check in, check up, check out

Today was Steve's "mystery" appointment at the Chest Clinic.  I say "mystery" as we had no idea why he had been called back between cycles 1 and 2 of the pemetrexed / carboplatin chemo regime which started on 8 October.  

It seemed like lots of other people had an appointment at the Cancer Centre today as well.  Queues to get into the car park and out again because there were no spaces...we eventually took a chance and left the car in a staff car park at the other end of the site and walked.  Thank goodness Steve is mobile!  Although we were late as a result, the clinic was also running late so no harm done and Steve didn't miss his slot.  

I think for the first time ever, I sat in the waiting area and didn't feel nervous or apprehensive - we'd had the bad news back in September.  This time round it was just a feeling of curiousity.  We didn't have to wait long until Steve was called into the consulting room and we were joined by Dr T, the consultant oncologist, who always puts us at ease.  It's been a long time since we last saw him, so it was good to meet up again.

He said he was pleased that Steve had self-referred to the hospital the weekend before last when he had felt very poorly and developed a fever.  Although most of the blood tests taken at the time came back normal, in one of the tests for C-Reactive Protein (also known CRP) the results were off the top of the scale! A high or an increasing amount of CRP in the blood suggests an acute infection or inflammation, although it doesn't identify the location or cause of the infection, so that's still a mystery...

We also told him about the saga of trying to get help and advice from the hospital's own triage assessment centre, only to find that no one picked up the phone even though its supposed to be a 24/7 service.  Because of that, we'd had to contact NHS Direct for advice, been passed on to the GP's out of hours locum and then on to the out of hours medical centre, who eventually got Steve  a referral to the hospital where we had tried but failed to get advice hours earlier in the day.  I think it's fair to say that Dr T was horrified to hear what had happened and apologised profusely.  The triage assessment service is something the hospital is very proud of, and our experience should not have happened. We will leave it to him to sort out!  I'm sure he will.

He has switched Steve on to new anti-sickness medication to see if that helps with nausea next time round.  He also explained that Steve will have a check up and X-ray every three weeks while treatment is in progress to assess how he's feeling, tweak the medication if necessary and check the response to chemo. So that explains the mystery of today's appointment; now we know that these hospital visits will happen the week before each new chemo cycle, we can put some more dates on the calendar.  

Check up completed for this time round, Steve made an appointment for his next visit to the Chest Clinic on 15 November and we checked out of hospital.  Lucky for us, we hadn't been given a ticket for leaving the car in the staff car park and there was even a parking space on street, almost outside our house when we arrived home.  

Bloods at the GP tomorrow.  Let's hope they put the samples in the right coloured bottles this time so that the correct tests are done in time for Monday's chemo session and the start of cycle 2.  But we have a free weekend to enjoy before then. Wrap up well and make the most of the sunshine due tomorrow before the clouds return! 

Chemo cycle 1- end of week 2

We have reached the end of week 2 of Steve's first cycle of alimta and carboplatin and, slowly but surely, things are on the up - albeit with the odd hiccup from time to time...

Eating little and often seems to be the key to keep nausea at bay, so the fridge is full of healthy savoury nibbles which he can dip into whenever Steve feels the need to eat something quickly. There's been no more retching or anti-sickness tablets so his head is clearer too. He is eating more, although still not as much as pre-chemo probably because his stomach has shrunk over the last two weeks. Weight now 61.7 kg give or take a gram or two. 

Tastes and smells are still heightened making some items food and drink less appetizing than others.  However a Campari spritz or tonic water with ice and a slice seem to go down well! The Meso Warriors have made other suggestions which we can try out if necessary as time goes by.

Although still tired, Steve hasn't needed a nap everyday and has occasionally stayed up until "normal" bedtime, rather than take an early night.  Today he even summoned up the energy to come out with me for a walk, the first exercise of any note since chemo started.  We had to take it easy, but he kept going for a lot longer than intended which is encouraging.  Maybe he's been inspired by the wonder horse Frankel, who we watched win his last race on Saturday before retiring to stud, unbeaten in 14 races...

The course of antibiotics that Steve has been taking for the infection which knocked him out in chemo week 1 finished on Friday, but not before causing the onset of an itchy rash. Luckily this was dealt with relatively easily over a few days with lashings of Eurax (crotamiton) cream and now seems to have subsided. The cough which began a few days into the first week of chemo still hasn't gone way completely. However, the bouts of coughing are far less frequent and don't last so long, so its going in the right direction.

