• ‘Careful – we don ‘t want all these ladies going beserk’ after being asked to unbutton my shirt without the curtains being drawn.
• ‘Be assured, Mr. Brightside, I’ve seen it all before and so have these ladies’ – the nurse’s quick-fire response which filled the room with laughter.
• ‘It’s the secret of a long and happy marriage doctor’ – my response to a surprised doctor’s reaction to the news that my wife had already examined my backside earlier that morning.
• ‘Do you mind if I have a feel ?’ ‘No – go ahead – it’s the best offer I’ve had this week’. My response to a pretty Irish nurse attempting to rectify a failed attempt to access the portacath device.
• ‘Has the ileostomy bag been a great help then ?’ I was sorely tempted to reply ‘Not really – it was much easier to pooh out of my arse like everyone else’.
• ‘Any problems with breathing ?’ Standard fortnightly medical checklist question. The reply was always ‘Nope – I am still breathing’.

The only feedback I had during the three months chemotherapy was that the ‘cancer markers in my blood were down (from 10 to 5)’ which I took as good and welcome news but it didn’t really tell me much about the state of the problematic lump in my backside.

The doctors told me that the chemotherapy had ‘been beneficial’ and there was evidence that the centre of the tumour was ‘necrosed’ (dead). When I said it was strange, the central core had been affected and not the edges, the doctor explained that the central area was blood rich and as the chemotherapy attacks rapidly growing cells, this actually made sense. Although the size of the tumour was unchanged (8 cm), the doctors also seem pleased with the way I had tolerated the chemotherapy with relatively few side effects which meant the frequency and dosages didn’t need modifying with only two delays of one week each.

To summarise, the doctors confirmed that we are still on course for a ‘curative solution’ – curing the cancer not just treating the symptoms and we will continue now with external beam radiotherapy. The sole purpose of this targeted radiotherapy is to reduce the size of the tumour in order to give the subsequent surgery to remove the tumour the best possible chance of complete success.

In fact, the doctors stressed that it is not necessarily the size, per se, of the tumour that matters. It is the areas around the edges and borders with other organs that is crucial. As the doctor said, ‘We need 5mm to be able to safely remove all of the tissue. If we get more, than that’s even better’.

I asked what the best and worst case scenarios were. The worst was ‘no reduction but this was unlikely’ while the best outcome was that the tumour would shrink away to nothing, negating the need for surgery. My ears pricked up at this prospect as this was the first time, this had been aired. However, the oncologist immediately urged caution and said this was a ’20% chance’ but not for my type of ‘mucin producing tumour which doesn’t tend to respond as well to radiotherapy’.

The next stage was a planning session for the radiotherapy where the radiologist would perform another CT scan and etch three small markers (tattoos) which enable them to align and aim the laser beam accurately into the correct area for the 30 days of radiotherapy.

After one session, I left the hospital and when I went to open my car door, I felt a strange feeling of pins and needles in my fingertips as soon as I touched the metal. This was the neuropathy side-effect I had been forewarned about. The feeling wasn’t painful – more of a surprise – and it was short-lived. In the following weeks, I experienced neuropathy quite often and it was always associated with cold temperatures; for example, getting milk out of the fridge and once, my voice went all husky when I went outside on a nippy winter’s day.

At Christmas, I had a conventional winter cold, with a runny nose, sore throat and a couple of mouth ulcers. This caused my final chemotherapy session to be delayed by one week to early January but to be honest, as I felt pretty lousy, I was almost quite relieved.

I was aware mouth ulcers were a cause for concern during chemotherapy as they appeared on the ‘Call us immediately if you get any of the following symptoms’ checklist. Inevitably, my oncologist seized on this – ‘When did you first notice the ulcers ?’ ‘On Christmas Day’ ‘Did you ring the hospital and tell us ?’ ‘Err, no’. ‘Why not ?’ ‘Well it was Christmas Day and I was having fun, eating nuts and playing Scrabble’.

The oncologist sighed, smiled and told me to sluice some white, creamy mouthwash around my mouth three times a day. The truth was there was no way I was telling my wife about the mouth ulcers let alone calling the hospital on Christmas Day and risk being summoned for a consultation or, worse, being admitted again.

I am a keen fan of football and bore people incessantly about the subject.

In August 2011, I was diagnosed with bowel cancer.

There is a UK bowel cancer charity support site, supported by various footballers, called ‘Know The Score‘ which includes and supports the ‘Mr. Brightside project‘.

Cue twilight zone music.

