Chemo cycle # 7

Today is the day of my penultimate cycle of chemotherapy. I was moved from Mondays to Tuesdays because of the bank holiday. I had tried to get back on Mondays but the chemo nurse was rather, um, anal in this matter - I used to believe I was the Queen of Anal Behaviour before that, she made me look like a complete amateur. Not that it matters much of course. I have to admit that I'm not looking forward to today. I'm not that bothered about the treatment per se, and I'm quite sure the side effects will not be too bad. I simply hate the place. On top of that I'm fully aware that I'm reaching the end of chemotherapy and my mind is getting very impatient, which means I find being pragmatic more and more difficult. I want it to end. Still, in three weeks time I'll getting the last lot and that will be the worst over as far as overall treatment goes, hopefully. Obviously I'm not looking forward to surgery either but at least there'll only be the one of that.



I managed to overdo it last week again and I haven't quite recovered yet. I went to see The Last King of Scotland - very good film, Forest Whitaker was worryingly convincing as Amin but some of the scenes, notably the torture, were simply impossible to watch as far as I was concerned. Then filled with the happiness of being out of the house I decided to go shopping. I got home, had to go and lie down and that's more or less how I've spent the past four days. I had planned to go for a blood test - yes, my silly blood count was again low last week - and/or go and see Miss Potter - mainly for the Lake District scenery, which I love (photo of me above Rydal Water below taken in June 2006) - yesterday but I couldn't do either. Thankfully we're able to see some of the Australian open on the BBC so I've been able to enjoy this from the comfort of my bed.






The weight is now definitely on the way up. The main culprits are likely to be the steroids and/or the chemo drug as they're the main things to have changed recently and the kilos have only piled on since starting them. I'm not particularly fussed - there's nothing I can do about it. The only problem is trousers - it's getting to that point where it's a choice between wearing jeans/trousers and breathing. That's when you know you've lost the battle. My 'hair', on the other hand, is growing reasonably quickly. I've done a bit of reading on the topic and it will probably take up to six months for my hair to be back to normal. At least it's not growing back grey and I'm still waiting to see whether it will be curly/wavy. It looks very thin and even though there's a reasonably large amount of it I'm not sure how it'll look. I'm getting quite impatient - typical - and I'm debating whether to dye it red with one of those dyes that washes out easily. A sort of midlife crisis if you want.



And now for my first instalment of Nerdy Corner. I've kept it simple - my brain can't cope with anything too demanding - but I can never guarantee that I'm making sense. I'm adding visual aids for those who just want to skip this part.



*** NERDY CORNER ALERT ***



Chemo drugs target rapidly dividing cells by targeting, among other things no doubt but in my case, enzymes and other proteins involved in the cell cycle. Very broadly speaking (and purists can cut me some slack here) the cell cycle can be divided into two stages:



1. DNA replication - Because a cell gives rise to two daughter cells the DNA needs to be duplicated so that each daugther cell gets a full copy of all the genes of a particular organism.



2. Cell division - Here the two sets of DNA are segregated at opposite poles of the cell and the nucleus is then divided in two. This results in the formation of two daughter cells.

Both stages are highly regulated and if problems occur mechanisms are in place to trigger cell suicide and prevent errors to be transmitted to daughter cells. This of course is only valid in the case of healthy cells. Cancer cells somehow managed to bypass the control mechanisms and replicate despite such errors.



Right, I've been subjected to three chemo drugs, administered in two times four cycles in the following way:



1. Adriamycin (also known as doxorubicin) and cyclophosphamide - These drugs effectively prevent DNA replication by binding to an enzyme called topoisomerase II. When DNA is being replicated it needs to be unwound and separated for the process to take place. In turn this leads to increased tensions in other areas and generates coils and supercoils (sorts of loops) in the DNA, making replication much more difficult. Topoisomerase II removes these coils by cutting both strands of DNA, allowing them to rotate and sealing the DNA strands again. Adriamycin and cyclophosphamide, however, bind to topoisomerase II once it has cut the strands, thereby stabilising it and preventing it from sealing the strands again. This leads to the cell's inability to replicate its DNA and cell suicide follows.