All in all, Steve is noticeably better than this time last week, when he had not long returned home after an overnight stay in hospital on IV antibiotics and hydration. 

We are also a little less stressed about Steve's mum, who was taken into hospital as an emergency four weeks ago. She is still there, but has improved considerably in the last week much to the family's relief and delight.

So....chemo 1 week 3 starts tomorrow, as does the building work on our roof and gutters to deal with the leaks that have got worse over the wonderful British summer of 2012, the wettest in 100 years according to the Met Office. 

Steve has an appointment at the chest clinic on Thursday, although we're still not sure why!  He's not due for a scan until the end of cycle 2, so it can't be to assess whether there has been a positive response to chemo at this stage. He has his bloods done at the GP surgery rather than in hospital, so it can't be for that either!  Perhaps it's just to talk through what side effects the chemo is having and how he is managing....we shall find in due course and let you know!

Looking backwards, looking forwards

As Steve is now well into week 2 of his first cycle of Alimta/carboplatin chemotherapy, I thought it worth a quick review of what's happened so far before looking forward.

The first week of chemo was a bumpy ride to say the least. Although we didn't realize it at the outset, Steve appears to have picked up an infection shortly before treatment started on 8 October.  It wasn't until a few days into the cycle that he started coughing and developed a fever which ended up with him having an overnight stay in hospital last Saturday and being put on a course of antibiotics.  

Fighting an infection is not a good way to start chemo. Doubtless, the infection has exacerbated the side effects of treatment and made him feel very poorly.  His reaction to chemo this time round is therefore unlikely to be typical of what to expect in future cycles, especially as the side effects of treatment have been complicated by antibiotics with side effects of their own. However, unless I note his experience so far in cycle 1, I'll forget/blank out what has happened with the passage of time.  So here goes, warts and all.  You have been warned!

The most obvious side effects have been fatigue (needing an afternoon nap and having early nights) and nausea/retching (mainly bile and clear gastric juices, just occasionally little bits of food) in spite of taking a battery anti-nausea tablets as instructed. The anti-emetic medication made him feel edgy and fuzzy-headed, unable to focus and concentrate but unable to settle down.  

These feelings have reduced as the number and type of pills he has been popping have gone down as the week progressed. He also became constipated, but nothing that a gentle dose of senna couldn't sort out.  A tiny sore on the corner of his mouth has come to nothing, so I thought it was probably unrelated to chemo. However, he now has another small sore on his lip, so I'm not so sure. In terms of other side effects, although his skin feels rather sensitive, he has not come out in a rash.

Tastes (and maybe also sense of smell) seems to be intensified by the chemo.  Not so much of a problem when he eats, but not so nice when tastes linger in the mouth for hours afterwards!  Tonic water found to be more palatable than tap water or still mineral water.

On Saturday (chemo day 6) he had IV antibiotics and rehydration in hospital.  Since then, the constipation has been replaced by diarrhoea, a common side effect of the antibiotics he's taking.  His digestive system is a bit all over the place - lots of strange gurgling sounds coming out of the stomach - and, as a result, he is eating less than usual. However, in recent days there has been very little nausea, so no need to continue with metoclopramide anti-sickness pills.  This is a relief - the mere thought of taking one was making him gag!  His head is much clearer as a result.  

Of more concern is the cough which started last Thursday (if I remember correctly) and which still continues.  This is making him worry, as well as feeling washed out, or "put through the ringer" to use his phrase. However, he started using the puffer last night and that seems to open up the airways and help stop the cough.  He will probably continue using it as and when necessary....which brings me to a quick look forward....

The course of antibiotics continues until Friday, so I hope the cough will clear up by then.  Ditto diarrhoea.  I also hope that then he will start to eat a bit more, as this will give him energy which he lacks at the moment and halt the weight loss resulting from his reduced food and non-existent alcohol intake.

Whether he will have the energy or inclination to venture outside over the next few days is another matter.  The thought of picking up another infection is scary; I think he is likely to be a hermit for a bit longer....

Lastly, thanks to everyone for your concern and good wishes.  Much appreciated, as always.

