Being ill abroad - part 3

 When I had returned to my room there was another patient in there in the other bed, and a woman sitting on the sofa the other side of the room, Turned out it was her son who had appendix problems, and was awaiting surgery. I had been told to fast after 08.00, and by 19.00 I was feeling very hungry, and, though I had some water with me, had not even been given anything to drink. An orderly came in with a small jug of slightly yellow liquid with a straw in it, but told me it was very hot and I should allow it to cool - it tasted rather like hot water with lemon in it, and soon after I was brought some food. It was a chicken "soup" with vegetables and a chicken thigh in it, but only a spoon to eat it with - and was delicious, and very welcome!! I also got a visitor!! A friend here, who is a vet and married to a British lady, popped in - he works in the city, and brought a "get well" card drawn by his two young sons, and that was very nice!

The surgeon came to see me shortly afterwards and said he would come in the morning and discharge me if everything continued to look OK. During the night a nurse came in several times and checked blood pressure, temperature and so on, for both of us, and the father of the other young man had replaced the mother, and spent the night on the sofa! I didn't get much sleep, partly due to the discomfort of my shoulder, but also it was quite noisy in the corridor outside, so was really looking forwards to being discharged so I could go home! Breakfast was - well, I am not actually sure what it was. It was a very thin, runny porridge-like concoction, served in a mug, that had a slightly medicinal taste - but I was too hungry to really care that much.

The surgeon appeared, as promised, and gave me the all-clear to go home, and then showed me the amount I owed on his phone, so I had the strange experience of paying the surgeon in cash from my hospital bed! A short while later a nurse appeared with a trolley doing the morning rounds. She was dressed in a protective overall, which also covered her head, and had a mask and facial shield as well as gloves, but, very surprisingly, she did not change the gloves after tending to the other patient first, and then removing my cannula!! 

I was then allowed to get dressed and leave, but was given a prescription for antibiotics and pain relief (opiates!) and had to take my samples, which were in two flasks by my bed, downstairs to the lab for the biopsy! I had to pay for the biopsy, and was told I could collect the results the following week, and then waited by the pharmacy to collect my prescription. It was closed, but I was told they would be back in a few minutes, though after waiting for 40 decided to get my meds elsewhere. I was exhausted by the time I finally got home.

I was told that I should keep the dressing dry, so washing became a bit of a chore, especially hair washing, but fortunately the wound did not get infected - something the surgeon was concerned about due to my age and diabetes - and he changed the dressing after three days, for a smaller one, which did make life a little easier!

As soon as I got the biopsy results, which indicated that Chip, was indeed a benign lipoma, and nothing sinister, I emailed them to the surgeon, and he arranged an MRI scan for me, and the day before I had an appointment for him to remove the stitches, replacing the heavy dressing with a strip of tape.

This fell off after a couple of days revealing the scar!

The day of the MRI I had to fast for 8 hours prior to the 20.20 scan, so no food after midday, and I knew that it would probably be after 22.00 before my next meal - in fact it was 22.30 - so I was starving by the time I got back home and bought in a takeaway! The scan itself was OK, though the noise inside the MRI scanner almost drove me nuts! They stuffed some cotton-wool in my ears, but it just seemed interminable, though probably no more than 40 minutes in total, and I was eventually allowed to go home. I could have waited 40 minutes for my "plates" (X-ray type images) or collect them on Monday (this was Saturday), and they would email (or rather WhatsApp!) the "report" to me on Monday as well. I opted for returning on Monday as I was frazzled and so hungry by then.

After collecting my results the following Monday I forwarded the report to the surgeon, and expected him to ask me to bring in the images (and CD they had also provided). The MRI had also confirmed that Chip was a Lipoma, but called it a Fibrolipoma, a fibrous lipoma, which is hard (a lipoma being fatty is usually soft and pliable), and they also confirmed it was non-malignant. Instead of being asked to see him he arranged an appointment with a surgical oncologist, his professor, and I had to take the results along to him.

He took some notes, looked at the biopsy report, examined Chip, muttering about how hard it was, and how big it was, and then looked carefully at all 8 of the images (each one is a series of about 40 smaller images) - I had shown him the report on my phone as I did not receive a hard copy - and said he thought we might need another biopsy, as he was not convinced it was a lipoma! He said from the images it was very close to my ribcage at the back, and looked as though it was attached to, or underneath, my shoulder-blade, but that he would refer me to the Neoplastic (abnormal cell growth, including tumours and cancer) hospital for further investigation!!

