Archive for the 'More treatment!' Category

Monday 18th February… Ib+5 and a Result!

It was check up day today, 5 days after I started taking the Ibrutinib. One of the questions I asked was how long it might take to start acting, but as the response is variable, there wasn’t really a definitive answer, but I was hoping that there might be some evidence today. However, yesterday I thought could sense some changes in the shape and nature of the visible enlarged lymph node. My concern was that I was seeing what I was looking for, but this morning I was convinced that I was’t imagining things, so it was with some excitement that I attended the outpatient clinic for blood tests and a check up.

The results are good – very good! The visible lymph node has shrunk and is softer (and its reasonable to assume that any other enlarged but non visible ones will be shrinking too). But the blood chemistry results sowed a reversal of the past deterioration, particularly liver function and some other markers. My kidney function (creatinine clearance) has also improved, but I need to keep up the hydration which will help improve things.

So a very good day. 🙂 My next check-up is in three weeks, but I will be doing a weekly blood test at my GP – this is to ensure that I’m not in danger from the breakdown products of the cells, (tumour lysis syndrome).

Longer term, I’ll probably have a PET scan in about 3 months or so to see where we are with the lymphoma.

So very much Onwards and Upwards 🙂

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Saturday 16th February… Ib+3

Day three of the Ibrutinib, and I’m pleased to say that I haven’t detected any of the possible side effects! 🙂 . On the other hand it is very early on in the regime, so I will continue to look out for them. Similarly I haven’t noticed any reduction in the size of the visible lymph nodes, but again early days. I have another check up on Monday, so it will be interesting (such an understatement!) to see if the chemistry has stabilised, or better still, improved.

Meanwhile I am reducing my steroid dose, down to 30mg a day until Monday, when I reduce it to 15mg for 5 days, then down to 10mg. This gradual reduction should reduce any unpleasant side effects of steroid reduction (such as the oedema) that can occur after a course of relatively high steroid dose.

I’m feeling well in myself, and eating well, and more importantly, drinking plenty of fluids to ease the load on my kidneys – I hope there will be an improvement in creatinine clearance as well as some of the liver markers on Monday.

Onwards and Upwards!

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Thursday 14th February… It’s here!

I’m sitting in the cafe area of Southampton hospital having just had my blood taken for the blood test, and I have just heard from Mairead that the Ibrutinib has arrived! It will take abou 90 minutes for it to be dispensed down to the outpatient pharmacy, butby that time the blood test results should start showing so once I have collected them, I’ll wander up to the outpatient clinic to see how they are doing! Good news though!

And this is what I had waiting for me at the outpatient pharmacy! 🙂

My daily dose

My blood results were OK, and hadn’t deteriorated too much since Monday, but there has been a deterioration since the end of January, particularly kidney and liver function markers. However I hope that now I have started the drug, that will start improving. My next check up is on Monday and I’ll post after that!

Onwards and Upwards! 🙂

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Wednesday 13th February… And still no Ibrutinib

So a call to the Oncology Pharmacy this morning and this afternoon confirmed that it hasn’t arrived, but I was assured that they are looking out for it and will let me know when it arrives. One problem is that while drugs from a distribution centre arrive at a set time, this comes independently (presumably by courier) so the time of arrival is not known.

So the plan for tomorrow is to go into the hospital early for a blood test (which if I’m really early, means that i will be nearer the start of the analysis queue and wait for the results to see if the blood chemistry has changed. There is also the hope that the Ibrutinab will be available for collection!

So Onwards and Upwards to another day! 🙂

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Tuesday 12th February… Post check up

Yesterday was supposed to be the first check up after starting the Ibrutinib – scheduled for last week! However it went ahead anyway so that the overall state of my blood could be monitored.

The consultation was with the Clinic Nurse Specialist, Mairead, and very though it was too! Long chats about how I was feeling physically and emotionally, and perhaps one outcome is that although I feel well in myself, I am actually quite unwell (Yes, I know that sounds like a statement of the blindingly obvious, but sometimes the blindingly obvious needs stating!). We talked about the efficacy of the Ibrutinib in my circumstances, and the reassurance is that if it wasn’t thought to be worth doing, it wouldn’t be being done! The reason for the delay was explained (it does come direct from the manufacturer on a compassionate basis, but the NHS Trust needed assurance that this would continue for as long as the drug is effective – which was confirmed last Saturday. The current forecast is sometime on Wednesday – we shall see!

