If you have a job and your ability to work is not too badly affected so that your employer continues to pay you as usual, a loss of income may not be an issue. If this is not the case, you will need to find out whether you are able to claim any State benefits to help you. You may find this difficult, particularly if you are accustomed to supporting your family financially, either alone or jointly. The idea that you are no longer able to guarantee to ‘provide’ for them in the same way is not easy to accept. In spite of this, it is important to ensure you receive any benefits you are entitled to – this is not a time to allow pride and your sense of independence from the State to stand in the way of financial help.

If you were not working or were retired, then your usual sources of income may be unaffected but it is nonetheless important for you to establish whether you are now entitled to any benefits as a result of your cancer.

You may feel disinclined to wade through booklets and forms when you already have enough on your mind. There is likely to be a social worker attached to your hospital whom you can consult fof help in determining whether you qualify for any financial help. Do draw on their expertise – they may be able to save you time and effort by advising you and providing you with booklets and the relevant forms to fill in, and help you with the forms if you wish. If you prefer, information about Social Security is available by phone on Freeline Social Security 0800 666 555. The Benefit Enquiry Line on 0800 88 22 00 also exists for information on benefits for people who are sick or have a disability. The Benefits Agency produces a number of booklets containing information about these benefits, and you may be able to obtain these from your hospital.

For me initially the Benefits Agency appeared a complete mystery. I had never had any direct dealings with the DSS (from a personal rather than a business perspective) and their whole manner and method – not to mention the thickness and complexity of the application forms – was enough to make me feel that the whole exercise could not be worth the effort. The level of questioning and intrusion into what had previously been private matters was very disconcerting. However, I was very lucky to be referred to the hospital social worker who immediately – and correctly – identified those benefits to which I and my partner were entitled. (Neither of us was working now – I was not physically able to and my partner was spending all the time she could with me in hospital or supporting me at home.) The social worker also guided us through the application forms. The moral is to use the resources which are available to you as a patient. Do seek out the key social worker who will be on ‘your side’, don’t accept any initial rejections by the Benefits Agency if you are sure you have a good case and hold out for those benefits to which you are legally and morally entitled.

The details which follow give an outline of the more common benefits available. They are not exhaustive, and you may be entitled to more help depending on your circumstances.

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In fact, this fear is more likely to be imagined than real. Of course your family and friends will be sympathetic about your cancer and want to do all they can to help you. But this does not mean that they perceive you purely as a cancer patient, and no longer as their husband/son/brother/friend, etc. You will almost certainly feel that you have ‘changed’ as a person as a result of your cancer, in terms of your outlook or changed perspective on life. This is not the same as becoming a lesser person!

Keeping in touch is one of the best ways to guard against losing your confidence and sense of self. Your cancer will necessarily be on your mind for a large proportion of your time, either because you are thinking about it or because it has practical implications for your deeds and actions. This can increase your sense of isolation. Try to ensure that your family and friends keep you informed about what is happening in their lives, so that you continue to feel involved. Seemingly trivial details about what A said to B or how your friend’s new job is progressing are valuable for keeping you in touch and ensuring that you continue to have the same conversations you always had rather than talking always about your cancer. Of course, you will talk about your cancer too – it is part of your life – but a balance can be struck so that you do not become shut off in a restricted world of your own.

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You may also feel a sense of guilt at causing them so much worry about such a serious health issue, and that you are responsible for inflicting this pain upon them. Perhaps you also feel guilty that your cancer is in some way your fault, that you have ‘allowed’ it to happen and you fear that people will blame you for it. This may be irrational, but when you are under such stress your thoughts and emotions will be very confused. However, putting off telling people is more likely to make these problems worse than better for you, and people who thought they were close to you may feel hurt and upset that you didn’t feel able to talk to them sooner.

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Chemotherapy literally means ‘chemical therapy’ and involves the use of cytotoxic (cell poisoning) drugs. There are many types of chemotherapy drugs, which, in broad terms, work by preventing cancer cells from growing and dividing, interfering with the reproduction process so that the cells become damaged and cannot reproduce themselves. The reason why there are so many different drugs is that they damage cancer cells in different ways. Different combinations of drugs have been shown to be effective in treating different cancers, and the drugs which you are given will be chosen on the basis of that research and experience.