[ Sadly, the derivation of the Mr. Brightside project name is inevitably sad and involves the premature death of a young man who liked The Killers so don't feel obliged to go and read about that. ]

I did what I normally do in these circumstances and called my therapist. He’s a lovely chap who sits on a wooden bench in the beer garden of the Pear Tree hostelry (‘Where Progress Is Measured In Pints’) clutching a pint of Hooky Gold. His pint glass is always half full. Obviously.

His helpful advice for my quandry was as direct and helpful as ever – ‘Pull yourself together, you soft get’.

‘But, hang on, that’s easy for you to say – what about my two questions ?’

‘Oh those questions, right – I’ll help you out there. Firstly “‘How did you get here ?”. Well you walked which is more then some of those people back in the hospital who are confined to wheelchairs can do, so count yourself bloody lucky’.

As for ‘Where does this end up ?’ – well 2012 may see the following events:-

• GB top the medals table at the London Olympics.
• England win Euro 2012 beating Germany 4-2 in the final.
• Manchester United pip local rivals, City, for the Premiership on goal difference in the final game of the season.
• These blog posts are collated into a best selling e-book that goes viral. You become an overnight Internet sensation and a multi-millionaire.
• You emerge victorious and find yourself participating in a sponsored rickshaw ride for a bowel cancer charity from London to Cairo accompanied by 80′s pop singer Kim Wilde, snarling Fall frontman Mark. E. Smith and roly poly Christopher Biggins.

Now be honest – which of of those scenarios is most likely to come to pass ? – the last one of course so stop feeling sorry for yourself and get back in there.

Buoyed and encouraged by this, I walked back into the hospital and retraced my steps to the ward where the lovely Irish nurse hooked me up for IV antibiotics. I got to order my ham and cheese sandwich, chatted to my friends in the chemotherapy room and dipped into ‘The Stephen Fry Chronicles’.

Later that afternoon, a room on the ward became free and, feeling like a fraud (as I felt perfectly healthy), I reluctantly took up residence for the next five days. At the weekend, I managed to negotiate day release to get home after lunch and return at night to accommodate my thrice daily 30 second injections and various medical observations.

The IV antibiotics worked their magic and chemotherapy session 2 was resumed the following Wednesday after just a weeks delay.

Two days after the blood clotting episode, I drove to the Royal Marsden Hospital for my second chemotherapy session. The doctor went through the lengthy symptom checklist to gauge my bodies reaction to my first exposure to powerful chemotherapy drugs. Most of my answers were ‘No’, ‘Nothing’ or ‘None’. When she finished and asked ‘Any other symptoms or problems ? ‘, I just mentioned the ‘ongoing pain and discharge from my backside’. The doctor raised her eyebrows – ‘Discharge ? Well I think I need to have a look at that’ and so we adjourned to a consulting room.

Chemotherapy is similar to the calamari from my local delicatessen. It is made up in batches in the morning and it is expensive.

My trusted oncologist examined my naked bottom and, like tens of women before her, didn’t like the look of what she saw. She opened the door slightly and shouted out with some urgency – ‘Mr. Brightside, please cancel his chemotherapy. Now’. No chemotherapy or calamari for me today.

My heart sank as I pulled my tracksuit bottoms up and awaited her diagnosis.

‘You have an active infection in your bottom that is discharging pus. I have taken a swab and will send it to the microbiology lab. There is no way we can give you chemo with this infection present. To clear this infection up quickly and resume chemo, we need to admit you and give you IV antibiotics for a few days’.

I went back into the chemo room and pondered on this development. The Doctor came over – ‘Right, currently we don’t have a room free so we can’t admit you. However, we could give you oral antibiotics but these probably won’t be strong enough to clear up the infection but don’t worry, it’s early yet, hopefully a room will be freed up later today’.

Oddly, after all I had been through, this seemingly inconsequential news had the effect of a straw delicately placed on a camel’s back.

The brilliant colorectal specialist who first diagnosed me back in August had been unerringly accurate in every single word he uttered. These prophetic words in particular – ‘The main problem here is the risk of recurrent infection in your bottom during the chemotherapy when your immune system is compromised’ and my wife’s polite request for ‘proactive antibiotics to reduce the risk of infection’ that fell upon deaf ears.

So, after just one chemo session, this scenario had indeed come to pass. We couldn’t treat the tumour in my rear end with chemotherapy because  of a raging infection in my rear end (that was essentially the tumour).

There was only one Catch and it was Catch-22.

