Tiger, leopard, baby elephant

A white blood cell.
I need lots of them.

My white blood cell score last Tuesday was 1.4 megatons per millilitre (or something). I had been given medicine to boost my score higher than 2; anything lower, and my body would be unable to take the punishment of chemo. We rolled up on Wednesday to get my new score and crack on with the chemotherapy. I was gutted to hear that my immunity levels had actually dropped to 1.1, and chemo was therefore out of the question. Again. Chorio needs to be whacked hard and fast, so my worry rate increased.

Moniek preparing the syringes.
Sponsored by Fray Bentos, dedicated to the Conway.

White cell boosters could become a regular necessity, so Moniek had to learn domestic syringe skills. My worry rate spiked. The nurse injected another dose into my self-squeezed belly fat during a live demonstration. The side-effects of this potion are bones which ache to their very marrow, bronchitis-light, and monsoon sweating. It’s not fun, and not conducive to writing a blog.

The tiger-leopard

We waited by the tropical fish tank for the blood lab to open on Thursday morning. Moniek joked about my long-overdue hair loss, and grabbed the back of my head. A big clump came off in her hand and the joke fell flat. An hour later a borderline white cell score of 1.9 arrived, and Dr Karmen decided to go ahead with the B-mix chemo. I sighed with relief, and jumped into the bed to be poisoned.

The chemo depleted my white blood cell score again. Moniek gave a practice injection under medical supervision. Her technique was that of a beer-swilling darts player going for treble-twenty. I over-squeezed in panic, trapping the needle in my spare tyre. The nurse was shouting ‘let go of your fat! let go of your fat!’ but, despite the mild chaos, Moniek was given her needle proficiency badge.

Dr Karmen reviewed my data and called me to the clinic on Friday for yet another booster. A gruelling 5-day major cycle was drawing near, and so a plan was agreed for Moniek to give me another injection on Sunday. We were given a cool-bag to transport the medicine to the fridge at home.

Instrument of torture

My sister Elaine arrived on Friday afternoon. I was full of aches, coughs and sweats but cheered up immensely by her arrival. Her suitcase was full of gifts from well-wishers including a box of Quality Street which, as it turns out, are also enjoyed by the Dutch. Our ensuing gold coin debate had nothing to do with Eurozone matters.

Torture

My hair was dropping rapidly, so I offered the girls the rare opportunity to hand create a half tiger stripes, half leopard spots ‘style’. 5 minutes later, I was completely bald save for some easily ridiculed ‘baby elephant’ bristles.

Moniek needed to inject the booster medicine on Saturday, so I made elaborate omelettes to delay the inevitable. The actual size of the needle was, admittedly, quite small - but the psychological trauma it created was massive. Unfortunately, Elaine photographed the entire drama.

The baby elephant and Elaine.

My next major chemo cycle is scheduled to start tomorrow. Dr Karmen ordered more tests to check if (a) my white blood cell score was considerably higher than 2, and (b) my Chorio count had dropped from 6.7 since last week. We avoided the rain and nervously awaited the results under the awning of a coffee shop.

The nurse called mid-afternoon: white blood cell score 50, Chorio count 2. There was much cheering, hugging and chocolate eating.

Click

I put the revolver to my head again today, and took 240 tortuous minutes to pull the trigger. It clicked.

We arrived early for two 8am blood tests - one test for white blood cells, and another for beta-XCG (the hormone marker for Choriocarcinoma). Moniek was laughing about how cancer had changed me. The old, wrinkly purple-rinse lady in the lab has magical pain-free needle skills; I was hoping for her instead of one of the young nurses. I got lucky. But I think she was taking the piss, because she used the cartoon dinosaur arm-strap instead of the proper paramedic one. The vials were filled red, triple-checked, and marked ‘urgent’ so we could get the results today. Over coffee, I braced myself for the dreaded B-chemo. I’d been quietly steeling myself since yesterday afternoon.

I’ve been eating like I’ve got two arseholes, but the scales in Dr Karmen’s clinic showed that chemo has eaten 5kg of me. I flicked through a vacuous, sycophantic fashion magazine with (as Bob Dylan sneered in ‘Like a rolling stone’) all the pretty people drinking thinking that they’ve got it made. I was called into her office at 10am.

My white blood cell results had arrived, but not the beta-XCG; it’s a much more complex and time consuming test. My immunity levels had dropped, and so it would be too risky to undergo B-chemo today. My blood had been exceptionally strong until now, so the anti-climax was disappointing and exhausting. Instead, Dr Karmen administered a new concoction to boost my white blood cell count and re-planned chemo for tomorrow. The deadline for ‘Brian’ quotes (see below) has therefore been extended ... ‘ooh, you lucky bastard’.

We  discussed potential scenarios. If this booster medicine fails, she has a stronger alternative on the top shelf. If that fails, I’ll need a bone marrow transplant.

Someone's watching over me ...
bit it ain't no porcelain statue!

She extrapolated my beta-XCG data to predict where my Chorio count should be when the results arrive. It’s calculated from the ‘half-life’ of Choriocarcinoma.  She hoped for 3 half-lifes since my last count of just under 100. Best case scenario: half of 100  is 50 ... half of 50 is 25 ... half of 25 is 12 ... and a half ... but she would be happy with any number less than 20. Another scenario: what happens if my Chorio count is more than 20? This would mean that my cancer has become resistant to PEB chemotherapy. Chorio is infamous for this. The back-up plan is to switch my cocktail, possibly to Lance’s PIV mix, and extend my chemo programme. The beta-XCG results were expected around 2pm.

The stakes were high, and we had 4 hours to kill. The nurses offered to call us with the results when the report arrived. We left Dr Karmen’s office and bought a remedy for my anxiety: an ice cream. Fearing an imminent descent of the angel of death, I went for a large caramel coffee with vanilla cream and Toblerone chunks on top. Moniek was feeling a bit chilly in the air conditioned mall (yes, really) and went for a cafe latte instead. The hands on my watch turned very slowly. I thought about friends I hadn’t managed to contact yet, possible locations for my cremation, and other ‘what if?’ practicalities.

