Going under the knife

Alex3 by FreddieBrown

And so, unexpectedly swiftly, I find I am to present myself at Addenbrooke's at 07:00 this Saturday to be admitted for an open partial nephtectomy (following the recent diagnosis of suspected kidney cancer).

Laparoscopic vs open surgery

I have avoided hospital all my life so far, so the sudden prospect of major surgery is a little daunting. I discussed various surgical options with my consultant – I was attracted by the idea of laparoscopic surgery, but perhaps only because my inner geek was interested in having a robot involved in the procedure (the hospital has a da Vinci Surgical System). The chief advantage of the laparoscopic approach is that it is less invasive and therefore tends to have a shorter recovery time – and exhibiting perhaps a dry sense of humour the consultant observed I was probably “keen to get back to the gym”.

However, in my sort of case the Cambridge team tends to favour open surgery. This is in part because they can dump ice into my body cavity during the operation, so that the (cooled) kidney remainder dies a little less as a result of the necessary ischemia, but also because of the “endophytic cyst” that has been found in the centre of the kidney. Ah yes, that cyst. The doctors seems sure this is nothing to worry about, since many people develop simple (fluid-filled) renal cysts at some time. However just to be sure the surgical team will perform an ultrasound scan on my exposed kidney to confirm whether this cyst really is as simple as it appears, and if not – cut it out. Given that I am learning that doctors are practised in the art of gradual disclosure, I feel a little nervous about this.

Radical vs partial

There was also the question of whether to have the whole kidney removed (radical nephrectomy), or just the diseased part. The thinking here is that for smaller tumours (such as mine) it is better to preserve some kidney, and so some kidney function, where possible. This is not so much based on direct clinical evidence – since one kidney always takes-over so over effectively when the other is removed this would be hard to measure – but on logic: if something else goes wrong with the remaining kidney later, it is surely better to have preserved whatever one can.

Retail therapy

Faced with various discomforts ahead, I decided I needed to treat myself to some compensatory camera equipment, and plumped for a second-hand Nikon D700. This is a camera that Nikon is about to discontinue, but has many points in its favour:

  • It’s now been around long enough (since 2008) that second-hand ones are available at reasonable prices.
  • It’s a “full-frame” camera, with all the attendant benefits that brings – particularly in ultra-wide lens choice, which intereste me.
  • Unlike some Nikon models this has happy colours.
  • It’s so well-established that supporting software (such as my favourite RAW converter, DxO Optics Pro) is thoroughly de-snagged.

I’ll post some more thoughts on this camera when I’ve had a chance to use it more, but in the meantime … Merry Xmas!

Xmas Cheer


What are the odds?

I suppose it was during the ultrasound scan that I first realised something was really up. Here I was, having my bladder and kidneys scanned, as a result of two years, on and off, of what we Brits might term “waterworks problems”. We were chatting away (“Good drainage! — yes that looks fine” … small-talk like that) when the scanner reached my right kidney.

“Everything okay?” I enquire.

“Let me finish and then we can discuss it,” the sonographer replies. The tone had changed.

Now, I say this was my first realisation that something was wrong, but it’s not quite as simple as that. As a mild hypochondriac I often live with the strange internal doublethink of believing that every ache or pain betokens some dreadful illness, while simultaneously knowing that that’s silly and that I'm fine really. Now the balance had changed: the dark fears had become the reality; the self-reassurance the self-deception.

“Maybe some kind of cyst – it’s worth having it checked out. I’ll put something in a note to your GP.”

And so she did, as I find out on getting the ”I'm so sorry” call from my GP with the (not very meaningful) news that the scan had found a 27mm heterogeneous vascular lesion on my right kidney, and the (rather more meaningful) news that as a consequence I was being urgently referred to Addenbrooke’s with suspected cancer of the kidney.

More scans

“This is the worst bit,” said the consultant, “the waiting around not knowing.”

I doubted this: an early and painful death was potentially the worst bit I thought. In any case, it seems that in the World of Cancer “not knowing” is a constant. Or at least not knowing everything. You don’t how well you'll respond to various treatments, you don’t know what’s happening internally between scans, you don’t know what the limited resolving power of the of scanners can’t reveal. An ultrasound scan, it turns out, doesn’t give a very precise image of the organs, so I was now to have a CT scan during which a contrast agent would be injected into my body so that my organs “lit up” in the images produced.

