So two strapping young ambos arrive with the full emergency resus ambulance and they found their reportedly semi-comatose patient to be awake and now fully responsive. No longer hallucinating and seemingly perfectly normal. But they did confirm the low oxygen saturation level and high temp so, despite mutterings about the doctor's competence, rehydrated Philip, administered oxygen and whatever else their protocol demanded (ignoring the doctor's instructions to "just get him to hospital"), then took him to Calvary while I drove the 3 km there in my car.
At this stage there were two competing possible diagnoses - infection, and the side effects of too much opioid. Each could explain Philip's symptoms and probably the ambos see more drug overdoses so that was their favoured diagnosis. It was certainly possible, given the amount of pain yesterday and the on-demand pain relief in the form of liquid hydromorphone which Philip had had six doses of yesterday.
Once in ED we had to repeat the full history, again, and the full medication schedule, again, to a young Irish registrar, Lindsay and the nurses. They took blood and urine samples and set up intravenous antibiotic. Philip was starving by this time, having missed dinner and only having had a tiny lunch smoothie. He had to wait for an hour until after taking his empty-stomach Tarceva but at the tail end of the day the only food available was a stale and unappetising sandwich which he found inedible anyway. I went home at about 10.15 pm and later that night Philip was transferred to MAPU,
Today, Thursday morning, he was given an ultrasound of the right leg, two brain CT scans, two CT scans of the torso, upper and lower, and a bladder scan, I think by ultrasound. He was not permitted to use the heat-wheat packs which gave pain relief to the leg and foot for 'safety' reasons - whether this was for patient safety or the nursing staff was not clear. They were afraid of burning, or spontaneous combustion, or something.
Before coming to the hospital I had a lengthy discussion with the pharmacist as to Philip's medication history. Again. It has been reported that Minister Ley is determined to bring the medical profession into the digital age and it can't come soon enough.
For hours in the hospital I was trying to speak to the nurse or preferably the doctor in charge of Philip's care but they were quite impossible to track down. Until finally some action when the team leader discovered that Philip's meds, which I had brought in, were sitting in an open box on his bedside chest. They included morphine which The Rules said were to be kept under lock and key. Panic! Outrage! Near hysteria! But it got some action when I threatened to administer a dose of pain relief to Philip myself. (Mind you, he had had three occasions of diarrhoea while I was there and I gave him Gastro-Stop. The nurses had not been the slightest bit interested.)
Looking back I realise I missed a golden opportunity to make a fortune flogging the morphine-based meds to other patients. I just don't have that criminal entrepreneurship. Sigh.
After I'd returned home a phone call from Philip produced an unexpected third diagnosis which explained his recently-developing leg pain: Dr Jun tells him that the ultrasound had revealed clots in the leg. The doctors now have to have a confab about what is to be done. In one sense it is good news, I think, as at least the pain does not seem to be coming from a new cancer growth. Will keep you posted as to developments.
Thursday 28 April 2016
Post #23 - Too much happening!
A huge amount has happened since last weekend. Life has not just been turned topsy-turvy but stirred vigorously as well.
On Tuesday a recliner chair and wheelie-walker were delivered from ACT equipment hire, both intended to make life comfortable and safer, respectively. The walker has been used and the recliner tried briefly only.
Also our kind neighbour Grant lent a shower seat and over-toilet seat with arms to assist in getting up. "Hospital in the home" by now, I guess you could say.
In the afternoon Chris, nurse from Home Based Palliative Care, came to formally admit Philip to their program. Philip was very unwell, in a lot of pain, muddled, needed a lot of the 'on request' pain reliever. She was quite shocked at his state. He had a fever, low blood oxygen saturation, fairly high blood pressure. She thought he would need a wheelchair soon and Level 4 personal care.
On Wednesday, Philip was quite chirpy in the morning - got up,showered, dressed and expressing the desire to 'go swimming' - i.e. sit in spa pool - at AIS. Philip finds he warmth of the water and weightlessness very soothing. However the TCH clinicians dissuaded him, apparently thinking he was in danger of drowning.(!). As the morning wore on he sagged and by the time nurse Narelle from HBPC arrived (you have to repeat the whole history and medication regime every time to each new person) he was asleep and couldn't be properly roused to respond to questions. She told me that he should be taking paracetamol with the opiates as they work synergistically. and gave me a few handy syringes to get up the liquid medicine. Also recommended an electrically-operated, hos[ital style bed.