2. Taxotere - This drug affects the stage of cell division but also leads to cell suicide. Once the DNA has been replicated, what is known as the mitotic spindle forms. This enables the segregation of chromosomes at opposite poles of the cell and is made of microtubules, themselves formed of tubulin (a type of protein) segments, which run along the length of the cell in a number of 'strands'. The movement of chromosomes along the microtubules depends on two mechanisms: motor proteins and the microtubules themselves. Basically Taxotere inhibits microtubule function. Microtubules are in what is called dynamic instability - tubulin is constantly being added and removed from the microtubules, and it is this process which generates force/movement (don't ask me to elaborate this bit). Taxotere binds to the microtubule-bound tubulin and prevents it from being removed. This in turn leads to an accumulation of microtubules within the cell and an inappropriate supply of tubulin. This ultimately triggers the beginning of cell suicide. A less important function of Taxotere is the blocking of the bcl-2 oncoprotein which prevents cell suicide from occuring. More on this when I tackle the genetics of cancer - something for you all to look forward to.

*** END OF NERDY CORNER ***

I hope this has made a little sense at least. If not please let me know. And now it is time for me to go and get prepared for my long day - I can't avoid the blood test today, which means a very long day lies ahead. I hope you are all well and I'll leave you with my current favourite song: 'Where's ya moped, where's ya moped, where's ya moped Petr Cech? Where's ya moped, Petr Cech?'

Hasta la vista, alopecia

My hair's growing back. Well it might be a bit premature to call it hair - it's more like a layer of fluff some two millimetres long - but it's definitely growing. This has come as quite a surprise as 80% of people treated with Taxotere experience hair loss, and this usually starts approximately two weeks after the first treatment. Obviously I was already bald but five weeks after the first treatment my hair is growing. And I'm not complaining -I was expecting my hair to start growing again in April so it's a bonus.

Along the same same positive lines I've not felt this 'mentally alert' since treatment started, and it feels great. I've been able to carry out some extra research into things and it's all falling into place. Overall I feel less tired but I'm aware I need to be careful. Feeling less tired I opted to prepare my own meal on Thursday - and ended up having to spend three days in bed recovering. I guess I'm going to have to learn to get the balance right, and it might take some time. Still, I only have two more lots of chemo to go, so with a little luck it won't be a problem for much longer. Of course if I do get radiotherapy it may well be worse but we'll just have to cross that bridge in due time.

Unfortunately for you a more alert mind means that I can now officially launch my 'Nerdy Corner' section. I know some of you are interested in my findings on a variety of cancer-related themes - apologies to everyone else. I was going to start with an explanation of how my chemo drugs work but I realise it's not the best place to start. So I'll have to think about how best to do it. Expect an update soon.

Perplexed, but I'm not complaining

Well here I am, just over one week after the last chemo cycle and things could not be more different from the last lot. As you all know I didn't have the best of time with the first Taxotere cycle but things have been a lot better this time round. As soon as the pain started last Thursday I started taking Paracetamol and took it regularly, irrespective of the level of pain. I'm assuming this is why pain hasn't been that bad - I certainly have been able to move quite freely. To add to this I've not (yet) reacted to the injections, so no temperature - if the injections were actually the cause for the temperature in the first place. I really don't understand this - and I don't have enough knowledge of the human body to even make a guess. I'm hoping it's the 'pre-emptive strike' on pain that minimised the side-effects because I'll certainly be repeating that behaviour.

Fatigue remains the main problem, and my mouth has been quite sore. I'm not sleeping well at all because of hot flushes and night sweats, which undoubtedly adds to the fatigue problem. Thankfully I can have a lie down whenever I need it during the day so things could be a lot worse from that perspective. And of course Mum takes very good care of me, which means there isn't much I actually have to do.

As a result I've been able to do a bit more. Those who know me will know I get bored if my mind isn't stimulated. So I'm now working on a few things and getting nowhere fast - I really need to be concentrating on one thing at a time as my mind shuts down quite quickly. But fear not - I shall be boring you with nerdy facts relating to cancer very soon. I read an interesting article today on how a compound of the japaleno pepper has been shown to kill lung and pancreatic cancer cells grown in the laboratory. It does so by targeting the mitochondria - "the cells' energy-generating boiler room" - of cancer cells as apparently "the biochemistry of the mitochondria in cancer cells is very different from that in normal cells". Which, as far as I'm concerned, currently roughly translates into 'U wot?'. Anyway this ought to keep me busy for some time.

I hope you're all well - especially my fellow Liverpool supporters.

Happy New Year - and good riddance to 2006

I hope festivities were happy all round. I can't complain as such - I was stuck in bed for the bulk of it but only because of fatigue and not because of pain or other side-effects.

