The weekend effect

It was all going so well… I had a lovely visit from one of my mastectomy friends who came from Cambridge on a walking weekend and stopped off, bearing cake, including the best Bakewell tart ever. It was lovely to see her. I was feeling okay till dinner time, at which point the nausea and headache struck. Ondansetron and paracetamol didn’t help, and by 10pm there was no change so I took a second Ondansetron. I slept sitting up, and woke at 4 with a headache and nausea. So the weekend effect strikes again; I have my weekly review on Thursday afternoon and then everything changes ready for the weekend.

So on Saturday I doubled the Ondansetron to 8mg morning and evening, to no effect. I toyed with the idea of calling the out of hours GP, but I’m pretty sure the cause is brain swelling from radiotherapy. I wonder whether having the weekend off will help, but Dr Sarah has already explained that it’s about fractions of doses of radiotherapy, and those build. So I took a second 2mg of dexamethasone at 12. I still felt nauseous and headachy on Sunday, when I took 4mg of dex in the morning. I also dropped one of the steroids while trying to take it, but couldn’t find it on the floor. Then I noticed a small white blur in Bun’s water bowl; there it is, the mostly dissolved little pill. Just imagine the results of that, Bun on roids!

I feel down about upping the steroids which as you know make me feel all-round crap. At that dose they start to cause steroid myopathy (muscle weakness especially in the thighs and upper arms). I’ve got a lovely trip planned next weekend, and I was thinking that it looked hopeful that I could do it. Still, the focus has to be on getting through this six weeks, and on managing the signs and symptoms. Maybe the myopathy won’t reestablish itself for a couple of weeks. As Plum said I know it’s worth doing this treatment in terms of extra good time, so I have to stick my head down and get through it. Also as of Thursday I’ll be two weeks in which is a significant proportion.

I’ve over-committed myself, voluntarily, and and spent much of the weekend failing to finish the feature I’m writing for the Tavistock Times, and fighting to make some curtains for my brother and sister-in-law’s bus. It was curtain Armageddon, with a series of disasters involving some pink tailor’s chalk that turned out to be wax and wouldn’t come off, shrinkage in the wash that took 3cm from the length (I told you I should have washed the material first Mum), and unpicking 1.8m of machine-stitching using a pin and some dressmaking shears, wearing a Petzl head torch because I can’t see well enough and we’d lost the stitch unpicker, and the shops are closed. It was all okay in the end, and the curtains were duly installed in the bus using the only ten curtain hooks we had. The two cushions I’d made in the week also looked pretty good. I managed to eat dinner (currently the meal I have trouble with) but then went through 3 hours of being unable to keep my eyes open, which kept happening in the two weeks before Hunt was diagnosed. It’s more than tiredness. Bun asked to go out, and I just couldn’t summon the energy to get up from my bean bag. In the end I rolled onto the floor on all fours and forced myself to go downstairs an inch at a time like Peter Crouch’s robot goal celebration in super-slomo.

I did sleep last night, and woke at 6 feeling as alert as I ever do in the mornings. So today I’ll speak to one of the oncology staff about what to do, bearing in mind I now have another five fractions of IMRT coming up.

Kari returned from Iceland full of stories about her new best friend whom she’d met with near her home in the far north of the country.  Kari found this new friend via Facebook after she was told about her by a man she met – who’s probably quite famous but she can’t remember his name – on a tv programme she appeared on as a part of her Diamond Duke of Edinbugh ambassador role. This woman tans hides in the north of Iceland in a disused herring processing plant. She’s tanned seal hides including from a near-term foetus found inside its mother, all of whom drowned in fishing nets; such a horrible thought. This woman teaches Inuit how to tan hides too, since much of their knowledge and skill has been lost.

There are geothermal chimneys in the fjord near to the woman’s home, that are normally only found in the very deep ocean, but which here are just meters from the surface. The sea is still utterly freezing, however. Kari is utterly enthused. I want to swim over the chimneys, and to meet Kari’s new best friend. Something to look forward to.

 

 

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One down five to go

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Yesterday marked a whole week of radiotherapy/chemotherapy. With the build-up, the dread and the various tales of what might or might not happen, I’d expected something worse. I have a long way to go, yes, but while it’s not pleasant, overall I feel – here it comes – positive about it. Dad and I have got into a kind of routine where he drops Bun and I off on the moors, goes to do the shopping, gets his papers and returns to collect us. We then do our Derriford stint.

