Oncology Outpatients and GFR Estimation 3 Sample Scan and other stuff – 21st July 2021

Well, it’s a full and busy day at the hospital today in preparation for starting chemotherapy on Friday.

Before having any treatment at UCLH you now need to have a Covid Swab Test done at the hospital which is understandable. What I don’t fully understand is why you don’t need the test for scans and other tests.  So, this is another reason to be here twice in a week.

On arrival I headed for the Blood Test department and booked in for my Covid Test, as it was early, I only waited a few minutes before I was called in for my blood test.  The phlebotomist had barely got the needle in my arm when the receptionist appeared and said I was in the wrong place as I was booked into something called “The Pod”.

Just arrived at the hospital.

So, without hesitation the Phlebotomist pulled out the needle and aborted taking my blood which seemed a bit strange as she had completed the painful and difficult part of the process and could have soon drawn my blood as well!!

I was thinking that today I will be a human pin cushion!!

I got myself sorted and made my way upstairs to “The Pod” which was a portacabin type building setup just outside the exit doors.  I was met by the nurse who was going to take my blood and do the covid swab.  He wasn’t quite sure why I was booked into the pod, but I suspect someone had made an error while booking me in and booked me into the wrong place.

Anyway, the covid test and the blood test then went smoothly although by now I had two plasters on my arms where the different needles had been put into my arm.

Then it was off for my outpatient’s appointment, I had my eye on the coffee stand and a Flat White but thought I should head up for the appointment.

The outpatient’s appointment went fairly smoothly and was just a simple check up to see how I was feeling and to get me to sign the consent form for chemotherapy.

Job done it was now time to head for the main building and the Nuclear Medicine department where I was going to have the GFR Estimation 3 Sample Scan.

The Main Building.

Once again, I eyed the coffee stand but I knew there was another one in the main building so off I went only to discover that the coffee stand in the main building was closed!!

It was too far to go back and so I headed up to Nuclear Medicine and checked in and while the procedure is called a scan it’s not.

What happens is that I was injected with a radioactive source and then had to wait 2 hours while the source circulates around my body and then they would take 3 blood samples each an hour apart.  The 3 different blood tests are then compared and from that comparison they can work out the strength of the chemotherapy I can have.

GFR stands for Glomerular Filtration Rate and is a test which measures Urine Albumin which is a protein in that is filtered by the kidneys and so by measuring the amount of Albumin over the 3 different blood tests they can work out how well my kidneys are working and how much chemo I can have.  The radioactive source enhances the test and they can see how fast the radioactive source is being processed by my kidneys.

I hope that makes sense?

This is the first time I have been through this process and so it must be something that they do when using Carboplatin the chemo I was going to have this time.

Back to being a human pin cushion!

What the process also meant was that I was to have 2 cannulas fitted, one to inject the radioactive source and the other to be used to take the three different blood samples.

Cannula One

I was fitted with one in my left hand and the radioactive source was administered and then the cannula was removed.

I was then told I could do what I wanted for the next 2 hours while we wait for the source to circulate and so I thought it was coffee time!  Only to be told no tea or coffee, I needed to be caffeine free!!

Ah well.

I checked the map and looked for a nearby park to sit in and read my book for an hour.  I found a park called Gordon Square which was nearby and found a shady spot to read. 

As an aside the book I am currently reading is “The Stand” by Stephen King, which is about a global pandemic, quite topical for a book first published in 1978!!

Time passed quickly and soon it was time to head back to the hospital another cannula and the first of my blood samples to be taken and then it was a case of waiting an hour for the next sample and so on.  I couldn’t go far and so read and dozed in between the samples being taken.

Finally, the third sample was taken, and it was time to head home, it felt like a long day and I was feeling a little tired, I also had four plasters where the different needles had been.  I call these sympathy plasters as they will get me a few minutes of sympathy when I get home!!

I would soon be home and be able to rest before returning on Friday.

