Being ill abroad - Part 6 - endgame!

***GRAPHIC IMAGE ALERT*** There are some images of the wound post-surgery that may affect those of a sensitive nature. 

When I was in hospital for the biopsy I found out that things worked very differently in Peru. I kept being asked who my "familiar" (Spanish for relative) was, and I assumed they were just asking about next of kin - but it was much more than that. A relative has to be on call to run errands, collect meds, and so on - and many stay at the hospital all day in case they are needed! Twice a day the nurses/doctors check if you need more supplies and give this to the familiar to collect from the pharmacy (which could entail going into the centre of Trujillo)! I explained that I had no family in Peru, and was told that normally there are volunteers who can do these for patients, but due to the pandemic the volunteers could no longer enter the hospital, and the social workers (who had in fact collected things for me the previous stay) couldn't for long stays. In my case, too, as a foreigner who had to pay for everything, collecting meds from the pharmacy entailed going there with the prescription, getting it digitised, then going to the cashier (not at the same location) to pay, and then returning to the pharmacy to collect the items - if some were unavailable the relative also had to go out of the hospital to find the items elsewhere, and this was twice a day! The relative also is not allowed to come into the ward and see the patient due to Covid restrictions!

I was at a bit of a loss what to do, but a friend (from my volunteering days) told me she would be happy to do this for me - and then spent much of the next 9 days outside the ward waiting to be called upon by the ward staff! It was way more than I expected, and I realised I had a guardian angel - Carmen!

Carmen - my guardian angel. This is how you had to cover up - double mask and face shield - to enter the hospital grounds!

She assured me that she didn't mind, and had some friends among the support staff, so was visiting them as well, but what she did for me was above and beyond what I expected from a friend, as opposed to a relative! Prior to admission I had to pay for one night's stay plus a selection of medical "supplies", but after admission the first "familiar" collected prescription arrived, and this included the surgical supplies required for the operation - and included things like scalpels, gowns for theatre staff, anaesthetic, and so on! It also included 3 units of blood, which might be needed if there were problems during surgery requiring a transfusion! Since I had no-one to call on for this I had to pay for 3 units to be on standby, which were not needed and took me three weeks post-discharge to get refunded for!

While I was in hospital the nurses came round every 4 hours to take "stats" and this included pricking my finger for blood sugar testing (I only do it once a day at home), and although I had my own testing kit, though had to ask Carmen to buy me some more test strips as I hadn't anticipated the 6-a-day tests, they preferred to use a hypodermic needle to "prick" the finger rather than the test kit lancets - the problem with this is the lancet controls the depth, while using a needle they were pushing it in much deeper, and it hurt like hell! My fingers were bruised from this, and they were very reluctant to use my test pricker!

One of the surgery team came to speak to me prior to the procedure, to ensure I understood the risks involved, and warned me that worst case scenario (well, second worst case as death is always a risk with major surgery!) was that I could also lose my right arm. They already knew that the scapula (shoulderblade) would have to be removed, but if the tumour had attached to my humerus (upper arm) as well, they would have to remove that too, and also there was a possibility that the skin covering Chip was too badly damaged so I would need a skin graft, taken from my stomach, to replace that. As with everything else I accepted this with good humour - what else could I do? Whatever transpired I had to live with, as I could not carry on without getting the surgery.

December 8, 2020 - 4 weeks before surgery

The day, Tuesday, of the surgery arrived and I was prepped in the ward - with my shoulder and stomach (in case they needed to take the skin graft) shaved - and then taken down to the operating theatre.

In the operating theatre before surgery.

The next thing I was aware of was coming round in recovery, and I recall I was "growling" as my throat was so dry. They wouldn't give me anything to drink, but after a while allowed me to suck on a small gauze square, which did nothing to allay my raging thirst, though eventually they did give me a tiny beaker of water. My first action was to try and wiggle the fingers on my right hand, and, with some relief, discovered I still had the use of them, meaning I still had my right arm as well. My stomach was exposed, so no skin taken for a skin graft, and a while later the English-speaking surgeon appeared to tell me all had gone very well. They had removed over 7kgs of tissue, including 5.23 kgs of tumour, which had been sent for pathology!