The timing of everything seems inordinately complicated, to the point where I’m considering volunteering the problem as a SATs question for 6 year olds. But how much is due to my still slightly less than agile brain? I have to take my usual meds, which include the steroid, early. For these I need some food so I have toast and tea. I have to take the Temozolomide one hour before the radiotherapy starts because its role is to render the cancer cells more vulnerable to the radiation. The radiotherapy time varies between late morning and mid afternoon, and is planned to the minute. So I take the T on the five minutes before the hour, because by the time I’ve opened the four little sachets a couple of minutes have passed.

Now, I must also take the T on an empty stomach, which means at least two hours before the last food (which includes drinks with milk and so on, though water is fine I think). So when Dad offers me shortbread, I’m not supposed to eat it… ooops. I must also not eat or drink tea for one hour after I’ve taken the T. Oh, and then there’s the ondansetron. The T makes me feel quite nauseous in a stomach-churning way. So I take ondansetron thirty minutes before the T.

Yesterday, Dad and I had a plan involving going into oncology early so I could have my weekly bloods taken (reading up on this, there’s a point called the nadir when blood counts, and thus resistance to infection are lowest, and this is from 7 – 10 days). So I’ll take the T en route, grab my ticket, get the bloods done, and we’ll dash off to B&Q to pick up a few bits including the paint for my front door which my brother Dave is going to paint for me. Then we’ll return for rads at 1.38.

I open my sachets as we pass Runway Road, and promptly drop a capsule which slips between the sachet and my mouth as I hold my water bottle up to wash it down.

Stop! I’ve dropped one! Dad obeys, and the water slaps from the water bottle over my face and down my front. We stop in the bus stop but I can’t find the capsule. It’s not on the floor, it’s not in my scarf, or hiding in the folds of my coat, or by the side of the seat, or under the mat.

In your bag? Says Dad? I must admit that very many lost items show up in my bag, including swimsuits and elderly bananas. So I empty it – and yes, there it is, a glimpse of lemon yellow, nestling right at the bottom in the seam. I yam it fast with the remaining dribble of water.

We arrive at 12.25. I grab my ticket, number 22 for bloods, and 21 is on the display so things are looking up. Fifteen minutes passes. No change. Do I ask? I know they have other things to do, and maybe there’s a problem. So I wait. It’s now 1250, and they close for an hour from 1-2. The phlebotomist appears and places the bag over the ticket machine – so I tell her I’ve been waiting – oh I didn’t know you were here I was looking for 21 and they’d gone! I’ve been restocking, you could have come in straight away! Drat. My veins are still missing on the right.

So, bloods done, Dad and I race to B&Q at 1. I choose the paint colour (I was torn between a lovely bright turquoise, a burnt orange and pink, but plumped for the pink – I have standards to maintain). I leave my request at the paint mixing counter and we dash off for the rads…except there’s a complete jam outside and we can’t get out of the car-park.

Finally we creep onto the road with minutes to spare, and I make it through the doors at 1.36. The minute I check in with my barcode I get called and wander down to the waiting area, stopping for a wee on the way – I don’t want to be uncomfortable. I’m getting to know some of the faces in the oncology waiting area, and wonder at the constitution of the waste products being flushed down these toilets. Not much can be alive in the sewers beneath Derriford; the recent research that mentions the amounts of medication finding its way into the water supply via excretion have nothing on this cocktail. These must be among the most toxic toilets in christendom.

Having wondered about the type of tree in the ceiling light panel of the radiotherapy room, I have noticed that each radiotherapy treatment area is named for a tree. Mine is Acer. There’s my clue then. On the wall by the tiny waiting space is a series of oak plaques carved with a poem. It’s taken me five days to decipher with the odd fluorescent light casting shadows in the wrong places, but I rather like it. There’s also a second hand book shop run by POOCH, a fundraising charity founded by a local man I know called Dave Hocking.

I’m getting to know my radiographers now, and we chat about this and that. I know exactly where to put my bum on the gel pad (much closer to the head than you’d think), and I know when I’m central, and which part of my neck needs to press into the rest, and the angle to place my nose and chin so the mask clamps without pressing. As one of them said, correct positioning is as much about me knowing it’s comfortable as it is about them measuring and lining up. The mask clamps, I wiggle my head slightly, there are some minor adjustments as they check either side, everyone except me leaves the room and we’re off.

