Radiotherapy

Today I was booked in for the first fixture fitting at UCLH at 12.00. On arrival at the department I was informed that there would be a 20 min delay. That didn't seem to bad, so we sat down in reception and waited.

At 12.20 I was called through to the fitting room. I recognised the two staff, and in turn they recalled me from last year. This time round the type of fixture would have to be different as my stump is fairly small. They decided on a method using what looked like a large pillow size bean bag. I laid on the table with the bag under my bum and also had my leg resting on it. They then packed the bag around my waist area and also around my leg, then they attached a vacuum line to a valve on the bag and evacuated all the air in the bag. By evacuating the air in the bag it moulds itself around your body and leg. This then becomes your location fixture for the treatments. It's fairly simple but very effective.

This process had taken about 30 mins to complete, during which time one of the CT scanning staff had come in to say that I could have the second part of the process also completed today as they had a window in their programme. This was really good news as it meant that I wouldn't have to come up to town again for the Friday appointment. I then moved to the CT room and was put on the scanning table and laid in the fixture. At this point it's a fairly complex set of stages of lining my leg up accurately with X,Y, & Z lasers (left and right, forward and back, and up and down) Once they are happy with the alignment which has to be +/- 1mm they tattooed a series of small dots on my waist area and also my leg. These tattooed dots act as reference points when I am on the Radiotherapy machine so that I can be accurately positioned for treatment. Following this setup I was then given a CT Scan.

This CT scan will now be used to build the programme for my treatment, including the angle and shape of the electron beam, and also the dosage each day. I have 33 sessions planned starting on Monday 17th December at 12.00. With Christmas and the New Year in my programme I will probably have to have treatments on Saturdays to cover for lost days during the week.

Treatment Starts

Just taken a call from the Radiotherapy Department at University College Hospital to say that my first appointment for the fixture manufacture will be tomorrow (28th) at 12.00. Followed by the second appointment on Friday. So that's good news

The Varian Rapid Arc Radiotherapy Machine

During the second appointment I will be placed in the fixture and a enhancement die pumped into me whilst a CT scan is taken. Lasers will be used to set my leg up in the correct position. This scan will then be used by the Oncology team to precisely plan the treatment programme.

So then it's 30 treatments, Monday to Friday for 6 weeks.

Updates will follow !!

Oncology Appointment

Yesterday (Friday 23rd) I had an appointment to see Dr Seddon the Oncology Consultant at The new Macmillan Cancer Center, University College London Hospital.

I don't always see Dr Seddon as she is the head of the team, however, I had seen her on the 22nd Oct  prior to the operation to remove the tumour, and she had indicated that we would discuss the possibility of post operation Radiotherapy at my next appointment.

My appointment was for 11.45, and we were called in a little late around 12.05. Dr Seddon went through the pathology results of the removed tumour, most of which went over my head as it's all in medical speak. We looked at the CT Scan of my leg and it all became a little clearer. It showed the tumours, there were 2 of them adjacent to each other. In one position the tumour was pretty close to either the main vein or artery, so the the margin in this area was small. Surgeons like to take a good margin around the tumour to ensure they get all the cancer cells.

Dr Seddon was pleased with the surgery results and suggested that it would be sensible to follow a 6 week programme of Radiotherapy to reduce the risk of the caner re-occurring. I was of course happy to go along with this, and the wheels were put in motion. This means daily trips to UCLH at Euston Square Monday to Friday for the 6 weeks. I should be contatcted next week to go along for the 2 appointments which are required for the fixture manufacture. If this happens next week the radiotherapy should start the following week, or possibly the week after. All being well this course should be finished by the end of January, I then have to wait a few weeks for the stump to recover before I can go to Stanmore to get a new socket made for my prosthetic leg. Then the process of learning to walk again starts.

Before I left Dr Seddon sent me down for a chest X-Ray to make sure all was well in that department. The guy doing the X-rays was really nice and he allowed me to have a look at the result. Nowadays it's all digital and instant.

I had a really good look over the X-ray and to my untrained eyes my lungs looked good. But what do I know !!  On Monday the 26th November I have an appointment in London to see Mr Skinner the Surgeon for a follow up check on the operation.



Clips Out !!

14 days after the operation and today was clip out day. I had an appointment with our practice nurse at 11.00. Last week when I had seen the doctor about the infection he had requested that he be bought in prior to the nurse removing any clips so that he could just check over the wound.

The nurse removed the dressings put on in the hospital and revealed a pretty neat wound that had healed nicely. The doctor checked the wound carefully and gave the OK for all the clips to be removed.  I guess there were around 30 clips and the nurse started by removing every other clip. They do this to ensure that if there is a problem with the wound at least it wont split open.

As I mentioned in previous posts the surgeon cut along the old wound line, and as you can see it's a really neat job and when it's healed it'll be hard to see.