Surprisingly I felt no pain at all in the following days and weeks and even until today, 18 months on, which was because they had removed or killed off the nerve endings, which do not appear to have regenerated. It was quite bizarre to have them change dressings and clean the wound, and not be able to feel a thing - except for the rip of the plaster which extended beyond the immediate surgery site! In the following days I was repeatedly being asked if I required additional pain relief, but since I could feel nothing (even though I was half expecting at any moment for the sensation to return!) I declined, leading them to nickname me "El ruso" - The Russian (presumably they consider Russians to be tough as nails!). I had my phone with me - they gave all my valuables to Carmen for safekeeping as I went into surgery - so managed to update my daughter (and Facebook) after my return to the ward.

I remained in hospital for a further 6 days before being discharged and the only thing of note was that the canula they inserted in my groin - in case I had needed the transfusion - started leaking, leaving me with a huge bruise on the back of my left thigh, and a colourless liquid staining my clothing and the bed. They had left it in "just in case", but that almost caused a further complication!

Carmen helped me leave the hospital and return to my flat in Huanchaco and I could never have coped those first days without her help. She did my shopping, though at my bidding just chopped vegetables and fruit for me, so I could try and cook, and discovered that I could manage that myself. For the next 3 months she came round at least twice a day to change the dressing on my shoulder, at times breaking curfew to do so.

This was taken on April 14, 2021. We asked a doctor to come and check the dressing, and Carmen took this once the hospital provided dressing was removed. 8 days after surgery and everything was healing brilliantly, apart from a small opening where the two incisions met. The drains are clearly visible under the wound.

I am a fiercely independent person, and was very conscious of the amount of Carmen's time I was taking up, so tried to get her to cut that back. She had a family of her own - grown up - and also worked part-time for a charity, and did some other private work, so I tried to do my own shopping (initially ordering in heavier things I could not carry from the shops), but I still needed her to change the dressings, so still needed quite a bit of help.

On April 30, 2021, I had an appointment at the hospital to see if the stitches and drain could be removed, so Carmen came along - ostensibly to translate if needed (my Spanish was adequate!), but also as she wanted to see how it was done.

April 30 - before the stitches were removed. The dark area where the incisions met was necrotic tissue (scab) and the surgeon decided to remove this.

Left edge of the wound - healing extremely well

Bottom of the vertical incision, and the drain holes - all appeared to be healing very well

Where the two incisions met - the horizontal and vertical incisions - there was some evidence of necrotic tissue, scabbing, so the surgeon decided to excise that with a scalpel (could not feel a thing, thankfully) revealing a large opening in the wound.

Although this looks pretty horrible it was not infected, but it did provide an alternative drain for excess fluids.

The surgeon showed Carmen how to dress this wound, and prescribed medication to use, and this was required twice-daily until I left for the UK in July - and still had not fully closed! The biggest issue here was that this "hole" now became the drain for any fluids, and as well as the dressing it had to be covered with absorbent material - and adult incontinence pads proved to be the most successful at this.

May 15, looking much better, but still closing very slowly

I was having regular follow-up appointments at the hospital as well as Carmen's ministrations, and was even referred to a plastic surgeon to see if he could do anything about closing the wound, though he said he would have to cut the original scar open to get enough skin to close the wound, and if they were intending to do any reconstruction of the shoulder he felt it better to wait for this. As it turned out on my final hospital appointment in June the traumatologist (lead surgeon) admitted that they could do no more for me in Peru, and advised me to return to the UK (the borders were finally open for international travel) to continue treatment.

I will cover the preparations for departure in another post, but I finally arrived in the UK on July 2, 2021, and entered the quarantine hotel (also to be covered later!), but despite twice-weekly dressing changes after I arrived at my daughter's on July 13, it took until September for the wound to finally close completely - the medication used here in the UK was much more effective at actively closing the wound.

