28. Chemotherapy, part 9

Tuesday 7th February 2012, 02:00 PM


Chemotherapy, Second Cycle, Day two


Self injection day, GULP !


Thankfully the side effects of this second cycle of chemo have been 'so far' far less arduous than the first.


The 'atomic' hiccups and there associated heartburn are only a third if not one quarter as severe as they were the first time, and probably only a quarter or less as frequent. Coupled with the fact that I'm taking indigestion relief when I need it, and sleeping pills when I need them too and it has so far been a far more manageable experience. I suspect my body has become accustomed to all the drugs I'm now taking. Even with the daunting prospect of having to give my self an injection its been a much more tolerable week so far.


2:00 PM and its injection time


24 hours-ish after chemo, I read the instructions, I read the instructions, again. I read the instructions for a third time. There's no putting it off any longer. Everything is set up. I read the instructions, again, just to be sure.

Pre-filled Syringe of 6 mg Pegfilgrastim (Neulasta), ready and waiting...

I give my belly a antiseptic wipe. Pinch a lump of skin. Take a breath. Pause the needle over my belly. Touch the tip of the needle to the skin. Slowly push the needle in to my tummy. Painless ! Less than giving blood. I push the plunger slowly in, and in, and in. At the bottom of the syringe I hear a small "click !". I slowly withdraw the needle, a tad skewiff and it scrapes ever so slightly on the way out, but nothing to bad. There's a single glisten of one tiny drop of liquid on the needle s it slips out. I release the plunger and the needle is automatically withdrawn in the barrel of the syringe, safe and sound. Done, finished, all over, phew ! what a relief. I feel that I have achieved a significant personal break through.

I almost dislocate my arm patting my self on the back.

I hope everything else will be so easy...

27. Chemotherapy, part 8

Monday 6th February 2012, 11:00 AM


Chemotherapy, Second Cycle, Day one


The two weeks rest after the first chemo cycle were much needed, today sees me back at the Dimblby Cancer Care Unite for the beginning of my second cycle.


I'm quite exited about this after having experienced such a positive result from the first cycle i.e. one tumor undetectable to touch and one shrunk in size by half.


First things first though, a blood test, and an hour wait for the results to get the 'go ahead'. Pathology have had a system crash so the hour wait, is an hour wait. It wouldn't be so bad if it wasn't for the chap sitting next to me in the waiting room is playing a game on his mobile phone, with the sound on full volume. I move away from him as far as I can. After half an hour - 45 minutes I can't stand it any longer. I'm just about to ask him to turn the sound down, or better 'off' altogether when he stops of his own accord. It's staggering to think how a grown man can have the sensibility and common courtesy of a teenage girl on a bus. Both he and I are called in at the same time and end up in the same suite, just my luck. Turns out he was 'as good as gold' for the rest of the day.


The unit is much busier than it was on my first visit three weeks ago, I'm seated in Zone B this time, with spectacular views north with the London Eye and St Paul's on the horizon. Although somewhat hampered by the inclement whether.

My blood test results are in now, "1.4". ( 1.4, what ? I don't know, and forget to have explained ) the automatic therapy acceptance level is 1.5. As 1.4 is only just below the cut of point I should be OK for treatment 'but' only with one of my doctors approval. We get it, as expected, but better safe than sorry.


The 1.4 is a measure of white blood cells, they 'are depleted' as expected and by an amount that is to be expected too. The concern is that as they are curtail to fighting infections, I'm now more susceptible than usual and have to take extra precautions accordingly, no mixing with the general "riff-raff" or plebs etc. Oncology have a plan to help deal with this, but they don't share it with me, yet !


Sister Mimi Salvador ( who was 'very' smily ) hooks me up to start with, she's almost finished giving my PICC Line and arm a full clean & service before I realized that the nurse that did my blood test only an hour before had done that all too, I kept quiet and went home twice as clean.

nice and clean and shiny

The second cycle will be identical to the first, so no unexpected suppresses expected there, foolish me.


Jo has been too poorly her self to be able to come with me this time, as this is repeat of the first cycle I'm fine with this, i'll miss her company of course, but at last she wont be getting board with me so quickly.


Instead I get a visit from my good friend Paul Rogers, and we spend a few hours laughing and joking around, the time flies by. Pauls' a highly accomplished designer and he takes the opportunity to give my camera a thorough work out.

Nurse Charlotte, comes to change my I.V. bags over and Paul starts to get up to leave so she can get on with it. "No ! No !" I tell him, watch this, Charlotte with have the I.V. swapped as quick as a Formula One team can change car tires, that amused her and actually I think she managed the swop over a little quicker.


