CA TU M A ANCER URNED ME INTO SOFTY
He was star — cancer, cut his m reveals yet hum changed s a bruisingly macho rugby — but now, fighting prostate , Andy Ripley is on drugs to male hormones. And as he s in this unflinchingly honest morous account, it has ed him in all sorts of ways .
ANDY RIPLEY is a former England rugby player, top hurdler and rowing record holder. At 58, he looks the picture of health — but this June he became one of the 30,000 men diagnosed with prostate cancer each year in the UK. Here, Andy, who lives with his wife Elisabeth and three children, Marcus, 24, Claudia, 22, and Stef, 19, in Surrey, writes with candour and humour about living with cancer . . . and the unexpected bonuses of facing death.
LIt’s funny to think that at that moment, while I was worrying about my friend, cancer was already spreading in my body. It was just sheer luck, if that’s what you can call it, that I was diagnosed before it was too late.
The moment I first noticed anything was wrong came on a sunny morning last June. I was doing my usual morning session on the rowing machine, but I was struggling.
All my adult life I have enjoyed exercise. Rugby was my first love. I played over 1,000 games for various teams over 20 seasons — earning 24 caps for England in the Seventies and playing a Lions tour to South Africa in 1974 — but by the age of 41 my knees gave up on me after repeated injuries, and I retired. Then triathlons filled in a gap, until ten years ago when I fell in love with rowing and became the world record holder for 2,000m on the indoor rowing machine.
But that morning in June, my shoulder was hurting so I stopped and took the dog for a walk. About a mile later, the pain was getting worse and I became breathless. Somehow I got home and, being of the Monty Python school of medicine, I decided it was only a scratch. I took a hot bath and laid down, hoping it would get better.
But I was still sore the following morning. It was Saturday and my wife, Elisabeth and I had a friend’s wedding to go to. By the time we got home at two that morning the ache in the shoulder was joined by a sharp pain on the left side of my chest. I felt like an elephant was crushing me. Elisabeth called NHS Direct and an ambulance took me to East Surrey Hospital.
The doctors immediately suspected a heart attack and I was given morphine, drips, anti- coagulant injections and an ECG scan, which pictures the heart.
BUT two days later, doctors told me I hadn’t had a heart attack — but a pulmonary embolism, which is when blood clots form in the lungs. I was told I was very lucky to be alive and that the blood- thinning drugs warfarin and heparin would sort it out. I counted my blessings while the doctors did tests to find out what had caused the problem.
All these tests came back normal apart from one — my PSA count. The doctors didn’t really need to take this for my embolism — it was just part of their general health check — but thank God they did.
The PSA, or prostate specific antigen test, predicts the likelihood of prostate cancer by measuri tein called prostate not 100 per cent ac speaking the hig greater the likeliho of cancer.
The average res above 5 is a conc ment of 10 would was in the stratosp
‘We can’t ignore t I didn’t realise it a result changed eve
The doctor orde tal examinations days. I lay on the my knees drawn u felt my prostate wall. It isn’t dread the examinee — b fun for the doctor.
All three examin tor Dr Shrilla, Dr and, the following consultant — sa same thing. My pr ally large for a m
ring the level of a prote specific antigen. It is accurate, but generally igher the score, the ood that you are at risk esult is 3.5; anything
cern, and a measured be a real worry. Mine sphere at 133. e this,’ the doctor said.
at the time, but that verything. ered three digital recs over the next three e bed on my side with
up while the doctors e through the rectum
dful stuff, well, not for
but it can’t be much
r. iners — the ward docr Kumar the urologist ng day, Mr Swinn the aid pretty much the prostate wasn’t unusuman of my age, but it was slightly distended on the righthand side.
Then I was given a procedure called a trans-rectal ultrasound and biopsy. A needle is inserted through your rectum wall into the prostate and samples are taken. There is a sort of twang, like an air pump, but I felt nothing. This was followed by a bone scan. A few days later, on June 21, I was sitting in the hospital grounds with my wife and a couple of friends. Mr Swinn walked over and said he had a verbal report about the biopsy. Nothing was through in writing yet but he was going away for a couple of weeks and wanted to talk to me before he went.
He asked if I would like my wife to join us. I said no. I don’t know why, but I wanted to see him alone.
He was direct. ‘Based on the pathologist’s verbal report’, he said, ‘ it’s unequivocal, you have prostate cancer.’
Unequivocal: it’s a very angular word. No room for doubt. I had prostate cancer. I didn’t know what to say.
I didn’t even have any of the symptoms of prostate cancer — such as wanting to pass urine frequently, being woken in the night by the need to pass urine, or passing blood in the urine. In fact now that my blood clot had gone, I felt better than ever.
MR SWINN continued. He explained that my high PSA count and the biopsy suggested the cancer was probably beyond surgery, because it was likely that it had spread beyond the prostate, but there was a possibility of radiotherapy.
He wouldn’t know for certain if it had spread until the results of the bone scan and MRI came back, but he was putting me on hormone treatment immediately. This was not a cure, but it could slow both the spread and speed of the progression of the cancer.
I found myself asking questions which sounded like lines from a poor movie script, such as: ‘ How long have I got Doc?’ Poor old Mr Swinn, as I found out later, had just spent six hours in surgery removing someone’s bowel. He probably wanted to get home, but here he was being asked a question to which he really had no answer.
He explained that if the cancer was already too invasive things might move rapidly. But the scans could show that the cancer was contained and there would be some value in radiotherapy, which could be a cure.
I went out to the hospital garden where my wife was waiting and broke the news to her.
Now, Elisabeth is rubbish when it comes to me walking into the house on a wet day when I’ve forgotten to take my muddy shoes off — she goes nuts. But at the other stuff, the big stuff, she is brilliant. She was so strong.