Each time the phone rang, my heart raced. False alarms. Back at Ilse’s apartment, I was too edgy to watch television. The mobile rang and Dr Karmen’s name appeared on the screen. Deep breath. Pleasantries were rushed before the nurse gushed ‘we’re happy to say that your beta-XCG count has dropped to six point seven’ ... ‘can you repeat that?’, I gulped in amazement ... ‘yes, six point seven’ ... ‘thankyou Dr Karmen, thankyou God, thankyou to all my family and friends’. Click.

I feel like screaming, dancing and air-guitaring with joy in star-spangled boots: http://www.youtube.com/watch?v=ZBR0T3f7tUw

He ranks as high as any in Rome!

This is for my family who gathered to say prayers with mum and dad: Margaret; May & Norman; Angela & Roger; Eddie, Ruth & Karen; Anna, Pat & Andy. It’s also for my friends around the world who have been having a word with ‘Him upstairs’ on my behalf. Preparing for more n-n-n-n-nasty chemotherapy tomorrow, I’m strengthened by your prayers and wishes - and I thank you from the bottom of my heart.

Somewhere in the Middle East with hair

I’ve led quite a wild life, so many people are shocked when they discover I’m religious. Yes, I mock all the man-made hierarchies, costumes and rituals. And 'Life of Brian' is, perhaps, my favourite film of all time. But I have unshakable faith in God and the life to come.

In 2003 I set off on my motorcycle, rode around a lot of countries, and haven’t turned around since. I met the fabulously wealthy and the poorest of the poor, wise men and fools. On the road, I studied many religions. In the Bible, I concurred with what Ecclesiastes saw on his journey. It’s from Chapter 9, verses 11 & 12:

I returned, and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.

For man also knoweth not his time: as the fishes that are taken in an evil net, and as the birds that are caught in the snare; so are the sons of men snared in an evil time, when it falleth suddenly upon them.

Death is certain - life is not. Life just throws stuff at us. Good and bad. I believe it’s all a big test of character and faith on which we will eventually be judged by our maker. The snare of a rare and deadly cancer has fallethethethed suddenly upon me. God only knows when my time will come but, when you pray for me, take comfort that I have no fear of death. I fear only God. And needles. And wasps.

... and at Dr Karmen's office - without!

I’ve been deeply touched by the hushed prayers of a great many people who are more usually found in a bar than a place of worship. Desperate times call for desperate measures and all that. For them, one of my favourite passages from the Koran; it’s from Sura IV; Women:

O ye true believers, come not to prayer when ye are drunken, but wait till ye can understand what ye utter ...

Now if that doesn’t start some intellectual debate on the comments page, I don’t know what will.

For the pious, it's time for Elvis with a spiritual belter: http://www.youtube.com/watch?v=mdrBWiSxStI&feature=results_video&playnext=1&list=PL8A918EDB65602384

I'll need cheering up after a tough day tomorrow. So, my fellow sinners, think carefully and post your best ONE line from 'Brian' please. And, all together now: http://www.youtube.com/watch?v=WlBiLNN1NhQ

Comment writing and sedition for dummies

McMurphy: "Why don't ya shut your
goddamn mouth and play some music."

I'm overwhelmed by the emails I've received from well-wishers. I eventually read every one of them but, I'm really sorry, I'm just too knackered to respond to them all. Some days, like today, I'm buzzing around but more often I'm like Jack Nicholson in the final scenes of 'One flew over the cuckoo's nest'.

This blog enables me to let everyone know what's going on, in my own time, with limited effort. The open, interactive nature of it is a wonderful way for me to have a laugh (and sometimes a cry) at all your comments.

Some people have tried to write comments, but have given up after hours of fruitless frustration and despair. I'll name no names, but there seems to be a typical profile: they're over 30, have an opposable thumb, have been to school, managed to hold down a job, carry a driving license ... but need the help of a 5 year old if they want to play a DVD. For the further advancement of humankind, here's a simple guide to posting a comment:

First, get a pen and a piece of paper. Don't run because you might poke someone's eye out. Write down the important points in steps 1 to 7 below just incase you get lost and confused later. We're going to practice on this 'blog'. You can try it out as many times as you like until you feel confident enough to write a real comment.

Down below, in the middle, there's some blue writing showing how many comments have already been posted. For example, it might say 3 comments. Quite soon, you're going to click on it using the left button of the 'mouse'. If you're already confused, shout for child assistance. Ready? OK, let's begin:

1. Click on the X comments below. A new page will appear called Post a comment. Take a deep breath and relax. 
2. Click on the big, empty box. Use the different keys (square things with letters on them) to type a message. Let your creative juices flow. For example, you may wish to dream up a scene where Hilary Clinton gets her comeuppance in a bizarre, frenzied, anatomically improbable 'accident' with some sharp objects from your garden shed. Or perhaps you could just write 'hello' or 'test message' or something.
3. When you are happy with your message, look at the small box below your message. It says Comment as with 'Select profile ...' and a little arrow pointing downwards at the side. Use your mouse to click on that arrow. As if by magic, a list of scary stuff will appear. Don't cry, it'll be OK. One of the things on the list is Name/URL. Use your mouse to make it go away.
4. Another new thing will appear called Edit profile with two new empty boxes below. Write your name or nickname in the one that says Name. (If back in Step 2, you did write something violent and rude about an influential figure in the US industrial/miltary complex - put someone else's name instead). You can leave the other URL box blank. That's for under 5's only. Click on the Continue button.
5. The name you have written will automatically appear in the 'Comment as' box with some brackets () after it. Don't panic, brackets are more scared of you than you are of them. There are two other buttons. Click on the one that says Post comment.
6. Word verification will appear. It's a made up word in some wibbly-wobbly writing. It's not the beer - it's a clever gadget that spies use. Copy the wibbly-wobbly words ... carefully, so you don't make a mistake ... into the box below in normal writing. Ignore the guy in the wheelchair; he doesn't do much.
7. Click on the Post comment button and 'hey-presto' your message has been posted for all the world to see.