Then Dr Ann Oxner from HBPC came and we repeated the history/medication story again while she typed it up with two fingers. She confirmed yesterday's readings of high fever, low blood oxygen and highish BP but didn't have access to recent blood tests. Also Philip was very confused, to a quite unusual degree. She was worried that he had an infection and thought hospital and IV antibiotics could be necessary so called for an ambulance.
To be continued... (I am going out now and this program doesn't auto save, so I will 'publish' this much.)
On Tuesday a recliner chair and wheelie-walker were delivered from ACT equipment hire, both intended to make life comfortable and safer, respectively. The walker has been used and the recliner tried briefly only.
Also our kind neighbour Grant lent a shower seat and over-toilet seat with arms to assist in getting up. "Hospital in the home" by now, I guess you could say.
In the afternoon Chris, nurse from Home Based Palliative Care, came to formally admit Philip to their program. Philip was very unwell, in a lot of pain, muddled, needed a lot of the 'on request' pain reliever. She was quite shocked at his state. He had a fever, low blood oxygen saturation, fairly high blood pressure. She thought he would need a wheelchair soon and Level 4 personal care.
On Wednesday, Philip was quite chirpy in the morning - got up,showered, dressed and expressing the desire to 'go swimming' - i.e. sit in spa pool - at AIS. Philip finds he warmth of the water and weightlessness very soothing. However the TCH clinicians dissuaded him, apparently thinking he was in danger of drowning.(!). As the morning wore on he sagged and by the time nurse Narelle from HBPC arrived (you have to repeat the whole history and medication regime every time to each new person) he was asleep and couldn't be properly roused to respond to questions. She told me that he should be taking paracetamol with the opiates as they work synergistically. and gave me a few handy syringes to get up the liquid medicine. Also recommended an electrically-operated, hos[ital style bed.
Then Dr Ann Oxner from HBPC came and we repeated the history/medication story again while she typed it up with two fingers. She confirmed yesterday's readings of high fever, low blood oxygen and highish BP but didn't have access to recent blood tests. Also Philip was very confused, to a quite unusual degree. She was worried that he had an infection and thought hospital and IV antibiotics could be necessary so called for an ambulance.
To be continued... (I am going out now and this program doesn't auto save, so I will 'publish' this much.)
Saturday 23 April 2016
Post #22 - Sunday 24 April
The large box file is filling up with papers, the medication box is filling up with medicines and we are both getting cranky - Philip with pain which is proving very difficult to manage and me with fatigue and a peripheral neuropathy/arthritis flare-up in my hands.
For Philip, his three Friday activities - morning swim-cum-spa, walk to the shops with a friend visiting from Melbourne and then a visit to the GP to renew scripts - was over-ambitious and he paid for it in pain and exhaustion. It seems that Browning/Andrea del Sarto's advice, that "a man's reach should exceed his grasp", is not the way to go. (Who else remembers that poem from school days?)
On Friday night I tried to get the locum service CALMS only to get an engaged signal, while the National Home Doctor Service took our booking but later - after more phone calls - told me that the area doctor had closed his books, However Saturday morning I tried the National Home Doctor Service again and struck lucky: a doctor who locumed from Sydney at weekends and who had worked in palliative care and so was across pain management. He upped the baseline medication of Jurnista (morphine) and Lyrica (nerve blocker) to be supplemented p.r.n. by the liquid form of Jurnista, Diluaudid, popularly known as 'happy juice'.
Have updated the meds spreadsheet to show the new schedule, which includes an antibiotic for skin rash from Tarceva and.an antinausea tablet before meals (optimistically so called).
This doctor diagnosed the new nerve pain up and down Philip's right leg as coming from L4 and L5 vertebrae. We have yet to find out the significance of this. Will ring first thing on Tuesday to discuss it but it might need hard evidence in the form of imaging - not scheduled until 2 May - and then possibly more radiation??