The effectiveness of the drugs varies depending on your type of cancer and how advanced it is, and how sensitive the cancer cells prove to be to the chemotherapy drugs. This is difficult to predict until the chemotherapy is underway, and you will be carefully monitored throughout your treatment. In some cases, a complete cure may be possible and in others the aim may be to shrink the cancer as much as possible while not eliminating it completely. Your doctors will be best placed to advise you on the anticipated outcome for your particular treatment, although they will not be able to provide you with any guarantees.

Chemotherapy drugs can be given in different ways:

by mouth in tablet form;

by injection, into either the skin, the muscle or a vein. An intravenous drip into a vein is the most common route. This involves the insertion of a needle into a vein in your arm, and this is attached to a fine tube through which the drugs flow. The drugs will often be diluted in liquid, and administered by a pump which carefully controls the rate at which you receive the drugs: this may be a few hours or up to a few days. The needle and tube are removed at the end of each treatment. In some cases, a tube is inserted into a vein in your chest (under anaesthetic, usually local), and this can be kept in place for the duration of your course of chemotherapy. This avoids the need for needles to be inserted in your arm for each treatment. You will be shown how to keep the line clean and to prevent it blocking between treatments;

by infusion pump. This is similar to an intravenous drip, but involves using a portable pump which you can take home with you. It is small enough to be carried around with you in a bag or special belt, and allows controlled doses of drugs to be released into your bloodstream over a longer period – often 24 hours a day, seven days a week, for weeks at a time – without the need to stay in hospital for the duration of the treatment.

Depending on your chemotherapy regimen, you may have your drugs as an out-patient or you may need to stay in hospital for a few days. Chemotherapy is generally given as a number of cycles of treatment, each one lasting from between less than an hour to a few days. You will then have a rest period of up to a few weeks which allows the normal healthy tissue in your body to recover before your next treatment.

There is a general perception that undergoing chemotherapy is a particularly nasty experience, and that unpleasant side-effects such as prolonged nausea and vomiting cannot be avoided. It is worth remembering that not everybody suffers from all the side-effects of any given treatment, and that the medical staff will be trained and experienced in caring for patients having chemotherapy. They will do all they can to make you as comfortable as possible, and if you do suffer any problems, you should let them know as they may well be able to give you drugs to counteract your side-effects.

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The main type of kidney cancer is renal-cell carcinoma. Its main symptoms are bleeding, which will be noticed in the urine, and possibly pain, discomfort or swelling in the kidney region – in your back and side of the abdomen, below the ribs. Again, it should be stressed that blood in your urine may result from a cause other than cancer, but it should nonetheless warrant an appointment with your doctor.

Kidney cancer can spread via the lymph nodes, but may also travel to other parts of the body via the bloodstream. Diagnosis is likely to involve physical examination, urine tests and various X-rays (with dyes to show unusual features in the kidney), and scans to check whether the cancer has spread.

Surgery is generally the mainstay of treatment in kidney cancer. Treatment is likely to involve surgery to remove the affected kidney, sometimes even when the cancer has spread further. If it has not spread, then the hope is for a complete cure. Even if it has spread, the surgery can be worthwhile to relieve any pain and discomfort.

Other therapies might be proposed, such as hormone therapy or chemotherapy, and if so these should be discussed with your doctors.

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If you make progress on your own, congratulations! And don’t let one setback throw you off course. If, however, you eventually decide to seek professional help, don’t feel that your time has been wasted. Because you are so well informed, you may be able to proceed a little faster than someone else. If you do seek out a professional, be sure to share your self-help experiences with the therapist.

Self-help sex therapy requires thought and careful progression. You have to start at the beginning, with communication, and not just jump right into the exercises. Sex therapy is a little like taking a course: You have to put in study time, you have to do your homework, and sometimes a teacher or therapist is not only helpful, but essential. That’s why we think it’s important to emphasize that if your attempt at self-help isn’t satisfying, you shouldn’t necessarily give up on sex therapy itself. An experienced professional may help you overcome the roadblocks to success that you couldn’t overcome on your own.

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A more serious situation can occur when a shot produces a full, firm erection which will not subside. As we’ve explained, an erection that won’t go down can cause permanent physical damage which could prevent you from ever getting another erection. If an erection ever lasts longer than four hours, contact your doctor immediately. Do not wait until the next day!