Dwight D Eisenhower:
"I told you, but would you listen?"

If you can hear a helicopter, it's some Navy Seals coming to blow your brains out for seditious criticism of US foreign policy. And they won't listen to objections about sovereign territory, freedom of speech laws, or finger-pointing stories of 'it wasn't me, it was him'. By the way, if one of the choppers crashes into your garden fence, the Chinese are paying top-dollar for souvenirs on E-bay.

The guy on the right gave a prophetic warning of this in his farewell speech of 1961: http://www.youtube.com/watch?v=8y06NSBBRtY ... this should be part of every school curriculum, along with George Orwell's 1984.

This great cover of a Bob Dylan classic, especially the last verse, is for all the 'hawks': http://www.youtube.com/watch?v=hG443N7lo4Q.

I were Pearl Jam, I wouldn't be going anywhere in a light aircraft.

What's the chances of that?

Lance looking at his 7th
Tour de France trophy

So much for my 'rare' cancer. I've only gone and contracted the same bloody tumor as the chemo world's poster boy. It's like turning up to the Oscars in the same dress as Angelina Jolie. Or something.

Lance Armstrong is the greatest cyclist in history, and an inspiration to millions. He won the Tour de France a record 7 times - 7 in years in succession - after beating Choriocarcinoma. He was in a much worse state than me. Apparently the doctors gave Lance PIV chemotherapy for his 60% mix of Chorio, rather than PEB for my 95%, due to potential side-effects on his lung capacity.

I've learned that 'side-effects' are such a prominent part of cancer treatment that the term is misleading.

I've always had a high metabolic rate, burning up food and energy faster than most, and so I'm rattling through various new side-effects faster than you can say 'paracetomol'. Yesterday I had teenage spots, sores and cold sores; deafness followed by tinnitus; loss of appetite then hunger and heartburn; extreme lethargy and insomnia; and, after morning tea, I developed paranoid hallucinations and diarrhoea (a messy combination).

Then, in the afternoon, I lost my voice for 3 hours, developed an inexplicable fear of pointy things and glass, and one of my teeth broke in half and interrupted my enjoyment of a Marmite sandwich. What's left of my hair is due to fall out the day after tomorrow.

We were having a laugh about it with today's nurse. She was showing Moniek how to clean my pipe (please, remember that children read the comments you write) but reckons my rapid-fire approach to side-effects is the best one. Her attitude was 'well, you're gonna get X so you might as well have it done with and move onto Y, because Z is coming next week'.

I only have to put up with the side-effects; the nurses have to treat them. Is the side-effect serious enough to warrant another medication, or will that create yet another side-effect? Many medicines inter-react with each other, and so medical staff are continually evaluating, compromising, adjusting and refining their treatment of every patient. My hat goes off to them (taking some hair with it).

Cancer and its intended cures are hard on the body, but much harder on the mind. Some people talk about an 'emotional rollercoaster', but that's bullshit. You choose to get on a rollercoaster, the ride lasts a short and predictable time, it loops the same loops, and your chances of death are infinitesimally small. The psychological impact of cancer and chemotherapy is more like Russian roulette.

Remember the scene from 'The Deerhunter'? Apparently, today at 7pm, my gun has 1 bullet and 9 empty barrels. Others have much worse odds. It's 'will I, won't I?' every time the doctor walks into the bamboo hut and reveals a new piece of information. Being so tired and confused from all the pills and their side-effects, it's impossible to remain objective or maintain perspective about what's being discussed. It's pure mental torture.

Me looking at Trev's arse for the 7th lap

Dr Karmen has been well impressed with my ability to withstand industrial-grade PEB. There's no doubt that my Tour de Pokhara physical condition going into chemotherapy has been a major contributing factor to my resilience and rapid improvement (so far). But, in my experience, psychological condition and attitude play an even greater part. I'll read Lance's book to pick up some motivational tips for next time I have to pick up the revolver. I hope it's not all 'woooh-yeah- alright dude' septic style.

Move over Lance, because I plan to end up on Dr Karmen's office pinboard too. It's jam packed full of photos of her beaming survivors. I daren't look in her bin.

My nurses are absolutely wonderful. They have such compassion, respect and dedication for all their patients; every one of which has a different gun to their head, a different personal story, and a different state of mind. Moniek and I were heartbroken today; a pretty girl in a funky knitted hat was in the chemo chair next to my bed. She couldn't have been more than 15 years old. The energy and optimism our nurses create in the clinic, day in day out, through all the tragedy is truly inspirational. Today's tune is dedicated to them with huge respect.

It's also for Lance. He got back on his bike; I'm going to get back on my motorcycle. I doubt I'll become 7 times world champion, though. I can't even catch Trev on a track day.

Grab a tissue. This time you'll need it to wipe away dancing sweat rather than tears: http://www.youtube.com/watch?v=0L4Bonnw484

My eternal thanks to Ellie, Moniek, Ilse and Corine Wittens

Before reading on, plug in a decent set of headphones because there's something very special at the end.

The last few weeks have been the darkest, roughest time of my life. I was in real trouble: tired, skint and alone in Kathmandu, with no hope of finding my way to my family and closest friends.

Moniek (in the silver shirt), Ellie, sick boy and Ilse.
Corine's at home with her family in the Netherlands.

The Wittens family laid down everything to get me to the best doctors in Singapore. In pain, and unable to think for myself, this big man was as small and helpless as a baby.

They took control and continue to involve my family every step of the way. I thank God I've got them by my side.

I was told I have a life-threatening disease in my blood and lungs. They comforted me, dried my tears and eased my mind. The Wittens family know all about cancer. Harry, the father of the family, died of melanoma and a brain tumour in 1989.

I never met Harry but apparently he loved this song too. It's dedicated to Ellie, Moniek, Ilse & Corine with my eternal gratitude. And, of course, to Harry: http://www.youtube.com/watch?v=C-PNun-Pfb4&noredirect=1

Mo - it's your time to shine.