September 7 - wound finally closed, and scars looking very healthy

Surgery had been performed 2 years and one month after I first discovered Chip, and the wound finally closed 5 months after surgery. Quite an adventure, but I remained positive throughout - many have been surprised by my attitude, but I just felt I had no choice - I had to keep going, and I had to find a way to cope. Yes, my life has changed - I am right-handed and can no longer use my right arm, though can use the hand - but I am managing quite well, and realise that I am fortunate in that millions of people are in much worse predicaments than I am. It was difficult getting initial treatment due to my blood sugar levels, and then the Covid pandemic shutting everything down, but once I was able to see a doctor in Peru in September 2020 things started to move reasonably quickly, and I am pleased with the outcome - and the specialists here in the UK were very impressed with the treatment I received in Peru. Total cost of all the treatment, including the diabetes control, which was essential in getting the surgery performed, was around £4000, with over £2500 of that being directly attributable to medical costs regarding Chip. That does not, however, include the taxi fares for the innumerable trips to the hospital, or for tests elsewhere, which probably raise the total by at least £500!

Being ill abroad - part 5

 Unfortunately this was a false start! I was fully expecting to come out of surgery with no more Chip, but when I came round the surgeon told me they decided to simple take a deep tissue biopsy. This meant that I was able to go home the following day as I only had a very small wound on my shoulder, but I was rather annoyed that this meant another long wait before further treatment.

In early January I was called back in for the biopsy results, and they confirmed that Chip was a chondrosarcoma, and that surgery would be scheduled as soon as possible. The first date I was given was cancelled as the lead surgeon's father passed away due to Covid, and he was on an extended leave of absence, and I had a long wait for a new date. Eventually I was told that surgery would take place on April 6, 2021, and given a new list of pre-admission tests I would need - but as always things in Peru never go according to plan!

I was told to come in on April 1 and would be admitted as an emergency cancer patient, so had to report to the oncology department at 9.00. I then had to undergo pre-admission procedure, including a Covid test, blood tests, ECG, and was told I would also need an x-ray, a CT scan, and an off-site MRI scan (which they would take me to after admission).  After several hours the head of oncology, who I had met previously and spoke perfect English, came to speak to me. There were no beds available, and also 5 days prior to surgery he felt it was too soon for all the tests I had already had - which were supposed to be 48-72 hours prior to surgery! - so he sent me home, telling me to return as a normal admission on Saturday April 3 before 15.00. I was told I needed to have blood tests before admission, as well as the MRI (which they cannot so on-site), and they would arrange the x-rays after admission, so decided to get the blood work done in Trujillo prior to the booked MRI (the hospital booked it for me as I couldn't get one done that quickly!). I arrived in Trujillo at 8.30 (the blood tests and the MRI were fasting, so no breakfast yet), to find a monster queue already outside the blood testing centre! I had plenty of time so joined the queue, but suddenly my phone rang.

It was the hospital - "Where are you?" I explained I was waiting for blood tests and then would get the MRI before going to the hospital. They told me I had to go there immediately as I needed the x-ray. I told them they said that would be arranged after admission, but they insisted I went there straight away as it had to be done prior to admission! I got a taxi to the hospital and went straight to x-ray - blood tests are only done until 9.00 at the hospital, so I was already too late for this, but there was an independent centre across the road so I had them done there, before catching a taxi back home to collect my bag before heading for the MRI! It was all now a manic dash to get things done, whereas before I had everything in hand!

I took a taxi back into Trujillo and had the MRI - then there was a 90 minute wait for the results. They will email the details, but the "plates" have to be collected, and the hospital needed these, but I had to collect them at 13.00 - so still plenty of time to get them before admission prior to 15.00! As I hadn't eaten - it was now about midday - I looked for a local eatery, but I was carrying my admission bag, as well as a pillow this time, and the closest restaurants were all closed (still Covid restrictions in Peru), though eventually found one open and ordered a meal. Then my phone rang again - "Where are you? You should be here!" I explained that I had to wait for the MRI scans and had to have some food as well, but would be there as soon as possible. "You have to be here by 15.00!" 

I had my lunch, walked back to the MRI centre, and only had a couple of minutes to wait for the test scans, and caught a taxi. It was now about 13.00 and maybe 20 minutes away from the hospital, but again my phone rang! "Where are you?" Upon arrival at the hospital they rushed me through to admission, and found me a chair inside the entrance to the ward - and I sat there until after 16.00 before finally being admitted to the ward, having rushed around all day due to them, when I thought I initially had everything in hand!