The doctor will probably insert another needle, drain out the medication and release the trapped blood. When this relatively rare complication occurs, future doses need to be drastically reduced, and, in some cases, penile shots must be avoided entirely.

Once you determine your dose, make sure the doctor shows you exactly how to position the needle so you inject the drug without injuring any of the vital nerves which run along the top of the penis. After the injection, you need to apply some pressure to stop the bleeding. And doctors recommend that you massage the penis gently to distribute the medicine.

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(Some men have reasoned that they’ll save money and use their vacuum cleaners to produce erections—with absolutely disastrous results. Vacuum cleaners are designed to clean floors and furniture, not to make your penis erect. These machines can literally strip the skin off your penis and cause permanent and serious injury. So don’t even consider using a vacuum cleaner.)

Because the suction devices work by pulling blood into the penis and then trapping it there, a man who can’t get an erection using a cock ring alone may find the suction apparatus does work for him. However, some men do find these devices uncomfortable to use.

You’ve got to be careful with these devices. If you pump one up too energetically, you can bruise your penis, in much the same way that you can give yourself a “hickey” by sucking on your arm. The biggest danger is leaving the constricting ring on too long and constricting the blood flow to the penis, because gangrene can result.

Again, as with a cock ring, if s extremely important that a user not leave the ring on longer than 30 minutes.

After using such an apparatus, some men may find it somewhat uncomfortable to ejaculate. This is because the ring constricts the penis, making it difficult for semen to get out.

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Surgery for advanced bladder cancer requires removal of the bladder and the prostate. New nerve-sparing techniques can help prevent erection problems. Early tumors can also be treated by limited surgery performed through the urethra. This surgery will not affect potency.

Rectal Surgery

Rectal surgery for cancer is similar to radical prostate surgery in that crucial nerves may be injured. Unfortunately the nerves essential for erection are just too close to the rectum to allow for nerve-sparing techniques. Surgery on the rectum for non-malignant disease, however, can be modified so that the nerves are preserved and the ability to get an erection is maintained.

Penile Surgery

The good news about surgery on the penis is that it’s rare. It’s usually performed when a patient has cancer of the penis (a disease which strikes very few men) or for a very severe case of Peyronie’s disease, discussed earlier. It is not true that all penile surgery inevitably leads to lack of erection. Crucial blood vessels or nerves must be damaged for this to happen.

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If only William knew what Will Shakespeare knew: Alcohol can cause erection problems. Alcohol is a drug. In very small quantities it may stimulate arousal, but that’s not the same thing as promoting erection. Far from it. Ultimately, alcohol is a depressant. It slows down reflexes and decreases all sensation, including sexual pleasure. Researchers have confirmed Shakespeare’s assertion that liquor can cause temporary loss of potency. It can also reduce pleasure and, in some men, result in even less intense orgasms.

While a rare binge will not permanently affect potency, long-term abuse of alcohol can wreak havoc on a man’s ability to get and maintain an erection, even when he is not drinking. And in some cases this physical loss can be permanent if it’s allowed to go untreated.

Often, alcoholics don’t come for treatment of impotence until they’re on the wagon. Once on the road to recovery, the alcoholic man may find that his potency has not returned. Roger, for example, a 50-year-old accountant, visited a clinic complaining of a potency problem. A widower for many years, Roger was now living with a woman he hoped to marry. He wanted his new relationship to work, but his sexual problems were causing a strain.

Many alcoholic patients don’t volunteer information about their drinking habits, but Roger was rather direct about his past habits, his medical history and the details of his erection problems. He had been drinking very heavily for more than a decade and he had been a recovering alcoholic and “dry” for two years. Over the last decade, he noticed his erections getting softer. Sometimes he was incapable of getting an erection, no matter how aroused he felt.

Combining Alcohol and Medication

Coming back to our friend William, it’s important to note that he was combining alcohol with his high blood pressure medication. It’s possible that either alcohol or the drug alone would not cause erection problems. But the combination is powerful and may have been too much for his system to take.

In general, anytime you combine alcohol and medication you’re setting yourself up for a potential health problem—which may or may not affect your sexual potency. Before you add hard liquor, wine or beer to your body chemistry, ask your doctor or pharmacist: What are the possible side effects if I drink while taking this medication? Could the combination of alcohol with this drug affect potency?

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