Visit to hospital today for Deb to have blood tests and review effects of chemotherapy.
This time, Deb's fourth cycle of PCV, I think the side effects have been slightly worse. Deb has had a bit more sickness, headaches and general flu-like symptoms. Psychologically she has also been affected. She has not been able to lift herself as well as for previous cycles and has been depressed.
Unusually for the Cancer Centre, this was a quick visit. There did not seem to be as many people around and Deb did not have to wait for the blood test and as soon as she got the results we were called into see the doctor. The results of the blood test were very good. In particular the platelet count was 137 (almost within the normal range).
We saw the SHO, Dr Meade. She was pleased with Deb's progress and we agreed:
1) To return in 3 weeks time (5 April) for more blood tests and if these are OK Deb will start her fifth cycle of PCV.
2) As Deb's platelet levels have recovered so well we will stay at the current reduced chemotherapy dose (ie lumoustine reduced by 25%, procarbazine reduced by 20%).
3) Next brain scan will be arranged for end of April/beginning of May.
Monday, 14 March 2011
Tuesday, 22 February 2011
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.
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.
Monday, 14 February 2011
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.
Tuesday, 11 January 2011
4 January 2011 - Cancer Centre, Old QE Hospital
Hi everyone; happy new year. Sorry I haven't posted anything for a while. It was a combination of my lethargy and the laptop being out of action because of a faulty power supply.
Anyway, I am happy to say that not much has changed since my last post. Deb went through her second cycle of PCV chemotherapy (she took the medication between the 15th and 25th November). I think her side effects were slightly worse than the first cycle. She was more tired and felt sick more often but nothing she couldn't live with. (Sorry - poor grammar I don't think you should end a sentence with a preposition.) Physiologically Deb was fine over Christmas and New Year. She was not taking the chemo - the start of the next cycle was delayed for a week so Deb would not have to be taking the medicine over the New Year - and she felt well. Psychologically it was not such a good time. If you are terminally ill you don't want to dwell too much on the past or think about the future. Christmas when traditionally you remember the past year and make resolutions for the future is not a good time for living in the 'now'.
On the 31 December Deb had her usual blood test (which was OK) and we saw Dr Sanghera on the 4 January. We discussed how Deb had been over the previous 6 weeks . The doctor was pleased and surprised at how well Deb was tolerating the chemotherapy. It was agreed that she would start her third cycle of the PCV chemotherapy. As before, the vincristine was administered intravenously at the hospital and the other two drugs were taken in tablet form at home. All seems to be going well so far. Deb's side effects are at about the same level as for previous cycles.
Dr Sanghera has arranged an MRI scan for Sunday 16 January. It will be interesting to see how the PCV therapy has effected the tumour.
We see Dr S again on the 14 February for the next cycle of chemotherapy. I expect we will look at the scan results then.
I promise to write more often - if only to say nothing is happening.
Anyway, I am happy to say that not much has changed since my last post. Deb went through her second cycle of PCV chemotherapy (she took the medication between the 15th and 25th November). I think her side effects were slightly worse than the first cycle. She was more tired and felt sick more often but nothing she couldn't live with. (Sorry - poor grammar I don't think you should end a sentence with a preposition.) Physiologically Deb was fine over Christmas and New Year. She was not taking the chemo - the start of the next cycle was delayed for a week so Deb would not have to be taking the medicine over the New Year - and she felt well. Psychologically it was not such a good time. If you are terminally ill you don't want to dwell too much on the past or think about the future. Christmas when traditionally you remember the past year and make resolutions for the future is not a good time for living in the 'now'.
On the 31 December Deb had her usual blood test (which was OK) and we saw Dr Sanghera on the 4 January. We discussed how Deb had been over the previous 6 weeks . The doctor was pleased and surprised at how well Deb was tolerating the chemotherapy. It was agreed that she would start her third cycle of the PCV chemotherapy. As before, the vincristine was administered intravenously at the hospital and the other two drugs were taken in tablet form at home. All seems to be going well so far. Deb's side effects are at about the same level as for previous cycles.
Dr Sanghera has arranged an MRI scan for Sunday 16 January. It will be interesting to see how the PCV therapy has effected the tumour.
We see Dr S again on the 14 February for the next cycle of chemotherapy. I expect we will look at the scan results then.
I promise to write more often - if only to say nothing is happening.
