My Last Injection... For Now

On Tuesday morning at 10.15 I had my latest lanreotide injection, and as the initial decision was that I would have them for three months and then review, I'm now waiting to hear back from my endocrinologist as to whether he wants me to continue with the injections. The answer to that will almost certainly be yes, unless the next MRI scan shows that my pituitary tumour has fallen out of my nose at some point in the last two months;* the real question is whether the dosage needs to be increased, and if they're thinking about sending me in for more surgery.

Actually getting the injection was fun, because it was administered by my favourite nurse. I know it's wrong to have favourites, but I was almost heartbroken last month when both she and her lovely Australian colleague were away at injection time and I had to book in with The Rubbish Nurse. She's not a bad nurse, I should clarify, she's very competent, but she hasn't got the hang of Making Injections Fun yet. This is a valuable skill and, in case there are any nurses out there, it goes like this:

The Idiot's Guide To Making Injections Fun:

1. Recognise the patient. If you don't recognise the patient, you can just pretend. This is an acceptable fiction and they will almost certainly pretend back.
Pro tip: Once you are practised at this deception, or if you are interested in a career in acting, consider taking this a step further and invent a complete backstory to your relationship with each patient. Imagining that you are administering an injection to the wife of the man with whom you had a torrid affair in pre-independence Kiribati will add spice to an otherwise dull day.

2. Greet the patient. Do not disappear down the corridor so quickly that they can't work out which dread medical portal you emerged from.
Pro tip: Alternatively, if you really can't bear to wait for your patients to pick up their coats before exiting the waiting room, why not turn this into a game of Hide and Seek (Nurse Edition)? There's nothing like the sight of confused patients blundering into the wrong consulting room to raise a belly laugh in the morning.

3. Put The Patient At Ease. When unwrapping the syringe of lanreotide, remember to refrain from comments such as "Bloody hell, that's a big needle!"
Pro tip: Consider tapping in to your patients' latent competitive natures by introducing a leaderboard of Bravest Patient of the Week. That way, they'll be practically queuing up to be spiked by giant needles, instead of fleeing you in terror.

4. Be Awesome. This guideline may be difficult for new practitioners to grasp immediately. Examples of Being Awesome include (but are not limited to): telling patients interesting medical facts (this week I learned about the sciatic nerve), having an awesome accent, telling amusing family anecdotes, laughing frequently, and adopting unusual pet names for each patient.
Pro tip: Like the finest cuisine, the best pet names are based around animals and vegetables. Everyone's been called "duck" or "pumpkin" - why not mix it up? Try referring to patients as "prarie dog" or "aubergine".

***

In other news, I had a bit of minor drama trying to get hold of my beloved Somatuline Autogel injection this month; when I got the prescription, I headed straight to Boots Pharmacy as usual, who always have to order it in directly from their supplier because it's a pretty unusual item. I happily skipped to the counter, only to be informed that their supplier didn't have any in stock, and they couldn't say when they might have it, so I should go elsewhere.

Somewhat surprised, I decided to transfer my business to the Superdrug pharmacy. "I'll have to check with our supplier," said the young man behind the counter. He immediately phoned them, while standing in front of me. Apparently everything was fine and they'd have it in the next day. Impressed by this speedy service, I skipped off on my merry way.** Of course, next day I got a phone call from them saying that their supplier didn't have any and they couldn't say when it would next be in stock. Heaven only knows who the bloke behind the counter had actually phoned while I was watching; perhaps he's the chap keeping the Speakng Clock in business.

So I picked up my prescription and, feeling a little panicked, decided to try Boots again before walking miles to another pharmacy. And lo! the bloke behind the counter looked at my script and quoth: "Oh yes, we've got that for you." I assumed he was confused - perhaps a relation of the guy in Superdrug. But no! Boots had lovingly ordered in my medication even though they had encouraged me to look elsewhere, just on the offchance I would return for it. So that was nice.

____________________________________________________
*Just to clarify for any non-medically-qualified readers: this is unlikely.

**I was doing a lot of skipping that day.

Health, Wealth & Happiness

In the ladies bathroom* at my place of work, a minor change was recently wrought when the former hand-drier/paper towel dispenser combo were replaced by a single hi-tech hand drier, of the new variety which seem designed not merely to blow water off your hands, but to have a crack at taking the skin off as well.

It's highly efficient, no doubt, and proudly states that by using it, you are helping to reduce landfill and thereby save the world. But today, after walking to work in a downpour, I found myself reflecting on the fact that its highly-specialised hand-drying design has come at the cost of other convenient functions of the hand-driers of old: namely, drying off wet clothes and hair and warming you up a bit. Of course, you can still use the Air Force Sandstorm Erosion™ to dry your hair. Providing you don't mind being scalped in the process.

But anyway, it got me thinking about its designers, who were no doubt given a clear spec: make the best hand-dryer possible. And they did. And everyone was delighted. It probably wasn't until monsoon season rolled its way around to Dryer Towers** that someone thought: 'Hang on a minute - the old hand drier was far less exciting and high tech, but at least it could deal with waterlogged socks.'

