Medical Journey of Gerald

During the last week (27th - 30th March 2017) of our stay at the Prama Hotel in Sanur, Bali, I noticed a lump in Gerald's neck. He said he had noticed it there about a month or six weeks earlier, but hadn't mentioned it as he thought it was 'nothing'.

On Monday 10th April, our first weekday home from Bali, we saw Dr. John Thompson at Berry Medical Centre at 4.45 pm. He recommended an ultra sound, and we managed to get an appointment the next morning 11th April at 9.30 am at Nowra SMI.

On 12th April, the next day, John Thompson rang and said they had found 'a few lumps' which needed further investigation, and recommended an ultra sound guided biopsy, which involves inserting a fine needle into the deep tissue.

Gerald had two large precancerous areas of skin removed in late August 2016, prior to going to India, by our skin specialist Dr. Graham Marning in Shellharbour. There was apparently a lump on one of these scars. Wanting further guidance, I sent Dr. Graham Marning our skin specialist an email telling him of what had happened, and he assured us that both the areas he had removed tissue from were precancerous, clean, and he had 'got it all out'. He felt the lump on the neck could be from Gerald's cold and said that a 'stitch granulation' was possible - ie. when the internal stitches do not dissolve entirely. We were reassured, and went ahead to make an appointment for the second ultra sound, this one to be a guided biopsy.

The first appointment available, given that Easter weekend occurred and that 'only certain doctors' can do this procedure was for 9.45 am on Thursday 20th April.

The young male nurse was Andrew and he prepared Gerald for the procedure, saying he was uncertain who the doctor was who would do it. Eventually the doctor arrived, introducing himself as Zane, and asked Gerald "What do you want done today?" Gerald and I both sat in silence for several seconds, both thinking "Surely you should know what you are going to do?" Gerald eventually spoke saying an ultra sound biopsy, yes, but where, Zane persisted. Andrew had alarmed me somewhat on arrival, as he too seemed unclear about where the biopsy was to occur, but I assumed the doctor would know. He said the lump in the neck could be from the cold that Gerald had in Bali, and that it wasn't really going to help much to biopsy that, and 'if I were to do anything, I would do the one in the back'. But, he added, he could 'biopsy all day long' unless we know where we are going. I said that the information would be on Gerald's notes? - and he said they were very 'vague'. He said in his opinion, biopsies are invasive, painful, and risk infection. What he would recommend is a PET SCAN, he didn't know where they did them in this part of the world, as this was his first day on the job, he was from the Gold Coast, and had come down with his wife and kids to see the grandparents, and doing a few days work. He also said 'That is what I would recommend to my parents, wife, or siblings - its not invasive, and it gives a very clear picture of any extra activity and from there, a fine needle biopsy could be conducted.' And he added, 'You're on the treatmill/roundabout (?) now, you may as well do all the logical steps.'

This made sense to Gerald and I, certainly we did not want to 'biopsy all day long' like looking for a needle in a haystack. In ignorance of what a PET SCAN was, we walked to the Standish Centre, who said they did not do them, she thought they did in Wollongong.

I texted Dr. Graham Marning, telling him that no action had been taken, and what Zane had recommended. When we got back home, we spoke to him, and he was very clear he felt that a PET SCAN is way too 'heavy duty' - its nuclear and they inject a small amount of radio active material and trace it through the body looking for hotspots. He felt perhaps Zane as a locum, did not want to do the fine needle biopsy. PET SCANS are only done at Macquarie University and another place in Sydney he mentioned, there is a long waiting list, and they are expensive.

He thought that a CAT SCAN was the next step, and that we should speak to Dr. John Thompson again. If a ultra sound guided biopsy was required after that, he would ensure we saw a very good doctor in Wollongong, Dr. Bruce Ashford. He gave Gerald an appointment tomorrow at 1 pm at his practice in Shellharbour.

We phoned John Thompson to request a CAT SCAN, and are waiting for him to call us back.

Friday 21st April. We call the Berry Medical Centre and speak to Gail - telling her that we have not heard from John despite two phone calls. We ask if we can pick up the report from the first ultra sound for Gerald to take with him to Graham Marning today. Yes, we can. On the way there, John Thompson calls, and Gerald tells him what happens. He says he would not recommend a PET SCAN, that is for people who have had cancer and when doctors are looking for possible secondaries, he does not think there is anything sinister, and supports Gerald seeing Graham Marning today. Depending on what Graham says, he will then recommend either a CAT scan or an MRI as our next step.

Gerald had a good massage with Penny Craig, who says she can feel at least one of his lymph nodes are swollen, and that would be in alignment with the cold he had.

Gerald had an appointment with Graham Marning at 1 pm in Shellharbour. Graham checked each of the sites thoroughly, and said "I know what cancer feels like, and this is not cancer." He says that doctors are not trained in working to a plan - ie one doctor sees a random event, and takes appropriate action, then another doctor takes a different approach - they don't string all the random events together, each case is treated individually, they are not working as a team. He says he will speak to John Thompson, and he believes these lumps are swollen lymph nodes from the flu and inflection that Gerald has had. He thinks to refer to Plan A - ie - the next step is an MRI or a Cat Scan.

This was a very reassuring visit, and I feel so grateful to this man.