Category Archives: Nurse

Jan14

It’s D-Day

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Tuesday 14th January

Another long drive to Exeter. It’s D-Day today: provided I pass the final day of tests, I’ll be given my drugs!

The Pigmented Lesion Clinic is first ~ Dermatology. All clothes, apart from underwear removed, and the consultant checks me all over, very carefully, using a dermatoscope. He is very thorough, and finally announces that all is good, and he wants to see me again in four weeks.

Next stop is the lovely trials nurse for another batch of form filling, blood pressure, temperature, and four vials of blood taken from my arm. All looking good here.

We then move into the main waiting area, which is filling up fast. I’m called into one of the consulting rooms, and introduced to the ob/gynae consultant. He seems quite pleasant and cheerful ~ “I’ve been called down here to perform a technical function”. Well, if that’s what you want to call a pap smear, that’s OK by me! Bottom half clothes removed, smear sample taken, time to get dressed.

I move back into the waiting area, but it isn’t long before I’m called in to see the oncologist. Clothes off again ~ apart from underwear!! He wants to check my scar, the lumpy swelling at the top of my leg, lymph glands, my liver, abdomen.

And, and, and, well? Yes, all seems in order for me to take part in the Combi-Ad drugs trial! This is now getting serious. Down to business ~ I am given two pots of tablets: the big pot ~ Dabrafenib/placebo, two to be taken twice a day, twelve hours apart, one hour before food/two hours after food; the small pot ~ Trametinib/placebo, one taken each morning.

Combi-Ad, for one year! Well actually 12 months x 4 weeks = 48 weeks, or 12 months x 28 days, which is only 336 days in total.

Bring it on! Placebo or not, drugs or not, I’ll be incredibly well monitored with monthly visits to Exeter to see how I’m progressing.

If this helps me to live longer, live healthy, live happy, then GlaxoSmithKline you can look after me for a year. I’ll be on that tropical beach, under a parasol, cocktail in hand, living, loving, laughing for a good few years to come.

Jan10

Lymphoedema and Support Stockings

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Friday 10th January

Well, that was the most un-positive day I’ve had for a long, long time.

I’m normally very upbeat and try not to let things get me down. Even if I’m feeling low, I try my hardest to put on a ‘happy mask’.

Today though it all seems very hopeless and a slide down towards despair and inevitability. Nothing is going to make this right, or better, or normal.

I rarely use the words don’t, can’t, won’t as far as my actions are concerned. But I don’t like this. I feel I can’t do this anymore. I won’t ever get back to being how I was.

My appointment with the lymphoedema nurse lasted an hour and a half. Many measurements were taken of both of my legs. Every four centimetres the circumference was measured and noted down. And yes, there were fairly large differences between the two. It turns out my left leg is carrying 800 mls more fluid than my right. Almost a kilogram in weight! No wonder the skin feels tight and stretched, no wonder my knee and thigh feel heavy and numb, no wonder I have trouble walking properly.

And what is the solution? A support stocking. There you have it. I will have to wear a tight garment on my left leg for the foreseeable future. This thought really does depress me, and the happy mask that I wear everyday, seems to slip away.

I leave the hospital feeling very low and despondent. I didn’t sign up for this!

Jan6

Second Day of Tests

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Monday 6th January

My second trip to the hospital in Exeter sees me undergoing another batch of tests for the Combi-Ad trial.

My first stop is at Cardiology where I am to have an Echocardiogram to check the structure of my heart and it’s pumping capability. The technician explains it is similar to an ultrasound scan whilst pregnant. I have to totally strip off my top half, and have the sensor, with gel, placed at various positions around my heart. The three-dimensional imaging is amazing. Many screen shots are taken, measurements made, and numbers crunched. The whole process takes about half an hour, then I wait for the printout to take with me to the trials nurse back in oncology.

After a ten minute wait in oncology, I am taken into a consulting room with the senior trials nurse. She is great, very friendly and willing to listen and answer all my questions. She remarks that I have super veins, and then proceeds to take a number of vials of blood.

‘Observations’ are next: blood pressure, temperature, pulse, height and weight. Oh my, I have gained a couple of pounds in weight, and lost an inch in height!! Diet time and I need to improve my posture and do some stretching!