Cold turkey and ravioli sandwiches

Don't panic! I'm still alive.

It seems that this Choriocarcinoma bollockus really is exceptionally rare, so Dr Karmen has been consulting with international colleagues about my case. The larger of my lung tumours is a bit bigger than first thought (5mm x 3mm), and Chorio is a nasty little bugger, so they're not taking any chances. Maybe I'll make it onto the cover of Cancer Today or something (apparently the title's strapline is 'because there may not be a tomorrow'). The doctors will also monitor my brain in future for any previously undetected signs of normality.

Highly detailed pro/con emails about the possibility of 4 chemo cycles were considered by eminent scientists in Australia and the USA. Meanwhile, in a parallel universe, others were debating the toffee/chocolate dilemma in a tin of Quality Street. Eventually, consensus was reached that (a) 3 cycles of chemotherapy appears optimum for my case and (b) the gold coins are definitely bad for your teeth.

I had soundly slept or dizzily daydreamed through my first chemo cycle. I listened to a lot of great music, warmed and comforted by the fact that my family and friends were listening to the same tunes somewhere in a different time zone. My hands felt like two balloons and I had, indeed, become 'comfortably numb'.

The Chorio count in my blood has decreased again to 99.8, which is obviously great news, and the fact that there's even a decimal point involved gives me huge encouragement. I'm more used to numbers with a lot of zeros on the end. My blood seems to be in remarkably good shape, and Dr Karmen commended my 'best ever' tolerance for PEB chemotherapy. They say pride comes before a fall, and I now regret feeling so chuffed.

The de-tox from PEB has been the worst experience of my life. By a fucking mile. Torrents of burning-freezing sweat, hallucinations, knife-twisting stomach cramps, ice-pick headaches, oozing skin sores ... my body and spirit being torn apart. John Lennon described it better than I ever could: http://www.youtube.com/watch?v=n6wxTkkfLqM&feature=related

I'm OK now. I've bounced back, and Moniek made me ravioli sandwiches for breakfast this morning. I can deal with 2 more cycles, but some of the people I see in the clinic have been taking chemo for years - many with no hope of recovery. I really am a lucky by comparison. This beautiful song http://www.youtube.com/watch?v=MmkI--ZZ3xs by The Verve reminds me how fortunate I am.

I can't reply to everyone's emails, but I'm so uplifted to read comments from old friends, and that so many people share so much joy and inspiration from music. Today's bedtime song, a Paul Weller masterpiece, is for Mo. Turn it up to 11, mum: http://www.youtube.com/watch?v=hMoFzC6gEpQ

Weighing-in at 88.4kg - Round 5

Eyebrows were raised this morning as a stepped on the scales before my 5th, and final, round of chemo for this cycle. The deitician's prescription was basically my dream menu, and Moniek's family have been treating me like a king. Somehow, I've managed to gain half a kilo!

I don't need any pharmaceutical support for my white blood cells; my liver and kidneys are functioning well, and Dr Karmen is re-jigging my schedule for next week. I've got 2 days of rest and light exercise ahead, with a bit less honey in my tea. I couldn't have hoped for better!

Punch drunk - Round 4

Yesterday's chat with Dr Karmen focused on my state of mind. She reckoned my brain needed to slow down, and prescribed some kind of horse tranquilizers - two before sleep. I managed a page of my book before all the lines blurred into one and I zonked-out for 8 hours of much-needed kip.

Moniek helped me shuffle out to the taxi, into the hospital, and back into my personal bed for Round 4. Small nurse mixed her potions and I slipped into a deep, peaceful sleep. I vividly recollect Dr Karmen shaking my shoulder to wake me up, and asking difficult questions. However, she was wearing a traffic cop's high-visibility neon waistcoat, so I'm not 100% sure if I got all the answers right ... 'errr, sorry, the clutch came out a bit too quick officer" etc etc ... or was it a dream?

After I had been properly resuscitated, a guy called David knocked and came into my room offering counselling and prayers. He's been riddled with incurable cancer for 8 years, and spends his days visiting clinics to fill others with hope. Everyone had warm smiles and kind words about him. We discussed life, the universe and everything for an hour. The flow of conversation was interrupted twice by my unstoppable flow of piss, but he didn't mind a bit.

He ducks, he dives - Round 3

Mental preparations at 7:30am for Round 3

Moniek, Ellie and I pitched up at Dr Karmen's clinic before the staff had arrived. I'd had a rough night, with very little sleep, and was actually relieved when small nurse told me I would be in the bed again. She seemed to know something I didn't.

My summary of symptoms was completely normal, and she already had the antidotes laid out on the bench. These girls don't miss a trick.

She opened my chest-pipe and primed me with a large syringe's worth of hiccup serum. With just one 'hic', I reckon I'm starting to build my credibility in this hidden underground chemo culture (it's actually on the 5th floor, out of the lifts, turn right, 2nd office on the left - the one with the wonky oil paintings and angel/cherub statues all over the place).

Mo & Ellie waved me a cheerful goodbye and went of for a nice walk around the botanical gardens next door.

As soon as the first drips of my cocktail hit my veins, I passed out. Small nurse woke me up every 40 minutes for a blood-pressure test, and precisely swapped my chemo bottles according to Dr Karmen's precise schedule. I had many vague pisses at vague times.

I woke up alert some hours later with a craving for U2. St Bono's lyrics in 'Walk on', 'Kite' and 'Sometimes you can't make it on your own' took on new meaning, and small nurse discretely brought me a box of tissues. Cancer nurses must see a lot of tears.

Macho defences down, in for a penny, in for a pound ... 'Time' by Pink Floyd massively influenced my life, and I've hardly frittered a day since I first heard it 25 years ago. Choriocarcinoma has made me shorter of breath, and God only knows how many days closer to death. I was pulling tissues like a magician pulls hankies from a hat. The segue into 'The great gig in the sky' http://www.youtube.com/watch?v=V7NyO9NPZbQ was divine. How those 3 women express so much about life and death in 4 minutes and 47 seconds - without saying a single word - I will never know. I'm just so glad they do. 

