Linda Foulger

About Us

The background to how this all came about is detailed in this copy letter to the GP. Also, the operation and treatment up to the end of March 2023. The up to date position is at www.shanedowling.co.uk (you might need to copy & paste the link):

I have received a copy of (consultant’s) letter to you dated 18 January, 2023 outlining the then position. She also refers to the background which is factu, the ally incorrect. This will probably have absolutely no significance going forward but might as far as our travel insurance claim is concerned as my illness has forced the cancellation of a January trip to Australia.

The correct chronology is:

28 Feb 2022 – called your surgery concerning a persistent chest infection and antibiotics (Doxycycline) were prescribed which cleared it up

August, 2022 (approx.) asked for a repeat prescription of the antibiotics in case of a similar infection should occur as I was going to Australia in September. These were prescribed but were not necessary to take

30 November, 2022 went to Malta with a chesty cough that had lingered. No other issue. In December, with another Australia trip looming the following month, decided to take the standby antibiotics to clear the chesty cough. A few days later a rash appeared and skin irritation. The local pharmacist in Malta said it was probably an adverse reaction to sun and Doxycycline which can happen. The pharmacist prescribed antihistamines and topical creams which did not help.

14 December, returned to UK late that evening

15 December, went to Boots to get something stronger to get rid of the itchy rash. The pharmacist immediately noticed slight jaundice and recommended contacting my doctor. That afternoon had a telephone consultation with (local GP) who said come for a blood test that afternoon

16 December, appointment with (local GP) who had the results of blood test and said an urgent ultrasound was required as could potentially be serious

22 December, ultrasound at 11.00. Approx 5 pm (local GP) phoned and said that it appeared to be a pancreatic mass, quite probably cancer, and that an urgent CT scan required. Prescribed steroids etc to help the symptoms

28 December pre-arranged telephone appointment with Dr Allam, consultant gastroenterologist to discuss the ultrasound. Changed medication and said she would try to expedite CT scan. Ordered more blood tests for CMV and high level liver function

29 December, 09.00, blood test at Salisbury District Hospital (SDH)

30 December, CT scan at SDH

1 January, 2023 . The rash discomfort unbearable so called NHS111. After assessment they said go straight to the walk-in clinic. Minutes later the walk-in clinic called to say go straight to A&E as they could not deal with it. Dr there managed to track down the CT scan results and that confirmed the pancreatic condition. He referred this further to try to get a care plan in place and other meds prescribed but told to report to the Acute Medical Unit at SDH first thing on Tuesday, 3 January as they would need to insert a stent for bile to drain

3 January, report to AMU at SDH. They said they needed to do more scans, including MRI and that I’d be admitted and the stent procedure would happen next day

4 January, taken to endoscopy unit for the procedure. At 12.30 the Dr emerged and said he’d run out of time and would do it the following week, Monday 9 January. This was devastating news as the skin irritation was, by now, unbearable

4 January, it was today we should have left for Australia

5 January, transferred to a Ward at SDH where I remained as in-patient

9 January, stents put in and bile said to be draining but condition slow to improve

11 January, the planned update on way forward. The MDT meeting in Southampton conclude I am a candidate for the Whipple procedure subject to a confirmatory PET scan in Southampton

12 January, discharged from SDH

15 January, called NHS111 regarding severe constipation probably the result of Colestyranine. Already we went looking for glycerin suppositories which were unavailable in every pharmacy between Verwood and Salisbury due to supply chain issues. Very helpfully the Nurse in Charge at my Ward at SDH supplied 4no.

23 January, 08.00 Dr phoning to discuss constipation!

23 January, 11.00 PET scan at Southampton Hospital

Next step – surgeon to say yes or no to Whipple or otherwise the options.

So, this has been how it all came about. Other than the delayed endoscopy and the bed-blocking, incessant chanting by dementia patient in (a SDH Ward , relocated after messaging PALS) my care via NHS has been excellent. This especially so during the Christmas and New Year period and industrial action. I’m very grateful.

The operation and treatment to 31 March, 2023 The Operation

Linda will be going into University Southampton Hospital on Tuesday, 21st February with the operation the next day. It is scheduled to take six to eight hours. A period of ICU is definite, and complications are very common with this major surgery.