I am then taken into another private consulting room and have a full physical check with one of the trial doctors. (I have to remove all clothing apart from my bra and vest top!) He checks my visual response to his moving finger; he asks me to frown, screw up my eyes and blow out my cheeks; he checks the strength in my neck and shoulders; he listens to my chest and back; I have to say “aaahhhh”;  he feels my stomach; and lastly I have a rectal exam. I had been really, really dreading this particular part of the exam, but it was painless, and soon over.

My husband and I then take time out to have some lunch and a cappuccino before the final appointment of the day with my plastic surgeon. (I have to remove my trousers this time!). It is eight weeks tomorrow since my surgery. The hardish, red, black lumpy lump at the top of my leg is unsightly, but not sore. A seroma is a nasty side effect of the operation, but the surgeon is not unduly worried. He could drain the fluid using a fine needle, but that could introduce infection, and in all probability would fill up again. He is pleased with the scar healing, and will see me again in three months.

My first appointment was at 12:30pm, the last at 4:40pm, but I didn’t go in til 5pm. We drive away just after five thirty and arrive home at a quarter to eight.

Another long day, but ultimately it will be so worth it. I am due to come back on the 14th for more bloods, obs, a smear test, a check with the oncologist, and then to be given my four weeks worth of drugs. £7000 worth!!!

Things are looking positive for a much better year.

Jan2

The Tests Begin

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Thursday 2nd January

We set off early for our 100+ mile journey to Exeter, arriving about 11:30am. Husband drops me off and continues into the city with elder son, (no point staying, as they wouldn’t be able to accompany me during the testing!).

My first stop was to oncology where I had to pick up a trials worksheet, and other paperwork.

I then walk down the hospital’s long corridor to Medical Outpatients. I didn’t even reach the reception desk, but was intercepted by a lovely  voluntary worker who asked where I needed to go. She took me to a room marked ECG, knocked on the door, and told me to take a seat: the door opened before I sat down! A number of sticky pads are attached to my ankles, tummy, chest and neck ~ no more than ninety seconds later and it’s all over. The only data I understand from the printout is my heart rate: 65 bpm, not too bad, I suppose!

My next move is back along the corridor to x-ray for a CT scan. Here, I have a wait of about ten minutes, then I’m ushered down the department hallway to a cubicle, and told to strip off, and put on a wonderfully fetching hospital gown. My name is called, and into the room I go. Lying down on the couch I have to clench and unclench my fist with a tourniquet tightly around my upper arm. A needle is inserted into the vein of my right arm, in the crook of my elbow and secured in place. I then have to raise both arms above my head; as the nurse leaves to go to the safety of an enclosed ante-room, my back and forth journey through the big white doughnut begins. As the radioactive dye enters my system I get a metallic taste in my mouth and a warming sensation. Thorax, abdomen and pelvis are first to be scanned, followed by head and neck. The whole procedure is over in less than half an hour, the nurse removes the line from my arm and sticks a dressing on. Thanking her, I leave, get dressed and go and find the coffee shop! Not having eaten breakfast, but just the requisite 500ml of water an hour prior to the scan, I was looking forward to a cappuccino!

My last port of call was to the Eye Unit. When I arrived at reception there was no record of my details on the system. A quick visit to one of the consultants, and he knew why I was there, and what tests to carry out. A standard eye test was followed by some strange drops into my eyes. Two vials were mixed together, forming a fluorescent yellow liquid ~ and it did sting ~ making me cry toxic tears. Various eye movements were called for, as the consultant peered through lenses and shone bright lights to carry out a variety of retinal ophthalmic examinations.

And then, it’s all over for today. Not too much waiting around, nothing particularly painful and everyone so kind and helpful. Our drive home begins, and we are there in time for dinner.

Dec31

Appointments ~ all change!

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Tuesday 31st December

The trials nurse from Exeter rang three times today ~ she joked she felt like my stalker! What she was doing, was trying to arrange all my appointments into as few days as possible. And I think she’s succeeded.

This Thursday I have a CT scan, an ophthalmic review and an ECG, all at Exeter hospital.