This was just too much. I’d come to this session on my own expecting no complications. I expected a chat with my new found friends, a ham and cheese sandwich and being hooked up for 2 hours reading a book.

I eased myself out of my chair and walked out of that damned chemo room full of poorly people waiting patiently for their expensive, light sensitive chemotherapy drugs to be made up by the pharmacy. I walked down the long corridor with the blue carpet past ladies with colourful headscarves on, I walked past friends and relatives who had just popped to the shop for a newspaper. I walked past smiling and laughing nurses. I walked past a middle aged woman who had clearly been crying while she simultaneously walked past a middle aged man on the verge of crying.

I walked past a father and son anxiously looking at signposts looking for directions to some ward named after a famous surgeon. The father wasn’t the patient – the 14 year old lad was and had no hair to prove it. I tried not to stare, bit my lip and walked out of the hospital. It was a mild, grey day and drizzling. I carried on walking past the ambulance set-down area until I reached the furthest edge of the lucrative, PCT income stream that is the visitors car park.

It would be tempting to say I looked up to the heavens and screamed ‘Fuck you, cancer’, ‘Live strong’ or ‘You can take my life but you can never take my FREEDOM’ but I didn’t.

I looked down at the tarmac, looked at the raindrops staining my shirt and briefly wished I’d put my coat on before my sudden and spontaneous departure from the ward.

‘How on earth had we got here ? And where in the name of fuck were we going to end up ?’

So, Sunday 23rd October dawned and after lunch I settled down to enjoy one of the biggest football matches of the season – United versus high spending and high flying Manchester City. Mario Bolotelli opened the scoring and unveiled a T-shirt adormed with ‘Why always me ?’ I simply love quizzes so I tweeted hin immediately ‘Is it because you are a complete arse ?’

Jonny Evan’s dismissal early in the second half and a second Balotelli goal failed to lighten my mood. The wife then interrupted a stony silence with ‘What’s that rash on your arm ?’ ‘Dunno – probably just a bit hot’.

My wife then attacked me with an indelible, black CD marker pen and proceeded to draw a circle around a red blotch on my upper left arm, explaining ‘I’m a bit worried about this’. When my view of the TV screen was clear, I sighed as Aguero made the score 3-0 to City.

Minutes later, the wife passed me the phone – ‘Here’s it’s your sister’. For God’s sake, why is my sister calling me, from Brisbane (near Australia) in the middle of the footy. ‘Hi Rachel  – hang on. Isn’t it 3:30 in the morning out there ?’

‘I’m sorry but this is Sister Monaghan from the Marsden hospital. You wife tells me you have developed a serious rash on your arm after chemotherapy.’

‘Oh yes – sorry.’ ‘Is is itchy ?’ ‘No’ ‘Is it getting bigger ?’ ‘Don’t know’ ‘Can you draw around it with a biro ?’ ‘Yes – we’ve done that’. ‘Are you feeling hot or unwell ?’ ‘No’. ‘OK – keep an eye on it and come in tomorrow if it gets any worse’. OK will do. Thanks’.

Inevitably, the rash got bigger and a little more red and raised so I duly went in to see the doctor. I assumed it was an allergic reaction or one of the 17 minor side effects from chemotherapy. The doctor examined the rash and said ‘You’d better get an ultrasound scan as this might be a blood clot’.

30 minutes later, an Indian lady was rubbing clear jelly onto my left arm and probing with her scanning device. She was quiet and obviously concentrating very hard. I turned my head to see the monitor and gauge when it might be appropriate to crack the old ‘Is it a boy or a girl ?’ joke.

I saw some grainy images, some things highlighted in purple and some things pulsing. Then I saw a round, grey circle of matter that looked like a tennis ball. I lay in silence as the consultant completed her diagnostics. She wiped the jelly off my arm and said ‘I think I would like the Senior Radiologist to look at this’.

Another doctor came, applied more jelly and scanned my left arm until he also found the tennis ball structure. He didn’t seem too perturbed and summarised his findings thus: ‘Yes – Mr. Brightside, you have a couple of blockages there – one under your armpit and another on your upper arm. You’ve heard of little old ladies with DVT’s in their legs after long flights. Well you’ve got two but in your arm. Go back to Doctor S. who will prescribe you some blood thinners which will sort that out for you’.

Doctor S. was not unduly concerned – ‘Yes – this is not uncommon. Cancer itself thickens the blood as does chemotherapy which increases the risk of clotting’.