Most of you are fully aware of what is planned but you can read all about The Whipple's Procedure by Googling it or pasting this link into your browser (it doesn't click):

https://www.mayoclinic.org/tests-procedures/whipple-procedure/about/pac-20385054

In the scheme of things, being offered this is actually lucky(!) because the vast majority of pancreatic patients are not given the opportunity.

By all means, you can still WhatsApp or call Shane if you need to know more. A sure sign Linda is on the mend is when she messages directly but please don’t expect this for several weeks. Shane will continue to update this page for as long as necessary. We have yet to decide where convalescence will take place – Salisbury city home or our Fordingbridge cottage. Probably end up a mixture depending upon Linda’s mobility.

Daily updates will follow under here:

13.00 Monday 20 Feb. Hospital called. Not a cancellation but brought forward! Need to leave for hospital more or less straight away as going in this afternoon and op now tomorrow, 21st Feb. Will keep you posted. Be ages before next 'proper' meal so the mountain of lamb chops we bought for tonight's feast will have to wait a good while. LATER...all checked in and much paperwork done. The op will be first thing and only one on list as will last most of the day.

Tuesday, 21 Feb Prep for surgery started before 6 a.m. Linda went down to theatre just before 9a.m. They needed to ensure HDU bed was available for post-op. Quite what they do with the huge team of people doing just this procedure today, if it had not been free, goodness knows.
Last night one of the surgeons explained everything that they hope/expect to do (Whipple) or if unexpected spread an altenative procedure that would be purely palliative. All scans so far have been good but the decision left in their capable hands. The surgeon, Mr Tom Pike, will call me later in the day letting me know how it went. I'll report here. Meanwhile, I've got a pile of ironing to keep me busy.

17.53 - no news yet :-(

18.00 Tom Pike, surgeon, called. Everything went well removing the bit he needed to and connected everything up. Still a bit dopey (Linda, not Tom!) but being now moved to Surgical High Dependency Unit. Obviously, a long road ahead - probably with a few bumps. I will continue to update on here but by all means message me if you need to know anything etc. Thank you, all, for your kind good wishes, prayers and the rest. Please keep it up!

20.20 - hospital called (causing me panic!). Was the nurse from HDU saying Linda still in Recovery but going to HDU shortly. Quite awake but obviously needing considerable painkillers which will make her drowsy. I am able to call any time so will do so before I go to sleep and again in the morning and update you all.

22.50 - Linda made it to HDU about 8.30 pm. The nurse said she is doing fine, sleepy after the ordeal and they are just dealing with her meds. The first thing she asked is if I can visit tomorrow, which, of course, I will in the afternoon. In the morning I will call again and update here. Thanks for your kind messages x

Wednesday, 22 February 09.00 - called the HDU. Nothing especial to report overnight. Right now dealing with some sickness which is normal post-op with this major surgery. Also they will try to get her up. I'm going in later this afternoon and will be upsetting to see her with tubes everywhere having walked in ostensibly entirely fit and well. Inside it was anything but. Update early evening unless anything occurs before.

18.00 - was only about ten minutes away from the hospital when phone rang and it was Linda. Wanted to know where I was! Abandoned the car a few streets away, got bike from boot and cycled the rest as traffic horrible. Was very encouraged to see her better than I’d feared. Certainly, lots and lots of wires, probes and tubes including one up the nose draining bile. A bit sleepy but otherwise perfectly lucid. The surgeon will be around in the morning when she will be able to ask more – Linda thinks he said that he removed the ugly bit along with the rest as necessary with this monumental re-plumbing job. As I typed this, I got another Whatsapp message from her. If anyone wants to visit please phone or call me so I can check how she is, coordinate etc. I will be in again tomorrow afternoon but if I hear anything sooner will update here.

18.11 Linda says: Just got myself up the bed by myself (they are keen to get her out asap but was too painful this morning)

Thursday, 23 Feb. I told Linda to message any time as I would have phone on. So she messaged 05.35 to say the box of buscuits I took in for staff yesterday was half gone. That was me awake but was also end of her broadcast! Good sign on phone. The biscuits bought by brother in law, Neil, obviously not my idea!

09.15 messaged: 'I have sat on edge of bed without help VERY SLOWLY been for a short walk. Now in chair. X.' Also said phone heavy (!) and wondering if maybe might be moved ward. If they move her from High Dependency then I guess good news although care reduces. I'm visiting at 2 pm and will report later.