The following Monday I go to cardiology for an Echo cardiogram, then oncology for bloods and obs, and finally to surgical out-patients to visit with my plastic surgeon for an eight week review following surgery.

A week Tuesday I have an appointment at the Pigmented Lesion clinic for a full dermatological check-up. This will be followed by a visit to the trials nurse for more blood and obs, an appointment with my oncologist, where ‘randomisation’ takes place, and I’m issued with my first course of medication. Combi-Ad. Things are beginning to get serious.

I also have appointments closer to home as well, with the lymphoedema nurse, the occupational health officer, and at the local surgery for a pap smear.

I am entering new territory, feeling rather apprehensive, a little scared, but oh so hopeful and positive for what lies ahead.

As 2013 comes to a close, I will awake tomorrow assured that all my consultants, specialists, doctors and nurses all want the very best for me.

And I’m with them on that one! Bring on 2014, I’m ready to fight for my health!

Dec30

Check up with the Macmillan nurse

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Monday 30th December

Today I have an appointment with the lovely Macmillan nurse in Truro. We talk for almost an hour. She checks the lump at the top of my leg, and is happy that it hasn’t become any worse. She says it is no longer infected nor cellulitic, but slowly repairing itself, the blood clots breaking down and being absorbed.

My actual scar is healing well, and looks neat and tidy. She says I should be pleased with this.

We talk further about what to look out for in the future: lumps, bumps and discoloration, mostly on or around the primary mole removal site on my foot, but I must also check my left leg quite scrupulously.

She wishes me well as I begin the medical tests later this week, and tells me to get in touch if I have any questions, queries, or just want a chat.

When I arrive home there is yet another appointment for me in Exeter! On Tuesday. With the Skin Lesion consultant. Mole mapping, (and removal ~ be prepared for a four and a half hour visit, if we have to cut out any nurglies ~ no the letter didn’t say that, but it may as well!!). So that makes trips to Exeter on Thursday, Friday, Monday and now Tuesday. Great planning!! Still, I knew I was going to be very, very closely monitored.

Dec18

Three nurses’ telephone calls

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Wednesday 18th December

Yesterday we left Exeter and drove to Plymouth where we spent about four hours Christmas shopping. I took it slow, stopping for coffee breaks and lunch, but by the end of the day, my foot, ankle, calf, knee and thigh were incredibly swollen. Up until now, my only exercise has been bursts of about twenty minutes, going from the house, to the car, to the local supermarket, and then sitting in a coffee shop.

So on Wednesday I didn’t get out of bed. The swelling of my left limb was quite scary, and I didn’t want to risk any further problems. I lay there, with my leg elevated, and dozed for most of the day.

The first phone call I received was from one of the Macmillan nurses asking how I was doing, and whether I had made a decision on the Truro trial for Brim8 (vemurafenib). I apologetically declined, stating the very frequent monitoring, increased side effects, and the fact that all I had read made the Exeter trial, Combi-Ad, the more preferable. She was very understanding, and thought that would be my decision anyway. She also made an appointment for me to see the other Macmillan nurse after Christmas.

The second phone call I took was from the trials nurse in Truro; she wanted to know my decision. I felt a little bad declining their offer, but she too was most understanding.

Finally, I was called by the lymphoedema nurse at the local hospital in Hayle. We organised an appointment for later in January, where she would show me lymphatic drainage massage to control the swelling of my leg, and when she would take a lot of measurements of my leg, ready to have garments fitted. ‘Garments’???  Oh, those wonderful support stockings that guard against lymphoedema.

Well, anything that helps me return to some semblance of normality, I suppose I will have to accept. Trials, tests, monitoring, travelling, even support hose ~ if I value my life, I will do as the experts direct me.

Dec11

A shower. A bag. A trial.

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Wednesday 11th December

Had a shower this morning, first time in four weeks! Oh my goodness, how wonderful to feel really clean!!! Up until now I have been making do with a ‘sink wash’, so I wasn’t really smelly, stinky or dirty! As I had a waterproof dressing over the wound from where the tube exited my leg, I thought all was OK. Whoops, no it wasn’t. The dressing became waterlogged, and then I began bleeding/weeping from the wound. Up until that point, I thought that the hole had almost sealed over, and everything had dried up. Wrong! For some reason I had begun to drain fluid again ~ maybe the warm (certainly not hot), water from the shower had caused this. Anyway, I couldn’t really stem the flow, and used up three dressings before it seemed to slow down sufficiently for the thing to stick, and stay in place!

