Interestingly, nurse Susan put the cannula in Steve's forearm, (rather than try to find a vein in the back of his hand which has been difficult in previous sessions) and there were no problems at all today - sorted!
Whilst we were waiting for the results, Liz Flanagan the lead chemo nurse we met for the first time last Thursday came in to say hello and update us. We have been working on the basis that Steve would have six cycles of treatment - that's what we had understood from the consultant oncologist. Liz explained that whilst four cycles of Alimta/carboplatin is the norm, Dr T likes his patients to have six cycles of treatment, if they can tolerate it and there is a positive response to the regime.
A decision as to whether Steve would go on to have two further cycles of treatment would be made by the doctor based on a scan following chemo cycle 4, whenever that happened. However, the good news is that Steve's X-ray taken last Thursday suggests that the reduction in pleural thickening seems to be continuing, so things are still going in the right direction!
The blood test results were back by 11.15 am. The neutrophil count was back up again, so he was cleared for treatment. However, Steve's haemoglobin level had fallen to its lowest yet, down from 10.1 on Thursday to 8.9 today. He was advised to have his blood tested again next week at the GP's surgery. If it remains low, it's a sign of anaemia (which causes fatigue) and the doctor will be asked to arrange a blood transfusion to give him a boost.
At 11.40, the pharmacist arrived with Steve's Emend anti-nausea tablets and a bottle of special mouth rinse Difflam which will numb the ulcers which have been causing him pain recently.
Chemo 4 finally started at 12.50, with Alimta and carboplatin, topped tailed and interspersed by saline flushes, whilst Steve dozed off with his feet up in the reclining armchair. Treatment was all over by 3 pm, we were free to go home and it was still daylight!
Now we have to wait for the scan appointment so that the doctors can look in detail what effect of four cycles of chemotherapy have had on the mesothelioma before deciding whether Steve should have two more cycles of treatment.
In theory, today's chemo session could be the last one of this regime. Because we were both assuming Steve would have six cycles of chemo, this has come as a bit of a surprise! However, we shall wait and see what the scan results show and hear what the doctor has to say...
In the meantime, we are preparing ourselves for week 1 of cycle 4 and all the antiemetic pill-popping that involves, plus the steroids high and comedown, the tiredness and fuzzy head.....Roll on week 2!
For those who are interested in the science bit, this is how Steve's blood counts have changed during the four cycles of treatment to date:
Blood cell type Cycle No 1 2 3 4
Haemoglobin (Hb) 15.6 12.9 11.2 8.9
carries oxygen in red blood cells
White blood cells (Wbc) 9.0 6.4 5.3 4.8
prevent and fight infection
Platelets (Plts) 288 518 471 312
stop bleeding and form blood clots
Neutrophils 8.1 5.3 3.8 3.6
white blood cells which kill bacteria
For comparison, typical "normal" ranges of different blood cells are
Hb 13.0-18 cells per microlitre
Wbc 3.8-10.8 cells per microlitre
Platelets 130-400 cells per microlitre
Neutrophils 1.5-7.8 cells per microlitre