This afternoon Linda was out of bed in the chair and walking a little with a frame towing the equipment. The nurse gave her some broth and jelly for lunch only to discover that it was three times too much and had to syphon it back out of her stomach! No ill effects but does shake faith somewhat. Various iv lines have been removed and some difficulty putting back in elsewhere. Presumably progress is satisfactory as Linda has been moved off HDU this evening to an adjoining ward but large private room with ensuite Not quite sure how that favouratism arose - maybe the biscuits or the seriousness of her procedure. Saw the surgeon this morning and the tumour is being examined but will be weeks before anything known. It's not urgent but will influence what happens in terms of chemotherapy. Linda has her phone working but admits falling asleep mid-sentence!

Friday, 24 February - Linda was wide awake at 1.30 a.m. so we had a long video call. Was really nice. Now had a long text and she has seen the surgeon and asked lots of question (he remarked!). Apparently he has left all of the stoach intact and removed top third of pancreas There was nothing wrong with liver but born with a duct a particular way. One drain is being removed. a naso-gastric tube is to come. I'm going in again this afternoon. Thanks to everyone for your messages (no need to use the form if you have WhatsApp). Thanks to the consecutive calls from Kelvin, Kevin and Keith and apologies for mixing up your names as we chatted - you can undersatnd why!

12 Noon. I was talking to Linda and she has been given a thick drink. If she can tolerate it then the nasal drain can be removed. As we are talking lunch comes in. Soup, jelly and something else. I hear Linda question if she should be eating this. Yes, was the reply. So Linda says are you SURE? So she goes out and comes back and says: "Oh, no, not for you." The thing is, this is not just a dietary nicety but something so much more serious. Everything has been 're-plumbed' and something too solid could mean everything comes adrift and back in theatre to try to fix it. Yesterday, when Linda more drowsy, she ate it and they had to syphon it back out. I have seen the pictures of the inflated bag of diluted green bile. Earlier put in a chair, "be back in five minutes," one hour they return. And there we have the NHS. It is life saving and life threatening by the weakest link in the chain. We're so grateful for all it has done and all for free (yes, we pay taxes) but if you are vulerable you could very easily be a goner.

Afternoon – Linda was very sleepy whilst I was there for a couple of hours and considerably more uncomfortable. This due to being awake all night and that they have removed the epidural leaving paracetamol intravenously and two lines to the abdomen around the wound (incision the shape of a large L). One drain was also taken out whilst I was there (tube goes in a long way!), leaving just one. The tube through the nose is no longer draining to a bag so that, too, is being removed, perhaps tonight. That will enable the big plaster on her nose holding it in place to come off. The bi-product being her glasses will fit better – so beware, direct messaging volumes could increase exponentially! Let’s hope tube doesn’t have to go back in to syphon off food that has been consumed through another mis-delivery.

11pm. Not heard anything since I left this afternoon and was beginning to get worried. This especially as Linda evidently incommunicado on her phone. Then she messaged, followed by a short telephone conversation, phew! Been for ultrasound as they are monitoring fluid retention. Nasal tube out and much more discomfort today. Getting oral morphine to control pain but making her sleepy. She thanks you for all your emails and messages but just does not have the strength to reply or even read when she’s at a lower point. Suggest you hang fire until she messages you in due course as she surely will. By all means use me as a postbox and no need to fill in that form, just email or WhatsApp. Her surgeon is apparently in over the weekend which is good news. Overall, they are said to be pleased with her progress.

Saturday, 25 February Had a reasonable night, up early and making it to bathroom on foot (Linda similarly!). Had I made that joke Linda would say: "It's not all about you, Shane". Anyway, they are beginning to remove the drains and other tubes. Been a bit emotional today triggered by the kindness of others. They are suggesting solid food again and despite reassurances it doesn’t seem entirely right based on what we’ve read. Last Saturday, we had a hugely helpful video call with Anthony, a friend of a friend, who underwent this procedure in November, 2019. He made clear everyone’s experience is different but based on what he said, and we read, it seems very quick. It might be they did not remove as much as usual so Linda needs to ask more questions when the surgeon comes back, probably tomorrow. It’s hard to think of everything at the time of the ward rounds in this teaching hospital.