We are getting quite an overview of the ACT medical system. So far the clinicians Philip has seen include: GP, consultant physician, hospital registrar, oncologist, pathology technician, radiographer, radiologist, pharmacist, nurse practitioners in pain management, cancer care coordination and palliative care and no doubt others which don't come immediately to mind. Luckily these are not 100% in their own little silos, there is an attempt at wholistic treatment. Unlike in the mental health area.
Our solar electricity installation is working well and today's sunshine powered clothes washing, dishwasher, ironing and blender. I intend registering interest in the new government-subsidised trial for battery storage as the installer we used for the PV panels is one of the three companies selected for the trial.
For Philip, his three Friday activities - morning swim-cum-spa, walk to the shops with a friend visiting from Melbourne and then a visit to the GP to renew scripts - was over-ambitious and he paid for it in pain and exhaustion. It seems that Browning/Andrea del Sarto's advice, that "a man's reach should exceed his grasp", is not the way to go. (Who else remembers that poem from school days?)
On Friday night I tried to get the locum service CALMS only to get an engaged signal, while the National Home Doctor Service took our booking but later - after more phone calls - told me that the area doctor had closed his books, However Saturday morning I tried the National Home Doctor Service again and struck lucky: a doctor who locumed from Sydney at weekends and who had worked in palliative care and so was across pain management. He upped the baseline medication of Jurnista (morphine) and Lyrica (nerve blocker) to be supplemented p.r.n. by the liquid form of Jurnista, Diluaudid, popularly known as 'happy juice'.
Have updated the meds spreadsheet to show the new schedule, which includes an antibiotic for skin rash from Tarceva and.an antinausea tablet before meals (optimistically so called).
This doctor diagnosed the new nerve pain up and down Philip's right leg as coming from L4 and L5 vertebrae. We have yet to find out the significance of this. Will ring first thing on Tuesday to discuss it but it might need hard evidence in the form of imaging - not scheduled until 2 May - and then possibly more radiation??
We are getting quite an overview of the ACT medical system. So far the clinicians Philip has seen include: GP, consultant physician, hospital registrar, oncologist, pathology technician, radiographer, radiologist, pharmacist, nurse practitioners in pain management, cancer care coordination and palliative care and no doubt others which don't come immediately to mind. Luckily these are not 100% in their own little silos, there is an attempt at wholistic treatment. Unlike in the mental health area.
Our solar electricity installation is working well and today's sunshine powered clothes washing, dishwasher, ironing and blender. I intend registering interest in the new government-subsidised trial for battery storage as the installer we used for the PV panels is one of the three companies selected for the trial.
Friday 22 April 2016
#21 - Diffficult decisions
I am shocked to see that the last post was written weeks ago The days fly by with meetings, phone calls, daily tasks and some personal time-consuming matters - .a medical for licence renewal and flu jab for myself, a Lung Education Day (3 speakers, all on relevant topics) and time spent helping Lisa get her out-of-order phone fixed and begin an NDIS application. My diary has lots of other potential fun activities which have all been crossed out!
Philip has now been to two Exercise Physiology sessions with the cancer group. Both of them ended with him being totally exhausted for the rest of the day and the day after. Hopefully he will learn to pace himself better and take more rests.
He was also taken to the AIS by a friend and had a relaxing time in the spa and 'a little bit' of swimming. He finds kicking in the water an easier way of exercising his legs than using a Theraband.
Jocelyn came down last weekend and was a huge help in talking through a future care plan for which Philip was earlier assessed by ACAT. She also rang around the various care providers in the ACT to find one which had a Level 3-4 package available. (Most have already been taken up so the service providers have only Level 1 and 2 packages left.) We struck lucky with Baptist Care who had just that morning resumed a few Level 3-4 packages as previous holders 'moved on'. Baptist Care apparently have quite a good reputation in the aged care area.