Wait 'til you see the main course!


Moniek, yet again, saved the day with her beautiful smile and a chilled pint of some healthy hippy drink. Small nurse said the big boss wanted to see me before I left, and my heart sank.

Dr Karmen studied my fan of papers on her desk and pushed her tortoiseshell specs upwards. She wants to consult with some eminent colleagues about my exceptional progress. I seem to be whacking Chorio so fast that she's considering reducing my 9-week programme to 6. Wow. Chorio must be KO'd, and we can't take any chances with an 8-count, but I don't appear to be a typical opponent. Even if I stay on the original 9-week programme, the fact that she's even considering this approach has given me a huge boost. Watch this space.

She enquired about my opinions on how this remarkable situation had arisen. I didn't need much time to think: 'I've got strong will-power, a firm faith in God, superb doctors and nurses, and my family and friends are cheering me on'. 'Hmmmm', she nodded in agreement, 'we should talk about this more another day' and shook our hands as we rose from our seats. Back at the apartment, Moniek fed me veggie burgers and switched on some film with Nathalie Portman in different ballet frocks - and I forgot about cancer for 90 minutes.

The time has gone, this blog is over, thought I'd something more to say ...

Ding ding - Round 2

324 is a massive improvement, but still life-threatening if the Choriocarcinoma continues to lurk in my blood and the tumors continue to grow in my lungs. Dr Karmen has a cunning plan to get me down towards zero by the end of the 9-week period. Apparently, the count won't actually hit zero because we all have a small amount of this hormone in our bodies.

Bottles of P, E, B, Benadryl and Saline were bunched-up on the rack so tightly that they couldn't hang vertically; there were more bottles outside on stand-by. Today would be a 5-hour marathon. I was administered a large syringe of anti-vomit serum into my chest pipe, plus another unknown substance. The anti-vomit serum gave me instantaneous hiccups, and all the nurses started giggling. It seems that it always has this effect on men - never women - and the joke never wears off.

Various anti-fever and anti-whatever tablets were washed down with good old fashioned water. The new element of this PEB cocktail, B, came in a metallic purple bag which reminded me of the wrapper of that curved caramel/nut sweet you get in a tin of Quality Street.

There was general concern that this was going to be a rough session. Having learned from yesterday, they doubled-up on piss bottles. I was given a large chrome hotel lobby bell to ding-ding in the event of an emergency. The nurse felt it necessary to give me a demonstration but, because I had placed it on the far side of the bed from her, she had to stand on her tip-toes and lean all the way over me to ding-ding. I got distracted, and the essential safety feature of the dry-run was lost. I would have to improvise if something went wrong.

The staff were astounded that I remained alert through the whole session, watched TV, and only ding'd my bell once - by accident, whilst re-mounting the bed after one of my countless pisses. Moniek arrived with a gift of fresh orange & pineapple juice. As she led me away, I glanced back and secretly hoped that tomorrow they'll let me graduate to the comfy chairs.

It ain't over 'til the fat lady sings

Just before Dr Jimmy lopped off my starboard berry, my hormone marker was a certain-death 14,638. Just before I started chemotherapy, Dr Karmen took another blood sample to see how effective the surgery had been on it's own.

Today's nurse flicked the readout onto my horizontal chest, face-down, with the precision of a casino croupier. I nervously lifted one corner. The important number was in red - 324. Woo hoo! It ain't over 'til the fat lady sings. My eyes darted around the clinic. Thankfully, it was the big nurse's day off.

Oi, Chorio! ... say hello to my leeetle friend

"Say hello to my leeetle friend"

I'm fighting Chorio - not chemotherapy. This was a big mental leap for me. PEB chemotherapy is the weapon of choice for this vicious cancer.

Sure, the side-effects are unpleasant (hair loss, vomiting, anaemia, insomnia, weakness, rapid heartbeat, paleness, headaches, anxiety, depression, fever, infections, loss of appetite, constipation AND diarrhoea (?!?!), mouth/gum/throat problems, and a total alcohol ban) ... but they are lot better than the alternative.

I'm facing 9 weeks in bed. Maybe I'll start a petition for a director's cut of 'Scarface' re-dubbed without the Giorgio Morodor soundtrack.

Seconds out - Round 1

The hands on my watch seemed to spin faster as my first chemotherapy session approached. The nurses explained the process and escorted me to a tiny, private room with a bed and a what looked like a hat-stand with 4 or 5 drip bottles hanging over a small computer. Today I was to be given P and E; tomorrow we'll whack a shot of B into the chemo cocktail.

Pint of coffee - be careful what you wish for, small nurse!

Small nurse gave me a Lasix Frusemide tablet to help me pee; she needed urine samples for various tests once the intravenous drips started to take effect. Ellie (Moniek's mum) had bought me a can of draught Guinness the night before, which I gratefully washed down with several Tiger beers. I had also kick-started the morning's chemo preparations with the most enormous cup of coffee I have ever seen. I didn't think I needed the tablet but she insisted, and I obliged by presenting her a total of 2.7 litres during the session. I don't think she will force the tablet issue again.

Big nurse gave me Benadryl, a strong anti-histamine which would make me sleep, and Emend to suppress vomiting. I asked why I was being confined to a bed without a view, rather than shifting my bum cheeks in the comfy chairs like everyone else. The lazy-boy recliners looked like business class airline seats from which one could keep an eye on all kinds of interesting activities.

Small nurse said that I needed to be isolated and monitored because I would feel dizzy, nauseous, extremely tired, and desperate for a piss. I asked her to predict how bad it would get, but she couldn't say. From what I could ascertain, it sounded like 2am after 8 pints and a dodgy kebab. I began to question my lifestyle, and just did what I was told for a change.

