Phone consultation, Tuesday, 1 September 2020

 Dr M. first phoned while I was trying to do something with some undetectable muscle during my Zoom Pilates lesson. She was trying to fill an empty slot by calling me early. As Pilates Teacher had specially rearranged my time so it came before the next bout of chemo, I had to ask Dr M. to ring back so I could return to my search for the elusive muscle. Cue severe twinge of anxious guilt at presuming this of highly-qualified, very busy, VIP in my life.

When she rang later, it was with mostly good news. She had previously said that the Ca 125 often goes up after the first cycle of a second round of chemo before going down at a later stage. But after the first cycle my Ca 125 from yesterday was 40, down from 189 just pre-chemo. So she was pretty pleased with that. The not-so-good news was that my neutrophils (white blood cells) were only 0.97 and they  need to be >=1.0 for chemo to go ahead. She thought they were almost bound to go up enough by 2 September, so I should take the chance and go into the Centre for a quick full blood count (FBC) in the expecttion that the chemo could go ahead. And that's where I am now, waiting to hear. In order to prevent this in the future, she's going to have me sent home after chemo with some injections which will boost WBC production. Having looked online later, I think these are probably high-tech, expensive things - a 2013 US website said they cost $4000 a shot.

We ran through the anti-nausea meds business. She's going to prescribe aprepitant again - one pre-chemo, then a couple more every 24 hours. As my chemo apointment is for the early afternoon, there's a good chance that with the domperidone it'll take me safely through the night for the first few days.

She wasn't surprised I hadn't had pink wee as this is mostly associated with higher doses of doxorubicin. Reading between the lines, she thought I was imagining the slight increase in my peripheral neuropathy, even though I detected increased pin sticking when sewing, and minor kitchen cuts when cooking. To be fair, it's very difficult to tell because it varies from day to day anyway. She was happy to prescribe some mouthwash for the sore mouth that's likely to recur, but I opted to stick with good old salt water. Residual headachy and faintly nauseous episodes she didn't seem to fancy as late chemo side effects. Maybe they're a sort of lingering memory effect, like a bad smell sometimes seems to persist in your nose and recur.

I'm going to reserve judgement on the phone consultation thing, but on the evidence so far, I'd rather do it face to face. I want Dr M.'s intent attention and quicker understanding (on my part) that comes from being in the room.