At the end of the day Nurse Charlotte gives me me big goodie bag of anti sickness drugs etc to take home,exactly as last time, and then says " hang on i'll just go get you your injection too...


WHAT INJECTION ? 


"Didn't someone tell you about the injection that 'you'll' need to give your self tomorrow"


NO !


"Oh it's no problem, here it is, you clean the skin with a wipe, pinch a lump of tummy between your fingers, pop the cap of the syringe, push the needle in, push the plunger all the way down, you'll here a click and just pull the needle out again, all done, easy".


( my first thought was, ARE YOU MAD WOMAN ! )


She goes through the whole process with me a couple more times, and tells me that "if I like I could always get the District Nurse to do it for me, or even my G.P.". I decide to do it my self, if a 7 year old can give them self a shot of insulin then I should be able to do this too. It will be a "learning experience"...


It's a shot of '6 mg of Neulasta', which will help boost my bone marrows ability to produce white blood cells and hopefully restore my ability to fight infections, but i'll still avoid mixing with the Oi-poloy! 

26. Radiotherapy, part 1

Friday 3rd February 2012, 10:00 AM


St Thomas Hospital 


The Head Shell Game


I'll be receiving 30 days of RT ( Radiotherapy ). About a hour a day, 5 days a week, for 6 weeks in a row. I'm not looking forward to it.


I'm not looking forward to it at all, frankly it still worries the 'dickens' out me.


The alternative is to live with the knowledge that there might still be rogue cancer cells hiding in my neck just waiting to erupt again. And frankly they can all just fuck off and die. NO ! not "just fuck off and die", we are going to kill every last one of the vicious, mean, little fuckers, dead !, forever!. "Take that, you useless, little, fucking bastards".


Radiotherapy is an exact science. So exact that even the slightest chance in body shape i.e. weight loss or gain, or slightest movement while being eradicated will throw the targeting off.


So as well as the RT bed having footrests, hand grips, chest buffers and shoulder grips I will also be having my head "immobilized" in a "Head Shell".


Before being handed over to the 'Mold Making Team' I have a Pre-Treatment Consultation with Radiographer Sajeesh Raj.


Sajeesh is a lovely chap, very calm, gentle and softly spoken. He explains everything that I can expect to me in a manner that was consummately reassuring. We might even meet again as he is about to start a posting at Guy's Hospital where i'll be receiving my RT. I like him he's another excellent example of the caring-professionals I'm constantly meeting.


Sajeesh takes a couple of photographs of me for my I.D. Card, we don't want anyone else stealing my radiation. He like the first, I like the second, not sure what one will get used.


And 'one other thing', Sajeesh 'pops' out of the room and returns a minute later, Julian the 'Mold Technician' thinks that "yes! if I can trim my beard closer then that would be preferable". However they have no scissors, so I have to 'pop' out and buy some from the local W H Smith's.


The bathrooms/toilets in the Radiography Dept. don't have mirrors (?). What they do have is chrome flush mechanisms for there toilets, the size of paper back books and with large round chrome buttons. So to trim my beard I'm keeling on the bathroom floor with my head over the toilet bowl using the chrome flushing mechanism as a mirror. I forgot to lock the door. Some one opened it, what they must have thought I was doing I can only begin to imagine.


The actual mold making process was to me, fascinating. Victor Lee the Dosimetrist & Julian Chapman the Mold Technician have there own little workshop with an exact copy of the RT bed that i'll be treated on.


They go to great lengths to explain everything to me in as much detail as I can handle. They are both really nice guys ( no surprise there ) polite, charming, well spoken, calm and gentle, they are gentleman. I like them too, I think that they would both be very pleasant men to work with. I tell them about this blog, "Yes I have herd about it" says Julian "from either Dr. Guerrero-Urbano, or possibly on of the other doctors no your team", "don't these people have anything better to do ?" 


They seem to have an excellent working relationship, Julian, who is the older of the two and I suspect also the more experienced seemed to be running the operation, but at no point did I ever get the impression that Victor was in any way subservient to him. They worked in tandem with an ease and familiarity that was most reassuring and clearly highly professional and efficient. 


After tailoring the bed to my exact measurements which took a few minutes and was aided by laser positioning came the actual molding of the shell to my head.