She assured me that we’d handle it, that it would be OK, we’d be OK. I was feeling surprisingly good, and strong. Or maybe I was in denial.
We drove home from the hospital that night and told the children all that we knew. There were hugs and tears. Somehow I felt that I was letting them down.
I started the hormone treatment almost immediately.
First there was a 30- day course of Casodex, a pill which blocks the action of testosterone and hopefully inhibits the spread of cancer — in which testosterone is thought to play an important role — and then I started an injection of Zoladex, which stops the production of testosterone and was the chemical equivalent of castration. Both, I was told, would not exactly boost my sex life.
Two weeks later, results from the
MRI and bone scan suggested that
the cancer had seeped into the
adjacent lymph nodes, but it hadn’t
spread to the bones.
Surgery was not an option, now
that it had spread, and radiotherapy was a possibility in the
future, but first I was to continue
on the hormone treatment. We’d
just have to wait and see. An early test, two weeks after starting hormone therapy, suggested that it had lowered my PSA slightly, to 95, so it was a step in the right direction.
Between doctors’ appointments, and struggling with the holy grail of finding a parking spot at the hospital, I started to organise the few pathetic assets I’d gathered over my lifetime.
I drew up a will and started to sort through boxes of old pictures — I just felt the need to get my affairs in order and to take a wander down Amnesia Avenue. I even found myself going through all my clothes and taking some to Oxfam. It was then that I decided to stop — you can take all this impending death stuff too far.
THE realisation hit me that the limited time I had left should be enjoyed and not wasted thinking about dying. I could be dead by Christmas or I could just get away with it — and I decided to focus on the latter. In the meantime I continued to exercise, getting up in the early hours to row either on my machine or on the Thames, although my interest in fitness was declining, and I was putting on weight.
I had also been warned that the hormone treatment could cause impotence, muscle loss, hot flushes, and although I didn’t suffer bad reactions to the drugs, there were some changes. My libido vanished. I worried that ejaculating would only kick up my testosterone, which wouldn’t help my cancer. Doctors told me it didn’t work like that, but that was how I felt. My testicles also appeared to be shrinking, and I didn’t have to shave every day.
But it wasn’t all bad, I joked, there were definite pluses to getting in touch with the kinder, more feminine me. For the first time in my life, I really started to listen to what people were telling me. I don’t know if it was the change in chemicals, or perspective, but my approach to life changed.
Cancer had become my mistress. I thought of her constantly and talked of little else. She’d even moved in with me. Summer passed, without any symptoms apart from an aching shoulder. I didn’t know what this meant — arthritis, or that the cancer had spread to the bones.
Although initial indications suggested it hadn’t, the number of old injuries I had made it hard to definitively rule out cancer in the scans. But there was nothing I could do, so I tried to carry on regardless.
That didn’t mean I didn’t think of cancer constantly.
At a fundraising lunch, I started talking to the lady sitting on my left, to whom I hadn’t even been introduced. When she asked me how I was, instead of saying ‘ fine’, I started giving her a blow-by-blow account of the past six months.
Her face fell and about a tenth of the way into my epic of stoicism and bravery — mine that is — she said: ‘Oh no, not another old man droning on about his illnesses!’ We laughed. She had a point.
Then on September 12, I had incredible news. My PSA, which I had dubbed my ‘ Permanent State of
Anxiety’, had gone down to 1.1. I was stunned. While it is possible to have a low PSA count and still have cancer, there was no arguing that this was a positive indication. It would seem to imply that the hormone treatment was controlling the situation. Shortly after this result, I took my daughters on holiday to Greece. Paradoxically, it was there, when I was at my happiest, that anxiety really hit me. One day, on the beach with my daughter, I started crying. Claudia put her arms around me and kissed me, and asked me why I was crying. I told her I was crying because I’m a silly old man and I was wondering what’s going to be written on my headstone. For the first time, I was crying unashamedly for myself. She held me and let me wallow. But since then, things have been looking up. Another hospital appointment, last week, found that my PSA had dropped even further, to 0.8, and after reviewing my results my oncologist has arranged for me to be treated with a new form of radiotherapy in March, called IMRT (Intensity Modulated Radiation Therapy) which should kill the remaining cancer cells around my pelvic area. Although nothing is for certain, for the first time it seems that a cure is possible. The radiotherapy will probably have some undesirable effects — such as impotence and incontinence, as you would expect when someone is frying an area you really wouldn’t want frying — and the hormone treatment, which I’ll stay on for three years, will also do its bit to reduce my performance, in the bedroom and on the rowing machine. But that’s a reality I’m happy to accept, although I admit it’s my rowing speed I’m more concerned about. Sad really. Being impotent, or a lack of libido, is not what any man would want. To be a man and yet not a man could, if you let it, be the start of a slippery slope to depression. But it needn’t be that way. There are all sorts of aids and medication, which for me at present I feel are not appropriate, but for others may be just the way forward, or at least part of the way forward. Paradoxically I feel more loving, more caring, and more passionate than at any time in my life. Communication, physical, mental or emotional is the key. The side effect of this disease is that it has made me love everyone. The moment my daughter held me on the beach — does life get any better than that? Love is the best and thanks to cancer I know I am loved. Usually in these situations, courage takes the form of, ‘ We are going to fight this’and ‘ We are going to win’. But dying from cancer isn’t losing. It’s just dying from cancer and we’ve all got to die of something at some time. I’m just hoping my time isn’t yet. I’m also hoping if I bore people enough about cancer, erectile dysfunction, death and rectal examinations, I could help just one man do what they dread most — go to the doctor. I promise you it’s not as bad as you think and it could just save your life.
The Prostate Cancer Charity’s helpline is 0845 300 8383 or visit www.prostate- cancer.org.uk