I came home with a large bag of anti-coagulant injections to be administered (x2) each evening by my lovely wife. I think she was pleased that she had diagnosed a potentially serious problem, could finally get to jab me with a needle and feel useful

When people occasionally ask me about the chemo treatment, it’s clear that the exact process is not always fully understood. For example, some people think I have to stay in hospital or that is, in some way, an uncomfortable or painful process.

Hopefully this post will clarify the treatment, or rather my specific treatment. Your (or your friends and relatives) chemotherapy mileage may vary with the drugs administered, the duration and frequency and the possible (and actual) side effects.

Firstly, we had to review the list of possible side-effects and sign the consent form. This had already been covered in an earlier meeting but the most common side-effects seemed to be:

• Neuropathy – sensitivity to cold in extremities (fingers and maybe toes, mouth and lips). Wrap up well with gloves and scarf.
• Tiredness. Err, sleep.
• Mouth ulcers – This one is on my handy chemotherapy credit card checklist so tell your consultant.
• Shortness of breath.
• Nausea and vomiting. You are given injections and pills to counteract these symptoms.
• Fever.
• Shivering.
• Increased susceptibility to colds and infections. Avoid sick people and hospitals.

Anyway, enough of that scaremongering – let’s sign the flipping form and get started.

Chemotherapy always starts with a blood test to check your white blood cell count. If this is below a threshold, the chemotherapy must be suspended to let the body and your immune system recover. Obviously, the first blood test is to establish a baseline. Handy terminology to impress the nurses – ‘Any news on the results of my bloods yet ?

The weigh in – I have lost a stone since being diagnosed. Other positive side effects are my alcohol consumption has been significantly reduced and I have stopped snoring. Hurrah !

I was embarking on six chemotherapy treatments with a period of two weeks between each treatment. Handy terminology to confuse friends and relatives – ’6 fortnightly cycles’.

My chemotherapy drugs were oxaliplatin and fluorouracil. Handy medical shorthand for fluorouracil to impress oncologists – ’5FU’ which has the added advantage of sounding slightly rude so care is needed with volume and intonation here.

Before the chemotherapy is started, there is the inevitable saline flush which checks the portacath line is working correctly. Then there is a hormone injection and anti-sickness drugs. These are all just quick and easy 10 second injections via the portacath – the medical term is ‘push’.

The oxaliplatin is also injected via the wonderful portacath device over a period of 2 hours. The drug is suspended in a bag  from what looks like a metal coat stand. This drug is light sensitive so is shielded in a bag and is combined with a flushing agent (I think).

The infusion process is absolutely painless. You basically sit in a small room with other patients – you can read the paper, chat to the wife, eat, drink and if you disconnect the mains plug and manipulate the coat stand on wheels, walk about making new friends.

After the two hours is up, the machine beeps loudly and the nurse hooks up a final 10 minute ‘glucose flush’.

The 5FU (see I told you it sounded rude) is then administered over a longer time period (48 hours) so this is provided in a handy takeaway clear bottle (like a half-size baby’s milk bottle complete with pink trim). The bottle comes in a camera sized case and fits into your shirt or trouser pocket. Again, this is a minor inconvenience but doesn’t preclude you day to day activities and is preferable to two days in hospital for all concerned.

After two days, when the 5FU has been fully dispensed, a nurse comes to your home to disconnect the pump and that’s it for two weeks until the next cycle.

After the PET scan (which didn’t reveal any hidden small mammals up my back passage), I met with another oncologist at Sutton on Wednesday 5th October together with a couple of nurses who explained about the lengthy list of potential side-effects and counter measures.

Having been initally diagnosed on 26th August and although lots had happened in the intervening six week period, I was getting slightly frustrated that the elephant in the room was this malignant tumour in my bowel. While we knew how large it was (7.5cm) and where it was (low down), we didn’t know how long it had been present nor did we know how fast it was growing.

For all the tests and procedures, we still hadn’t done anything directly to start attacking this pesky lump that was fermenting away, sub-dividing to create more cancerous cells, and without being overly dramatic, threatening my existence on this mortal coil.

So, just as I was looking forward to being told the date of the first chemotherapy session, another hurdle was placed on the running track in front of me.

‘Before we can start chemo, we’ll need to put a portacath in which will make everything much easier for you and for us’.

Chemotherapy involves lots of blood tests – before every treatment, blood is taken to check your white blood cell count. In addition to the chemotherapy drugs, steroids and anti-sickness are also injected into the body.