It took 3 hours and 15 minutes for all the drips to drip through the flow-control computer, along the pipes, into my chest via my new robo-tap, around my body, and into the rapidly-replaced piss bottles. Given the nature of Chorio and the typical horror stories of chemotherapy, I was expecting to feel a little off-colour. When Moniek showed up with a pint of freshly-squeezed banana & mango juice she said 'wow, you look better'.

I'm now back at the apartment, next to the flowers my family sent to Moniek's family (beautiful, and greatly appreciated - thanks!). There's a smell of warm ciabatta bread coming from the kitchen, and I can hear the ting of a salad being tossed in a stainless steel bowl.

I'm told I'm in for a rough ride on day 3 but, for now, I'm doing great.

Rickster the Lionheart

I can't stand needles. The prospect of 9 weeks' continuous vein jabbing drained my will to live. I had jumped at Dr Karmen's offer of a semi-permanent tube/tap system which could be inserted into my chest, and arrived at yet another specialist's clinic to have it fitted. The young, friendly Malaysian Dr Ken Sheah had learned his trade saving trauma victims in various Accident & Emergency wards across Zone 1 in London.

The procedure took 90 minutes because (a) the veins in my right shoulder were hard to poke and (b) in his words, Dr Ken has obsessive compulsive tendencies with his craft. He used ultrasound to locate the most suitable vein, a heart condition monitor, and some gadget to measure the amount of oxygen in my blood. He said 'your cardiovascular system is extraordinary ... your veins are pumping blood as hard as most people's arteries ... and some athletes I know train at altitude to build their oxygen capacity to your levels'. Nice one. Cheers, doc.

I decided to keep my (slightly unorthodox) training regime hush-hush for now. If I can beat Chorio, there might be an opportunity to pay my medical bills by grabbing a slice of the fitness publication market. It won't be popular with the yoga and mung bean crowd, but I feel there's a niche.

The wheezing skinhead

Dr Karmen reckons that Chorio usually attacks the lungs first, and she wasn't satisfied with the quality of my chest x-ray. She wanted another hi-resolution scan to double check. I had undergone so many tests recently that the nurses at the imaging centre were struggling to find a vein in my arms. It was like a scene from 'Trainspotting'.

Lung capacity and volumetric flow tests involved me sitting in a clear perspex box. Inhaled sharply through a pipe until my eyes bulged, and blew out as hard as I could until my ears popped and I turned blue. Everything was measured on an important looking computer. Living in the Himalayas, these tests should have been a breeze. However, I only hit 89% of my predicted abilities (it's a function of height & weight) and this didn't stack up with my other 'fit and healthy' results.

We carried my out-of-breath charts to Dr Karmen's office in a plastic bag. The new lung scans zipped across town by courier motorcycle. My wheeziness was (currently) only a minor cause for concern, but the scans confirmed my fears that the cancer had spread to my lungs with 4 tumors of up to 5mm across. Doh!

The Chorio is still active in my blood, and so there is no doubt about the treatment: a rigorous 9-week course of chemotherapy. 1 weeks on, 2 weeks off. During the 'on' weeks I'll be spending 4 hours a day, 5 days a week pumping a poisonous cocktail called PEB (Platin Etoposide Bleomycin) into my body via a rubber tube hanging out of my chest.



'A number 1 please'

Dr Karmen Wong runs a busy cancer clinic in one of the most respected hospitals in Asia. To give you an idea of the rarity of male Choriocarcinoma, the last case she treated was 10 years ago - and her patient is still alive! Dr Jimmy Beng had only seen my testicular variant 4 times in the last 25 years.

Dr Karmen was realistic about the seriousness of my situation, but also optimistic about my chances of survival. By my calculation she's got a 100% survival rate; she offered me 90% and said with a soft smile 'don't worry, it's curable, you will get better'. I love this lady.


Bzzzzzzzzzzzzzzz


In typical Singapore style the chemo was available immediately, but we decided to wait for a few days.

It was hard to comprehend, but only 5 days had passed since my operation, and the wound was still tender.

Psychologically, I was absolutely exhausted and felt that a bit of rest would enable me to prepare more thoroughly for the chemotherapy. Dr Karmen whole-heartedly agreed.



Waiting nervously for the tap & pipe to be fitted, 8th November 2011

C-day is Tuesday 8th November. I spent the weekend looking for a hat, and made a pre-emptive strike at Chorio by shaving my head.

I keep frightening myself whenever I pass a mirror.

At Matt's request, here are some before-and- after pictures.

My pubes were shaved completely for the berry removal but, sorry, I'm in negotiations with 'Hello!' magazine for the photo exclusive.

Mike Tyson vs a feisty lady with tortoiseshell glasses

From my research, it seems that Choriocarcinoma is the Mike Tyson of cancers. It's fast and aggressive. Once unleashed it attacks the lungs, brain, kidneys and liver. And it doesn't give a f*ck about the Queensbury rules.

The pathologist's formal report showed that my Choriocarcinoma had escaped from my ex-testicle and into my bloodstream, and was now lurking all over my body. I needed further examinations of my head, chest and abdomen to see if any of my organs were under attack. More x-rays, CT scans and blood tests ensued.

Some good news: my brain, lymph nodes and kidneys appeared fine. I didn't have Hepatitis B. My hormone marker had dropped, but was still dangerously high. The lungs seemed OK, but the x-ray wasn't clear enough to say for sure.

Dr Jimmy said we could be 'cautiously optimistic' and referred me to a highly respected oncologist (cancer specialist), Dr Karmen Wong. She's a feisty, straight-talking, no-nonsense lady with tortoiseshell glasses.

Singapore sling and the cruel heart-breaker

I recovered extremely quickly from the operation, and was discharged the following morning with some painkillers, antibiotics, and a John Wayne walk. I've been prescribed tight, ball-hugging underwear to keep everything in place during the healing process. It brings a whole new meaning to 'Singapore Sling'. I have raised my objections about the unpleasant chafing it causes in the nether regions, but the surgeons seem to be absorbed in more urgent medical matters.

