Monthly Archives: June 2011

A day of two halves

After a good day yesterday , the chemo hit back today. Started off not too badly although muscle soreness was back, even managed to get to our local theatre to see Yes Prime Minister, driving there through torrential rain .

Coming back though the pain really started to kick in, in the main around the chest area and top of the diaphragm , no idea why it was so much worse today than for the last few weeks, just when we thought it was getting easier. Got to the extent he was starting to look quite grey – has headed off early to bed, with luck it will be easier tomorrow.

A visit to Barts- PET & CT scans

PET scan image

Image via Wikipedia

Day dawns on our pre chemo check up appointment, due 1.30pm today. Awake early as usual ,always starts to get a bit stressful, you’d think we’d be used to it by now, hospitals are never the best place to be going on your day off.

Going in early to check out bloods, hopefully will be OK, or at least marginal, still another three days to treatment day , which gives them a bit of time to recover. Overall he is quite perky today, put on some dance tunes yesterday and had a dance around the kitchen which got the blood moving ( no prizes for content, Britains got Talent won’t be calling).

Watched Springwatch with the cats last night (their favourite programme), looking forward to making the most of summer as he starts to recover from chemo, now trying not to think about the next scan.

Quick update on the visit , asked about difference between a PET and CT scan, doctor used analogy of the stuffed white tiger that caused 4 helicopters to be scrambled recently , a CT scan would show the shape of the tiger , the PET scan would show you if its heart was beating. Apparently the latter picks up on cells that are using more energy , which show up more brightly , you drink a tagged sugar drink beforehand. As active cancer cells use more energy, they  show up more brightly – the drawback about having one in 6 weeks , is it is still within 6 months of the original surgery so the pleura etc is still healing which means they are also using more energy. making the results difficult to interpret.

Blood results hadn’t come through before we left, so fingers crossed all OK, at least had the benefit today of a really good nurse , who took the bloods with no pain at all – you’d think it was a pretty basic nursing skill , but very few have done this painlessly , most have left bruising and some have been really painful, in overall scheme of terminal cancer it may seem minor but these things do make a difference. Suggest in all this NHS reform that maybe a bit of extra training for nurses on taking blood painlessly might be useful

At this stage , CT scan booked for 29 July , but oncologist is going to check with the surgeon to discuss our case and see if he feels a PET scan is appropriate.

Also mentioned that at last chemo , they didn’t have any prescriptions for us, so he entered everything into system whilst we were there- don’t want any mix ups on Tuesday , bad enough dealing with the Unions and their strike actions on the underground.

Angiogenesis- where foods can help

Continuing to increase my medical knowledge and the feeling we have swallowed a textbook, angiogenesis is one of the new hip happening phrases-

“Angiogenesis” is the body’s process for creating new blood vessels, but cancer cells can interfere with this process and use blood flow to stimulate their own growth. Eating an anti-angiogenesis diet aims to starve cancer by cutting off its blood supply, inhibiting the production of cancer cells. Anti-angiogenesis foods include strawberries, bok choy, broccoli, soybeans (especially fermented soy products such as miso and tempeh), and tomatoes (cooked is better). Green tea, dark chocolate, and various spices such as cinnamon can also decrease cancer risk.

Still yet to see eclairs or ice cream making a late entry, buy guess who will be having broccoli and bok choy ( will have to look up what this is ) followed by strawberries and chocolate this weekend.

Chemotherapy – anti nausea drug options

One of the biggest factors in getting through this treatment , is the success , or otherwise in controlling nausea. Anyone who has ever experienced sea- sickness, knows just how depressing and debilitating it can be. Now imagine  sea sickness for weeks , then just when you start to feel better , going right back to square one- voluntarily!!

The good news is  lots of drug options to help, the bad news is everyone seems to react differently , so there is no one right answer. At first weren’t sure just how much it could be improved and thought that as long as he wasn’t vomiting constantly , it was as good as we could hope , but in fact , over the past few weeks have controlled it to a much better level, such that whilst still nauseous at times, never stops him eating and never results in actual sickness.

Over the past few months , this is our experience of the following  drugs

Steroids – dexamethasone , starts day before each treatment and continues for four days afterwards. These have proved really effective , seem to stimulate his appetite and keep nausea at bay really well. Their main downside is they do make him a bit hyper at night and disrupt his sleep as well as increasing restless legs syndrome.

Ondansetron – this is given intravenously during the day the chemo is administered, it appears to target nausea actually caused on the day and its immediate aftermath, apparently it works best in conjunction with steroids  and is a serotonin blocker. Again this seems to have been  really effective as nausea reduced in those first couple of days.