12.00 Noon - all the tubes and wires removed! Linda is a free agent

Afternoon visit – the freedom of untethered movement was a great plus this afternoon. Apparently, for lunch, ate half the cottage pie just in case they have got the diet wrong. This is perhaps the most confusing aspect – how come she’s not on liquids and puree for ages. Maybe it is because the procedure avoided some removals – Mr Pike will get quizzed on next ward round. A rather pleasant time this visit. Abi (youngest daughter with whom I’m staying until tomorrow) and I watched The Piano on All 4 (UK TV channel) last night. Was so good. So, Mrs D and I settled down with her iPad to watch it together with a cup of tea and biscuits they brought. Thinking an eviction from the nice room must be on the cards but, in an attempt to avoid this as long as possible, I’m detailed to get VERY nice biscuits from M&S on my way tomorrow. Seriously, the mostly Filipino nurses have been terribly kind.

Sunday, February 26 - Linda had an uncomfortable night after everything removed yesterday. In part this is due to not wanting the oral morphine in case of addiction. Dr. Shane Dowling has advised to take it as needed because we have no local drug dealer at home from which a private supply will be forthcoming. Paracetamol alone is not quite enough.

The surgeon came around and is thinking the patient might be able to go home by the weekend! Linda has decided to recuperate at the cottage. He has also clarified the situation with the op itself. He performed a procedure that’s similar to the Whipple’s, but none of the stomach is removed. This is called a pylorus-preserving pancreatoduodenectomy (PPPD). As part of the pancreas is removed, digestion is affected requiring pancreatic enzyme replacement therapy (PERT) to help food digestion. This we knew requiring taking Creon capsules in a lower dose even before the surgery. As the tail of the pancreas has also been preserved (tail mostly produces insulin, head mostly stomach enzymes) becoming fully diabetic is not definite. We also know from Anthony that it sometimes works for a while then packs up.

So, encouraged with the knowledge she can eat what she wants Linda decided on bran flakes. Shortly after she was reacquainted with them! Now trying an apple and ice cream. Abi and baby Hendrix is going in this afternoon and I will follow a little later.

Afternoon report – Abi and Hendrix were denied access to the ward as babies not allowed. Two days ago, in High Dependency Unit, babies were allowed as I specifically asked if okay. The truth is that half of them just don’t know what the rules are and the probability is that babies should keep out. Anyhow, they sat in another area nearby, quiet as weekend. Linda is amazing given that the op finished just five days ago. She’s been going up and down the wing corridor and did 0.18 miles in 14 minutes. I think she needs to not show off too much as premature discharge isn’t sensible (something slightly dodgy with that phrase). The only bad news is that her recovery has demoted her to the regular ward and thus lost her spacious private room.

Monday, 27 February A very uncomfortable night back in the ward and can't do better than paste Linda's message to me replying to how it went: Awful. Crazy woman super crazy and attacking nurse Lynette. Spitting, biting, kicking, terrible language. Really rough woman whose life has been ghastly. I’m exhausted and nauseous and wouldn’t feel this way if I were still in my side room. Got a shock that the doctors want me out today! Have said maybe tomorrow as don’t think you’re ready yet.

Yes, it is all about me(!), but seriously, coming out before everything entirely stable is crazy. I think likely that tomorrow may be parole but I don't want to get into situation of having to rush to A&E later in the week when they haven't a clue what has gone before. Watch this space. Today get arse in gear relocating stuff to the cottage in readiness for the patient.

Afternoon, Everything set for Tuesday exit! A lot to think and get right. They must be quite pleased to be discharging so soon. Basically, in next period eat as many calories as L can tolerate, Every cloud and all that!

Tuesday, 28 February - end of the month and end of Linda's incarceration. I am picking her up this afternoon. it's incredible that discharge can be so soon, just one week from the 7.5 hour op. We will be going to the cottage in Fordingbridge rather than Salisbury. The biggest issue is adequate calory intake. For so many of us the kind of challenge we'd like to have! I will update on here so family and friends far and wide can dip in when they want to. You can be sure no news is good news. Thanks again for all your kind messages via WhatsApp, phone, email etc. How lucky we are to have you.

18.45 still not home because even now, this late, waiting for meds from pharmacy. Said she is feeling very tired and back ache and wants tio go straight to bed when back here. I think eating enough is going to be the hill to climb. 18.50 on way to hospital!