So, an early, early appointment at the hospital in Truro ~ I was the first one in ~ just for a review of my blue/black/red inner thigh. The cellulitis that had decided to form at the top of my leg was painful, especially when trying to sit down, or get back up again.
Really, the nurses agreed that I am still waiting for the antibiotics to kick in properly, it has been barely 48 hours, so it was no worse, and maybe a tiny improvement with the swelling/redness could be seen. The Macmillan nurses thought it best that as I was still leaking/bleeding, the sticky-on drain bag had to be put back on ~ thought I had seen the last of the pesky, dangly bag!!

I was then taken over to see the oncologist in a different building: a waiting room full of people, cheerfully given a coffee, and then we went straight in to his consulting room!!!!
We talked about the trial he is running, and have come away with more paperwork!!! This one is again a double-blind trial: drug vs placebo. The drug is Vemurafenib, and has shown amazing results on Stage 4 patients, but there are side effects.

What to do, what to do?
We are going to Exeter tomorrow, to their oncologist, so will have to make a decision soon. Such a dilemma . . . . .
1. Truro trial
2. Exeter trial
3. Do nothing.

Will have lots to think about by the end of the day tomorrow.
So much uncertainty and confusion!!!

Dec9

Another mad dash!

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Monday 9th December

Having gone to our local hospital on Friday, we were back again this morning for another emergency visit!!! I was seen immediately by the specialist cancer nurse, and a consultant. The swelling/redness/pain/hard lumpy feeling is cellulitis 😦 This can become dangerous if left, and lead to septicaemia.

So I am now on a mega dose of penicillin, 2000mg a day. Hit it hard, and it should go away!!

I hate feeling like this.

But, some vestige of good news: the plastic drain bag is no longer stuck to my leg. There is still an open, exit wound, where the drain tube came out of my leg, but this is slowly beginning to close up. The ‘stuff’ that should have been draining out is further up my leg, which has now become infected ~ oh joy!!

Anyway, back again for a review on Wednesday morning. If there is no change, or the bruising and redness have increased, then the ‘lump’ may have to be drained off using a fine needle ~ not a pleasant prospect!

Still, I can’t fault the service; I have been seen, at the drop of a hat, every single time 😉 The nurses are amazing, and take time out to talk and reassure you.

Hopefully normal service will be resumed soon.

Dec6

A quick dash to the hospital !

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Friday 6th December

Well, I didn’t expect a rushed visit to Treliske today!!

Having seen my plastic surgeon on Monday in Exeter, and told the drainpipe in my leg was not ready to come out (still losing too much fluid), I phoned the Macmillan nurse in Truro today.

The top of my thigh really was beginning to feel very ‘wooden’, hard and bruised. She said to come along straight away!!! At Truro they don’t like drains being in for more than two weeks, mine was there for three and a half weeks.

I saw the nurse immediately, who then brought in a consultant, and a phone call to Exeter made. Yes, the tube could come out!!!

The nurse thought the bruising and hardness was due to a blood clot or a haematoma. The tube was unstitched, and came out quite freely. It was blocked!!! Not allowing the blood and lymphatic fluid to drain away as it should. She then massaged, or ‘expressed’ the area, and lots of ‘stuff’ came out, and it really did lessen the hardness of the tissue below the surface of my skin.

I now have a plastic drain bag stuck to the inside of my thigh, carefully placed over the hole/open wound, but no invasive plastic tube!!! Yay, so much more comfortable!

The consultant drew a line in black pen, showing the outline of the hardness below the skin ~ if it spreads any further, I’m to get myself back there as quickly as possible.

I then asked the Macmillan nurse about possible drugs trials at Truro, and she said she would put things in motion for me to see the oncologist here, instead of having to travel all the way to Exeter on a monthly basis. We’ll see.

So, I end my day, minus the invasive plastic tube inside my thigh. The area still remains bruised and swollen, but hopefully now any further fluid can drain out properly, and the wooden feeling will subside.