22 February 2011 - Cancer Centre, Neurosciences Outpatients Department, Oncology Unit, Old QEH

Last week, the start of Deb's fourth cycle of PCV chemotherapy was delayed because of her low platelet count. We returned to the hospital today for Deb to have a further blood test and to see Dr Sanghera to consider the next cycle of chemotherapy.

Cancer Centre

This took along time. The blood analysis machine was faulty and would not print out. Eventually we got the results which were not good. The platelet count had increased but only slightly. (Last week= 60, today = 78, minimum of healthy range = 140, minimum for chemotherapy = 100). Other counts - red blood cells etc - were slightly down but not enough to worry.

Neurosciences OPD

We saw Dr Sanghera who said that Deb could start her next cycle of chemotherapy but he would reduce the dose in some of the components because of the low platelet count. (Vincristine - as before, administered intravenously; Lomustine - 25% reduction, 3 tablets instead of 4; Procarbazine - 20% reduction, for 8 days instead of 10). Dr Sanghera wants Deb to return in 3 weeks for another blood test.

Oncology Unit

Chemotherapy unit has been decanted (their word) from its original site in the Cancer Centre to the second floor of the Old QE. This is a 'pre-move' in preparation for a move into the new hospital later in the year. We had to wait a long time before Deb had her vincristine. In total out of the house for 5.5 hours.

Yesterday we went to the West Midlands Brain Tumour Support Group. We had a talk from Latha Senthil, Consultant Neuroradiologist at the QE. I found her talk very interesting. One of the things she said was that grade IV brain tumours (like Deb's) grow very quickly and therefore have to generate their own blood supply. Because the blood vessels that supply the tumour have grown fast they do not have time to develop a blood brain barrier. So when contrast medium is injected during an MRI scan it leaks into the fast growing part of the tumour from these malformed blood vessels. It is this leakage that shows up as 'white' on Deb's scans. This lack of a blood/brain barrier around the fast growing parts of the tumour also allows the chemotherapy to be effective. It leaks into those parts of the brain where it is most needed. The tumour's fast growth is its own Achilles heel.

14 February 2011 - Cancer Centre, Old QE Hospital

Deb, Kate and I on a visit to Southport, October last year

Visited cancer centre today following Deb's completion of her third cycle of PCV chemotherapy. Deb had only minor side effects during this cycle. She has not had any significant headaches and her bouts of dizziness have been minimal. She has been a bit nauseous and tends not to finish meals but generally Deb has felt really well.

Deb had an MRI scan on 16 January. Today we met Dr Sanghera to discuss the results and consider the next cycle of chemotherapy.

Scan Results

The results of the scan were positive. The overall size of the tumour was slightly reduced and the 'active' (Grade IV) area was about the same size as on the previous scan (9 September 2010). This shows the chemotherapy has been effective. Dr Sanghera was pleased with the results and Deb's general health.

Blood Tests

The blood test today showed Deb's red blood cell count and her platelet levels were low. The platelet level was of particular concern (Deb = 61; bottom of normal range = 140). About 2 weeks ago Deb had a bleed into her left eye and has developed a number of bruises on her legs. Dr Sanghera said this was due to a low platelet level which would have reached its lowest level 2 weeks ago (he said 'nadir') about 4 weeks after the chemo was administered. (He said spontanous bleeding was only likely to occur with platelet levels below 10). He thought that Deb's platelet level would be increasing now but wanted chemotherapy to be delayed for a week to allow levels to rise further. Deb will return for a further blood test next Tuesday (22 February) and providing the platelets have recovered (>100) will start her next cycle of chemotherapy. If platelet levels are still low then he would consider whether a blood transfusion was necessary.

Steroids

Deb has been on a dexamthasone dose of 4 mg per day since she stabilised after her operation in July last year. We discussed reducing the dose. Dr Sanghera reviewed the scans and thought that the fluid (oedema) levels in her brain looked similar (September 2010 compared with January 2011). He thought that Deb could start reducing her steroid dose but suggested that this was done very gradually. As a start Deb will have doses of 4 mg and 2 mg on alternate days.

Overall this was a positive visit. Deb had been very concerned about the results of the scan and has not slept well over the past week. To get good positive news was a great relief.