29 January 2022

Medical issues on return from 4 years in South Africa, in urgency order.

Left lung

3 pleural effusions in 2021 when the diagnosis was TB. Then on 28 October 2021 a CT scan showed a growth or tumour near the top of the left side pleural sack - these are my words after seeing the scan, not the words of the examining specialist. The specialist stated: ‘The most probable diagnosis is left- sided mesothelioma.’ Although I had been treated for TB for a year, it may not have been TB. TB was suggested by symptoms of breathlessness and some chest and upper lung pain. I did not have Covid-19 at that stage though some symptoms were similar. The big questions are (1) how has the tumour developed over the last 3 months? (2) is the tumour malignant? (3) is it definitely mesothelioma, which I believe has no cure?

Iron deficiency

In 2018 I went to the blood services clinic and donated blood. Three months later (the minimum periodicity allowed in South Africa) I returned, and was refused because of low iron. Whatever had occurred had happened in the previous three months. I experienced serious fatigue. I went to see my GP and began a series of tests and examinations to see what might be the cause. One of these tests was an MRI of my prostate. Several months later, nothing had been revealed as the cause of the anaemia and we settled on stronger iron tablets than he had prescribed at the start of the investigation. I have been on Ferrimed D.S. Chewable tablets – iron polymaltose – with 100 mg elemental iron. I started on one a day but for the last 2 years have taken two a day. If I stop, the fatigue returns. I would think it is necessary that I continue on iron supplementation prescriptions because they have been very effective.

Prostate enlargement with developing cancer

I had prostate enlargement when we went to South Africa in 2017. It continued to enlarge to the point where I visited a urologist, Dr Deon Marais several times. The issue was some lack of normality in my urine flow, for which he prescribed Uromax. My PSA test results didn’t suggest any urgent need for surgery – about 5 if I remember correctly. I have found that I am more comfortable if I only take a Uromax tablet about once every 3 or 4 days. Some traces of malignancy showed up in an MRI in November 2019 (see separate reports) and I suspect this has increased, but he felt that at my age it wouldn’t affect my life expectancy. In the last month however, I have been getting up to pee in the night between 3 and 8 times, and on two days in January 2022 needing to pee every hour or even more often in the daytime. It’s time for another PSA and further diagnosis.

Lower spine misalignment causing right leg pain.

I had a right hip replaced in August 2011, so when in 2018 I began getting serious pain in my right leg, I worried that something had gone wrong associated with the hip replacement. X-Rays showed otherwise. There was a protrusion of cartilage between L2 and L3 (?) causing referred pain in the leg. I was prescribed Celebrex (1 per day) and Tramacet (2 per day), and also received exercise therapy when I learned, for example, how to get in and out of bed without pain. I am still taking the Celebrex and Tramacet, and if I stop the pain returns. With the pills there is absolutely no leg pain. The pills also reduce chest and lung pain (see left lung above), and give me a general feeling of well-being, perhaps because Tramacet is an opioid. I have never increased the dose.

Detached retina

In cataract surgery for both eyes in December 2020, the left eye had proved troublesome. The eye surgeon found damage which might have been from my ski accident in 1985. When the cataract had been dealt with, my vision was blurred in that eye. Fortunately the vision in my right eye was better than it had been without glasses. A week or so after I noticed something like a curtain being drawn across my left eye over a period of days; my retina had detached. I was recommended from one eye specialist to another, ending with Dr James Acton in Bellville. He took me on even though it was now two weeks since the detachment, which a few years ago would have made re-attachment impossible. These operations must often be repeated if they don’t work the first time. We could not afford duplication of the cost. In the event he reattached it on the first try. It had been necessary to fill the eyeball with oil. My vision was still blurred, but at least there was (and still is) sufficient vision to allow me to walk around, but not to read. We decided that removal of the oil would have to be done after our return to Canada. Dr Acton recommended a surgeon in Toronto to perform this second part of the operation, and I contacted his staff and confirmed that he could do it, and under OHIP.

Bunnions

I inherited bunions from my mother. Before coming to South Africa I sought out a medical recommendation. There was no time for surgery, so the best option was orthotics. I had them made and bought special sandals with them in. I was also able to buy New Balance walking shoes, that the orthotics fitted into. Four years later and I am always wearing one or the other. My big toes have grown to be at right angles with my feet, but in these shoes I can walk without pain. If they had not worked out and I hadn’t bought orthotics I would be crippled in a wheelchair by now. Since my wife is disabled and can only walk with a walker, to have both of us unable to walk normally would have terminated our mission, though whether we could have returned earlier would have depended on Covid. A very recent development has been tough dead skin breaking off from the soles of my feet, that isn’t relieved by moisturising. I don’t know if this is connected in some way to the bunions. I take magnesium for leg cramps, and the cramps have occasionally attacked my feet which is extra painful. My toes have fungus, which is normal I believe at my age; I am able to cut them myself at present. If my present shoes remain operational I am OK with the status quo, Would an operation help at this time? I would need an expert opinion.

Skin cancer

Since 2019 I had something like a wart on my left shin that grew and grew. Eventually in 2021 I saw a skin cancer specialist who diagnosed it as a basal cell carcinoma. It was removed in the Mediclinic and the leg has healed completely. The specialist also found several other basal cell carcinomas. She prescribed Efudix cream, which has been effective. I suspect there will be more of these. She thinks the damage may have been done when I was in the sun a lot in the navy 60 years ago.