Wednesday, March 1 - Linda eventually got home at 8pm last night. Amazing achievement given the operation only got finalised seven days earlier. Reading the discharge notes she was apparently on a fast-track programme. We have no idea how that label was determined other than fitness for the procedure.
The night was not at all good with back ache and obvious lack of movement and agility. Trying to recreate a multi-pillowed, multi-moving and bending hospital bed at home is damned near impossible. Between 2 and 5 a.m, we attempted lots of configurations involving pillows, wedges and towels. At about 3 a.m. the idea was to bring up the leather tub chair as it is the most upright. It’s heavy, slippery and odd shaped but I did manage to put it on my head like a massive hat and attempted the ascent in nothing but my moccasins. Not a pretty sight but bizarrely funny and frustrating in equal measure. Unfortunately, it wouldn’t turn the corners of the stairs so had to abandon the assault. Eventually a little sleep, a poached egg for breakfast and we’ll take it day by day from here.

Thank you to whoever sent the lovely bouquet from Marks & Spencer, received this morning. The card had no message at all. Please own up by messaging us. (Thank you Kate & Garth)

Daytime - Pretty uncomfortable day basically counting down to next painkillers. Picked up a support pillow for tonight and hopefully will make sleeping a little easier. We’ve been advised to limit interactions beyond the necessary as post-operative infections are common and especially dangerous at the 10-14 day period – so that’s the next week or so. We’re ever so lucky to have a lovely neighbour, Sara, a retired practice nurse who has been helpful with advice and support on Linda returning home.

Thursday, 2 March - a much more comfortable night overall. Biggest issue now is back pain. We have a 24 hour contact number at the hospital for the first two weeks and they have made some suggestions to follow.

We've registered Linda at the Fordingbridge doctors' surgery temporarily as she normally uses a Salisbury doctor. The wound needs redressing tomorrow and Monday but they said the first appointment is next Tuesday! I said something like: "so it can just go septic?" This greeted with a shrug, staring at the screen indicating 'computer says NO.'

Lucky we have Sara as mentioned from yesterday. She has already offered to do the dressing. Later the surgery called having made an appointment at 7pm in Ringwood so, in fairness, they did try. We've gone with Plan B and Sara!

Friday, 3 March - last evening was the best yet. Linda more comfortable and stayed up quite late watching TV (Unforgotten - don't miss it!). Also, the night was a lot better and I was awake a full hour longer than she was. Sara doing the dressing for her this afternoon. Got the follow-up appointment with surgeon on Friday 24, March. We will hear what is next - chemo or otherwise.

Saturday, 4 March - not only did Sara come to do the re-dressing yesterday lunchtime but brought delicious home made parsnip and apple soup for our lunch. You don't get this with the NHS! Sara has been the saviour to so many in our little lane over the years and we are all grateful to her. Linda's appetite is still small but she does eat a very modest meal, fancy and eat the odd chocolate etc which is a very good sign. Mobility improving. Best of all, last night was by far her best sleep and mine. I know it's not all about me but the next stat is: I was awake 25 mins; REM 44m;Core 6h 28m; deep sleep 12m. It is kind of reflective and tomorrow we can compare scores via our new watches.

Sunday, 5 March - Another even better evening and night. Linda woke for meds at six a.m. and back to sleep. Definitely did at least as well as me with kip which was even better than yesterday. Walked over the Coop this afternoon at a decent pace so a bit more walking is on the cards and she is looking forward to. First day and night not taking the extra painkillers nor watching the clock for next fix! New Apple watches are very cool so have been fiddling with them and been a nice distraction. We can now walkie-talkie each other which has proven more fun than just normal human conversation. Even summoned her back from next door. All in all really encouraging.

Monday, 6 March - Each day gets better and Linda even overslept the time for 6 a.m. meds which is a first. It’s a pity we have to wait until Friday 24th to hear what the next stage is. Being realistic, it is a period of chemo.

If Linda’s health and the schedule allow we’d like to get away in May as we would like to catch up with our Australian friends, Garry & Faye, in Ireland for a few days. At least we will get to see them in Salisbury anyway. France in September is a definite goal visiting our favourite places, not least Gundi & Brian’s place near Brantome, and Saly & Phil in the Lot region. Long-haul stuff is less likely. In February alone we declined 46 home exchange offers so there’s no shortage of opportunity.

My late brother-in-law, Tony, said something that I’ve always remembered when talking about the three needs in retirement: Health; enough money to enjoy life; companionship. If any one is missing, you’re sunk. Never truer words.

Tuesday, 7 March - Nothing to report beyond all really good. Dressing change at surgery later. Not sure when they will come off, must be soon.