As a Point of interest, the crease below the wound is where the tumour was. So now it's been removed I'm left with a huge dimple !!  I think in time as the healing takes place this will smooth itself out.

I have a meeting next week on Friday 23rd with the Oncologist at University College London where we will look at the the Histology results on the tumour margins. This will determine what future treatments are necessary or not. On Monday 26th I have an appointment with the surgeon for a check up on the surgery.

So I'll be reporting as soon as I have further information.

Rest & Recuperation

After coming home last Thursday I started to rest up to assist the healing process. Unfortunately over the weekend my leg started to get tender, and by Sunday it was swollen and pretty painful. By Monday morning it was time to get professional advice so I made an appointment to see the GP at 3.00 in the afternoon. His diagnosis confirmed my suspicions that I had an infection.

So it' a week on Antibiotics, and back on my max dose of morphine for a while to help with the pain. That should sort it out !! I'm due to have the clips out next Tuesday (13th) and this may well have an impact on that. It's possible that I'll have some removed in the area not affected, with the remainder a few days later. Have to wait and see.

I said to the GP, that I thought that I had now all the money back from the NHS in terms of operations etc, that I had paid in NI over the years. So this was now possibly the time to stop !!  He gave wry smile. I don't think he took me to seriously.

I'll do another post when there's more to report.

The Tumour !!

I forgot to mention in yesterdays post that when I saw one of the surgical team I asked him if he had been in on the operation. The answer was yes, so I asked him about the tumour. Apparently it was about the size of a tennis ball, so not exactly small. When you consider that 6 weeks ago I had no idea it was there, it gives you some idea how quickly it had developed, and that's pretty frightening !! Lets hope it the last time.

The size of the tumour would account for the rather large dent I have in the back of my stump, but I guess that will balance out in time as the healing process kicks in.  Another interesting thing is that Mr Skinner, the surgeon, made the incision along the the old scar line so I'll only have the one scar, not that having two would bother me. Also they used clips to close the wound, and I'm happy with that they come out painlessly as opposed to stitches.

The clips are due to be taken out on the 13th, and today I arranged with our GP practice nurse for an appointment. Following on from that I'll be sent an out-patients appointment to see Mr Skinner in approx 3 weeks for a check up, and I have the appointment with Dr Seddon at UCLH on the 19th.

Home 24 hours after the Operation !!

I was No 2 on the operating list, and expecting to go to theater around 10.30. However this wasn't to be as the first operation took over 4 hours. I guess the team then had lunch and I was taken down around 1.30.

When I met the anaesthetist he said I had two options. Option 1 was a normal full anaesthetic, and option 2 was an injection in my back which would numb everything below my waist. I asked if I would then be awake for the operation. He said that I could also be sedated so that I unaware of what was going on. I then asked that if I was left fully awake would it be possible for the surgeon to show me the tumour after it was removed. I was interested to see what had been causing me this grief over the past year. His answer was 'YES' which surprised me. Apparently they do occasionally get these requests, so I opted for this route. This might sound odd to most of you, but I'm not squeamish and would it would be the only chance for me see what a cancer tumour looked like.

Unfortunately it wasn't to be. After three attempts to position the needle correctly in my spine he had to give up, as each time the needle tip encountered bone before reaching the correct position. So it had to be the full anaesthetic, and within a very short time I was under, and my next recollection was waking up in sever pain in the recovery room. The pain in my stump was so bad I was crying and begging for something to be done. The recovery team are pretty good and the pain was under control within I guess 30 mins, but it was really long 30 mins.

My next recollection was waking up for a few moment in the ward, I asked for my watch to find it was 5.00.  I next woke for a few moments at 10.00 late evening, and then 7.00 in the morning after a good nights sleep. Had a good breakfast, and then was body washed in the bed as I had 2 drain lines and a morphine line draped around me, so pretty difficult for me to wash myself. After that I felt like a new man, ready to face the day. My aim was to get home that day, and to do that you have to meet a few requirements.

Firstly the morphine and two drain lines needed to be removed, and they were planned to come out about midday. Secondly you have to be signed off by the physiotherapist dept to ensure your going to safe and will not injure yourself when you get home. Thirdly the pharmacy need to get your pills and potions ready and sent up to the ward, and fourthly and most importantly the surgical team need to be happy and sign you off.

Knowing that I would achieve all 4 requirements by lunch time I phoned Jane to arrange for a pick up around 2.30 which I knew would give small a margin if any problems popped up. Luckily all went well and I was ready with bag packed when Jane arrived about 2.15. So now I'm home and resting for a few days in order to give my leg time to heal. Interestingly the surgeon opened my leg up by cutting along the old scar line, not sure why, but I'll certainly ask him when I next see him.

So next it's a consultation with the Oncology consultant at University College London on the 19th November. At this meeting I will find out if they consider a programme of radiotherapy to be beneficial or not. This will depend on both the histology and surgeons reports.

Updates will follow !!