Thursday, 14 February 2013

Scan results

LMS has a never ending capacity for springing surprises. Katie and I expected our meeting with my oncologist today to focus on the size of my tumours and the side effects I've been having from the chemo, we were pretty taken aback then when the oncologist's opening remarks were that the scan shows that I have heart failure.
I must admit that I hadn't realised heart failure was a graduated condition, to me it suggests someone in an intensive care unit wearing an oxygen mask and wired up to a heart monitor. In my case heart failure seems to mean that the function of my heart is impaired resulting in me getting wheezy and breathless especially if walking up hill or having to walk quickly.
It seems that my heart problem is related to the fluid retention that I've been suffering from. The previous chemotherapy drug that I was taking, Doxorubicin, is known to be cardiotoxic and the oncologist thinks it may be the cause of my current issues.
The good news from the scan is that the tumours appear to be stable, though it seems that the extra fluid I have in my body is making the comparison with the previous scan less straightforward than usual.
The plan now is that I will have an echo-cardiogram and see a consultant cardiologist to review my heart condition. I will also have a two week break before my next chemotherapy treatment, hopefully this will give time for me to get rid of some more of the fluid before starting the next cycle and will also provide time to get an opinion from the cardiologist. I have to say that I'm not looking forward to the next cycle, the fluid retention has become more extreme with each treatment and was particularly problematic this last cycle.
On to more pleasant topics, we just got back today from a week in Norfolk. One of the aims of our trip was to see and photograph barn owls. We had some very good sightings of these ghostly looking birds but unfortunately we didn't have any opportunities to photograph them. We did manage to capture a tawny owl on video though, we put our trail camera out in the garden of the cottage we stayed in and this is what it filmed:
Not the best video but we were amazed to discover a tawny owl visiting the cottage garden.

Wednesday, 6 February 2013

My lucky fortune cookie?

Last Saturday Katie and I went to the England vs. Scotland Six Nations Rugby match at Twickenham. It's always a great thrill to be part of a crowd of 80,000 singing "Swing Low, Sweet Chariot", especially when England are in a comfortable lead! We stayed overnight in a very nice hotel in central Windsor - a great way to spend the weekend. 

Katie recently found some videos online of presentations from an oncology conference. One of the most interesting items included in these videos was a discussion on the importance of remembering a patient's condition and goals when selecting which treatment to use. The oncologist making the presentation described how three patients with the same disease but in three different situations might end up on different treatments:
  1. Patient one is an asymptomatic patient whose cancer has progressed too far to be cured. In such cases the degree to which a given drug may produce shrinkage in the patient's tumours is not of much importance. What is important is selecting a drug that is likely to hold the patient's disease stable for the longest period without causing severe side effects which would compromise the patient's quality of life.
  2. Patient two also has cancer that has progressed too far to be cured but in this case the patient's tumours are causing discomfort. A reduction in the size of the tumours may alleviate the discomfort so achieving shrinkage is an important aim of any treatment. In order to achieve the shrinkage the patient may be willing to endure some medium level side effects.
  3. Patient three is a patient whose cancer is thought to be curable. Here the degree of tumour shrinkage that the treatment may produce is much more important and the patient is likely to be more willing to accept even severe side effects if the treatment ultimately results in a cure.
Patients one, two and three could all end up selecting  different courses of treatment even though they have the same disease. I've found that my intuitive preference is for treatments that have the best chance of shrinking my tumours even though my condition matches patient one here. I believe this is a common bias amongst people with late stage cancer, it is difficult to get away from the feeling that shrinking the tumours must be the best course of action. In order to overcome this type of bias it is important for patients to double check that their treatment choices really do match their treatment goals. 
Finally I had my latest CT scan on Monday with the results due on Thursday 14th February. Waiting for a scan result is pretty stressful. Dinner at our local Chinese restaurant did provide an unexpected moment of light relief tonight when I opened a fortune cookie and found this message inside:

That made Katie and I smile. I just hope it turns out to be as accurate as it is relevant!