Wednesday, 8 March - not a lot to report as all fine. One bit of good news is that Mrs D announced that part of her recovery programme involves, tonight, going to The Ship. This like old times although Linda will remain alcohol-free for quie a while. Later on, modest alcohol will be entirely feasible if that's her choice.

Thursday, 9 March - all good. Easing off meds now and we made it to the pub last night to cheer me up as it's all about me, remember?! A very welcome bit of normality returning to our lives.

Friday, 10 March - everything just fine. Linda exercising more via longer walks. Woke later so able now to reduce medication intervals. Slept more than me last night!

Saturday, 11 March - this morning we thought we would go out to brunch in Ringwood. Everywhere was busy but then remembered, too late, that we had failed to bring the all-important Creon capsules. These are the vital medication that replaces the enzymes produced by the missing part (head) of the pancreas. This means eating is a waste of time as it is nutritionally void. So, we decided to just come back and go another day rather better prepared.

I just knew this was going to happen and, unbeknown to Linda, a few days ago I considered how to avoid this and went on Amazon. There I ordered little aluminium keyring canisters to hang on car keys etc. and they arrive today. I suppose the next thing will be forgetting to replenish the damned things after use! You are not supposed to keep them in trouser pockets as they should not be warm, nor to be taken with hot drinks.

I’ve been keen to keep an eye on sugar levels in the blood so Dr (Shipman!) Dowling did a blood test when we got back which was after a period of unintentional fasting. I was pleased to see the level was entirely normal as have all the other readings so far. This means the repositioned, remaining pancreas is working so far which you have to agree is a further medical miracle. Sewing the pancreas is likened to sewing cottage cheese or butter. On that advisory note I’ll sign off for today with apologies if reading over your breakfast pate or fare of similar consistency.

Sunday, 12 March - Good weekend so far after the Creon absence. Abi, Chris and Hendrix came over and we had fish and chips and the first time from chip shop in years. Then this morning over to Wilton to see Jo, Chris, Ada and Ted so an emotional day for Granny to see the children again after so long. Return to some ad hoc babysitting normality coming up on Wednesday afternoon, picking Ada up from school and Ted from nursery. Been too long and missed out on a lot. Thank goodness for Clem & Jill, the other grandparents, who have always done tons more than us and had to do even more. They are truly selfless people.

Monday, 13 March - Nothing much really to report. The painkillers were four times a day but now reduced to three times per day. At that interval not waiting for the clock to tick around so a good sign of healing.

Tuesday, 14 March – All dressings off from today and everything looking good. Trying to reduce meds further but no point being in pain!

Wednesday, 15 March - When meds are reduced pain returns so we need to not go too far too soon with their tailing off. This afternoon we are picking up Ada from school and Ted from nursery. First time we have done this since the whole thing kicked off in December. All positive small steps forward.

Thursday, 16 March – Linda bright today and energised into cheese omelettes - in her case with lashings of Creon. Have visitors shortly and tea with neighbours later. Yesterday Linda had two deliveries of books, neither with card so please own up. One package contained ‘Lessons in Chemistry’ and the other from Waterstones ‘Nine Days’ and ‘Good Wife of Bath’.

Now, having studied Chaucer in some depth for ‘O’ Level or ‘A’ Level I know two things about the Wife of Bath. One is that she had a gap in her teeth and the second that it used to be regarded as a sign of a lascivious disposition. In truth, it is the ONLY thing I recall about The Canterbury Tales. Been looking out for ladies with spaced gnashers ever since and, if observed, thinking to myself that I might know a thing or two about you.

Friday, 17 March - we popped over to the Salisbury house, had a little walk around the city and a coffee out. Think first time we have had a coffee out since the op. Little steps and all that. Everything good.

Saturday, 18 March - all about me so I have been really busy fixing the wooden garden walkways and first bonfire of the year. Linda been for a walk over the town coffee with neighbours and all going well. I read a very funny confession on a website that is usually extremely X rated and surely most 'confessions' pure fiction. If they are not then I have had an extremely sheltered life (thank God based on what people allegedly get up to). Anyhow, this one is a rare contribution for a more genteel audience and as medical related will share below. It is the reply that is most funny and made me laugh out loud (didn't chance the LOL abbreviation).

Confession: Literally every time I file anything in alphabetical order, I run the A-Z song in my head. Only 26 characters, but I still can never remember if S is before or after R without doing the song. I'm 47. I suspect this is common, but I'd like to use Fesshole comments to check.