Blood Test Results

Well, it took a week but I finally got my blood test results back from the blood test I had on 8th March.  Not sure why it took so long but I suspect that it took time to be reviewed and processed at the GP’s Surgery.

And there is good news and bad news!

The bad news is that my PSA had gone up from 163 to 241, a rise of 78 when I was expecting it to go down following on from the Lutetium treatment.  I had really hoped that the Lutetium would knock it down as it had done in the past.

On the plus side, for the most part I feel fit and healthy.

I have forwarded the results onto UCLH and will see what they say on the 24th March when I have my next outpatients call.

The rest of my blood work looked ok to me apart from a few things which looked a little low or a little high in one case.

Serum calcium level 2.11 mmol/L [2.2 – 2.6]

Haemoglobin concentration 116 g/L [130.0 – 180.0]

Red blood cell count 4.29 10*12/L [4.5 – 5.5]

Or High

Serum cholesterol/HDL ratio 4.46 [< 4.0]

Now I don’t know what this means, but it looks like my blood count is down a little and that maybe due to the Lutetium.

I don’t know how this may affect the thinking around having another Lutetium Treatment in April but for myself I think it would be worth it but of course I need to listen to advice.

I have done a graph to help track my PSA, I think it tells an interesting story.  It shows that the Docetaxel that I had first of all really made a great impact as did the first set of Lutetium treatments that I had.

Everything else has been less effective although there is nothing that shows what effect the Hormone Therapy may or may not be having as I have been on that consistently since being first diagnosed.

I do wonder how long it took my PSA to reach 226 when I was first diagnosed and how that could have been caught earlier, I am sure it didn’t climb to 226 overnight and probably took a few years or more.

I do think that had I been tested early, perhaps when I was 50 then the disease may have been caught earlier and I would have been a much simpler case to treat.

But that is hindsight and for now I need to focus on treating the current problem and on staying fit and healthy.

Blood Test and Oncology Outpatients

My next Oncology Outpatients was on the 10th March and was a phone call; it was a follow up following my Lutetium Treatment on 19th February.

I thought it a good idea to have a blood test done locally by the GP so we had an up to date blood test for the outpatients appointment.

So I contacted the GP and booked a blood test, it was slightly more difficult than they had been previously and there was a little confusion as to whether the surgery was still doing blood test for the Clinically Vulnerable.  But eventually it was all sorted and I was booked in for Monday 8th March.

Monday came and I turned up for my appointment, I was met at the door by a receptionist and hardly had time to sit down before the doctor came for me.  I had not seen this doctor before, but she was very good and got to the vein first time and before I knew it I was on my way home.

She said they normally get results in a day or two!

Wednesday came and it was nearly time for my Outpatients Appointment.

I checked online and there were no results, ah well it was a good idea!

The Outpatients call was a little anti climatic in that the doctor, who I did not know, just seemed to be familiarising himself with my case, he did ask how I was and I told him of my experience following on from the Lutetium Treatment.

I also asked about my spinal brace again and he said he would look into it although I do not think there are many options, but it is worth asking.

At the end of the call it was agreed that I would have another call in a couple of weeks and that is now scheduled for 24th March and will hopefully focus more on my next treatment.

Hopefully we will have the blood test results back by then!

Covid Swab and Blood Test 4 Jan 2021

Up to London today for a Covid Swab Test and a Blood Test at UCLH

The reason for the Covid Test is that I am due back at the Hospital on Wednesday for an Outpatients Appointment following by Zoledronic Acid treatment and because of the treatment I need to have the Covid Test and so I thought I may as well have an up to date blood test at the same time so we can see how I am doing.

Given the Covid situation in London I listened to advice and took a car up to London, mostly to avoid the tube but also the train as well.

London was fairly quiet, there were cars around and some pedestrians but nothing like you would expect on the first day back after the Christmas Break.  There was a notable exception at Costco on the North Circular which had a long queue; people stocking up before the next lockdown I guess.

A fairly quiet Tottenham Court Road.