I tend to close my eyes for the first minute or so, then once I feel okay with the pressure of the mask, I open them. The circular head of the machine begins overhead, then moves across and the imaging plates appear to the sides. This is the checking and lining up phase as far as I can work out. It’s similar to the feeling I get while sitting in my rocking chair at home, when people passing on the bridleway peer in through the sitting room window. Some even shade their eyes to get a better look.

Then the whirring starts. There’s a clunk and a jerk as the slab I’m on moves into position. At this point there’s nothing in front of me beyond the blurry bone-coloured plastic and the dark ceiling; in my peripheral vision to the right appears the machine head, like a sun rising. Pure 60s sci-fi, ominous, detached yet intrusive. When you feel someone’s eyes boring into your skull, this is the physical manifestation of how that feels, being probed by an alien you can’t quite see.

The machine head swings over the top, close to my face. The central area, glass-covered and framed by white plastic, turns. The machine head moves to the left, tilts on its axis, then begins to swing across and back to the right. The beep comes, and then a sound like a dying wasp trapped in a glass. This is the sound of the radiation, the particles being accelerated perhaps. I can feel it, a slight tingle that oscillates with the frequency of the wasp sound. All the while the dishwasher whirr continues in the background. There’s another beep, and the machine returns from right to left, tilting and stopping just above my left temple. Then it’s back to the middle, the machine staring straight at me from a foot above my face. There are some holes, some grey plastic parts. The reflections hide much. A blank, empty stare. What’s it thinking? The radiographer reappears, unclamps the mask, and I wait for the head to be raised so I can sit. All done. It’s taken maybe 20 minutes in total.

We return to B&Q, but not before I’ve eaten a rather nice fruit scone and then a Crank’s egg and salsa wrap from the oncology café. At this time of day I’m always hungry, and able to eat. Later on, I start to feel yeuch and eating isn’t an option. At the weekend with just the T and no rads, I felt slightly less nauseous. I’m unsure how much is T and how much is rads, but I think there’s a definite effect from the rads. I’ve taken to eating around 8, having popped an ondansetron a bit beforehand.

After three or four sessions in Acer my scalp is becoming sore, and I can feel some heat on both sides. The scar is reddening. Last night I used cold-pressed coconut oil as recommended somewhere on line, and gently covered the warm and sore areas along the right parietal area, and on the left where the rays have come through. These are the areas where my hair will fall out after 2 – 3 weeks, which will actually make it easier to oil, so there is a god.  It felt better, post oiling, although I did look like a Brylcream girl. I washed it out with my gentle shampoo this morning, and it feels far less sore. I also get a right-sided focal headache that begins shortly after the treatment, and worsens till I go to bed. I’m taking paracetamol for that, but it’s perfectly bearable.

Another bonus is I’m sleeping. I feel generally drained, and tired in a can’t-be-arsed to do things kind of way. I can walk pretty well in the morning, but less so in the afternoon. I don’t feel sleepy. When I go to bed, I nod off in minutes (I never do this normally) and wake between 6 and 7.30. I can quite happily nod off again in the morning if I don’t get up. I’ve lost my morning heat sensitivity too, which I think is more down to the low dose of steroids. This morning I showered Bun, who was pretty manky. After that we went for a walk at Long Ash, but it was so hot I couldn’t bear the sun. I’m rocking the keep out of the sun look, but each time I move the hat blows off.

Today I have my weekly review with Dr Pascoe, and she’s happy with how I’m feeling and my blood counts are fine which is nice to know. She asks about headaches and nausea, and warns it’s likely to worsen since I’m only at the end of week one; however, the area being irradiated is relatively small. She shows me the prescribed area – the larger one I noticed at the start is actually a slice taken vertically through the brain rather than horizontally as I’d thought. This corresponds to a 3cm margin around the tumour site. Sarah says we’ll try to stop the dexamethasone altogether by the end of this phase of treatment if everything continues to go to plan.

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IMRT treatment area through the horizontal plane
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IMRT treatment area through the vertical plane

I take my Temozolomide and go up to the Mustard Tree to await my radiotherapy slot; there I get chatting to two women with breast cancer. It’s the first time I’ve really engaged with anyone in the center generally, which isn’t like me at all. I wonder if it’s to do with the can’t be aresed-ness this week. Making conversation isn’t something I feel like doing. Nonetheless it was good to chat. Both of them volunteered that if things don’t work out for them (and I don’t know the details) they’re intending to stop treatment at the point when they become ill, to make the most of what they have left and to let nature take its course. Me too I say. We talk about wills, and about advance directives, both of which I need to address. I also learn the details of their recent marital breakups and we agree that friends and family are where it’s at when you have cancer. All in 20 minutes, cancer’s as much of an icebreaker for letting it all hang out emotionally as wild swimming.