Somebody's reply: I hear you. I'm a surgeon and have to do the 'hip bone's connected to the...leg bone' song every time before I operate.

Sunday, 19 March, (Mothers’ Day in UK) – last night about 9pm Linda had pains in her chest and back so had to go to bed a bit early. Fearing a trip to A&E, I poured my nightcap down the sink – a sacrifice proving unnecessary as the pain abated.

Today, lovely to have all (now three!) grandchildren here for a visit and Granny and step-mum really spoilt. One of our antipodean friends wrote to claim responsibility for sending the books mentioned in my post on Thursday, 16th. Turns out it was not true and proves two things: Firstly, dishonesty is inherited and more nature than nurture.

This gentleman’s great, great, great (recurring) grandfather was transported from England to Australia for his transgression. Secondly, it is hard to tell from a written message the real intent without the modulation of intention or pitch. I think a suitable punishment would be to send the convict’s g,g,g grandson back here as I can scarcely think of any punishment more fitting or grave.

Bottom line – we still don’t know the identity of the kind person who sent the three books. Please own up!

Monday, 20 March – as Linda feeling pretty good we thought we might go somewhere overnight. Maybe a nice cathedral city or something. Then I came up with a money-saving idea – let’s go to the Salisbury house first stay since the op! Got a cathedral with the tallest spire in the country (made famous by murderous, visiting Russians), favourite pubs and restaurants, luxury accommodation a few minutes from the market square. Sorted.

The mystery of the books has been solved. The kind friend was from Australia, but Melbourne rather than via the joker in Perth who we look forward to seeing in early May when they come over.

Tuesday, 21 March – we had our night away in the Salisbury house. A pint (for me, all about me!) and a ginger beer for Mrs D in the Ox Row, a favourite pub. A quiz starting so off to another before the intended restaurant. In the pub a roaring log fire and had it been practical to eat there we would have. Instead, another drink and then ordered a Chinese to collect on the way home.
This morning Linda a little bit down and moaning that she ate too much last night and maybe accounted for her slight stomach ache. We talked about why feeling a bit sad and is, in reality, down to apprehension over the Friday appointment. Every Dowling so far born is an utter pessimist and that way we rarely get disappointed by outcomes. So, I have been trying to manage expectations around the future treatment which, realistically, is a referral from Southampton to oncology in Salisbury. Considering the probabilities from December this is a lucky position to be in. Nevertheless, we will both be glad when Friday behind us.

More money saving ensued this morning and instead of rip-off café for brunch had a sausage bap and coffee from a market stall, sat in the sunshine diffused by high cloud. Some old blokes on the next table were talking about motorcycles and wishing he’d got one (know the feeling as still looking up Indian Chiefs on Autotrader). Anyway, he concluded that it was death-trap best avoided. The other bloke’s Dad once had a motorbike, he thought a Douglas. Another pondered where that was manufactured, and through our knowledge of geography within the British Isles, we all concluded the answer. I’ve just looked up the answer on Google. Kingswood, Bristol!!!!!!!

Next went to the shoe seller for new leather moccasin slippers but, along with the rest of the country supplying everything, he can’t get them any longer and only had one pair left, still £19.99. Linda bought yet another pair of red shoes for £39.99. He said to another customer that he hadn’t put his prices up as he just couldn’t be bothered having to re-write all his various signs all ending in 99p.
Thought might as well try M&S and astounded to see slippers were £49.99 in there! Despite having a son-in-law in M&S (with staff discount) that’s mad money and in any case have leather laces that even the market trader said just don’t work. Cowboy by name and nature, Shane, did have some leather ties on his old gun holsters as a boy and seemed okay on there to aid a quick draw, but on shoes just rubbish. Back to the cottage tonight with Linda feeling physically pretty good.

Wednesday, 22 March – it must be 21 days since Linda’s discharge from hospital since, last night, she had the last of 21 blood thinning injections. The 28 day course started immediately post-op and the remainder to be done at home. They even give you one of those yellow bins in which to dispose of the used syringe. Linda did the first one herself but didn’t like doing it so Dr Shipman Dowling had to take over. It hurt her just as much but at least she had someone else to blame!

Last night when I couldn’t sleep I was thinking I would back-fill the chronology leading to the diagnosis and op from which the daily blog began. It shoew how it is possible to be misled by minor symptoms and how the NHS works at its best and less well. That background is now near the beginning and is in the form of a letter we sent to the doctor so they didn’t mess up the travel insurance claim which is still pending, even now. The Dr charged £80 for the two forms to be completed (virtually illegibly) with a thick felt tip pen referring to our letter for dates!