Being ill abroad - part 4

 So much has happened since my last post, but so little progress has been made! Prior to going to the cancer specialist hospital, IREN, I had been attending private consultations and clinics, and all the various test results I had to collect and take along to the next consult, but at IREN it is all done "in-house" and the results sent straight to the consultant, so never get to see the reports. When I went back for the biopsy result the surgeon told me it was not very conclusive, but it now appeared to be a Chondrosarcoma, which is a malignant, cancerous tumour, which does not respond to therapy, but needs removing surgically.

After biopsy stitches removed

First off I needed another surgical risk assessment, including blood tests, chest x-ray, ECG, and before surgery I would also need another negative Covid test! The various tests were programmed, and as some had to be done "fasting" could only be done the following day, and then when the results were all in, I had to see a doctor for his assessment, and then return for another consult with the surgeon! This process took about 10 days and then the surgeon said I would need admitting for the surgery, so I had to go to a "window" where I would be allocated a date and bed for admission. The nurse there, said there were no beds immediately available, and it would probably be 3-4 weeks before I could be admitted, and would need the Covid test first, but only once a bed was allocated!! So I should wait for a call. I would need a CT scan, and the Covid test, which I could get once they called me in, so I was given a request form for these. I was also given a list of personal items I needed to bring along, which included a set of sheets.

4 days later I get a call saying I should come in for some "pre-op checks" and that I should report to "hospital admissions". She spoke so fast I had trouble following her and asked if she could send me the details in a message, but she simply said "December 7, 7.30.There was a security guard on the door so I explained my situation, and he said I should wait until I was called, and so I waited for 4 hours! Eventually a male nurse appeared so I asked how much longer it might be, and he looked at the paperwork I had and told me I should have reported back to the "window" first when I arrived! I made my way there and knocked on the glass, and eventually it was opened - the nurse said she didn't think I was coming, and there were no longer any beds available! This was Wednesday, and she said my surgery was scheduled for the Saturday, but they would call me later when a bed was available, and I should report to her on arrival. I did get my Covid test done, but not the CT scan, as she said if a bed did not become available they did not want me to go through the expense of that scan right now.

Thursday I went out to get my laundry done and they called me, saying I could come in and get the CT scan, so I rushed home, then grabbed a taxi to the hospital. Reported to her window and was told to go and get the CT scan done, so paid and then went to the Imaging Department, I went to admissions first and they told me it could only be done tomorrow! So back to the "window" and she came with me and explained it had to be today, so I was rushed in for my scan, then back to her window. She now gave me a list of supplies I needed, but said I need to go to hospital admission first to see if that was all that was needed, and then off to the pharmacy to get that digitised, then to cashier to pay, then back to pharmacy to collect. Some items were not available, meaning I had to go and find them elsewhere, and at this moment the nurse explains that I am actually being admitted today! Two days before surgery??

This means that I have to go home to collect my belongings, as well as finding the missing items at another pharmacy. I grabbed a taxi and explained my dilemma, so first we try the pharmacy across from the hospital, and I find a few of the items, then into the centre of Trujillo, where I eventually find the rest, and then home! I have to collect my laundry, so catch a quick bite to eat for lunch first, get my things together, and get a taxi back to the hospital, reporting back to the window, where she gives me an invoice for "hospital admission" I have to pay before going to hospitalisation!

Finally I am shown to a bed, where a nurse helps me put my sheets on it, but there is no pillow - I should have brought my own (they did not tell me!), and I can now breathe easily. It is Thursday afternoon, with surgery scheduled for Saturday, and I have no idea what I will be doing until then!

Storing my bike in Peru when I return to Brazil

 I have made a separate page about "My Bikes" (link here My bikes) but the only way I could "add" posts to that page was by commenting (there may be another way, but that is beyond my skillset). I added a comment last year about how Oli, my Ronco Demolition, had been abused in my absence and how it had cost a lot to get repaired. I had tried to get to Trujillo to a mechanic there, but the logistics of that proved difficult, and a local motorcycle spares shop recommended a Venezuelan mechanic, who had set up shop at a street corner. Eventually he rebuilt the engine for me, and all appeared well.

I didn't use Oli much last year, mainly to get me back and forth to Trujillo for medical appointments as Chip was occupying most of my time, so never gave him a decent run, but he did appear to be running fine, and I had no real concerns. Towards the end of my stay I was considering where to leave him this time, as I was rather reluctant to go through the same drama again, and happened to notice that a mechanic's premises was open again. I had used this young man extensively in the past, but thought he had given up as I never saw any activity at his workshop, but stopped off for a chat. He had opened a second premises a short distance away, and had been working from there, but was running out of space so had returned. He offered to store Oli for me, and then prepare him for my return the following March.