Monday, 15 November 2010
15 November 2010 - Cancer Centre, Old QE Hospital
Deb has been remarkably well during the six weeks of her first chemotherapy cycle on PCV. Initially she was very tired but she has not had any serious side effects from the treatment and especially in the weeks when she was not taking the drug she has felt good. She has had some dizzy spells (and these seem to be more frequent) but generally she has been very well.
Deb had an appointment today at the Cancer Centre. She had her usual blood test and the results were all good. (The red blood cell count was a little below the normal range but not enough to cause concern.) We saw Dr Meade - Dr Sanghera's new registrar. We discussed Deb's health over the last six weeks and reviewed the blood test results. It was agreed that Deb would start her second cycle of the PCV chemotherapy tomorrow.
Deb asked about reducing her steroids but the doctor thought she should stay on the same dose (4.0mg per day) until the full effects of the chemo were known. The registrar will also book Deb in for an MRI scan to take place around the end of December.
Not much more to say. No news is good news they say.
Tuesday, 5 October 2010
5 October 2010 - Chemotherapy Unit, QE Hospital
Today Deb had her first session of the new chemotherapy - PCV. I write this at 3:00pm and Deb is upstairs in bed asleep. I guess the tiredness and fatigue caused by the chemo has already kicked in.
This morning Deb first of all had a meeting with a nurse in the Chemotherapy Unit at the Cancer Centre,QE Hospital. The nurse explained the method of treatment, the possible side effects and provided Deb with a card giving 24 hour contact numbers in case there are problems.
The chemotherapy is a combination of 3 drugs. The first, Vincristine (the 'V' in PCV) was administered at the Cancer Centre by intravenous drip. This took about 10 minutes and the nurse stayed with Deb throughout the treatment and periodically checked the drug was still going directly into the vein. (Disturbingly the bag with the chemo in had a sign on it saying 'Fatal if taken other than intravenously'.) We then went to the pharmacy and picked up the other drugs to take home:
Lomustine (or CCNU, the 'C' of PCV). 4x4mg tablets to be taken this evening.
Procarbazine (the 'P' of PCV). One 50mg tablet in the evening and 2x50mg tablets in the morning for 10 days.
Ondansetron. Anti-nausea tablet to be taken half an hour before the lomustine and 12 hours after.
Domperidone. Anti-nausea tablets to be taken as required.
Senna laxative tablets - presumably one (or all) of the chemotherapy drugs can cause constipation.
So far so good. Lets see how this goes.
This morning Deb first of all had a meeting with a nurse in the Chemotherapy Unit at the Cancer Centre,QE Hospital. The nurse explained the method of treatment, the possible side effects and provided Deb with a card giving 24 hour contact numbers in case there are problems.
The chemotherapy is a combination of 3 drugs. The first, Vincristine (the 'V' in PCV) was administered at the Cancer Centre by intravenous drip. This took about 10 minutes and the nurse stayed with Deb throughout the treatment and periodically checked the drug was still going directly into the vein. (Disturbingly the bag with the chemo in had a sign on it saying 'Fatal if taken other than intravenously'.) We then went to the pharmacy and picked up the other drugs to take home:
Lomustine (or CCNU, the 'C' of PCV). 4x4mg tablets to be taken this evening.
Procarbazine (the 'P' of PCV). One 50mg tablet in the evening and 2x50mg tablets in the morning for 10 days.
Ondansetron. Anti-nausea tablet to be taken half an hour before the lomustine and 12 hours after.
Domperidone. Anti-nausea tablets to be taken as required.
Senna laxative tablets - presumably one (or all) of the chemotherapy drugs can cause constipation.
So far so good. Lets see how this goes.
Monday, 27 September 2010
27 September 2010 - Meeting with Dr Sanghera, Cancer Centre, QE Hospital
At the meeting, Deb told Dr Sanghera that she was going to proceed with the PCV chemotherapy. Dr Sanghera again went through what was involved in the treatment and the possible side effects. Deb signed a consent form and had a blood test (the results were good). The first cycle of the chemotherapy will start some time next week (the hospital will call us to confirm the date). It is likely that Deb will be called into the Cancer Centre before the start of the chemotherapy to familiarise with the procedure. We will now see Dr Sanghera every 3 weeks (at the beginning and half way through each cycle of the chemotherapy). The next appointment been made for Monday 25 October . For the time being Deb's steroid dosage will remain the same (4mg per day).
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