And so we arrived early for my booked time for the Covid Test.

The same as last time, the Covid tests were done in the Phlebotomy Department however there was a little confusion as when I arrived at reception I said I had a Covid Test and a Blood Test booked and was told to take a number on a paper ticket, there were 21 people in front of me so I found somewhere to sit.

It took about 45 minutes for my number to come up and in I went.  The phlebotomist listened to my advice to try a vein in my hand and was soon drawing blood.  It flowed well initially but started to dry up after a couple of the tubes were filled, I was also giving blood for research so there were additional tubes to be filled.  These last few proved a little troublesome and the phlebotomist wiggles the needle to try to improve the flow, it stung a little and I winced.

She apologised but i said there was no need, but it did sting!

And soon I was done only to find out that I needed a sticky label type sticker before I could have my Covid swab and so it was back to reception!

Fortunately I didn’t have to wait long before I was called again.  The nurse started to say that I was late for my slot.  I told him that I had been there since before my slot and that I had been misdirected.  He gave a knowing shrug and took the swab.

So now it is waiting time, hopefully I will get the Covid result tomorrow and find out about my PSA and bloods on Wednesday.  Hopefully the PSA will be stable and the rest OK.

I look forward to finding out on Wednesday.

Blood Test Results 26 November 2020

The great thing about todays technology is you can now access your test results online and so I now have my test results from the 24th November although I have not had a phonecall from the surgery yet and indeed I may not get a phone call as the test results for the most part are normal.

This test is the mid point test between my ocology appointments and the main thing I am interested in and the main thing they are interested in is my PSA which has risen slightly to 93.04 which is abnormal (as it states below) but is expected, it was previously, 6 weeks ago at 85, so while it is way above the range it should be (0.0 – 4.5) it is fairly stable and it is stability that we are looking for.

That and my general health which for the most part is good so I believe that when my Oncologist sees these results he will be pleased and will wait to see me in January 2021.

A copy of the blood test results are below for those who might be interested, I have highlighted things of interest.

Clinician viewed24 Nov 2020
Result typePathology
TestsSerum prostate specific antigen level
Filed by
ResultAbnormal, but expected
What you need to doOther (copy to oncology)

Pathology Investigations

Serum prostate specific antigen level 93.04 ug/L [0.0 – 4.5]

Above high reference limit

Please note: From 09/10/2009, age related ranges are reported — Afro-

Caribbean reference ranges:- Age :

40 – 49 Up to 2.0g/L —

50 – 59 Up to 4.0g/L —

60- 69 Up to 4.5g/L —

70 -79 Up to 5.5g/L ~

Clinician viewed24 Nov 2020
Result typePathology
TestsLiver function tests
Filed by
ResultNormal
What you need to doNo Further Action

Liver function tests

Serum albumin level 36 g/L [35.0 – 50.0]

Serum total bilirubin level 8 umol/L [0.0 – 21.0]

Serum alkaline phosphatase level 66 iu/L [30.0 – 130.0]

Serum alanine aminotransferase level 18 iu/L [10.0 – 37.0]

Result typePathology
TestsRenal function tests Bone profile Full blood count
Filed by
ResultSatisfactory
What you need to doNo Further Action

Renal function tests

Serum sodium level 143 mmol/L [133.0 – 146.0]

Serum potassium level 3.9 mmol/L [3.5 – 5.3]

Serum creatinine level 80 umol/L [62.0 – 115.0]

Glomerular filtration rate > 60 mL/min [60.0 – 150.0]

GFR COMMENT Interpret eGFR with caution for people with extremes of muscle mass.

Note: CKD staging would not apply in Acute Renal Failure.

