What the consultant said 21 July 2020

New elements to the  procedures this time. Strangely, perhaps, the Covid swab got taken in the chemo daycare area - curtained off in the section where blood pressures are taken and cannulae inserted. If I were organising things, I might put it somewhere with a lower concentration of people on chemotherapy. The swab was less troublesome than the ones I've done on myself - I'm either too tough on my tonsils or don't have the necessary fine motor skills.

I'd also arranged for Christopher to be on the other end of the phone once I got into the consultant's room - it does help to have someone else listening out.

Dr Miller had the same reassuring effect she has had at previous consultations. It's not a bland comforting but one referenced by facts. There are some particular phrases that do it. For instance, "we're still treating people who have been on X for five years," switches my mental railway points to a much more comfortable stretch of track . She is an intent listener, and her replies are apposite - not dredged from some store of standard phrases for the occasion. She didn't waste time telling me the news I already knew from seeing Dr Lee but let me led the conversation with my questions. 

I started off soft with Covid queries. Their practical experience has not been too bad. Patients have died or been seriously ill but it does seem to be related  more to being seriously ill with co-morbidities than simply to having chemotherapy. Of course, those on chemo will be taking extra care not to pick the virus up so that would reduce incidence and perhaps severity of illness. Dr M talked about the possibility, also raised by the Macmillan advisor I'd seen last time, that the chemo-dampened immune system may just work in favour of chemo patients who do contract Covid. It might do this by reducing the overblown immune response associated with some of the most serious cases.

In general, the hospital is being guided by central government advice (heaven help us) so the recommendation is to be very careful, only meet family outside, don't meet others unless absolutely necessary etc. There's no plan to change the 'no visitor' policy in the Cancer Centre.

So we moved on to my particular case, confirming the 'progressive disease'  of Dr Lee's letter, and discussing what it consists of. The enlarging lymph nodes are 'small' and would not be expected to generate any symptoms but it's understandable that I might be having some extra loo trips and unreliability due to the pelvic mass. There might also be some of the 'chicken membrane' disease on internal surfaces but it's not something that's seen on the scan. Leaving behind the miracle cure option, the main three are: growths shrink, growths stop growing or disease  progresses further. This will be monitored by blood Ca 125 levels, as before, although it is common after relapse for this to continue to rise until after the second chemo for unknown reasons. I'll have a scan after three chemo cycles. She thinks it probable that mine will shrink or stop growing - it's been two years since the previous carboplatin and that's a good sign that it will work again. (Even if there is no response, it's not the end game because they would try a different chemo regime.)

I asked what happens to the residual cancer tissues - last time they were removed by surgery in June 2018. Surgery's not now seen to be an option at any time unless there's a particular problem that needs fixing. The lymph node on the diaphragm is the awkward customer in Dr M's book and in any case, patients who have any disease left after surgery at this stage, tend to do worse. So the arrested or shrunken tissues are just left there.

Interestingly, it seems that the timing of the chemo is not imminently pressing. If it's going to be effective, it doesn't matter if the growths have got bigger, they will still respond. I'm due to get it now because the Ca 125 and scans show some fairly rapid changes and I have started to get symptoms. 

Next up - effects of this chemo combination (due to start on 23 July). It's still a poison, so there's the sickness and buggered blood cells again. Beyond that, the infosheet I took away leans to the negative, according to Dr M, giving the effects of doxorubicin as well as liposomal doxorubicin which is less toxic. She doesn't expect my peripheral neuropathy to get worse, and doesn't expect I will lose my hair - which really is trivial but it is a big outward expression of being ill so I'll be glad if it doesn't happen. There are side effects - doxorubicin is red so red pee and skin pigmentation changes, plus something called hand-foot syndrome and/or heart effects .... just have to keep fingers crossed. BTW - doxorubicin is an anthracycline antibiotic that comes from a strain of Streptomyces found in a soil sample taken in India. Thank you to whoever does that; and long live soil - down with plastic grass!

Lastly, going back to those scenarios -  in the longer term, assuming tumour shrinkage or growth cessation, after the chemo I would go onto PARP inhibitors (poly-ADP ribose polymerase) as a stabilising treatment. I predict hours of wholesome fun with parp jokes....

!!PARP!!PARP!! said the little car.

Too many beans, said Noddy.