Saturday night and Sunday morning

Saturday night

If you read yesterday's blog, you will know that Day 6 of Steve's first cycle of Alimta and carboplatin was not a good one.  His temperature fluctuated throughout the day, eventually peaking at 38C around 6 o'clock.  At that point, I insisted that we try again to get through to the Triage Assessment Centre at the hospital for advice, as instructed in Steve's little red chemo book.  Better to get advice in the early evening, rather than wait until later to see if things got any worse and then be called into hospital at midnight!

As before, the helpline phone rang and rang, but there was no answer.  So much for 24/7 support!  On to plan B - a call to NHS Direct, and another very long wait until an operator was available.  Steve explained his status and why he needed advice and, after consulting with the medical advisor, he was told that his case would be passed on to our GP's on-call service for a doctor to visit, and that someone would be in touch within an hour.

An hour later, the phone rang and Steve went through everything again with the locum.  The upshot of this phone call was an appointment to see a doctor at the Out of Hours Service Centre on the other side of Oxford at 8.45 p.m. When we arrived there, appointments were running an hour late, so we had another long wait in a room packed with people, many of whom had nasty coughs.  Not what you want to be doing when trying to avoid infections.....It was approaching 10 o'clock when we finally saw a doctor and went through everything again.  

An examination and a few phone calls to the hospital later (unlike our unsuccessful attempts earlier in the day to get through to the Triage Assessment centre, the doctor had a hotline to the medical and oncology registrars) and we were on our way to the Oncology Ward at the Cancer Centre around 11 o'clock for Steve to be assessed.

It was a bit eyrie to be sitting in a cubicle on a dark ward, with other patients sleeping all around us, whilst the doctor did a very thorough examination and history, took bloods and ordered a chest X-ray.  Cannula in, Steve was given antibiotics intravenously while waiting for the tests results. 

The good news was that his white blood cell count was fine, so no problems with his immune system.  Other tests results would take longer.  We dozed off while Steve had an hour or so of saline flushed through, then the nurse appeared with a wrist band to say that they were going to keep him in overnight.  Not what we were expecting or prepared for...I gave Steve my mobile and was told by the nurse to expect a call on Sunday morning with news. 

It was approaching 12 o'clock (how ironic, given my comments earlier in the day about not wanting to be in hospital at midnight...) when Steve was wheel-chaired down to X-ray before being bedded down for the night on the ward. We said our goodbyes while he was waiting to be taken back upstairs and I waited for a taxi to take me home. I finally got to bed around 2 am after something to eat and drink - our last main meal had been lunchtime on Saturday!

Sunday morning

Woke this morning to sun streaming through the blinds.  A good omen?  Up, dressed and breakfasted quickly, ready and waiting for the call.  It finally came around 10.20 a.m. when Steve rang to say that he was being released!  He'd had a fitful night's sleep being connected up to the drip so that he would be well hydrated if they needed to put through more meds this morning.  However, all the test results had come back clear. He was feeling much better; no nausea; head clear at last. He had to wait for the cannula to be removed and for more antibiotic tablets to take home, but he would be coming back in an hour or so.  

He's just phoned again to say that they are still waiting for the pharmacy to deliver the goods (if it goes on much longer they will just give him a prescription to get filled tomorrow) and to have the cannula taken out, then he will drive himself home.  What a relief!

Quite a Saturday night and Sunday morning....if he has another episode he is to ring the ward directly, rather than play pass the parcel and be handed on from one medical team to another as he was last night. That is also a relief!

expectations, a reality check and putting things into perspective

Cycle 1, Day 6

First, the expectations...

When Steve was on the Velcade/cisplatin chemotherapy drug trial in 2009, it was a pretty grueling schedule; five doses of chemo over a 21 day period.  I won't pretend it was easy, but we managed to get out and about during most "rest weeks" and the worst of side effects didn't peak until the last few cycles.  I suppose we expected something similar this time round with the current regime of pemetexed (Alimta) and carboplatin.  Just possibly not quite as bad as before, as he only has two doses of chemo every 21 days and carboplatin is generally considered to have fewer and less severe side effects than cisplatin.

Now for the reality check....