One of their reps came on Tuesday to discuss possibilities, then again yesterday to discuss the budget she had emailed through and to check the house for safety (for example, cytotoxic chemicals - anticancer meds - require rubber gloves for cleaning bathroom). The budget contained no information as to how the care plan would work in terms of actual services day to day but she has promised to give us a further document with all that info. It has been an exhaustive and exhausting process, with each meeting taking 2 1/2 hours.
Philip's lack of appetite continues to be a big problem. I have found that the NutriSip meal replacement drinks can be made more palatable by making smoothies with them, adding high protein milk, Sustagen, plain yogurt and banana to the strawberry one and concentrated coffee to the chocolate one. We have ordered a box of Endure which is similar but has a coffee flavoured option and hopefully is less sweet.
There are a few other things he can eat. But the fact that opioids zonk him out, plus continued back pain which requires him to lie down, means that he is not up and about but sleeping. Also Tarceva which he takes at night has to be taken on an empty stomach, so no nibbling after his evening meal.
A recliner chair and a wheelie-walker, both on loan from ACT Health, are to arrive on Tuesday. They will both be helpful, I believe.
On the pain-management front, his GP and the 'Queen of pain' nurse practitioner from TCH (and no, she doesn't wear black leather and wield a whip) are at war. His GP thinks Fentanyl patches are the way to go with Endone for breakthrough pain and Jurnista turns you into a zombie; while the TCH pain specialist says that Fentanyl does not work well if you don't have fat beneath your skin and they don't work anyway on (spinal) nerve pain which requires Lyrica. Philip does not seem to have done well with either regime.
However just this afternoon the pain management nurse practitioner in the Home Based Palliative Care program rang to arrange an appointment. I asked to postpone it for a few weeks until Regime #2 settled in, but with the subsequent news of Philip's GP's opposition, perhaps we will get this 3rd opinion by way of adjudication.
It would be marvellous to both have the pain managed and to have a degree of wakefulness in order to do things. Listen in to the next enthralling instalment ....
Philip has now been to two Exercise Physiology sessions with the cancer group. Both of them ended with him being totally exhausted for the rest of the day and the day after. Hopefully he will learn to pace himself better and take more rests.
He was also taken to the AIS by a friend and had a relaxing time in the spa and 'a little bit' of swimming. He finds kicking in the water an easier way of exercising his legs than using a Theraband.
Jocelyn came down last weekend and was a huge help in talking through a future care plan for which Philip was earlier assessed by ACAT. She also rang around the various care providers in the ACT to find one which had a Level 3-4 package available. (Most have already been taken up so the service providers have only Level 1 and 2 packages left.) We struck lucky with Baptist Care who had just that morning resumed a few Level 3-4 packages as previous holders 'moved on'. Baptist Care apparently have quite a good reputation in the aged care area.
One of their reps came on Tuesday to discuss possibilities, then again yesterday to discuss the budget she had emailed through and to check the house for safety (for example, cytotoxic chemicals - anticancer meds - require rubber gloves for cleaning bathroom). The budget contained no information as to how the care plan would work in terms of actual services day to day but she has promised to give us a further document with all that info. It has been an exhaustive and exhausting process, with each meeting taking 2 1/2 hours.
Philip's lack of appetite continues to be a big problem. I have found that the NutriSip meal replacement drinks can be made more palatable by making smoothies with them, adding high protein milk, Sustagen, plain yogurt and banana to the strawberry one and concentrated coffee to the chocolate one. We have ordered a box of Endure which is similar but has a coffee flavoured option and hopefully is less sweet.
There are a few other things he can eat. But the fact that opioids zonk him out, plus continued back pain which requires him to lie down, means that he is not up and about but sleeping. Also Tarceva which he takes at night has to be taken on an empty stomach, so no nibbling after his evening meal.
A recliner chair and a wheelie-walker, both on loan from ACT Health, are to arrive on Tuesday. They will both be helpful, I believe.
On the pain-management front, his GP and the 'Queen of pain' nurse practitioner from TCH (and no, she doesn't wear black leather and wield a whip) are at war. His GP thinks Fentanyl patches are the way to go with Endone for breakthrough pain and Jurnista turns you into a zombie; while the TCH pain specialist says that Fentanyl does not work well if you don't have fat beneath your skin and they don't work anyway on (spinal) nerve pain which requires Lyrica. Philip does not seem to have done well with either regime.