Three weeks before I was due back I contacted him and asked him to give Oli the once over and prepare him for collection when I got back. However when I arrived he said there was a "noise" in the engine which concerned him, and though it was running he would like to investigate further. 4 days later the pandemic hit, everything shut down, and work ground to a halt!

I was under complete lockdown, due to my age, and for the next three months only "essential" workers were allowed to go to work, and people were only allowed out for food purchases, or medical reasons - and the mechanic was unable to work as most motor spares shops were also closed.

Early June some restrictions were lifted and he said he would be able to continue the repairs, but was till finding sourcing parts to be difficult as inter-provincial transport was still restricted to "essential services" only, predominantly food supplies. I did manage to see him at the end of June, and he told me that when he opened the engine he found some damage, and some issues that had not been resolved the previous year, specifically that the counterbalance was missing! It had clearly broken, and caused some "non-fatal" damage inside the crankcase, and never been replaced - apparently the engine will still run without it, but just runs a little rougher, with more vibration.

Crankcase, showing damage right of centre

These pieces were sitting at the bottom of the crankcase, but fortunately had not done any further damage

Oli, stripped and looking sad

Despite being told the engine had been rebuilt the previous year the mechanic said that many of the damaged parts implied this hadn't been the case, and Oli needed a new crankshaft, piston, connecting rod, clutch and, of course, the missing counterbalance! The damage to the crankcase was not severe enough to require replacement. I gave him a substantial advance to cover parts he needed to buy and left it with him - he also offered to re-paint Oli as corrosion was bad in places.

He contacted me a couple of weeks later and said he was having difficulty sourcing the counterbalance, but that the engine would run fine without it - it would just run a little rough due to increased vibration without the counterbalance - and he should have the bike ready soon, once he managed to get the paintwork done.

I was given a series of collection dates, each which came and went with no sign of completion - paint wasn't dry, there were some missing bolts, a new bearing was needed, gaskets couldn't be sourced, and so on - "nothing major"! Eventually I went round and found him there - he had been ill, but was now getting close, but had had to repaint everything as the varnish he had used had not dried, and caused the new paint to run, and was now waiting for everything to dry!

I was given a new collection date, but when I went round the pieces were still hanging like in the pictures. Now there was a new problem, or rather two - the tank had been sandblasted (all the frame had been) and because of corrosion this had revealed some pinhole leaks, and he was unable to find anyone who could repair it, so I would need a new tank, and also the wiring loom was a mess and needed replacing. This last one threw me as the Venezuelan mechanic had told me he had to replace the loom last year as it had burnt out, but clearly had done nothing of the sort! I was beginning to realise I had been well and truly had the previous year! More money for parts changed hands, and I was given a new collection date.

That, too, came and went, and I was given another - "Guaranteed, I give you my word, I need 7 - 10 more days!" On the tenth day, last Saturday, I went round, and was told it would be ready later that day, but I could collect it on the Monday. I tried contacting him before going round, just to make sure, but received no response, so walked round anyway - only to find out that he was closed until Tuesday (turned out it was his daughter's first birthday and was a big deal), but he did message me that evening apologising, and told me that today, Tuesday, he was going to Trujillo for the final part he needed - a bearing for the handlebars - and would message me as soon as Oli was ready!

It is now 9 months since I first made contact informing him about my return to Peru, and 5 months since I was so confident of getting Oli back that I renewed my SOAT (compulsory insurance). I am currently 2 months past the expiry of my tourist visa (but due to the pandemic and state of emergency here Immigration has allowed all over-stayers to remain until we can leave once the borders re-open), and have spent goodness knows how much on taxi fares into Trujillo for medical appointments, and still, as of this moment, do not know exactly when Oli and I will be reunited!

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!

Social distancing - I have been doing it most of my life!

