29 July 2008 - Meeting with Prof Jones

E mail correspondence between Chris and Fred Berki summarising outocme of meeting with Professor Jones to discuss Deb's treatment plan


-----Original Message-----
From: Chris Eaton [mailto:ce012b1847@blueyonder.co.uk] Sent: 29 July 2008 16:47
To: Frederick Berki
Subject: Meeting with Professor Jones - 29/07/08

Hi Fred,

I thought the meeting was a bit rushed today and although I took notes I am not sure I got everything down correctly as I thought we would get some of the information in writing.

Please could you review my notes below and confirm that everything is correct (particularly the Temodal dose).

1 Chemotherapy (Temodal)

Issued with 45 tablets. Start treatment Monday 04 August. Take each day for 5 days then nothing over the weekend. Then continue 7 days a week until treatment is complete.

Take chemotherapy drug 1 hour before radiotherapy is due (states on bottle to take at least one hour before breakfast, does this mean Deb cannot eat before taking Temodal/radiotherapy). .

Pharmacist stated that Deb's dose was 135 mg. Temodal came in capsules of 100mg, 20mg and 5mg. Therefore Deb needs to take each day 1 x 100mg + 1 x 20mg + 3 x 5mg = 135mg.

2 Anti-sickness medicine (Ondanestron 8mg)

Take 2 per day for first 5 days of treatment. Take one 1hour before Temodal and then another in the evening. May cause constipation.

3 Steroids

Sunday 3 August - 3 x 2 = 6 mg
Monday 4 August - 4 x 2 = 8 mg
Tuesday 5 August - 4 x 2 = 8 mg
Rest of week - 3 x 2 = 6 mg

Dose to be reviewed at next meeting with Professor Jones - appointment letter to come through to us in the near future.

I assume the results of the blood tests are OK and treatment can start on Monday.

Many thanks

Chris Eaton

Hi Chris,

Deb's blood results appear OK to me. I will show them to Prof in clinic tomorrow, but if you don't hear from me then it is OK to carry on.

The chemotherapy should be issued to cover 42 days, i.e. 6 weeks of treatment. However, only take during the week for the first week until Deb has had another blood test, i.e. to see her response to the drug, with a view to then taking it 7 days a week. The staff in the treatment room will give you the blood forms, and usually blood tests are done either thursday or friday, ready for the clinic on monday. It is better to take Temodal on an empty stomach, more for the sake of reducing the risk of nausea, rather than any sort of reaction to the food. I suggest Deb should not take it within two hours of eating - so you may have to re-jig a mealtime, depending on what time the treatment is due. The general idea is to take Temodal 1 hour before the radiotherapy, and the antisickness Ondansetron 1 hour before before the Temodal. The Temodal dose is calculated on the person's body surface area, so it can vary from person to person. I agree with your drug calculation!

Prof usually recommends that the Ondansetron is taken for the first 3-5 days, and then maybe once a day thereafter - most people cope well with very little discomfort, and some even manage without the Ondansetron. NB - Ondansetron is famous for its constipating abilities, so a good fluid intake, fibre etc are helpful.

You're right with the Dexamethasone. Stick to that plan until seen by Prof in clinic.

I wont be in clinic as I've got two weeks holiday coming up, but Claire will be around and she is contactable via the same routes as me - I hope you've still got our contact details!

Best wishes,

Fred

Frederick BerkiMacmillan Clinical Nurse Specialist Neuro OncologyInternal: 8663Phone: +44 (0) 121 4721311Mobile: +44 (0) 7767442101Email: Frederick.Berki@uhb.nhs.ukWeb: http://www.uhb.nhs.uk Neuroscience - University Hospital Birmingham NHS Foundation TrustNeurosciences OPDQueen Elizabeth Hospital, Queen Elizabeth Medical Centre,Birmingham, B15 2TH