I decided to re-assess my priorities and turn my attention to my cancerous opponent. According to various medical websites, Choriocarcinoma of the testes '... represents the most aggressive pathological variant of germ cell tumors in adults ... is a malignant and aggressive cancer ... it responds poorly to radiation and chemotherapy and carries high mortality rate ... because of early spread and inherent resistance to anticancer drugs, patients have poor prognosis ... and is rapidly fatal'. Hmmmmm.

On Monday 31st October we went to see Dr Jimmy. A dark cloud seemed to overshadow his usually chirpy and positive attitude. He had received telephone confirmation from the pathology lab that I did, indeed, have Choriocarcinoma and that this was 'not good'.

Moniek and I were devastated. We held our composure all the way back to the apartment. Walking up to the door, her Mum saw the look on our faces and started crying. A split second later, we were all sobbing uncontrollably.

This heart-breaking scene is repeated daily, in families all over the world. Cancer is a cruel and indiscriminate disease.

Choriowhat? How much?

A pretty nurse woke me up on Saturday lunchtime. I was feeling dizzy, dis-orientated, slightly nauseous and had a red raw scrotum. It was much like a hangover from the Irish Club in Nottingham.

Dr Jimmy came to check my wounds and explained that he had performed a mini-biopsy on the removed testicle in the operating theatre. He was 100% sure I had cancer, and that tuberculosis had been ruled out. He gently explained that a formal pathology report would confirm his opinion and identify the specific nature of the cancer. Suddenly, my life took a new direction and my mood plummeted.

The 'markers' from my blood test showed that I had high levels of a hormone running through my veins. This particular hormone is normally found in pregnant women but, in men, indicates the presence of Choriocarcinoma. No, I hadn't heard of it either. I felt this hormone explained the growth of my 'man boobs' in recent years, but Moniek wasn't convinced.

I nodded my understanding at Dr Jimmy's diagnosis, but it was clear that I was not yet fully coherent. He asked Moniek and Ilse to join him in the corridor. I've seen this movie before. I could see Moniek's sobbing reflection in a glass door, and I overheard his words 'sky high'. I began to panic.

The normal level for this marker in the blood is somewhere in the range 0 to 5. My count was 14,638.

Bionic bollox

I'm easily amused. The motorised hospital beds could raise my upper body and/or lift and bend my legs. I watched TV, listened to some music, read a book, stared at the ceiling, and helped the nurses to make last-minute checks. Plenty of opportunity to re-adjust the bed for any given challenge.

The orderly arrived bang-on time, and pulled my bed headfirst through brightly-lit corridors and a big steel elevator down into the windowless bowels of the hospital. My heartbeat increased. Moniek and Ilse were with me but, to be honest, my thoughts were elsewhere.

My wristband was read and I was interviewed to double-triple-quadruple-check that I would get the operation I actually needed. I met the surgery team one by one in the holding area.

On the way into theatre, I was greeted by Dr Jimmy's receptionist who, as it turns out, is also some kind of medical professional. She cheerfully showed me the prosthetic 'bionic' bollock that would replace my manky one. She actually had two on stand-by, 1 medium, 1 large (but I think she was just trying to make me feel better), dependent on what they would find.

The anaesthetist, Dr Boey, probably moonlights as a hypnotist. I went out like a light.

Terminal flatulence and re-cycled Fosters

I checked into the Gleneagles hospital at 6:30am on Saturday, and was taken to a room with 4 beds. I couldn't see any of the other patients due to the swishy curtains, but was building up a mental picture from their hushed conversations and the sounds of sickness.

A middle-aged Singaporean guy (I think) with teenage kids opposite me had the loudest, longest, most frequent flatulence I have ever heard. At first, I giggled. It soon became tiring. Eventually I pitied him.

An old okka Australian fella in the far corner was too proud to call the nurses for help following a stroke. All he had to do was press a red button and they would come to his aid. He didn't want to impose. He kept pissing the bed and knocking over his stockpile of re-cycled Fosters. I had to call the nurses, discretely on his behalf, to mop up the puddles.

The other person? Absolutely no idea. Visitors came and went, but I couldn't deduce a thing.

Gladiator - blood and piss

Thursday 27th October was a busy morning. I needed blood, urine and heart tests so that Dr Jimmy could prepare for the operation. It gave me a first taste of the speed and efficiency of the Singapore medical system.

I showed up at a the blood laboratory, which looked more like the foyer of an accountancy firm. I took a a supermarket-style queue ticket, waited for 2 minutes, and went inside when my number was displayed. The nurse was a tiny old lady with a wrinkly, smiley face. I hate needles, and had to turn away while she did her job. She rubbed my arm with an alcohol wipe and said 'there, finished'. I hadn't even felt the prick! I confirmed my details printed on the vial, and the results were emailed to my doctor within a couple of hours.

When doctors suspect cancer, they measure certain hormone 'markers' in the blood before the operation. This provides a 'baseline' against which they can measure the impact of the surgery. Little did I know that just 48 hours later, my markers would give me the fright of my life.

The urine test was a little more eventful. It was my first time. I was expecting to be handed a caraffe-type bottle of about a litre. Instead, they gave me a plastic container no bigger than a 35mm film case. Suffice to say that I ended up emptying the rest room of liquid soap and paper towels. Again, the test results went almost instantly to Dr Jimmy.

The Electrocardiogram (ECG) is a machine to monitor heart condition. The senior nurse gave me the best news I'd heard in ages: 'you records say you're 41, but your ECG says you're young and athletic'. We took the spiky graphs directly to Dr Jimmy, who studied all the test results and declared that we were ready to operate on Saturday morning at 7am.

All 3 tests had all been completed in one systematic morning, the results were already being sent to the anaethsatist, and I waddled off to the restaurant for a delicious Malay lunch.

My hero, Dr Jimmy Beng

I couldn't resist a couple of 'Deacons' as I was wheeled through Changi Airport. Unless you are a man who grew up in the UK in the '70s, you will have no idea what this means. It's best left that way.