5 days later I got my appointment for 09.00, armed with my biopsy and MRI results, and  I arrived more than 30 minutes early. I was directed to "admissions" and to the "new registrations" counter, where I was asked for "copies" of my paperwork! No-one had told me I needed copies, and do not have the facility at home to make them anyway, but they sent me away to get some done - informing me that one of the "security" guards would show me where to go. This turned out to be a pharmacy outside the gates, and across the Pan-American Highway, and they could "copy" but not "print" - the MRI report was on my phone! So at least I got a copy of the biopsy report, but they suggested I go back up to the roundabout a couple of hundred metres away, and maybe one of the businesses there could print my report - I would have to send it to them by WhatsApp and they could then print it!!

I was starting to panic as my appointment time had passed, so tried contacting both the referring surgeon, and the person I was supposed to meet, while trying to get someone to print my report, with no success!

Both surgeons responded quickly, and both said that the printed reports were not necessary as they could do it later! So back I went to the hospital, and security on the gate were waiting for me - and directed me to a different entrance, where my name was called and I was give a "pre-appointment" ticket and sent back to admissions! The first thing the desk asked was for my copies, so I explained the situation and showed them the messages with the two surgeons, and the receptionist then told me I could send the MRI report to the hospital WhatsApp number and she could print it!! Why couldn't they have done this in the first place??

While waiting for this to go through a doctor in scrubs appeared and addressed me by name, but reception told him I had to be processed first so he wandered off again! I was given a ticket I had to take to the cashier, in another building, and pay for the consult, then return to admissions, and was given a numbered ticket for my appointment. Apparently the 9.00 original time was not an actual appointment time, but a registration time - once processed patients are seen on a first-come-first-served basis - so I had to return to the same area the cashier was in and take a seat and wait to be called. I was number 15, but had no way of knowing how many were still ahead of me, as they called people by name, not number, so I just had to wait patiently - for what turned out to be over three hours!

When my name was finally called the lady surgeon (another surgical oncologist) asked me some historical questions (family history, previous medical history, etc.) then took a look at Chip. Again surprise was expressed at size and hardness (of Chip!!) and then she looked at 2 of the images briefly, before declaring that she was sceptical that it was a lipoma, or that it was benign, and that I needed another biopsy! She handed me three pieces of paper and told me I had to take them to the cashier, then collect some "supplies" from the pharmacy (there is one on the hospital) and then return.

The cashier told me I needed to take one to the pharmacy, but I paid for the other two, and then went to the pharmacy with the "prescription" for the biopsy supplies - it is quite normal here for you to have to provide the equipment needed for the surgery, like needles, scalpel blades, and even Lidocaine - and they produced a typed "bill" which I had to take back to the cashier to pay, before collecting the goods!

Back to the consulting rooms and a brief wait before a nurse came out, took the bag of supplies, and then led me into another consulting room, where the surgeon appeared and performed the biopsy. It was pretty straightforward, and painless, and in 10 days I have to go back for the results, and the circus will commence again!

Being ill abroad - part 2

 I should have followed this up sooner, but very little happened over the next 14 months! I struggled to get my blood sugars down while in Peru, and it was consult, more pills, blood test, consult more pills, and so on, with the biopsy not happening, so eventually I asked outright whether they thought it was malignant or cancerous, and though they wouldn't commit themselves, they did say it was "unlikely" at this stage - so I decided to leave it, as it was not causing too much bother at this stage.

Chip March 2019

Returning to Brazil September 2019 I decided to see if I could get it looked at, as by then it did appear to still be growing, and I decided to give "it" a name - so Chip was christened - "Chip on the shoulder", get it? The dentist in the little town I live in in Brazil rents out a consulting room to various medical professionals, and one was an Osteopath, so I booked an appointment, and he took a cursory look and said I needed a biopsy!!! He recommended a hospital in Salvador, some 400 kms away, but when I contacted them they told me they only dealt with SUS (Brazilian Health Service) patients. A friend suggested I contact a Day clinic in the next town, some 70 kms away, as they might be able to help, or at least suggest a viable alternative, so I made an appointment, and after a short wait was ushered into a doctor's consulting room. I explained that I had tried to get a biopsy done in Peru, but they were concerned about my sugar levels (which were still considered "too high"), but he asked me some health questions and agreed to do the biopsy himself - later that day!!