For aggressive, intensive chemotherapy, doctors prefer to administer all these drugs via a portacath as it saves the hassle of trying to locate a suitable vein on the patients arm or wrist. Chemotherapy can also recess the veins which make conventional injections more difficult.

So, the portacath procedure is done under a general anesthetic but as an outpatient and I was duly booked in the following Monday with the first chemo treatment two days later on Wednesday 12 October.

My initial, brief consultant with the surgeon wasn’t overly inspiring – he hauled me into central London for a brief (but presumably lucrative) 5 minute consultation which mostly reiterated what I already knew. He rudely interrupted me as I gave a brief medical history and told me of the three possible side-effects (‘infection – but that happens down the line’, ‘puncturing the lung but as I am a specialist with 15 years experience that won’t be a problem’ and ‘line getting clogged which is why the nurses flush it every fortnight’).

Another day, another hospital – this time, the Cromwell in London. The facility appears to serve a lot of foreign people – not clear whether it’s embassy staff or rich businessmen but I can report they show Aljazeera TV and have copies of Arabic newspapers in the reception area.

The surgeon went up a little in my estimation with his pre-op visit by showing some humility and kindly answering my wife’s questions.

The procedure lasted 3 hours and I came home with a square dressing just below my left collar bone and felt absolutely fine.

Again, I found myself reflecting on the wonders of medical science. Last year, my father-in-law and I wall-mounted an LCD in my son’s bedroom. We had all the parts and tools ready and the simple instructions to hand. Inevitably, one hole went into ropey plaster and the screen was not horizontally aligned to my perfectionist’s workmate’s satisfaction so we drilled another hole. The whole process took us 3 hours 15 minutes and our lunch was lukewarm.

A skilled surgeon took less time to make a very neat incision into my chest and insert a short piece of thin rubber tube into my bloodstream. Amazing, just amazing.

Just as I was on the verge of being discharged, my colorectal surgeon paid me a visit and announced that he was going to give me a couple of enemas to fully evacuate the bowel to isolate it further and reduce the risk of infection.

So one morning an nurse squirted some lukewarm liquid up inside my bottom. I asked ‘How long before this will take effect as I’m going for a shower ? Will it be minutes or hours ?’ ‘Oh – it could be quick or it could take a while. Just leave the shower for a bit’.

As she left the room and asked whether I wanted the door open or shut, I felt something moving and had to rapidly hoist myself off the bed and make haste to the toilet.

I sat there and opened my bowels for the first time in a week. It wasn’t clear to me whether this was simply the same liquid she’d just squirted but it seemed like gallons.

Simultaneously, I noted that the ‘stoma was working’ (discharging into the colostomy bag) and gratifyingly, I was also urinating. I grabbed a cotton wool bud and wiggled it around in my ear. I later submitted an entry to the Guinness Book of World Records for ‘The Most Concurrent Outputs From The Human Body’. Unfortunately, Mr. Norris McWhirter kindly replied to inform me that I had been pipped by a Mr. Henry Rollins from Arkansas who had matched my superb effort back in 2008 but, in addition, also managed to force a simultaneous nose bleed.

The day before I went home, I had another infection flare up in my backside and my friendly colorectal surgeon said he would quickly drain the abscess to relieve the pain. Unfortunately, that meant another general anesthetic and another night in hospital.

I finally got home and the following week saw my first consultation with my oncologist from the Royal Marsden Hospital. He recommended a PET scan to gather more information about the state of my tumour before the treatment plan was finally confirmed.

The PET scan involves the injection of radioactive material that attaches itself to cancer cells and was quite amusing. The male nurse entered the room with a metal box clearly marked with the classic radioactive symbol. My wife looked a little nervous and asked whether she should leave the room. The scan was pretty similar to the MRI scan and took about 45 minutes. The nurse told me I was ‘radioactive and I should avoid contact with children under 5 and pregnant women for 24 hours’.

The results of the PET scan confirmed what the oncologist already knew. There was ‘signs of spread to the adjacent lymph nodes’ which, to be frank, frightened the hell out of me as I viewed the lymph nodes as the ‘gateway to all the other organs in the body’ but the specialist reassured me (sort of) but telling me that these lymph nodes were ‘going to be removed anyway’ and ‘any spread to the distant lymph nodes would be sorted out by the chemotherapy’.

The treatment plan was changed slightly – originally I was going to have 6 weeks intensive radiotherapy followed by surgery but now we were going to embark on six cycles of chemotherapy (fortnightly) followed by the radiotherapy at the Royal Marsden Hospital in Sutton.