I was whisked through customs and straight into a plush, air-conditioned Hyundai taxi. Compared to the ratty Maruti Suzukis of Nepal, this was bliss. The streets were smooth and organised, and we sped under neon lights to the Accident & Emergency entrance of the Gleneagles Medical Centre. En-route, Ilse called the doctor to tell him we were almost there.

Dr Jimmy Beng came to the hospital on his evening off especially to see me. I was impressed from the moment I shook his hand. He invited me into a pristine consultation room, and conducted proper, detailed examination. He confirmed that the problem could be either tuberculosis or cancer, and was extremely relieved that Moniek had saved me from the perils of FNAC in Kathmandu.

Dr Jimmy is a kindly, cheerful man with an air of extreme (but understated) competence, and a manner which immediately puts patients at ease. He didn't need Wikipedia to give calm, measured advice - and not once did he feel the need to read the latest gossip on Facebook. I cannot explain how pleased I was to meet him.

He proposed a treatment schedule there and then. It was 10pm on Tuesday 25th October. Wednesday I would rest; Thursday I would have blood, urine and heart tests; Friday I would rest again; and Saturday morning he would operate. He gave me some tablets to ease the discomfort.

It's hard to believe that anyone would be pleased about having a testicle removed, but after all the recent pain and anguish, I was genuinely relieved. I asked Dr Jimmy if I could have a couple of beers at Ilse's apartment. He replied in a wise, oriental accent 'oh yes, that will be very good, it will help you to relax'. My hero!

Eleanor Rigby and exploding plums at 33,000ft

While I lay in bed in pain and despair, Moniek and Ilse were pre-arranging treatment for me in Singapore. We flew out of Kathmandu on Tuesday 25th October.

I was genuinely concerned that the drop in cabin pressure could cause my swollen bollock to rupture, and spray my cancerous tumour across the passengers in row 11. I struggled with how to raise this isssue with the air hostess, and decided to listen to my iPod instead. I choked up and shed a few tears during 'Eleanor Rigby' by the Beatles. I reflected on what a fun-filled and action-packed life I had lived, and how luckly I was to be surrounded by such incredible friends and family.

Moniek had organised a wheelchair to collect me on a arrival. She's tall and pretty, but quite skinny. The porter's job sheet included 'cancer patient from Kathmandu'. He rolled up to the aircraft and tried to put Moniek in the wheelchair instead of me! Cupping my aching plums, I failed to contain my laughter.

Exodus

I had concluded a number of facts: (1) there was a big, nasty mass inside my right bollock; (2) the symtoms were consistent with those of testicular cancer; (3) there was a slim chance it could be tuberculosis; (4) either way, it was highly likely I would lose a testicle; and (4) I wanted to get as far away as possible from Dr Regmi and the Norvic Hospital in Kathmandu.

I was born in 'The United Kingdom of Great Britain and Northern Ireland'. My sister lives outside London; mum and dad outside Belfast. I worked in the UK for 17 years, and paid half my substantial earnings to the tax man. I felt morally justified to return for medical treatment, but had concerns about how easily I could drop back into the system after 9 years of exploring the world by motorcycle.

Moniek's sister, Ilse, lives in Singapore where the medical facilities are apparently world-class. It's expensive, I don't have any insurance, and would have to pay cash. But, critically, it's only a 5-hour flight from Nepal.

The necessary phone call to my family filled me with dread: 'Hi, how are you? Listen, I've got cancer, and need to leave Nepal immediately to have one of my balls cut off. What do you reckon? London, Belfast or Singapore?'

They were extremely supportive, and we reached a decision in less than 5 minutes - Singapore. I met my client for dinner to explain the situation. He was incredibly understanding and flexible (cheers, Shoban), and I started packing for the trip.

Radical orchiectomy for dummies

Once I had caught my breath, I went back to my room and did a bit of research of my own. I Googled 'testicular cancer' and went from there.

I re-visited Dr Regmi at the Norvic Hospital the following morning to hear his suggestions of how to proceed. He wanted to slice my groin open, pull my balls up through my body and onto my abdomen, cut one off, and shove the remaining one back in again. This was to be done with an anaesthetic to the spine which would temporarily paralyse me from the waist down. I would be conscious throughout. As he talked, the blood drained from my face.

His continued interest in Facebook distracted him from my questions about the operation. I was in genuine fear for my life. Eventually I lost my cool and demanded that he log-out of Facebook.  He re-focused and explained the operation by Googling testicular cancer, and then printed off the 9 pages of Wikipedia I had been reading the previous night. To our utter astonishment, this document was for his further reading rather than ours.

Dr Regmi then began to quiz me about the health service back home and the price of a return ticket. He was trying to decide a suitable price point for my operation. It was time to leave Nepal.

You want to do what?

Doctors use clever imaging technology to see how babies are developing in the tummies of pregnant women. The same equipment was used to study my lump. They smeared cool jelly on the affected area, and gently rubbed it with a curvy roller. Under different circumstances, it would have been quite pleasant. The scan clearly showed a substance, about the size of an almond, inside my gonad - but was inconclusive about its composition.

Dr Regmi wanted to perform FNAC to determine whether the substance was tuberculosis or cancer cells. FNAC is the acronym for Fine Needle Aspiration Cytology. Basically, he wanted to stick a syringe into my bollock - without any anaesthetic - and suck out some of the puss for analysis. My eyes watered, and I glazed into a trance of disbelief.

My girlfriend, Moniek, asked Dr Regmi an obvious question that would later prove to be a life-changer: 'If it is cancer - and you poke it with a needle - won't it spread around his body?' The doctor gave an unconvincing answer and eventually suggested MRI (Magnetic Resonance Imaging) instead. MRI involves laying down on a bed which slides under a machine; the machine then beeps, buzzes and whirrs for 40 minutes and takes some hi-tech photos. It's a bit like a 3-dimensional x-ray. Sold to the man with the glazed eyes.

The MRI scan was very expensive, but didn't tell us anything new - the lump could be cancer or tuberculosis. Either way, the recommendation was the same: my right testicle would have to be chopped off. Gulp.