The raw shell consists of a plastic hoop that 'clicks' into place on the bed. To start with the mesh in the hoop is flat, but becomes pliable then warmed in hot water. The sensation is like having a warm flannel draped over your face. While the mesh still warm Julian and Victor mold it to the contours of your face, paying particular attention to the nose, eye sockets and jaw. It is not an unpleasant sensation at all, more like having a face massage. It takes about 12 minutes for the mesh to cool, harden and set under the fans. Breathing is no problem at all, the holes in the mesh are between pencil and little finger size.

With my bespoke head shell I now have a CT Scan 'shell on' so that the RT Team can calculate & produce my final 3D exposure map, targeting the exact parts of each tumor to be eradicated and avoid sensitive ares like the brain and spine etc.


The CT Scan will be 'with contrast' so i'll be injected with "stuff' again ! As usual while I'm chatting to the nurse I'm telling her how much I don't like needles and I think i've put her off her game. They can't use my PICC Line, the 'stuff' is a bit thick and sticky and could gum up the tube, so it has to be 'old school' a channeler, a needle again.


She's being ever-so careful and considerate, but the first needle goes in 'but' not 'into' the vein, so that one comes out again and goes in the bin. She's ever so sorry and I try to reassure her that it's OK.


Second go, same thing again !, the second needle goes in but not 'into' the vein, so that one comes out and goes in the bin. She decides to go and get someone else who doe's a lot more of this kind of thing, and a lot more than she does.


The doctor arrives, straps the tourniquet around my lower arm, slaps the back of my hand a few times declarers that "this skin is much thiner and, that the veins are bigger and are easier to get to" and in the needle goes "just a 'tad' ouchie" but over an done with, phew!


The CT Scan even in the shell is just like all the other scans I've had, easy. With the head shell my only form of communication is by hand gestures, thumbs up or down or rather from me a divers OK signal.


A small prick with a pin, yes I know you are, but what are you going to do with it ?


Accuracy is curtal and the CT Scan is and RT will also be, laser aligned and as a reference point of a small ball-bearing is stuck to my Sternum. To be able to regain that exact point I now have a tattoo on my chest at 'that exact point'. The tattoo is the size of a single prick with a pin. Jo said "just like how Febe's mum sees her from heaven". I just hope it doesn't get lost I'm my forest of chest hairs, all 19 of them, Snowy the first white one, Snowy Junior my second white one, and there 17 friends.


As soon as I get back home I'm straight off the see the District Nurse for my PICC Line Flush & Clean. It's a different nurse this time, we have the same chat as I keep having re PICC Lines, and she agrees that there is absolutely no reason to 'over dress' the Line, and it really annoys her too.


She's half way through peeling of the old dressing and is about to slip a pair of scissors under it' but a stop her in time. I was quit prepared to shove my finger between the blades of the scissors rather than risk having my PICC Line severed. She was perfectly understanding about my concerns and with a little gentle peeling it was all taken care of, and I actually came away with a very neat and comfortable dressing.


Edited with thanks to Jo W

25. Weekly Consultation

Wednesday 1st January 2012


Guy's Hospital, Oncology Outpatients Clinic.


A fairly routine consultation


The "waiting room from hell" (see chapter 20) isn't so hellish this time.

Before going in to see Dr Duraha Kahn I have another blood test, it's via the PICC Line so it's completely hassle free. The nurse is very sweet and chatty, she has attended to me once or twice before ( I must get her name and title ). She is impressed with how clean and healthy my arm is ( not all are ) and fits a new optional, added, extra. My Line now has an anti bacterial 'donut' ( in blue ) fitted around the line just at the point where it disappears into my bicep ( as an added extra precaution ). We chat about how this blog is going and of "Oncology style" dressings. There has now been "TWO instances" of nurses cutting through PICC Lines because they have had to cut dressings off.

PICC Line wise I'm now "on guard".

Dr Kahn and I have met a few times now and we discuss the treatment so far, and the treatment forthcoming.


My Blood test were "as expected" showing a decreased level of White Blood Cells, which are on the increase again. And, decreased kidney function. Both as expected and both on the way up again.


We discuss 'at some length' and 'in some detail' my symptoms & the side effects of my Chemo and the anti sickness drugs etc.


We have a plan. We are slightly altering the medication regime in the hope that this will in someway reduce the side effects and allow me to sleep better. I 'can' take "Sleeping Pills" if I need them, Paracetamol if I need it, also anti intergestion/hearburn treatments if I need that too.


When all is said and done, and in the overall scheme of things, and taking everything else into consideration... three days of atomic hiccups is a small price to pay.


So "all systems go" for next cycle of Chemo.


Edited with thanks to Jo W