However just this afternoon the pain management nurse practitioner in the Home Based Palliative Care program rang to arrange an appointment. I asked to postpone it for a few weeks until Regime #2 settled in, but with the subsequent news of Philip's GP's opposition, perhaps we will get this 3rd opinion by way of adjudication.
It would be marvellous to both have the pain managed and to have a degree of wakefulness in order to do things. Listen in to the next enthralling instalment ....
Tuesday 12 April 2016
# 20 -- Big changes
Last Monday Philip had his first appointment at the Canberra Region Cancer Centre (at Canberra Hospital) since radiation treatment. While not as geographically convenient as Calvary Hospital it is a big improvement to get 'plugged into' the Oncology support services at TCH.
First he saw a registrar, Dr Bella, because Dr Ali is on leave. (My experience over many years in various hospital departments is that registrars have much better communication skills than specialists generally. Do they lose these skills as they progress up the career ladder?) She took an entirely different approach to Philip's pain management to that set up by his GP. She explained that his spinal pain was the major problem affecting his ECOG (performance, or wellness) rating, where Philip currently sits at 3 on the scale which goes from 0 (the best score) to 5 (where you are dead). So he needed a different medication which targets neurological pain.
Because his weight has dropped further to 56 kg (no appetite and feels nauseous so hasn't been eating) he is to take Maxolon to combat nausea. It is important to put on muscle not just by eating protein but by going to the cancer group exercise physiology class at UC.
He is continue to take the targeting the anti-cancer Tarceva at 100 mg and hopefully this will be upgraded to the more desirable dose of 150 mg later, depending on how it is tolerated. Bella was confident that it was working on the cancer as Philip "would be much worse" if it were not. This was very encouraging. He is to have another CT scan before the next appointment on 11 May.
At the end of the consultation I asked about his anaemia, Bella said it was much improved with a 112 haemoglobin level (was under 80 in Jan/Feb) and an improved blood cell size or 80 (was 67). I am not sure how these figures compare with normal levels but any improvement is welcome.
-------------------
We were unable to meet Nicole Taylor, the lung cancer nurse practitioner who, Dr Bella told us "will become Philip's best friend" but we did meet with Anne Booms, a nurse practitioner who, Bella told us, is "the queen of pain". She is a personable woman with a European attitude to personal space (i.e. she gets up very close) but one soon gets used to that. Her aim is to give patients better quality and better quantity of life.
She explained that the Fentanyl pain patch was doing nothing for the spinal (nerve) pain and was not working as well as it might because it needs fat for uptake (and Philip hasn't got any fat). Also it is best for stable pain but not for variable pain. A morphine-based medication is better, also because it works on the lungs (breathing and cough, if any.) So she recomended Jurnista (one-a-day tablet) supplemented by Dilaudid (hydromorphone hydrochloride) liquid for any breakthrough pain.
Specifically for the spinal (neurological) pain, Lyrica (one capsule at night) works better than an opioid. If this pain can be got under control he might be able to cut down on the opioid. It takes 3-5 days to work, however. Anne promised to phone every day to see how things were going.
Anne has put Philip on the books for the Palliative Care Home Team doctors. They will organise a recliner chair (relieves pressure on the spine) and possibly a shower seat. We have yet to find out if they will call us or we call them.
At the end of these two sessions Philip was too whacked to go to the cancer group Exercise Physiology class at UC but will begin today Wednesday. It is two days p.w. I know Kellie (who runs it) through her previous involvement with Lungs in Action and she will be very good, I think.
Today Philip is much better than yesterday when he could only sleep through the day and hardly ate a mouthful. But he has eaten an egg, some fruit, half a bottle of Fortisip and some macaroni cheese so far today and this is the biggest intake for some time. He seems to be able to get down soup easily so I am making that in industrial quantities. If his nausea is controlled then he should be able to eat more.
So some good news, and some signs of improvement. Will keep you posted, as the phrase goes.
