Day trip to London

Last night I had 7 hours of uninterrupted sleep, so perhaps afternoon kipping is off the agenda! Today was the day of my trip to outpatients, an here is how it went ...

The hospital transport turned up at about 9am; I was the first pickup. We drove around the north of London picking up two other patients, and arrived at the hospital at 10:30. The haematology outpatients is in an old building just across the road from the main hospital. It is here that I will receive my next cycle of chemo.

My appointment was not until 11:30, so I waited (rather uncomfortably) playing with the iPad :) and failing to do a single crossword clue! At 11:30 the PICC team duly arrived - the same two nurses as before, and duly inserted a PICC into my right arm. If a clot develops, I have no idea what they will do as it will mean both arms have had clots. But we'll cross that bridge when we come to it I suppose ...

After the PICC was inserted, I went across to the main hospital for a chest xray to confirm that the PICC had fed in properly (it has). And then I went out for a walk down Tottenham Court Road. I can walk reasonably well (I use my walking stick), but I do get out of breath due to lack of condition and lack of red blood cells! I decided to have an eat-in pizza for lunch at Ask, and returned to outpatients at about 1:30pm to have some blood taken, and see the doctor. I had to wait a while for the latter, but she eventually came and explained some more about why we have a consolidation phase, and how long it will be. This is why ...

Each cycle of chemo kills about 95% of the cancerous cells (blasts). But the remaining blasts reproduce more aggressively than the good cells (the very definition of cancer), so a relapse is inevitable. By having another round of chemo reasonably quickly, before the  the absolute number of blasts was back to where it was, fewer ad fewer blasts are left after each cycle.. When the the transplant is done, and the donor stem cells start making white cells, they will kill the remaining blasts; the fewer of these blasts to kill, the more likely a successful outcome of the transplant becomes. Thus, the number of chemo treatment cycles is a trade-off between discomfort and risk of infection against the overall number of cancerous cells remaining. The current wisdom is that two cycles before transplant is best.

The second cycle (consolidation) lasts 30 days. None of the drugs used are the same as the first cycle, and the drug regime is somewhat lighter. However, I will go neutropenic at some stage, so there is again a risk of infection, and the leg flaring up. We shall see how things progress! For at least the early stages, I will stay in the hotel, maybe being admitted after I become neutropenic.

I waited almost an hour for transport home, but eventually it came, and I got home shortly after 5pm. I am writing this whilst Rose is out for a well-earned drink with some friends; we will eat dinner when she returns. Whilst on the subject, with all the eating I have managed to gain  2 or 3 pounds since I came home, which I see as quite an achievement; it takes hard work and dedication to eat as much as I am doing!

I am looking forward to the weekend - David and David are popping over from America for a flying visit, and England play France at rugby. A mouthwatering prospect ...