Much is being made of "social distancing" at the moment due to the Covid-19 (coronavirus) pandemic - maintaining a safe distance between people to try and avoid the transmission of the disease. This is, in some cases, also combined with "self-isolation" where a suspected infected person, but showing no symptoms requiring hospitalisation, or someone suspected of being infected (returning form abroad, or from contact with an infected person) keeps themselves isolated even from their own families within the same building.
The government regulations vary a lot from country to country, from trusting the public to do the right thing (yeah, that is working in the UK!), to more draconian measures such as I am under in Peru - we have a daily curfew between 16.00 and 04.00, as well as Sunday, and the rest of the week, unless working in "essential" services (particular the food chain) you are only allowed out, and only one member of the household at a time, for food shopping, and medical needs, and we have to wear face masks in public. So no long walks, no drives in the countryside (you need a permit to use a vehicle, provided to "essential" drivers by the local authority), and not even outings for exercise. They even, for a short time, had "gender" days, where men were allowed out (for the essential things above) on Monday, Wednesday and Friday, and women on Tuesday, Thursday and Saturday - so effectively limiting our "available" out-of-the-house hours to 33 a week (the curfew then ended at 05.00)! Most people are accepting these as absolutely necessary to curtail the spread of the virus, though the police and army are still arresting around 300 a day in our Province for breaking the curfew, and so far in 5 weeks have arrested about 16,000!
All over the world we are reading stories about how people are coping, or not, under lockdown, and what you should do to cope - and many of these are coming from the countries with the least strict rules. In my case it has been pretty much life as usual! OK, I cannot go for my usual long daily walk along the seafront here, primarily for exercise, but I manage a slightly shortened version en route to the market or the shops 5-6 days a week. My usual routine - pre-lockdown - would have included rides on my motorbike, Oli, once or twice a week along the coast to deserted fishing spots, or longer rides, solo, to nearby towns in the Andes, or even journeys lasting a few days to further locations, again solo, and staying in single accommodation (as opposed to sharing a dorm room as many travellers do, for company as much as cost) - as well as trips to the supermarkets in Trujillo, 10 km away. But most of the time I spent alone, but not lonely - never lonely!
While in Brazil (for the other 6 months of the year) my routine was very similar, though I do have a garden surrounding my house, and live in a much more beautiful area, being in a National Park, so my bike trips tended to be shorter, and my walks less frequent (steep hill from my house into town!).
You see the pattern here? Solo/alone - both through choice - I have kept my social distance almost all my life, and so now when it is enforced it is not an issue. I was a very shy child, so much so that my parents worried about it - only telling me about this when I was in my late teens - and though I did have friends, I always (and this was repeated throughout my life, even as an adult) had a limited circle of close friends, rather than loads of acquaintances around me. In social situations I sat to one side, aloof and silent, though in later life I over-compensated by become garrulous, talking too much to fill the embarrassing gaps in conversations. Dating was a non-starter as such a shy person, and living in a small town in Mozambique during my "formative" years, where social conventions were very restrictive as well, meant I never really had a proper girlfriend during my teenage years.
We moved a lot when I was young - to Angola, and later Mozambique, and boarding school in what was Rhodesia - then as an adult I started working in Beira, Mozambique, after one year moved to Johannesburg, South Africa, then a year later to Durban, where I stayed for 3 years. This meant that I never had "life-long" friends, always moving on and leaving people behind, years before social media meant we could keep in touch, so maybe I developed a mechanism where being on my own was the norm, and the safest place to be. After I returned to the UK at 25 I then spent the next 30 years in Norfolk, within a 10 mile radius, but initially working with my family, and then married, I did not socialise that much - certainly not alone. In 19 years of marriage not once did I go out on my own for a night out, partly due to the fact that much of the time I worked night shifts, but also because family life was what was most important to me.
Since my divorce, apart from a few years when my daughter lived with me, I have lived alone - so that is for the past 15 years - and it has never bothered me. I am very independent, and, I think, very capable of managing alone, and do not feel any need to have other people around me. I would like to see my daughter more often (she is in t he UK and I am currently in Peru!), but thanks to social media we can easily keep in touch, and can chat using Skype if we feel the need. On the whole, though, I do not feel any driving need for social interaction, and, in fact, will actively try and avoid social contact on occasion. If I was not under lockdown conditions right now I would probably not do things very differently - I would go for rides on my bike, and longer walks along the seafront, but I would still be practising social distancing, and keeping myself to myself!