Metaclopramide – this has been the mainstay of our anti nausea controls  , normally starts day after the chemo treatment and is taken for round 5 – 9 days, it works by blocking the vomiting centre and encourages the stomach to empty , so that it gets rid of the heavy feeling you have when you feel sick. This had a lot of experimentation. At first we just took along with the steroids and stopped on the same day – this was a bad move as immediately started being sick the day after they stopped and although restarted them , never really got rid of the nausea at all. Also found  it was really bad first thing in the morning and during the night, when he was constantly waking up feeling sick and having to run to the loo, often just dry retching. As one of its common side effects is restlessness and muscle spasms , they didn”t help with the sleeping either ( not everyone gets same side effects of course )

Cyclizine – at round 2 when we said how bad the nauses was, they also prescribed this drug and suggested the metaclopramide was taken in addition for the first seven days. This is an antihistamine often used for sickness that combines well with other drugs – this one one didn’t work at all for him, still had sickness after the steroids stopped and same problems at night.

Levemopromazine ( Nozinan) – round 3 and  a new prescription to add to our growing medical chest . Again in combination  with metaclopramide, this stopped the dry retching in the morning , although had terrible effects on his moods ,  he veered between aggression and zombiedom.

Round 4 – here we found taking  metaclopramide for 9 days , but restricting it to morning and afternoon, at double the initial dose after discussions with the oncologist ,  reduced restless leg syndrome side effect and stopped actual vomiting but still left him feeling very nauseous for those first five days after the steroids stopped.

Round 5 – still taking the metacopramide, twice a day for the first 7 days, but supplemented with  levemopromazine at night . Strangely this time, the mood swings are much less, still can be a bit dopey during the day , but worth it as totally removes nausea at night , stops the dry retching and improves his sleep. Have kept this one going for a full two weeks and is best he has felt . looking to stop this now and go to no drugs other than the Folic Acid for the final week.

Fingers crossed same combination works as well  for round 6 .

Rainy days and blackbirds

Looking very tired, to be expected as this is the low point of blood counts, these should start to improve from next Tuesday as we enter the final build up week before round 6. Always a sign of low counts had very bad nose bleed today, been a while since these , but given low platelets number it takes ages to stop.

Sleep though has definitely improved , which makes a huge difference to his well being- no wonder sleep deprivation is used as a form of torture.

Avoiding bread has helped with the bloating, although digestion still a bit iffy. His self confidence is very low at the moment, as he is aware of how ill he looks. The local pharmacist didnt help , he collected his latest supply of supplement drinks, which are quite heavy but nothing major. As a grown man used to a physical job, found it a body blow to his confidence that she kept asking if was ok to carry them the 200metres to the car- kindly meant but as she was a gray haired granny herself made him wonder just how ill he did look.

As for the blackbird, the scruffiest bird in the world now not only visits the garden morning and evening , he taps on the window for you to go out and feed him. Heard this week on a gardening programme blackbirds are very partial to strawberries, so as a treat put one out for him- can categorically state while they may like strawberries this is only because there are no fruit cake trees available.

Getting to grips with chemotherapy

Had a really good couple of days, mainly because he has been able to get some reasonable sleep. This means he feels so much better during the day, no restless legs , no nausea and very few aches and pains. Still very lethargic and tired , so the afternoon black and white film has become a staple of the day , along with midsommer murders , but in his own words ” its taken a few months but think I’ve got to grips with chemotherapy”.

No more talk about not doing number 6 , now we just need to make sure blood count OK for number 6 on the 22nd June. Luckily not one of the prospective tube strike days which would have really messed us up – we thought we’d have to book an hotel the night before.

Talk is starting to turn to what he is going to do in terms of work , where we can go in August as we both need a break. How well he might be in July, so that we can do something. Have had my part time job offer through starting 1st September , so artmake the most of July and August.

With apologies to Bridget Jones

Sickness tablets – 1 ( v.good)

Weight – 67kilo ( good)

Hours sleep – 5 ( v. good)

Smiles/ laughes – 0 ( v. poor)

Glasses of wine – 2  (me not him ( good))

Chemotherapy continues to travel its course , now entering the bad flu stage , where all your body aches and no energy. Day routine is bed- couch – bed – couch , with occasional forays to the loo and the kitchen. On the up side nausea much reduced .

Ongoing search for drinks to reduce the chemo taste, Ribena now consigned to the orange squash, ginger beer dustbin of past phases. New ones on the block  are traditional lemonade and elderflower cordial. Our top five  food fads see chips retaining their number one position, toast is now a no go  but  a new entrant into number 2  by the rank outsider crumpets.

Chicken, tomatoes and of course carrots make up the top 5. Personally am disappointed to see chocolate eclairs didn’t sneak in this week.