated? That can cause dark-coloured urine, can’t it? Yes, that must be the explanation. Phew!

My relief was short lived however as the next time I went for a pee it was dark brown and cloudy and I had a dull ache across my lower back and in the front of my chest just below the ribs. Oh, bugger. I filled a glass container with my urine intending to show it to my GP the following Monday and then spent an uncomfortable night in bed due to the pain in my back which paracetamol did little to alleviate.

By Sunday morning the liquid in the jar had separated into a dark brown sediment comprising what looked to be very fine grains of grit topped by a clear and slightly yellow liquid. ‘I bet ‘I’ve passed a kidney stone,’ thought I, ‘that would explain the back pain.’ By Sunday afternoon the pain had gone and everything was back to ‘normal’ so once again there was no need to bother my busy GP, was there?

Then it happened again the following weekend; dark but not so spectacularly coloured urine but with far more back pain to the extent that I hardly slept at all. This time I did telephone the health centre on the Monday morning and after the call back by a nurse-practitioner I was asked to attend the surgery later that morning. The nurse did the usual tests, asked lots of questions and decided that I had more than likely passed kidney stones that had scratched the linings of my ureters and urethra as they made their way out of my body and that this would account for the back pain, the burning sensation in the todger and the traces of blood that she had detected in the urine sample that I provided. A blood sample was also taken and submitted for analysis.

Two days later my GP telephoned and asked me to call at the surgery to provide another urine sample then, a couple of days later he rang to say that he was referring me to the urology department of our local hospital for further tests as the second urine sample had also contained blood. A letter duly arrived from the hospital a few days later and in early November I presented myself at the day surgery unit for a flexible cystoscopy preceded by an ultrasound scan of my kidneys and bladder.

This is when the fun really started.

An ultrasound scan or ‘sonogram’ is a non-invasive procedure in which a scanning device linked to a computer and monitor is moved over the surface of the body to provide a picture of what lies beneath, its most commonly known use being the scanning of the unborn foetus in pregnant women. To my relief, I wasn’t pregnant but the scan did show a 5mm stone in my left kidney. Far more alarming though was the way the technician casually remarked, ‘You do know you have an abdominal aortic aneurysm, don’t you?’ Well no, I bloody well didn’t and it came as one hell of a shock as I know just how dangerous this potentially fatal condition can be if left untreated. My paternal uncle had had surgery to repair an aneurysm some years ago and they tend to run in families.

Stunned by this revelation I nervously made my way to day surgery for the ‘Todgercam’™ investigation. First of all, a nurse spent about half an hour asking general health questions and explaining the procedure to me. In essence a small camera is inserted into the bladder via the urethra and manipulated so that the surgeon can examine its interior surfaces in detailed close-up for signs of disease such as cancerous growths, bleeding or the presence of stones.

Prior to this procedure, having three attractive young women skilfully manipulating my wedding tackle had been high on my bucket list of desirable fetishes but thankfully Little Tom behaved himself impeccably, so much so that I commented to the doctor that on this occasion she would be perfectly justified in saying ‘Just a little prick’ rather than the now obligatory euphemistic reference to a ‘small scratch.’ I think I detected a smile.

I make no bones about admitting to having a marked aversion to medical procedures and my record to date includes fainting during two angiograms and waking up in the dentist’s chair prior to an extraction with the poor man sitting astride me hammering at my chest in panic to the rhythm of ‘Staying Alive.’ My greatest claim to dickheadery though came when I accompanied my wife to a pre-operation briefing prior to her knee replacement surgery and I had to be escorted from the meeting room by a nurse when they said it would be done under local anaesthetic. Shudder! Hard to believe that I spent a considerable part of my working life on meat inspection duties in abattoirs isn’t it?