Linda been today for her usual half hour walk around the river in Fordingbridge and back now for coffee. All okay and everything geared for the appointment with the surgeon on Friday at 3.30 pm. I will update after that.

Thursday, 23 March – everything is geared to 3.30 tomorrow afternoon when we see the surgeon and hear what is next. Meanwhile, we have a nice day both of us out separately with friends lunch/afternoon and at the Italian tonight with neighbours. Meds successfully continuing the Shipman reduction programme. Probably need to be English to get the ongoing sick reference to Shipman. My late, lovely brother, Neil, used to do my Mum’s meds and we called him Shipman. Family black humour.

Friday, 24 March – we had the appointment with the surgeon, Mr. Pike, this afternoon. As far as he is concerned he is very pleased. As expected, the tumour was malignant and about 28mm in size. It was all removed as evidenced by its examination. Also, the lymph nodes that he removed were free of infection. As we know all pre-op scans also showed no spread and if they had the Whipple procedure would not have been offered.

It was explained that cancer in the pancreas is designated by type as being linked to the bowel, bile or liver. In Linda’s case it was the former. There is nothing to indicate that cancer is elsewhere but as he said right at the outset a period of chemo will now follow to mop up anything small that cannot be seen via scan. They will also do a colonoscopy as polyps can be pre-cancerous and better safe than sorry.

So, the next step is, as expected, a referral to Salisbury oncology with the initial appointment in about two weeks or so. He did not know exactly the treatment regime as not his area of expertise. I will do the occasional update on here specially when we know more as to the ongoing appointments. We’ve been overwhelmed by the wonderful love and support from our family and friends. We are so grateful to all of you. xx

Monday, 27 March – wow, that was quick! Today had a call to offer an appointment with oncology tomorrow afternoon at 2pm, in Salisbury. We were returning to Salisbury house anyway tomorrow, so even better. Will let you know what happened.

Tuesday, 28 March – this afternoon we had the appointment with the oncologist in Salisbury which was quite detailed. As always on first meetings, he wanted the background to it all in our own words. The treatment so far is ‘curative’, the word they use in these circumstances when everything infected is removed as far as they are aware. We knew all along that the Whipple procedure would be followed by chemo to mop up any microscopic particles of infection that could lurk undetected. The fact that nothing has shown by various scans, including PET, bodes well and especially that removed lymph nodes were clear.

It turns out that the cancer was of a rare type of which very little research has been done. It had more of the characteristics of those associated with bowel so the treatment they will do will be that aligned to bowel cancer. What he does not know is what difference it will make as unlike most cancers where it is aimed at a specific primary area to shrink a tumour, or metastases elsewhere, this cannot quantified now. Quite logical.
In this case it would be three months in three weekly cycles. Infusion and two weeks of tablets. A further three months might be offered but unlikely to be of any benefit. Linda could have gone away to think about it but obviously it makes sense to go ahead. So, blood tests were done, height, weight etc.

On the subject of weight, he was a bit concerned that this has continued to reduce. Not drastically by any means and given what has gone before hardly surprising. Anyhow, the blood test will indicate the cancer marker (it had been very high before the op) and it should now be much lower. If it is higher than expected then he will organise a CT scan because then, putting bluntly, he might have a target to aim for and adapt the treatment accordingly. Hoping very much a CT scan is not ordered. The surgeon suggested a possible colonoscopy, but the oncologist was surprised at this and said he would check with the surgeon but didn’t think would be of any value at all.

Right away Linda given an appointment with oncology for noon Tuesday, 11 April. This will be preceded by a blood test CA 199 and CEA (plus other functions) at 11.30. I’ve just looked this up (CA 199 and CEA) and they are indeed those associated with pancreatic cancer. It isn’t entirely clear if treatment will follow that week or a date shortly thereafter.

Thursday, 30 March – yesterday afternoon the hospital phoned bringing forward the blood test that was scheduled for Tuesday, 11 April, to today. It is the exact same test as was needed for the pre-assessment appointment on 11th, just earlier. Have no idea if this test was expedited due to the blood test results from two days ago, any conversation between oncology and the surgeon or anything else.

For the current position and everything after this background please go to: www.shanedowling.co.uk (Copy and paste if link fails)