A Voluntary Colonoscopy

Roger was a very good friend. He was best man at our wedding and godfather to our lovely daughter Hannah. We often met him in various bars in Makati City, Manila, smart bars and dive bars. We often went out with him to try a new restaurant and many times we were invited to his house for dinner often at short notice, usually crowded and always served late, but that was fine as he was a great cook. He passed away in early August 2010 of cancer of the colon, at the age of  52. We miss him a lot.

A few weeks after the funeral I consulted my usual gastro-enterologist. I told her about Roger and asked to have a colonoscopy soon. She immediately agreed. I should have had my first one at the age of 50 and then every three years after, she said. Heart disease, prostate cancer and colorectal cancer are the most common causes of death in men over 50, she told me.

The doctor insisted that I spend the day and night before in hospital. She explained that the laxative was more controllable there and I should be monitored too.

At 8 am on the day I was to be admitted, the hospital admissions department called me to say that, as no room was yet available, I should wait at home for their call. I was finally admitted at 3pm to start a very unpleasant 14 hours. After the usual tests of my vital signs I was handed a bottle of laxative and told to drink it all. I read the label and it was plain old Castor Oil, which used to be my mother's way of dealing with constipation when I was a boy. She gave me two teaspoons of it and it soon worked.

The bottle in my hand now was 60 millilitres and the first of three.

I bravely swallowed it in two doses and waited. An hour or so later the stomach pains began, soon followed by a rush or several rushes to the toilet. This continued for an embarrassing 2 hours. My wife was there helping me but eventually she called the housekeepers to clean up.

Another 60 millilitres had to be swallowed at 8 pm with the same tiring, uncomfortable, messy results. My wife was great, she was so patient and uncomplaining.

One more dose of the same size at midnight woke me at 4pm with a sudden bowel movement in bed. Nurses had to be called to clean me and the bed up. Even more embarrassment, especially as these ladies a had to strip me almost naked.

At 7 am I was checked for vital signs and and dressed in a robe for the operating room and then wheeled down on a bed to the procedure room. I lay there, waiting for the gastro-enterologist and the anaesthesiologist, looking at the rack of equipment for the colonoscopy. Then I noticed the probe that would be inserted. It was long and thick, I nearly ran away.

Finally both doctors arrived and one said that he was administering the anaesthetic through the IV tube already connected to my veins. The next thing I heard-

"You're in the Recovery Room Sir. In half an hour we will take you back to your room"

I was hungry and thirsty but my wonderful wife had  coffee and a sandwich waiting for me. It was about 10 am.

Around 2 hours later the gastro-enterologist came to my room.

"I removed 2 polyps which is normal and there is a 20cm mass which does not look bad but if it is malignant it is only Stage 1 cancer. Come and see me in 4 days when I have the biopsy report".

So after some nail biting days I went to hear the worst or maybe best. She said the polyps were not malignant and the mass was still benign but it needed observation. Another colonoscopy in 6 to 12 months she ordered.

The following week I saw a nutritionist, a doctor whom I had found very helpful on several occasions. After studying the report she also confirmed that the mass was far from malignant.

However, she instructed me to make some lifestyle changes. Cured meats are banned for the moment, so favourites like prosciutto, jamon serrano, ham, corned beef, salami, chorizo and bacon are off the menu. I am to reduce red meat consumption to 2 to 3 times a month. I am taking calcium supplements and Vitamin D to reduce the acidity of my blood and now have Alkaline Water delivered with a ph of 8.2.

I can tolerate all of that to avoid surgery, chemotherapy and the horrors of a lingering end.

Christmas in the Philippines is different but enjoy it anyway

Oh no, I have just remembered the December dawn.

You see, each morning from December 15th to 24th, I will be woken by the sound of car horns at 5.45 a.m. Friends of our neighbours in the village come to collect them to attend 'miso de gallo', or ‘simbang gabi’, the Mass at cockcrow. If Romeo lived in the Philippines he would have declaimed “Soft, what light from yonder window breaks. It is the east and Juliet is the sun” near to that ghastly time. I cringe under the bed sheets to counter the sound of 100,00 birds in our village wakening as one and squawking the avian equivalent of Romeo’s tender lines, and that’s before their first worm of the day! At 6.15 a.m the faithful need to be kneeling at prayer. I am just relieved that we do not live near one of the many beautiful 16 or 17th century Spanish churches built here, tolling the deep, sonorous timbre of their bells, forged in Toledo perhaps.

Juliet (played by my wife, Gina) grumpily gets up and showers and dresses in silence, a warning to me to say nothing, collects her niece from the adjoining bedroom and heads off to pray. We live close enough to the church for them to walk there and back in safety. Vendors with wheeled carts hover at the church for the service to end. They sell warm ‘bibingka’ and ‘puto’, the traditional rice cakes, and hot coffee and “tsokolate”, aimed at strengthening the bodies and minds of the early churchgoers, the mass hopefully having fortified their souls. I look forward to Gina coming home with some warm rice cakes for my breakfast and strong black ‘kapeng barako’. Yes, the Philippines is a coffee producer, in the province of Batangas and elsewhere. So far Nescafé is the biggest buyer but watch out for it soon in your favourite Starbucks! The barako bean makes a strong dark and full flavoured coffee, ideal in the morning either straight or au lait or latte