The blood test results came through in stages while I was there. The blood counts were good, but the blood chemistry was less good. Calcium is still stable, but there was evidence that kidney function was less good, and also an impairment in liver function, and an increase in one of the cancer markers, LDH. (Lactose Dehydrogenase). Creatinine levels hadn’t been reported when I left, but as an interim measure, my steroid dose was increased for two days and another blood test scheduled for Thursday, by which time the Ibrutinib should have arrived. Apart from that, I had also lost a bit of weight, so I need to increase my food intake (regular meals!) and also pay more attention to my hydration to help my kidneys and liver.

So a very useful consultation, lots to think about, but overall still very positive.

(I also noticed that the drugs listed on my discharge note on January 25th have not been added to my GP repeat prescription list, so I spent an hour or so getting my fax machine working (no e mail address!!!) so I could fax a copy to them.)

So Onwards and Upwards!

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Friday 1st February … A slight set back!

I was hoping to have started the Ibrutinib yesterday, but when I rang the pharmacy I was told that the prescription hadn’t been written and there was a delay “with the form”. This was slightly worrying because I was getting to the end of the steroids and I needed new supplies!

However a quick call to the Clinical Nurse Specialist (Amy) established that there had been an error in the application form (this is a learning curve all round I think!) but it had been resubmitted, and a prescription for the steroids had been raised for collection today.

So quick trip to pick up a reduced does of steroids and the pharmacy say the Ibrutinib will be here on Monday.

So slightly frustrating because I really want to get started on this, but there is nothing I can do to influence the course of events, so I just have to be a patient patient and enjoy the weekend! There are still huge positives, the steroids have helped, and while they have been hugely beneficial, there are long term implications, so it’s good that it is being reduced!

I suppose I’m keen to start because there is also a small risk that I might not respond well, and I’d like the reassurance that I will, but again nothing I can do about it! At least I will know as I expect to see the lump shrink, just as I have with the steroids! Nothing like a bit of re-inforcing positive feedback).

So I think a relaxing weekend and fingers crossed for Monday when we will continue…

Onwards and Upwards!

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Tuesday 29th January…Update and good news!

I had a quietish weekend after the ‘excitement’ of the last three weeks – my parents visited which was good, and I spent some time getting the house back together after my lengthy absences.

But in reality this was just marking time for the follow up appointment scheduled for yesterday afternoon, when I was hoping to find out the direction my future treatment would take. Would it be the Ibrutinib or conventional chemo?

So it was with some trepidation that I turned up at the outpatient’s clinic to see what was happening – but prepared for either. So it was with some surprise and relief that I have been accepted for the drug on a named patient basis. I think the team at Southampton were surprised as they have not managed to get the drug on that basis, so it was purely bty the efforts of the team at Guys. Maybe this will provide an ‘in’ for the Southampton team – I hope so for the sake of other patients who may be in the same position. (I will write a page about the politics and background of Ibrutinib).

So the drug has been ordered and should be here tomorrow or Thursday. It is a tablet that I take once a day at home, and go into outpatients for periodic monitoring. It is well tolerated with few side effects, so a much less unpleasant treatment plan that the alternative.

It is a drug I will keep taking for as long as it works. In relapsed patients tis is typically 2 to 3 years (but typical is a statistical type term and applies to populations, not individuals)

So this is buying more time – but in effect that is what my treatment over the last 20 years has done. This does not preclude any other chemo or treatment further down the line, and there are new treatments under development. But this gives me back some control and ability to plan things for (I hope!) the next 12 months or more (provided I respond well to it – which will be revealed on the next few weeks)

So I will keep you updated with progress. I have also released this to the wider internet for the time being – I’ll see how that goes!

