Accessed at https://www.youtube.com/watch?v=vzCl1gJVWyQ on 18 January 2016
On Friday (15 January 2016) Elaine and I visited Ninewells hospital, Dundee to do the usual stuff as part of my Pre-Chemo assessment. I donated an armful of blood for tests; had my blood pressure, heart rate and temperature taken; provided my personal, oral account of the highs (not many of them!) – and the lows (but plenty of them!) of the last three weeks as well as handing over my daily diary. In addition to the foregoing all my carefully crafted, oral and volunteered minor complaints (severe skin itching, typical Oxaliplatin-cold interaction side effects: runny nose, eyes and mouth; tingling and numbness in fingers and toes as well as feeling the shivers, occasional constipation and an overwhelming irritability and need to walk around the house in short, staccato steps – to no good purpose), were dismissed as not significant by my angel nurse – so much for that bit of attempted “flattery gets you everywhere” nonsense- it doesn’t! I was assured I’d be contacted if my blood tests showed anything that needed to be dealt with promptly.
I pointed out that I had secured a special meeting with Dr P on Monday, 18 January (today), and I agreed to return to the ward following the meeting if there was to be any ‘change of the plan’. As it happens, there wasn’t, so I didn’t! However, Dr P did notice that, whilst my haemoglobin level had taken another step closer, albeit a small one (now 102.4 g/l compared) to ‘normal’ (150-170 g/l for us men), I did have a low neutrophil (a white blood cell that fights infection) count, and that I should have this checked to see whether there had been any further recovery over the weekend, before arriving for my Combo Chemo Cocktail early tomorrow morning. I’m not allowed to proceed to the Combo Chemo cocktail unless my neutrophil count reaches a ‘magic, safe’ number. So, a quick but impromptu full blood count was proscribed and different angel nurse arrived from nowhere with an armful of phlebotomy tools, swabs, towels and of course blood containers! Damn! Yet another armful of blood goes to the NHS. I’m not sure who is more indebted to whom here! I strongly suspect it is still me, but I have to try every angle to build up my current (or currency?) account with which I can do my bargaining, wouldn’t you? I had an approximately one-hour-long chat (again) with Dr P, this time straight to the chase, “how could I get a PET-CT scan if this might help more with my prognosis?”.
Once again Dr P did a brilliant job at explaining his reasoning for believing that a CT scan would be sufficient at this stage. He felt strongly that I should continue with further rounds of chemotherapy (between 6-8 cycles in total) unless the CT scan revealed a different course of action, such as increasing the dose of the current chemo or a switch to a different drug if my side-effects worsened. He also reiterated his strong view that surgery would not be an option for me, even if a PET-CT scan revealed dormancy of the cancer since it was still likely that some or even the last cancer cell, if remaining, could still re-kick-start the metastatic cancer growth. This is a real fear about surgical intervention for patients such as me, as he has seen the consequences (poor or even completely disrupted healing) of contamination of surgical sites (eg the joined faces of a surgically-reduced stomach) with such ‘feeder’ peritoneal cancer cells. Furthermore, we already have strong evidence (my first, though only CT scan, to date) of spread of my cancer to my abdominal cavity organs – at least pancreas, adrenal gland and a few lymph nodes- as well as possible, additional omental ‘seedlings’ of my peritoneal organs. Dr P believes that this could have occurred via peritoneal cancer cells. We can’t know otherwise, I guess.
The only minor flaw in this argument, however, is that we have no way of ‘knowing’ rather than ‘intimating’ such cells are present. Peritoneal samples were not taken nor examined for the presence of poorly differentiated adeno-carcinoma cells with characteristics of close proximity to my primary gastric cancer. It is possible, again in my view, even if less likely, that all my secondary cancer deposits could have been blood or lymph fluid borne, carried via the vascular or lymphatic vessels, respectively. Notwithstanding this latter point (which I couldn’t raise in the meeting since I only thought of it when we were driving back home over the Tay Bridge!), and despite all of my slight objections or queries, I have realized better now the merits of Dr P’s arguments and his stance – he fundamentally thinks it is in my best interests, and I am appreciative of his concern for my overall and long-term well-being.
Well folks, that’s it. I have to be back again in Ward 32 at 9:30 am tomorrow for my next cycle of intra-venous Chemo (Epirubicin followed by my dastardly Oxaliplatin!), assuming those little neutrophils have returned in adequate quantities to permit it safely. Now, I think you have deserved a bit of music for your bother of checking my blog (and the cupboard was bare – for three days) and for putting up with some of this medicine and biomedical science stuff. So here goes:
Paul Weller’s live acoustic performance, “Days of Speed”, 2001. Do try either Track 2, “The Loved” or Track 16, “Wild Wood”; just amazing, though you could equally put your i-pod, i-phone, i-pad (or similar android facility) on shuffle and you’d turn up something brilliant, a new version or acoustic rendition of one of his key songs.
That’s all folks. Bye for now.