Eye of the tiger

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I eat a scone at 10.30 then the time runs away with me, so I forgot to have an early lunch. I’m supposed to take my temozolomide when I get it at around 2.30 at oncology, but now it’s 1.30 and I need 2 hours of empty stomach beforehand. I drink a pint of water instead.

I’ve sorted the bar code machine in oncology, and it books me in for the meds appointment. Then I go through and receive my week’s supply, with the exception of the antibiotics. As I’m allergic to sulfasalasine I can’t take the Septrin which contains one of the sulfa drugs so Dr Sarah is having a think about a suitable replacement. So tomorrow, I’m to wait to see her after treatment and pick up the weekend’s supply.

We go over the medication which is ondansetron if required (my trusty Hunt period anti-emetic) and domperidone, also if required. The chemotherapy drug comes in three different-sized capsules, each of which is sealed in an individual foil package. I’m to take a total of 170mg daily, one hour before radiotherapy, and at least two hours after food, and one hour before food. I’m to avoid touching the capsules. So I take 1 x 140mg, 2 x 5mg, and 1 x 20mg. The woman who gives me the meds hasn’t seen the capsules before so I show her before washing them down with water. I wait with some trepidation, but nothing happens beyond the tight throat I get with dexamethasone and a dry mouth.

I return to the waiting area, and read my book for a while before I’m called through to radiotherapy. Once again, I’m name and address and dob checked, before being asked for the 50th time whether I might be pregnant. I tell them I’ll let them know if I pull, and they titter obediently.

I’m made comfortable on the slab again, and lined up with the marks before the face mask is clunked into place. It feels tighter today, and the flying saucer head obliterates the autumn branches against the sky, which I realise is a part of a large light insert. The three radiographers are all smiling and chatty, which helps no end. The lights are dimmed and the radiographers depart for their safe room as they take a set of images. The machine moves around my head, quite close in, the rectangular panels appearing in my slightly opaque peripheral vision which has a bone-coloured tinge from the honeycomb of the mask. The flying saucer moves to the side. I can’t really feel it, and I’m not sure when it’s going to start. The pulsing starts in my face.

Today the music is Eye of the Tiger, which forces me to concentrate on Katy Perry’s voice and how on earth it doesn’t crack and collapse at a range so close to her limit. I fix my eyes on one edge of the light panel, and feel entirely in control and relaxed. You’re gonna hear me rooooar!

Not much longer, Lynne they say, you’ll hear the whirring soon. Not much longer of Katy Perry I hope, maybe the whirring is so loud it’ll drown her out – but I think they mean the mask which I’ve forgotten about altogether. It’s all relative.

Then there’s a whirring, certainly not at roar level, and a whine, and the machine moves again. Ah, this must be the rays…there is a slightly warm feeling over Hunt, but as ever I might well be imagining it. The flying saucer manoeuvres over and jinks to its whirr. There is a beep, which sounds like a department store tannoy alert. Then a little later another, and then a third. I guess these are either starting or completing the different angles needed to zap the remains of Hunt’s smirk. I see the little Hunt smirk rootlets, zapped like sparkler trails.

The radiographer reappears, and warns me not to knock myself out on the machine (they call it the machine) which is about a foot above my head. She takes two more measurements and calls them out. Then the machine rises, and I sit. I ask them what the machine is.  It’s called a linear accelerator, and the active part is the flying saucer. The rectangular panels are for imaging, so the equivalent of x-ray plates. My radiotherapy is intensity modulated radiotherapy (IMRT).  Not many people know anything about radiotherapy, she says.

Dad and I head home, and I notice my head is slightly numb over the site, although it soon passes. I eat a Cranks wrap exactly an hour after the temozolomide. I rather enjoy it, and feel fine. The nausea hits me at home, two hours exactly from swallowing the capsules and shortly after I drink a glass of water that tastes like chemicals. The last time that happened, was when I was going down with Swine Flu a few years ago, and was utterly convinced there’d been some Camelford-style accident at the water treatment plant. I try a second swig of water, and it tastes better than the first. Then I start to belch and the bile rises. Down with the first Ondansetron. After half an hour I feel better, just vaguely yeuch. Later on, there’s a slight soreness over my scar, and it feels warmer than the other side of my head.