A view over Southampton Hospital

So very much Onwards and Upwards! 🙂

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Saturday 26th January…And home

Yes! Made it home! It did take 4 1/2 hours for my ‘party bag’ to be delivered, which was frustrating, but at least I had ordered an evening meal so I didn’t go hungry, but I was getting a little impatient! But Katie and Chris collected me at 7pm and whisked me home where I could settle down and relax. Of the 25 days in January so far, 22 have been spent in hospital!

But I have come away with steroids for the weekend, and the supporting tablets, and a return visit to the clinic on Monday, where bloods will be checked and I hope the direction of the next stage of treatment will be determined. Katie suggests I take an overnight bag with me on Monday – I might well do that!

But nice to be home and sorting the house out. I slept fairly well (although it seems very quiet after the hospital ward!) and today I have done my washing, made some sup and baked 4 loaves of bread – powerful stuff these steroids! Getting a bit of normal lie back. And I also have my parents visiting for the weekend!

So it has been quite a month so far – not at all how I expected the year to start, and it has been a bit of a roller coaster. The speed at which this developed has been a shock (no evidence of it at the November check-up) but at least it has been caught and a plan is in progress. It has been odd loosening the links with Guys and the wonderful people there, but good to be with the wonderful people at Southampton, and makes treatment much easier for me.

I will continue posting as the treatment progresses, and of course if you wish to add comments, I’m always delighted to receive them! (first comment is held for moderation as an ant-spam precaution)

So – Onwards and Upwards! 🙂

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Friday 25th January … Home?

And that is the question of the day!  Will I be allowed home for the weekend, to return as an outpatient on Monday?

That will depend on the blood results, due later this morning, but meanwhile I thought I’d share a selfie taken last night…

Not looking too bad though I say it myself!

It was quite quiet yesterday afternoon after the discussions about treatment and starting the steroids. Amanda popped in to visit – I’m glad to say that I was much brighter than the night before, and that the stomach cramps have not returned. Of course if there was a partial obstruction caused by the enlarged nodes, the steroids should help relieve that at the nodes shrink back a bit.

But I slept well last night, no stomach pains and feeling good (that will be the steroids!). The drip came down just before I went to sleep so I was untethered!

Not had bloods done yet, but I have just had my morning meds which included the more steroids.

I’ll update this later as events unfold, but as always,

Onwards and Upwards!

UPDATE:

Yes, going home this afternoon and then coming back on Monday to see you things are. Treatment will start a bit later.  If it’s Ibrutinib, that needs to be ordered, if it’s ‘conventional’ then I need a slot in the outpatient schedule, which may take a couple of days, but in either case, the steroids are providing a quick fix (think bandage on a wound, slowing things down temporarily, but not no substitute for sutures!)

O&U 🙂

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Thursday 24th January… A disturbed night!

I was still in a bit of pain when I settled down, lots of gurgling but not much relief,  I had something to damp down stomach action and a bit more oromorph, which helped dull the pain, but of course did nothing to alleviate the underlying cause.

But all went reasonably well (although very broken sleep) until I woke at about 4 this morning feeling a bit sick – and promptly was 🙁 .  Nurses were great at a speedy bed change and once I settled down again, I felt much more comfortable, gripes had gon and I slept really well until 8ish this morning when the usual bloods, obs, breakfast routines started.  I’m not on a drip at the moment, so I’m not tethered to my pole and have a bit more freedom of movement!

And hot off the press, just as I was writing this, Dr Lowns popped in with an update.

they are still waiting to hear whether the manufactures of Ibrutinib (Jansen) will supply the drug for me, and that decision is expected this week.  If the answer is yes, that is the route to go (it will take a couple of days to get it).

if the answer is no, then there are other options, localised radiotherapy to shrink specific nodes, but of course that is not a systemic fix.  But there are some new  chemo protocols which have been developed and used with success in relapsed MCL.

And there is talk about discharging me as an inpatient and possibly starting chemo (if the Ibrutinib is not forthcoming) next Monday.  The chemo routines seem a standard 3 days every 3 weeks cycle.  Part of the decision making for that will depend on my latest calcium levels.

Meanwhile I will have another short course of steroids just to shrink them down again.

So movement and progress and therefore very much (yes, you’ve guessed 🙂 ) …

Onwards and Upwards!

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