Around 10.30 am on the morning of Cycle 1, Day 2, I wrote "No noticeable side effects so far."  That didn't last long. Shortly after I posted the blog, Steve said he felt weird - he was finding it difficult to settle down, concentrate and focus on things.  Fatigue began to set in and after lunch he took himself off the bed for a rest and was still asleep in the early evening, when I decided to wake him up for his next dose of anti-sickness tablets.  He stayed awake long enough to eat the evening meal but was back in bed not long after, bucket at the bedside just in case.....

Early morning on Day 3 and he was retching into the bucket - not bringing up stomach contents, but bile/gastric juices. As before, he experienced the strange combination of (on the one hand) feeling unsettled; wandering around the house wondering what to do next, but unable to focus on anything in particular and (on the other hand) too tired to do anything much but unable to simply relax.  However, he did manage to stay awake until 10 pm with only a short nap around teatime. Other side effects of chemo are becoming apparent (look away now if you are a sensitive soul) including constipation, burping and flatulence, and there's the beginning of a small sore at the corner of his mouth which may possibly be a reaction to Alimta.

After another interrupted night's sleep and early morning bilious retch, on Day 4 Steve made a great effort to write the menu/shopping list for the week.  We managed to get out of the house to do the food shop - although it was clearly hard work for him.  However, the fuzzy head feeling seems to be improving slowly - this has coincided with the reduced dose of dexamethasone steroids he took yesterday and today. He even managed to stay awake until quite late, drawn into a documentary on TV about scientists who deliberately crashed an unmanned plane to observe exactly what happened to the aircraft itself and the crash test dummies inside.  

After another interrupted night's sleep, Steve spent Day 5 at home taking it easy, while I went off to Grand Designs at the NEC.  Pity we couldn't both go as originally planned....He was still feeling rough when I returned home and he took an early night.

Today, Day 6, if anything Steve feels worse rather than better. In spite of taking a veritable arsenal of anti-sickness pills, he had his head in the bucket every few hours throughout the night, into daybreak.  There was a bit of a panic first thing this morning as he thought he was going to run out of metoclopramide anti-sickness pills which he can still take as required (he won't run out this weekend, but will need to ask for some more on Monday if this carries on...)

His temperature went up to 37.5 C, he's been coughing and complaining about a sore/tight chest.  Worried that it might be a chest infection, we checked the cancer patients "Red Book" and based on these symptoms, he was supposed to contact the hospital Triage Assessment Team at once for advice.  After a lot of talking and persuasion on my part, he finally called the 24/7 helpline number given for out-of-hours advice, only for no one to pick up......Not good. Something we need to raise with the hospital when the lines are staffed on Monday morning.  

As the day has worn on, to my relief his temperature has gone down and he is not coughing quite so much, although he still feels poorly and is loosing his appetite.  I can tell Steve is really fed up with this already and we're still in the first week of the first cycle. How will he feel after 2, 3, 4 or more cycles?  I just feel helpless.  He's been shuffling around the house looking glum with his shoulders hunched up and freely admits he's feeling sorry for himself. 

My suggestion that we go out for a short walk in the sunshine to get some fresh air went down like the proverbial lead balloon.  Instead, he's taken himself off to bed again, which is why I am taking this opportunity to write the blog now. I may have to change it when he wakes up and tells me I've got it all wrong.  He's a bit like a bear with a sore head at the moment, not surprisingly...

I think part of the problem is that we had certain expectations about how things would be, based on his experience of chemo in 2009.  These expectations have proved to be woefully wrong. Somehow, we have got to find ways to manage what is happening now and look for the positives.....if the chemo is strong enough to do this to healthy cells, surely it must be having the same effect on cancer cells.  Leo, I hope you are under heavy bombardment in there....

Time to stand back and put things into perspective...

Alimta is proven to be extremely successful in treating many forms of cancer.  It is the only approved mesothelioma drug in the USA and the most effective way of treating this cancer currently known.  If he can handle the side effects, that's got to be good. We know of others who have gone through this regime and had a positive response, which is very encouraging.  

If Steve still feels poorly on Monday, there are people we can call for help and advice. Otherwise, he can talk through his reaction to this first cycle of treatment at the next clinic appointment on 25 October and maybe the team can tweak his medication for cycle 2. In addition, Oxford is setting up its first ever support group for people with mesothelioma. The inaugural meeting takes on 14 November, with a talk "New Directions in Mesothelioma Treatment and Care" from Dr Rahman, a consultant and senior lecturer at the Oxford Centre for Respiratory Medicine.  Liz Darlison, Nurse Consultant with Mesothelioma UK is also giving a talk about her work.  Having missed the London Meso Conference last Saturday, that will be a good opportunity to catch up!