I had to wait a month for the results to come back from Salvador and went to see the doctor again, and the report (not that detailed) said it was a benign lipoma. He told me that he could not do the removal surgery there, and that there were no hospitals nearby that could either, so I would have to get it done in Salvador, the city 400 kms away, but that if Chip was not really bothering me then maybe I should leave it alone for now.

Chip March 2020

March 2020, biopsy scar visible

By the time I was due to return to Peru in March 2020, Chip was still growing and beginning to cause more discomfort. The "lump" itself was not painful, but was exerting pressure on surrounding muscles and nerves, and causing occasional pain in my right arm, but mostly was making it difficult to sleep comfortably. The place I stay in Peru is close to a very large city, with excellent medical facilities, so I resolved to get Chip treated properly upon my return.

Unfortunately 4 days after my arrival in Peru the Coronavirus pandemic caused a State of Emergency to be declared, and Peru went on lockdown! That meant that people were only allowed out for essential shopping, non-urgent operations were cancelled, and many clinics and hospitals refused to attend to high risk patients, and due to my age and diabetes I was one of those! So that meant I just had to try and sit things out, but Chip kept on growing!

May 12, 2020

Chip also starting becoming more painful - I couldn't carry my shopping in a backpack using my right shoulder, and even just walking at times resulted in pain down my right arm, and sleeping became much more difficult. I contacted some hospitals but unless it was cancer, they didn't want to know, and with the country still under the State of Emergency international borders were closed so I couldn't even return to the UK for treatment there!

August 13, 2020

Towards the end of September, when I should have been leaving Peru, some of the controls here had been relaxed, and some friends here found a surgeon who was prepared to consider surgery, so sent him the picture above. I had an online consult with him, and he sent me for blood tests, which returned incredibly high results, so much so that he immediately referred me to another doctor (a specialist in internal medicine), further blood tests, another online consult, and being prescribed insulin and other meds to bring my sugar levels down. I was also tested for liver, kidney and heart functions, as the sugar levels were high enough to cause further complications (they were all fine!). 

September 22, 2020

Throughout all this Chip continued to grow, and continued causing me problems, and the costs were mounting up! Public transport does not run into the centre of Trujillo, so I was having to use taxis to go for tests, and usually that meant a second trip the same day to collect the results! Eventually my blood sugar levels were low enough for the surgeon to consider surgery, but I needed a "surgical risk assessment" from the other doctor, requiring a "face-to-face" consult, and a whole raft of additional tests, which fortunately could be done at the clinic where he worked, though the blood work had to wait until the next day as had to be done "fasting" - no food for 8 hours - and then I had to wait a few days for a follow-up consult!!

I passed the assessment, though on the day of the blood tests my sugar levels were the highest they had been for days, and 30% higher than my own finger-prick test taken just 40 minutes before the full blood work! I then had my first face-to-face consult with the surgeon, so for the first time he actually "met" Chip, and was rather surprised at how "solid" it was. A lipoma is fatty tissue, so should be fairly squishy, but Chip is rather hard, and he voiced concerns that maybe it was not a Lipoma but something more sinister! He still agreed to attempt the surgery and it was scheduled for 4 days away, at yet another clinic! But first I needed a negative rapid Covid test!! I found out that the "rapid" test here takes 24 hours!

The following Monday I checked into the clinic and was shown to a room with two beds where I could undress, and put on a gown (with broken ties so I could not fasten it closed), and wait to be taken to surgery. I had to wear a mask all the time, and the staff all had masks and face shields, as well as vinyl gloves, but what surprised me was that I was placed on a gurney (hospital stretcher) and covered with sheets and a blanket, and taken up to surgical reception, where they transferred me onto another gurney, where I was covered with different sheets and blanket - but a patient waiting to be returned from surgery was then transferred onto my recently vacated gurney, covered with the same sheets they had used for me, and taken away!!

The surgery was to be done under local anaesthetic, and I was wheeled into surgery and they started work on my shoulder, but after about an hour the surgeon said that they could not remove Chip, as he was extremely solid, and appeared to have a blood supply, so possibly was a Liposarcoma, which is a cancerous tumour! But they had taken samples for biopsy and this would confirm things, so I was returned to the ward/bedroom, and kept in overnight!