Peter’s Hospital Diary

Its been a few days since I lat wrote, simply because there hasn’t been a lot to report! I seem to be tolerating the ibrutinib well, and wahat was a visible abdominal lump – an enlarged lymph node – has shrunk back to the extent it is no longer visible, although it can be felt just below the skin/muscle layer, but a much smaller mass.

I feel well in myself, and my daughter came round today and said I looked much better than I did when she last saw me in Guy’s! 🙂

My weight is still a bit low, despite trying to eat more so I need to work on that!

Tomorrow I have another blood test, I will go into the hospital for that (because it will be analysed within hours rather than days if I go through my GP) but I’m not expecting to see any of the clinical team, although I will ring up later to see how things are.

So all in all things seem to be going Onwards and Upwards!

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It was check up day today, 4 days after I started taking the Ibrutinib. (this morning was the fifth dose). 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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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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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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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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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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I resolved not to chase things up today, so I was pleasantly surprised to receive a call from the the CNS office apologising for not calling me back yesterday, but saying the Ibrutinib was here and ready for collection (Clinical Nurse Specialist) – but she would check that it was in the outpatient pharmacy before I came out to get it. Great excitement – until I received a call 5 minutes later to say that it wasn’t there and it wouldn’t be here until next week. I don’t know if this is because of the conditions of supply or just a bureaucratic mix up, however I have a clinic appointment next Monday (supposedly to review how I was getting on with it) so I may be able to do some digging then – not that it s likely to speed things up. So somewhat unsatisfactory.

I do have a plentiful supply of the steroids so I’ll keep going on those. I suppose it doesn’t help that I have had a bad cold for the last three days, which is making me feel a bit lethargic and wary, I don’t really want infections at the moment (although I’m not neutropenic) but I hope I will be on the mend by the weekend.

So feeling a bit disgruntled at the moment, although I have some reassurance that the situation is being monitored more closely and I hope my name is near the front of the minds of all those people involved in the procurement!

And on the plus side – more toast and marmalade! 🙂

So, rather slowly, Onwards and Upwards.

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As you might guess from the title, still no sign of the Ibrutinib. I waa told on Friday that it would be here on Monday. Yesterday I heard that it was probably at the oncology pharmacy (where it goes to be dispensed and then sent to the hospital pharmacy for me to collect). So today, I rang again and eventually discovered that there was some hold up at the oncology pharmacy who suggested that “I ring the consultant’s secretary to find out what was happening”. Excuse me – who should be doing that?? Still, I can’t fault the outpatient pharmacy who have done their best and kept me informed.

Anyway in the spirit of enlightened self interest, I did ring the medical secretary and got a very helpful and proactive response. It seems that there is still a hold up with the paperwork, and while I don’t know for certain, I suspect that the the delay might be in an already identified non-proactive department. Very frustrating.

Meanwhile, I have been doing a bit more research into Ibrutinib (I will post a page!) and it seems that (like several other drugs) it interacts with grapefruit and seville oranges! So it looks like

for a while. And while I like marmalade, I hope it will be a long while as it will be while I am taking the drug. Still, every cloud has a silver lining, while I’m waiting for the paperwork to be sorted, I shall be enjoying

But this situation is very frustrating. I just hope it arrives before the clinic follow-up next Monday!

Onwards and Upwards (albeit somewhat slowly at the moment)

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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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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 by 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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