To my surprise, the Todgercam™ experience wasn’t anywhere near as bad as I’d feared, it was more uncomfortable than painful, and I remained conscious throughout and was even able to watch the proceedings on the monitor over the bed. First they inject a syringe full of anaesthetic lubricating gel down the Jap’s eye and then smear some onto the camera before pushing it through the penis and prostate and into the bladder. They then inflate the bladder with sterile fluid so that they can examine its internal surface while manipulating the camera. Here I learned that a) my prostate is a normal size (Huzzah!), b) my bladder is diverticulated i.e. there are two quite large pockets in the side walls that significantly increase its capacity, and c) there is nothing nasty inside my bladder such as stones, growths or bleeding. Then, after inserting a gloved and well lubricated digit up my fundament, the doctor was able to confirm that both sides of my prostate were normal sized. Being told that I had prostate cancer was, naturally, my greatest fear.

Before I left the hospital I was asked to call at the CT Department and make an appointment to have an abdominal scan.

The following morning I felt a bit tired but as it was a lovely day Mrs Pudding and I decided to walk into the village, something like a two mile round trip, to get some air and much needed exercise. Getting back home was a bit of a struggle though as I felt absolutely knackered by the exertion.

‘That will be reaction to all the stress of yesterday,’ commented Mrs P sagely.

Back home we had a light lunch and then I suddenly started to feel cold. Well, feeling cold is the understatement of the year as I was absolutely freezing to the extent where my teeth were chattering and I was shaking violently and uncontrollably, a condition known technically as a rigor. My hands went white, my fingertips were completely devoid of feeling and I was also vomiting profusely. Mrs P put the heating on, then the gas fire and covered me with a blanket before dialling 999 and requesting an ambulance.

Within 15 minutes the first paramedic arrived, took one look at me and told Mrs P to turn the heating and gas fire off and to strip me of as much clothing as possible. My blood pressure was low, my pulse was weak and I had a temperature of 41oC as opposed to the normal 37o of a healthy person. A cannula was inserted into the back of my hand and intra-venous fluids were administered while we waited for the ambulance to arrive. I was then rushed to hospital with lights flashing and siren blaring being bounced and rattled about to such an extent that they had to administer an anti-emetic to stop me from spewing all over the vehicle. Never having been in an ambulance before, I was expecting a smooth, cushioned and cosseted ride not the rattling, bone jarring ordeal it turned into. At least now I have some understanding of the extent to which the Somme casualties must have suffered during their evacuation from the front in July 1916. It can’t have been much worse.

At the hospital it was a case of waiting my turn for what seemed an inordinately long time in the corridor along with all the other emergency admissions as the doctors and nurses were being run off their feet on what was proving to be an exceptionally busy day for them.

Eventually it was decided that I had sepsis from the previous day’s procedure and should be admitted to a surgical ward on the grounds that as surgical had caused the problem, they could bloody well sort it out. Here I should say that the hospital had not given me an infection as I already had a urinary tract infection when I went in for the Todgercam™, I can only presume that they must have ‘stirred it about a bit’ thereby causing it to flare up.

During my four day stay in hospital I was catheterised (badly) by a male nurse who secured the tube to my thigh such that it pulled agonisingly whenever I tried to sit down. When I dropped the soap in the shower I was unable to squat to retrieve it and buggered my back bending from the waist to pick it up. I was pumped full of antibiotics, intravenous fluids and paracetamol to reduce my temperature and stabilise my blood pressure and was monitored at hourly intervals night and day.

The nurses were for the most part wonderful; kind and caring with only one, an Eastern European I think, who was brusque to the point of rudeness and unwillingly to engage even in casual conversation. One young Chinese nurse who was on an Open University apprenticeship scheme in partnership with the hospital was by contrast incredibly kind and attentive and it was she who noticed that my catheter had been incorrectly fixed and immediately re-dressed it thereby easing my discomfort and earning my eternal gratitude. Surprisingly, the hospital food was quite excellent and was ordered each day by the patients themselves using their bedside monitor touch screens.

One morning I had a surprise visit from a senior vascular consultant. She had called our home phone to talk to me about my aneurysm (referred to by the medics as a ‘Triple A’) and when my wife told her that I was in the hospital she said that she would go and find me, hence her appearance at my bedside. This delightful lady spent a good half hour sitting on my bed explaining my condition and even drawing diagrams to help me understand the surgical options and what risks and benefits the alternatives involved. She did tell me that my aneurysm or bulge in the aorta was ‘large’ but that until I’d had a CT scan she couldn’t give any specific dimensions.