Out in the slightly wider world, Steve's mum though still in hospital is now making progress, which is a little bit of weight off our minds.  Daughter Katie and her partner have taken another step forward along the road to buying a small flat in London, with a mortgage now agreed in principle. And I have had another photograph published in today's Guardian Weekend Magazine (the big one No 1).  Life's not all bad, and I hope it will starter getting better for Steve very, very soon...Keep your fingers crossed.

pill popping - cycle 1, day 2

If you have undergone chemotherapy, you will know that the hospital visits when drugs are administered are only part of the process. If chemotherapy is new to you, you might be surprised to learn that a lot of other other medication is given around the chemo treatment.  Curious?  Read on!  If you know this already, skip to the bottom of today's post...

Cycle 1, day 2 of Steve's Alimta/carboplatin treatment, and the table at breakfast this morning looks like a pharmacy counter....To give you a better idea of what's involved, here is the medication timetable that goes hand in hand with this particular chemo regime:

Daily for the duration of the treatment and beyond
Folic acid tablets

Every 9 weeks during treatment
Vitamin B12 injections

The day before chemo

• 7-9 am:  2 dexamethasone steroid anti-sickness tablets
• 12-2 pm: 2 dexamethasone steroid anti-sickness tablets

Chemo day 1

• 7-9 am: 4 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets; 1 ondanestron anti-sickness tablet 30-60 minutes before chemo
• 12-2 pm: 4 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets
• 6-8 pm: 1-2 metoclopramide anti-sickness tablets
• 10-12 pm:1-2 metoclopramide anti-sickness tablets; 1 ondanestron anti-sickness tablet bedtime dose 12 hours after morning dose

Chemo Day 2

• 7-9 am: 4 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets; 1 ondanestron anti-sickness tablet 
• 12-2 pm: 2 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets
• 6-8 pm: 1-2 metoclopramide anti-sickness tablets
• 10-12 pm: 1-2 metoclopramide anti-sickness tablets

Chemo Day 3

• 7-9 am: 2 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets
• 12-2 pm: 2 dexamethasone steroid anti-sickness tablets; 1-2 metoclopramide anti-sickness tablets
• 6-8 pm: 1-2 metoclopramide anti-sickness tablets
• 10-12 pm: 1-2 metoclopramide anti-sickness tablets

Chemo Day 4

• 7-9 am: 2 dexamethasone steroid anti-sickness tablets
• metoclopramide anti-sickness tablets as required, up to four times daily

Chemo Day 5

• 7-9 am: 1 dexamethasone steroid anti-sickness tablets
• metoclopramide anti-sickness tablets as required, up to four times daily

Side effects

It really is early days, but the good news is that Steve hasn't felt any nausea or been sick overnight.  He enjoyed last night's meal and wine without any metallic off-tastes. We were both in bed about an hour earlier than usual - it's been a stressful time for various reasons recently and neither of us have been sleeping very well, so that's not surprising....

He woke up on and off during the night.  This is his usual sleeping pattern these days, the only difference last night was that he felt more awake during these periods, probably because of the steroids (which shouldn't be taken after 4 pm, unless you like being high on the ceiling very late at night!)  

The vein in his arm where chemo was administered is stinging this morning, but not horribly painful.  Otherwise, no noticeable side effects so far.  

The thought that this regime is going to continue for 5-6 months is not a pleasant one.  However, if we think of it in terms of sessions, then it's one down, five to go - which suddenly sounds much more manageable :-)

Thanks to everyone for your good wishes and support - very much appreciated, as always!

Cycle 1 Day 1 ..and things can only get better.....

Chemo day today - the start of Steve's second regime of treatment since he was diagnosed with mesothelioma in June 2009.  The first regime was a drug trial - a combination of Velcade and Cisplatin - which probably kept his condition more or less stable for three years.  Today he has started on a combination of pemetrexed (aka Alimta) and carboplatin (another platinum based drug, but with fewer and less severe side effects compared to cisplatin). One dose of each, once every 21 days, for six cycles.