Christmas began in our house as soon as Halloween was over. Gina and the domestic staff climbed into the attic, burrowing for decorations. By the first week in November garlands and baubles were sparkling inside and outside the house, day by day. Two weeks later, their work finished, lights were twinkling all over the house. Our seven year old daughter, Hannah, was overjoyed, ‘Wow, daddy’. My annual protestations about waiting until December had been brushed aside-again! I must give my wife credit though. She decorates the house delightfully. I reflect that poorer people in the rural areas, using local materials, make many of the decorations, with usually enchanting results and so it is one way for us to help them

For me there are two signs that Christmas is coming. The first, in August, is carols and Disney snowy music on the PA system at the malls, at the airport, in hotel lobbies, even in hospitals. The second, and more dramatic, is the appearance, in September, of rows and rows of multi coloured lights under the expressway entry and exit ramps. These are not a revolutionary traffic control system but the beautiful night time lights of hundreds of ‘parols’ for sale. The 'parol' is a traditional Christmas lantern made of ‘capiz’, formed from carefully selected transparent seashells, supported by wire and filled with light bulbs. They are usually round or star shaped and are intended to be hung high on the front of the house. After living here for a few years it becomes clear that the squatters never actually left, they merely went to the province to collect parols to sell from home, so to speak.

Christmas actually takes place on Christmas Eve. After nearly 400 years of Spanish rule, the main event is the feast of La Noche Buena, the ‘good night’ when Christ was born, celebrated by most of the family coming together for dinner at midnight and exchanging gifts. The main dish is often a piece of baked ham, as large as the family can afford. It is traditional that the table be groaning under the weight of dishes of food on it, even if not all eaten that night. Steaming bowls of various local foods such as, ‘menudo’, ‘embutido’ and ‘caldereta’ (note the Spanish ancestry) will be served along with sweet cakes often made with tropical coconut and sugar cane. For the affluent there may be ‘lechon’, a whole pig roasted over charcoal on a spit. Piles of beautiful tropical fruit will also be on the table. One essential, and too me, mystifying dish, is ‘queso de bola’ or a cheese shaped as a ball. It literally is a complete imported red-waxed Dutch Edam cheese. Now how did that become part of the Filipino-Spanish Christmas tradition?

I have tried to have a traditional English Christmas lunch and present giving the next day. All the ingredients are available if you look around thoroughly, but my Filipino family’s attitude to it defeated me finally. I least I can cook a turkey or goose for dinner, which they like, and then be left to eat the Christmas pudding myself for nearly a week. I usually get homesick for my English family, holly and a roaring log fire at some point on Christmas day, but I suppress it with another bibingka and some queso de bola. Ay naku!

Maligayang pasko (Happy Christmas)

Sunset over Manila Bay

The sunset over Manila Bay is rightly famous, matched only in my experience by the setting sun on. the Nile at Luxor. There the orange orb slides slowly below the horizon, making you remember that the ancient Egyptians held the sun to be a God and you realize why the Valley of the Kings is on the Nile’s west bank. In Manila Bay it is the effect of the light on the clouds and the sky that is most memorable.

I have sometimes watched this beautiful sunset from a simple floating restaurant near the Manila Hotel. I have an ice-cold glass in which to pour my chilled San Miguel beer and the thoughts of what Filipino dish to order to eat with the icy quenching ale. Maybe I will have Crispy Pata, a deep fried pork shank but then I think of the cholesterol and decide on fish. As the Philippine Islands form an archipelago the fishing industry is one of the country’s biggest. As the fish is always very fresh and not too expensive it is a delicious meal prepared in a variety of ways. I could have Inihaw na Pusit, (grilled squid) or Sinigang na Sugpo, (a tamarind soured broth with prawns and vegetables). I choose alimango (a crab) steamed and eaten with the fingers, great! There is often great debate here about whether the best crabs are male, female or bacla (gay), generally the opinion comes out in favour of bacla, but this is no reflection on the sexual preferences of the Filipino. It appears that the orange lumps of fat inside the shell are superior and this is highly prized. My crab is served with rice of course; there is always rice in the Philippines.

A little later I walk along Roxas Boulevard on the bay side. This area has been substantially renovated and now has many small casual restaurants and bars, which together with the strollers makes it a busy and fashionable hangout after dark.

Behind me are the remains of the walls erected by the Spanish, IntraMuros, used as the center of government in colonial days. It is now an interesting tourist area.

Living in the Philippines is challenging. The country is geologically, climatically and politically unstable.

Geologically, the country forms part of the Pacific Rim of Fire that extends from
Japan and arcs through the Philippines and Indonesia, around Australia to New Zealand. There are many dormant volcanoes it is believed but also several potentially live ones, which are constantly monitored for activity. The biggest eruption of recent times was in 1991 when the apparently dormant Mount Pinatubo in Pampanga awoke from a 600 years sleep and gushed forth huge amounts of lava and ash. Local residents say the ash fell like snow as far south as Manila. The eruption was immediately followed by a tropical storm adding large quantities of water to the ash and lava, which therefore engulfed the whole area. It is called lahar and there are towns near Pinatubo where the roads and streets are still covered with now solid lahar. Earthquakes occasionally occur but there has not been a big one since 1990, meaning that maybe another big one is due soon. The country is ringed by some of the deepest ocean trenches in the world making an underwater earthquake and the ensuing tsunami a real possibility.