If your patient is an Afro-Caribbean, multiply eGFR result by 1.212

For general guide www.renal.org/eGFR

Bone profile

Serum calcium level 2.19 mmol/L [2.2 – 2.6]

Below low reference limit

Calcium adjusted level 2.27 mmol/L [2.2 – 2.6]

Serum albumin level 36 g/L [35.0 – 50.0]

Serum inorganic phosphate level 1.36 mmol/L [0.8 – 1.5]

Serum alkaline phosphatase level 67 iu/L [30.0 – 130.0]

Full blood count

Haemoglobin concentration 116 g/L [130.0 – 180.0]

Below low reference limit

Total white blood count 6.2 10*9/L [4.0 – 11.0]

Platelet count – observation 237 10*9/L [150.0 – 450.0]

Mean cell volume 87 fl [76.0 – 96.0]

Red blood cell count 4.16 10*12/L [4.5 – 5.5]

Below low reference limit

PCV 0.360 /L [0.4 – 0.51]

Below low reference limit

Mean cell haemoglobin level 27.9 pg [27.0 – 32.0]

Neutrophil count 3.8 10*9/L [2.0 – 8.0]

Lymphocyte count 1.3 10*9/L [1.0 – 4.8]

Monocyte count – observation 0.7 10*9/L [0.2 – 0.8]

Eosinophil count – observation 0.4 10*9/L [0.0 – 0.4]

Blood Test

Today I have been over to the GPs surgery for a blood test and I have to say that it went very well.

The doctor was very good and got into the vein first time and got the blood out and the vacutainers full. I was also quick to be seen, I barely had time to sit down.

This blood test is roughly at the 6 week point between my last appointment at UCLH where they are now seeing me every 3 months when I have my Zoledronic Acid treatment for my bones and the next one at the start of January.

Fingers crossed that the results will come back and show no major increase to my PSA and also nothing else to worry about.

Overall I feel fit and well and am getting around a lot better although I still use a walking stick when I go out walking.

I have tried to reduce the amount of morphine I take for the pain in my back, I now take 10mg in the morning and 5mg at night.  The are slow release tablets and cover me all day.  I did try stopping the nighttime dose but found it a little painful in bed and it interrupted my sleep so I have started to take them again.

I also take 10mg of Amitriptyline at night and wonder if I could get away with not taking this any longer. I think I will discuss it with my Oncologist in January in case there are side effects coming off it.

The Acupuncture that I had has been going well but I think it was more effective when I was having 3 sessions a week rather than one a month. So I am thinking of stopping them.

As I say I am feeling a lot better and what I really need to do is continue to build up my strength and endurance by walking more. I still need to be very careful with my back and in particular with bending and lifting as the vertebrae above and below T12, the one which partially collapsed and I had cement put in are both very vulnerable to collapse as well although I hope the Zoledronic Acid is helping to strengthen them 🤞.

X-Ray showing my damaged vertebrae.

So I am hoping the results for the blood test come back soon and show good news.

I am Iron Man!

Am I referring to that classic Black Sabbath song or a modern film? Well neither, I am talking about a man trying to increase the iron levels in his body and blood stream and move away from that Anaemic level that I was given after my last blood test.

So what am I doing?

I have a two pronged approach, the first being to take Iron supplements and boost my Iron levels in that way and the second and more interesting is through diet.

So today I dusted off the nutri bullet and made myself a smoothie, nice and simple, just orange juice and spinach. The orange juice gives it a nice flavour as well as the vitamins that come in orange juice while the Spinach brings in the Iron as well as even more vitamins.

I am also trying to eat more Iron rich food and so this evening I had some liver for dinner, in fact it was Liver and Bacon with Onions, Tomato and Apple served in Onion Gravy and I have to say that it was very very tasty.

20200606_191703

I had slightly over catered and will be having leftovers for lunch.

Below is a list of the different blood measurements that I am looking to improve by changing the diet. They are all just below the recommended range, which are the figures shown in brackets.  I will of course need to wait for my next blood test to compare them and in the meantime I will continue to try and eat more iron rich food.