So I’m underway, and I have no problems with the mask or claustrophobia, and the temozolomide feels manageable so far. It helps that I have such faith in ondansetron, although its bottom blocking capability is second to none. Which reminds me to yam a couple of Laxido.

Blurred

The blurred vision that hit me yesterday evening really did hit me. I tried to be calm, to contextualise it, but the realisation that such a thing could happen led to a kind of bleakness, especially because I couldn’t get on google and research it.

After dinner, I washed my face, and noticed I have eyebags that are protruding over 1cm, which started me thinking more about the steroids as a cause. By 9 I’d worked out how to see enough to read, and as I posted in a PS, blurred vision is on the list of side effects for dexamethasone – as is, rarely, breathlessness which has worsened recently as I said.

I can’t go with the cataracts, since it’s so soon and it developed in a flash, in both eyes (although I suppose it might have started in one, and the other compensated, till that went too).

I might suspect Hunt if it were in one eye, perhaps, but he’s in the wrong place for that unless generalised swelling were responsible. Over the past couple of weeks, though, the signs and symptoms associated with that swelling have improved steadily to the point where I know the steroids are working, so that doesn’t fit. So I feel calmer this morning, but the magnitude of the whole is encroaching on me by degrees and leaps as the dragging wait for surgery continues.

Back to that brain thing again, so many possible consequences for so many areas of my life, so that I’m back to bargaining (with whom? I don’t know) between preferable, tolerable and no way. I have a bloody good chance at least initially of recovering, but of course there are risks, and then there’s the whole cancer thing, and the effects of the treatment which can be permanent.

On a positive note, I’ve experimented with the ondansetron and it’s marvellous. I take 4mg about 15 minutes before breakfast and steroids, then again before lunch, and before dinner. If I take them twice a day as suggested, lunch is hard particularly because the second steroid dose is at one, and I most certainly need ondansetron for that. I forgot the dinner ondansetron last eve, what with everything else, and felt suddenly and dramatically nauseous at 9 till I popped the last pill of the day.

The saga of the Ms issue returned on Saturday; the final forms from the DWP arrived, following that tussle with the DWP advisor over the legality of a woman wishing to be addressed as ‘Ms’.  Under ‘title’, it says ‘Miss’. I’ve crossed it out, over-emphatically, in black biro and replaced it with and inch-high ‘MS‘. Take that DWP advisor! And I trust it won’t result in a delay to my benefits. I’m in no mood to compromise.

A final comment from my Mum, Jenny:

“Now don’t forget to take notes on all this, I’d say you’re sub-standard mentally and you’ll forget.”

Sick

One of the more subtle symptoms of my brain tumour is a vague, intermittent nausea. It’s one of those feelings I’ve been able to ignore perhaps because it’s not that troubling, and I’m used to GI symptoms.

The nausea worsened with steroids which are pretty irritating to the gut and my GP Dr H prescribed domperidone to help alleviate it a couple of days after the diagnosis. That helped, and enabled me to eat more which in turn made me feel better, certainly later in the day once the steroid doses were done.

But in the past two or three days the nausea has worsened considerably, from a slight annoyance to something more; for most of the day I’ve grown an acid gremlin that sits in the pit of my stomach and threatens to shoot. It’s not reflux, and eating doesn’t help. This afternoon I thought I might actually vomit if I laid down.

The duty GP at my surgery is Dr E, a man I know and like very much, partly because I’ve seen him a few times in recent months with my various troubles during which he has been excellent; he also works for the out of hours GP service locally. On the occasions when I’ve called him regarding a patient – one of which was especially complex and and involved an extremely upsetting mental health crisis where as ever we had no access to specialist resources – he has been unfailing in his willingness and ability to sort the most intractable situations.

Dr E had called me within 20 minutes, at 4.45 on a Friday, which was the point where I realised the domperidone was no longer working and that I have another weekend to get through. We discussed the options. His solution is to hit it with the big guns, because as he says, the point is to alleviate the symptoms for this period until I undergo surgery. So, within an hour my brother Dave has collected Ondansetron from the pharmacy.

It’s the first truly effective, multi-purpose anti-emetic that paramedics here were authorised to administer, and I have used it in a number of situations to great effect. I’m to take it prophylactically – with the aim of preventing nausea rather than treating it – starting with 4mg twice a day, with the option to double either or both doses.

Another  big up for our NHS.