And, in a really obscure and slightly convoluted fashion,*** health is kind of like that, in that you don't notice what you've got til it's gone - but even then, sometimes it can take a surprisingly long time to catch your attention. I went from someone who never, ever had a headache to someone who got them regularly, but the change was so insidious over several years that it never even occurred to me that maybe I should mention this to a doctor - even after my heart had made it blindingly obvious to all and sundry that there was Something Clearly Wrong. Yes, I am just smart that way.

 Now, I find myself (thank everything) on the flip side of that because I am (thank everything again) currently slowly getting better. Yes, I'm still not quite right, my hair's still falling out and my heart gave a very brief but exciting display of acrobatics as I ate my pasta last night,**** but I am so much better than I was. And I'm still in that happy honeymoon zone of improved health, where every now and again I have to take a moment to appreciate the fact that I can run for a bus without hyperventilating, that I can dance for an hour without needing a sit-down, and that my bruising has improved to the point where most days I can wear a skirt with no tights and not look like a victim of domestic violence.

 Obviously the hope that I'm hoping ever so fervently is that I'm fixed and will continue to be fixed and, bar the odd MRI and pituitary-adenoma-related chat (for old times sake) I will darken my local hospital's doorstep much less frequently. I don't know if that will happen. But, although no doubt we'll all get used to the new hand dryer in time, I hope that - for as long as this improvement lasts - I don't lose my appreciation for feeling healthy :D

___________________________________________________________________________
* I say bathroom. I mean toilets. There is no bath in there. Because that would be weird.

**Just to clarify, I am making this up.

***Or, if you live in my head, a really obvious and straightforward one.

****Because the pasta was just that good. Incidentally, another side effect of this illness has been that I've completely lost all ability to appreciate lines in songs like "my heart skips a beat". I just hear them and think: Quick! To the cardiologist!

Hot Off The Press

I have struggled to write an introductory sentence to this post, and having tried and subsequently deleted four separate attempts, I've decided to do what I should have done in my German A Level exam and Just Get On With It.*

The Bad News

Just over a month ago I had a phone call from one of the many endocrinologists who like to talk about me behind my back (they call it having "Multi-Disciplinary Team Meetings", but I know the truth). Unfortunately, despite my surgery in April, my recent MRI has shown there's still a lot of tumour left. The tumour originally had an "area of cystic degeneration" (i.e. it was liquid inside like some kind of hideous chocolate fondant pudding) and although they managed to get rid of that, pretty much everything else (ie. the actual main bit of the adenoma) is still there. Which is obviously really rubbish. I'm not exactly surprised; although some of my symptoms have improved a bit since the operation, I am nowhere near better yet. But it's still disappointing, especially as the surgeons were optimistic that it had been a success. When you've had your skull drilled into, you expect results!

The Good News

The rather more surprising news came when I was at college a couple of weeks ago. I was sitting in a three-hour-long lecture given by a woman whose incredibly shouty teaching style implies that she may have been a sergeant major in a previous life. My phone went off; I dashed out, in the happy knowledge that midday phone calls are almost always from the hospital. It was indeed my charming endocrinologist, to inform me that the blood tests I had done a few days previously had come back completely normal. My thyroid hormone levels were all fine.

Obviously this was something of a (very welcome) shock, seeing as I've still got a lot of symptoms - my heartrate is improved but still high, I still shake and my hair is still falling out pretty badly. Apparently it can take a really long time for symptoms to clear up, even after your hormone levels are normal. Darnit!

From what my endocrinologist said, this is definitely A Good Thing. Apparently sometimes this kind of pituitary adenoma does seem to switch off-and-on in their production of hormones, so it's possible that my levels of thyroid hormone will go back up. On the other hand, it's not impossible that the tumour is finally paying attention to the Cease And Desist notices which the rest of of my body has been sending it for years. Even if it does start producing hormones again, at least my body will have had a bit of a break.

I have been trying not to get too excited about this and resign myself to the fact that, chances are, it will start up making hormones again. But it is kind of a challenge not to prance around a little bit. I was due to have a range of exciting metabolic tests plus a PET scan; those have all been cancelled. Instead of spending several hours in a tube being irradiated, I will be having blood tests every few weeks to monitor my hormone levels. The downside of this: it means that I shall spend several nervous days fretting about what the results will be.

Blood tests are on tuesday, not sure when the results will get back but I'll update this as soon as I know!

__________________________________________________________________
* For those of you interested in my youthful academic failures (and let's face it, who wouldn't be?) I managed to get a D in one German A Level paper about the Nazis because I spent the first forty-five minutes of the exam endlessly trying to write the first sentence and then crossing it out in disgust. The only German phrase that kept popping into my head was "Hitler beging Selbstmord",** but as the question was about the siege of Stalingrad, this was not helpful.

**"Hitler committed suicide"