Haemoglobin concentration 117 g/L [130.0 – 180.0]

Red blood cell count 4.11 10*12/L [4.5 – 5.5]

PCV 0.367 /L [0.4 – 0.51]

Lymphocyte count 0.8 10*9/L [1.0 – 4.8]

Oncology Outpatients 3 June

Today I had my oncology outpatients appointment via a telephone call with the same doctor that I spoke to last month. The appointment was quick and efficient and to me it seems like a good way to do these more routine type of appointments and is something I hope they continue to do going forward.

The doctor was pleased with my PSA result as was I, 88 is a good number to be at and a good leap down from last month’s figure of 144.

We also discussed whether I was Borderline anaemic and he felt that there was nothing to worry about and that no treatment was needed as it was very borderline. I accept what he says but I will modify my diet to include more iron rich foods, I may also start to take iron supplements to give me that extra boost.

We then then went on to discuss whether I should have Zoledronic acid ( this is to strenthen my bones) at the start of July and he said I should go ahead with that appointment so that will be a trip to UCLH for that treatment. I will need to consider how I get there.

So with the appointment coming to an end and I was given the all clear to go ahead with the Lutetium treatment on Friday. I did ask a cheeky question as to whether the treatment was available on the NHS yet but the answer came back that it wasn’t yet available. So going forward I will need to continue with the London Clinic.

So being given the go ahead I am looking forward to my day trip to London and seeing a little more than just the view from the house and the garden, and of course it will be a little adventure 😁👍.

Great News – PSA 88

One of the good things that has happened recently is a number of Apps and ways to access your GP and NHS data have been introduced so you do not need to wait for the doctor to access information like blood test results.

And so I used one of my new Apps to look at my blood test results from the test I had last week and was very pleased to see that my PSA had dropped to 88, I have made it back into double figures 😁👍.

It’s actually quite a big drop, down from 144 last month and clearly a massive drop from 1,585 where it was last year.

On the downside the blood test also showed that I am borderline Anaemic which means a lack of Iron in my blood and other things which I still need to find out about.

While I wait to find out if either the GP or my Oncologist will prescribe Iron tablets and of course identify the underlying cause of the Iron deficiency, I can add more Iron rich food into my diet such as the following.

  • liver
  • meat
  • beans
  • nuts
  • dried fruit – such as dried apricots
  • wholegrains – such as brown rice
  • fortified breakfast cereals
  • soy bean flour
  • most dark-green leafy vegetables – such as watercress and curly kale

So I will be looking at some liver recipes, I have not had liver for years!  Liver and Bacon sounds good.

Pig's liver with streaky bacon | Tesco Real Food

And I’ll be getting the blender out and making those lovely green drinks with curly kale and spinach!

But such good news about my PSA, I feel it sets me up for my Outpatients call tomorrow and Lutetium treatment number 6 on Friday.

Can I Cope With This Much Excitement?

All this excitement two days in a row.

Today I have been out for a blood test at The Rivers hospital in Sawbridgeworth so a longer drive than yesterday and a pleasant drive it was to. The roads were pretty clear and it took no time to get to the hospital.

Once again I masked up and with my gloves on I made my way to reception. They were practicing social distancing with markings on the floor to help us with social distancing.

I was directed to the blood test waiting area where they were three people waiting. We looked at each other over our masks, it was a little strange just seeing people’s eyes.

I waited about 10 minutes before being called forward.

The nurse was experienced but it still took her two goes to get the needle into the vein.

And then it was over, my blood will be sent to Princess Alexandra Hospital in Harlow and the results will be sent to the GP. I will be hoping for healthy results across the board and especially anything to do with bone marrow function which helps with immunity and the production of white blood cells. And of course I will be looking for a reduction in my PSA, I would love to be back in double figures but cannot imagine it will come down that much.

Last time it was at 144 which is great as it was at 1,585 before I started the Lutetium treatment.

The drive home was pleasant, I was so tempted to go to the supermarket or something but managed to resist!

Now it’s a waiting game for the results.

Oncology Outpatients next Wednesday via a telephone call and then Lutetium treatment on Friday.

Oh that’s a day trip to London 😉.