The preparation started on Friday, when he had bloods taken at the GP surgery; small samples put in different coloured phials depending on the test requested.  Yesterday, he started taking steroids (Dextamethasone) twice a day with more this morning, before chemo which was due to start at 11 am.

We had psyched ourselves up ready for this.  However, when Steve phoned the hospital to check that the blood tests were OK, he was told that one blood was missing (we assume because it was put in the wrong coloured phial).  He would have to go into hospital to have more bloods taken first thing, come home, then go back again for his chemo appointment between 1.00 and 1.30 pm.  Good job we don't live too far away!

Just as we were leaving the house to go back to hospital, the phone rang.  It was one of the lung nurses phoning to see how he was feeling after his first chemo session. According to her notes, he was due to start treatment last week.  Ho hum.  She will ring back....

We played hunt the parking space on arrival at the hospital and eventually found one at the far end of the site.  By then, the car park office (where we were to pick up a ticket which allows cancer patients free parking) was closed, so we had to take a chance, leave the covering letter/instructions on the dashboard and hope for the best!

The Day Centre which had been quiet when Steve had been there earlier in the day was bursting at the seams by the time we arrived at 1.30.  Short-staffed, Steve was told he was number five in the queue waiting for treatment.  Luckily we had come prepared for a long wait, so just sat patiently as the minutes and hours ticked by. At long last, a nurse appeared at 3.15 to give Steve his pre-meds - more of the steroid Dextamethasone plus Ondansetron anti-sickness given intravenously, followed by a saline flush.  Then the pharmacist arrived and went through the anti-sickness medication regime timetable; three different drugs at different times of the day over periods of two, three and five days (longer if necessary).  He will be ratting soon, but hopefully not sick...

Chemo eventually started at 3.35, with 10 minutes of pemetrexed followed by a saline flush.  Then a 30 minute break, followed by 60 minutes of carboplatin and a last saline flush.  Hurrah!

The last thing before leaving was to go through the "red book" where everything is recorded, plus other odds and ends to help people on chemo, all in a neat little plastic zipped folder, just like the ones our kids took to school :-) And that was it....home in the rush hour, rather later than expected.

Ah well, after a start like that, things can only get better - can't they?  

countdown to chemo

We had hoped to use this week in the run up to the start of chemo as a time to relax, enjoy the simple pleasures of life and prepare ourselves for the journey that lies ahead as Steve has six cycles of Alimta (pemetrexed) and carboplatin between now and February 2013.  

Some hope!

Steve's mum remains in hospital in Bristol, about an hour and a half away by car from where we live in Oxford.  We have made two more round trips to see her in the last five days - one in appalling driving conditions - but sadly she has not been very responsive on our visits.  Because of the risk of hospital acquired infection whilst Steve's immune system is compromised, we won't be visiting her again in person until she is discharged. However, between visits we have been working away in the background, exploring Lasting Power of Attorney, reviewing accommodation options for the future and looking at ways of communicating long distance with someone who is profoundly deaf, not mobile enough to post a letter, and shown no aptitude or willingness to use technology.  

At the same time, we have been trying to sort out a builder to do work on our house before the winter weather gets a grip, and thinking about how we can help our daughter get a foot on the bottom rung of the housing ladder in London. Not easy tasks, any of them!

By the time we returned from Bristol, exhausted, late on Friday night, Steve couldn't face the thought of getting up early to travel to London the next day for the Mesothelioma Patient and Carer Day. He decided to stay at home, relax and get his mind in gear ready for Monday.  However, I spent a very enjoyable afternoon with daughter Katie and her partner over a long lunch, and was relieved to find Steve in much better spirits on returning home. 

So the count down to chemo is nearly over.  Bloods were taken at the GP surgery on Friday afternoon.  Steve started taking steroid tablets today. Tomorrow morning, we will phone the hospital to make sure the results of the blood tests were OK and then he's clear to go.  Must remember to pack a bag of things to keep us occupied during the chemo session, plus a drink and snack for me (as Steve will be fed and watered by the hospital).  

There's one last social do tonight before we get on the chemo train - the Private View of Oxford Photographic Society's 2012 exhibition, where I have a couple of prints on display.  If you happen to find yourself in Oxford during October, please drop in!  Entry is free and I'm sure you will enjoy it.