Meanwhile, I’d been able to gather information about kidney cancer from the Web. In particular it seemed that:

  • The kind of sizes being talked about for my “mass” meant it was small in kidney cancer terms. In some cases the tumours grow football-sized before detection.
  • Kidney cancer doesn’t respond to the usual radiation-based treatments used for many other cancers. It is treated by surgery and (recently) by new immunotherapy drugs which can sometimes be successful in stimulating the immune system into attacking the cancer.
  • If a kidney has to be removed, people can usually get by fine with just one.

Quoth the server, 404

In addition to factual information available on the Web there is a range of forums and mailing lists dealing with kidney cancer, from furrow-browed ones detailing experiences and reviewing the latest research, to softer ones offering more purely emotional support (“I’ll pray for you on your cancer journey”). Needless to say I prefer the former. There are also lists of kidney cancer blogs (of which I suppose this is now one) which range from the reassuring (“I had kidney cancer n years ago and following surgery have had no recurrence”) to the embattled (“we were very disappointed to learn the scan showed there were now nodules on the lungs”) to the despairing, where a distraught spouse takes over to leave grief-stricken postings following the first blogger’s death. And there are those blogs which just get you a 404 – which could be good or bad …

So at yesterday’s meeting to review the CT scan result I already felt reasonably well-prepared for what might transpire and what the options might be. The key points were that:

  • The CT scan confirms a 3.3cm × 2.5cm mass on the lower pole of my right kidney. Its removal is recommended as it is highly likely to be cancerous.
  • The chances of any cancer having spread, given the size of the tumour, are very low. Removal of the tumour should effect a complete cure.
  • Other organs (in the thorax, pelvis & abdomen) were surveyed in the CT scan imagery: nothing was found. My left kidney is “pristine”.
  • The recommended procedure is an open partial nephrectomy, to happen just before or just after Xmas. This will probably entail 3-6 days in hospital and some weeks of recovery at home; no driving for 6 weeks.

So this is where I am. A fuller picture will emerge when the pathology is known for whatever is removed – but for now, the plan is that after some fairly hefty surgery I can expect the disease to be gone. Or, even better, that the slim chance comes good that the tumour is not cancerous – for as Woody Allen has observed, the most beautiful words in the English language are not “I love you” but “It's benign.”

Which is witty but not, I think, true.

SC 34 Meetings, Busan

Bulguksa Entrance
Bulguksa Entrance

Last week I attended meetings of SC 34 and its working groups in Busan. Here’s an update on what is going on in the International Standard document format scene …

(For reference, the meeting resolutions are here [PDF]).


The multi-part DSDL Standard has reached a type of completion as all the active parts of the project now have (or will very shortly have) published Standards. Since our last meeting we have seen the publication of Part 5 (Extensible Datatypes), and the unanimous approval of Part 11 (Schema Association, also published as a W3C Note).


After several months of rather political wrangling the work is now underway to develop an ISO “ZIP” – or, to give the Project its formal title: ISO/IEC 21320-1 Information technology — Document Container File — Part 1: Core. The new Standard will take the form of a shell document which points to the well-established PKWare Inc. .ZIP Application Note. The chief merits of Standardization are that it will make the standard easier to reference from other International Standard (both ODF and OOXML use it, for example), as well as clarifying the IPR regime under which Zip technology can be used. The goal is to retain 100% compatibility with established code and archives out there, but there may also be a need for clarification in some areas – for example in the encoding of non-ASCII file names for items in an archive. Notice that this is Part 1 of a multi-part Standard; the idea is that future additional parts may build functionality on top of the core. Although nothing has even been formally proposed yet for this, some ideas that have been aired are for standardized encyption & signing, and for a URI scheme for addressing into archives.

Two‐and‐a‐half cheers for ODF 1.2

During the week the news broke that ODF 1.2 had been approved as an OASIS standard.

Document format confusion

Impressions of Korea

This is my third visit to Korea

Korea Train eXpress (KTX)

Breaking the Rules

Cowslip Meadow
Cowslip Meadow


You are supposed not to transition from an out-of-focus foreground into an in-focus background, or blow your highlights. Although (using my new old camera) I could have retrieved all the highlights in the sky, I decided a notch of pure white actually looked more effective. The Topaz Adjust “dramatic” filter has been applied the sky too, which risks making parts of it darker than the lit grass (another non-no).

Oh well …