I had chemo yesterday, which turned out to be quite a long day. I was happy as the blood tests I had last Wednesday, when I went to see my oncologist, showed that my blood count was high enough so that no blood test was required yesterday. I naively assumed that it meant I wouldn't be spending ages in the chemo uni but of course things are never as straightforwad as this. Because I ususally get chemo on Mondays, and that Monday was a Bank Holiday, they added the bulk of the Monday patients to the Tuesday clinic, effectively doubling the number of patients in the process. I think this would've been manageable if they hadn't been having problems in the pharmacy, not least with people calling in sick. My appointment was for 1.30pm but I only got my chemo after 5pm. Ah well, just one of those things I guess.

I'm not having any side-effects at the moment. If the last lot is anything to go by I will start getting pain tomorrow and this will quickly get worse. I'll be starting the injections on Saturday and I suspect I will react again, making the pain worse and getting a high temperature. The oncologist has already prescribed me some antibiotics as well as some strong painkillers so hopefully these will help and save me having to go into hospital for further tests again. I have to admit that the fatigue is a huge problem at the moment. I have lost a lot of strength. A slight hill or stairs make me completely breathless and I get quite bad muscle pain which leads to shaking. Which means I basically have to walk very slowly whenever I venture outdoors - which is only when I have to go to hospital thankfully. I struggled quite badly last week as I had to go in to see my oncologist and get a blood test on Wednesday. I then got a phone call in the evening to let me know I needed to go back as the tests revealed once again that my potassium levels were high. However, once again, it was a false reading. To be honest, if this happens next time, I will tell them that it's not good enough because it takes a lot out of me.

I'm not quite sure what 2007 has in store for me - I guess nobody does. I should technically get my last chemo cycle around 12-13 February. Then I suspect I'll have another MRI scan before surgery, but I don't know how much of a break I'll be getting. Radiotherapy is an option but not a certainty. Finally it'll be Herceptin and hormone therapy. On the good side, whenever I have a wee window of opportunity to plan things - about five days every three weeks - I can start making plans. So far this is what's looking very probable:

1. Going to Lymm to meet my nephew Theo and catch up with Justin (and Fiona and Patrick, of course).

2. Going to Dorset to a cottage we rented last year and we absolutely loved - the Cartshed. It is owned by an organic farmer who has access to a private beach (part of the Jurassic Coast World Heritage Site) which we can of course use.

3. Attending three football games - two at Anfield, thanks to the Willow Foundation and my friend Hazel, and one at Craven Cottage as our greengrocers are Fulham supporters and have offered to get me a ticket.

Then, depending on finances and health, I would like:

1. One week in the Peak District - it's an area I really don't know well but would love to visit. I've driven through it with my brother-in-law Patrick when we went to Castleton and some areas looked fantastic.

2. Two weeks on the North Coast of Cornwall - those who know me know that I'm a bit obsessed with Cornwall and would love to move there.

3. I have to admit that there are a lot of places I'd like to go but I know it's not quite an option but who knows? Because of climate change I've made the decision not to fly anymore unless an emergency occurs. I might, just might, bend this rule to go to Madeira as it's been recommended to me several times - apparently the flora is extraordinary there.

Other plans I have include:

1. Reclaiming a plot of contaminated land - Now this is really only an extremely vague plan. The idea is to find some metal-contaminated plot and use plants to remove the contaminants. The dissertation I wrote as part of my degree included a similar idea. I looked at how efficient two varieties of ryegrass were at removing lead from soils. In the project I'd like to carry now I'm thinking more along the lines of garden design, using, depending on the contaminants present, species such as willow from which a variety of objects could be weaved. At this point in time I have no idea if anything will come of this but it should at least keep me busy. Finn is using her contacts to check whether a plot is available - always a good place to start.

2. Helping to carry out an eco-audit on a housing coop to see how it could become more environmentally-friendly.

3. Carrying out voluntary work or finding some kind of graduate scheme.

4. Working on online Geographical Information Systems (GIS) courses as I'd love to do a Masters in GIS. I've found the ideal distance learning course but it is quite expensive so again I'll have to check all my options before I make a decision.

Anyway I've no doubt waffled on enough. I wish you all a very happy, healthy and successful 2007, whether you are in warm and sunny Dubai or Australia (great to hear from you Stephanie) and rather less warm and sunny Switzerland, Belgium/Croatia or the UK. Be good and look after yourselves.