When I mentioned that I’d already booked a CT (Computerised Tomography) scan for two weeks hence the consultant said that as I was already there, she would see if she could ‘pull some strings’ and get it done that day, and so it was that later that afternoon I and my bag of bright red urine were wheeled down to the CT unit for the scan.

Never having had a scan before, I was naturally a bit anxious about what it involved but I needn’t have worried as it all proved very straightforward. The scanner is a large circular device like a huge doughnut mounted vertically on its edge through which the patient is passed backwards and forwards on a moving bed with the machine telling you when to take a deep breath and when to exhale during the scan. At one stage, a contrast dye was injected into my bloodstream which made my face feel flushed for a few seconds.

A mate who had had his Triple A repaired when it reached 55mm diameter after five years of monitoring was surprised when I told him that mine already measured 63mm (30mm is normal) commenting that I was ‘bloody lucky’ that they had found it during the ultrasound scan for kidney stones. Apparently, most aortic aneurysms are found almost by accident during tests for other conditions as they are mostly symptom free.

Before I was discharged, the urinary consultant had asked me if all was well with my urinary pressure.

‘Not really,’ I replied, ’I have to adopt the squeeze and squirt technique to build up sufficient pressure and when I’ve finished I never feel as though I’ve fully emptied my bladder.’

‘I can fix that for you,’ he said. ‘You have a benign condition of the prostate where the ring of muscle around the urethra restricts the flow of urine. I’ll prescribe you a tablet (Tamsulosin) that will relax the muscle and restore your pressure. I’ll have you peeing like a teenager again in no time. However,’ he continued, ‘there are some potential side-effects. Some men lose interest in intercourse and some, instead of ejaculating normally, will ejaculate into their bladder instead of out through the penis. This is completely harmless and doesn’t affect sexual enjoyment.’ Oh, joy! I never knew that getting old could be so much fun.

As a result of the new medication, which worked like magic, I am happy to confide that while I am now available to take on all comers in peeing contests, I am nevertheless reminded that:

There was a young fellow from Kent,
Whose knob was incredibly bent.
To make up for this trouble,
He shoved it up double,
But instead of him coming, he went.

So, with the urinary tract infection sorted and my bowels now back to normal post-antibiotics, I am currently awaiting a pre-admission assessment to gauge my suitability for general anaesthesia. This will involve a 15 minute session on an exercise bike and I’m hoping that, all being well, they will then give me a date for the operation and tell me whether the repair will involve a stent inserted via arteries in the groin or major abdominal surgery. Fingers crossed!

Before concluding, the important lessons that all gentleman puffins of a certain age can learn from my experiences are that:
1. Abdominal aortic aneurysms are life-threatening. If they burst, eight out of ten patients will die before they reach hospital.
2. As they are for the most part symptomless, most Triple As are found purely by chance during examinations for other, unrelated conditions – urinary tract infection in my case.
3. Triple As tend to run in families and are more common in males than in females so if any of your male relatives has had one, make sure that you have a scan and encourage your sons and brothers to do the same as your and their chances of having one increase fourfold.
4. All UK males on reaching the age of 65 are eligible for a free ultrasound scan for a Triple A on the NHS and should automatically receive an invitation to attend a screening clinic. I am prepared to admit, to my eternal shame, that I received my letter about six months ago (six years late) but that I did nothing about it as the hospital was ‘too far away’ (30 miles). What a plonker!
5. Here’s a link to the NHS Triple A screening page: Abdominal Aortic Aneurysm screening If you are 65 or over and have never been screened then please have a look.

At the moment I am trying my best to be philosophical and to put on a brave face about the whole business for the benefit of my nearest and dearest. Yes, I am very lucky that my aneurysm has been detected so that it can be fixed before it ruptures and kills me. The problem is that in the meantime I can’t help feeling a bit fragile, somewhat vulnerable and more than a little nervous.

Anyway, assuming all goes well, I’ll bring you up to date with my progress in a few weeks time in a further action-packed instalment.

© Tom Pudding 2019

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