Maureen
First he saw a registrar, Dr Bella, because Dr Ali is on leave. (My experience over many years in various hospital departments is that registrars have much better communication skills than specialists generally. Do they lose these skills as they progress up the career ladder?) She took an entirely different approach to Philip's pain management to that set up by his GP. She explained that his spinal pain was the major problem affecting his ECOG (performance, or wellness) rating, where Philip currently sits at 3 on the scale which goes from 0 (the best score) to 5 (where you are dead). So he needed a different medication which targets neurological pain.
Because his weight has dropped further to 56 kg (no appetite and feels nauseous so hasn't been eating) he is to take Maxolon to combat nausea. It is important to put on muscle not just by eating protein but by going to the cancer group exercise physiology class at UC.
He is continue to take the targeting the anti-cancer Tarceva at 100 mg and hopefully this will be upgraded to the more desirable dose of 150 mg later, depending on how it is tolerated. Bella was confident that it was working on the cancer as Philip "would be much worse" if it were not. This was very encouraging. He is to have another CT scan before the next appointment on 11 May.
At the end of the consultation I asked about his anaemia, Bella said it was much improved with a 112 haemoglobin level (was under 80 in Jan/Feb) and an improved blood cell size or 80 (was 67). I am not sure how these figures compare with normal levels but any improvement is welcome.
-------------------
We were unable to meet Nicole Taylor, the lung cancer nurse practitioner who, Dr Bella told us "will become Philip's best friend" but we did meet with Anne Booms, a nurse practitioner who, Bella told us, is "the queen of pain". She is a personable woman with a European attitude to personal space (i.e. she gets up very close) but one soon gets used to that. Her aim is to give patients better quality and better quantity of life.
She explained that the Fentanyl pain patch was doing nothing for the spinal (nerve) pain and was not working as well as it might because it needs fat for uptake (and Philip hasn't got any fat). Also it is best for stable pain but not for variable pain. A morphine-based medication is better, also because it works on the lungs (breathing and cough, if any.) So she recomended Jurnista (one-a-day tablet) supplemented by Dilaudid (hydromorphone hydrochloride) liquid for any breakthrough pain.
Specifically for the spinal (neurological) pain, Lyrica (one capsule at night) works better than an opioid. If this pain can be got under control he might be able to cut down on the opioid. It takes 3-5 days to work, however. Anne promised to phone every day to see how things were going.
Anne has put Philip on the books for the Palliative Care Home Team doctors. They will organise a recliner chair (relieves pressure on the spine) and possibly a shower seat. We have yet to find out if they will call us or we call them.
At the end of these two sessions Philip was too whacked to go to the cancer group Exercise Physiology class at UC but will begin today Wednesday. It is two days p.w. I know Kellie (who runs it) through her previous involvement with Lungs in Action and she will be very good, I think.
Today Philip is much better than yesterday when he could only sleep through the day and hardly ate a mouthful. But he has eaten an egg, some fruit, half a bottle of Fortisip and some macaroni cheese so far today and this is the biggest intake for some time. He seems to be able to get down soup easily so I am making that in industrial quantities. If his nausea is controlled then he should be able to eat more.
So some good news, and some signs of improvement. Will keep you posted, as the phrase goes.
Maureen
Tuesday 5 April 2016
#19 - The topography changes
The Big Dipper has been replaced by the Steep Learning Curve. It seems that one should ideally be young and on top of one's game to master this growing old business. There is sooo much to learn and it requires a degree of physical stamina as well.
Yesterday the morning was spent having an at-home ACAT (Aged Care Assessment) which is necessary before any form of home help can be accessed. It seems that you are assessed at Level 1,2 3 or 4 of need and then get a 'self-directed' support package -which essentially, I believe, means a monetary allowance - from which you pay a care provider a fortnightly or monthly admin fee plus service fee. It is up to you to ring around to find a care provider who has a package available. This, as with ATMs and petrol stations and self-service checkouts at the supermarket, is supposed to give you control by having you do the work of people who once would have been paid to do it.
In the afternoon Philip had another long assessment at the University of Canberra Exercise Physiology area, which has student-led clinics - they work under supervision of course - in specialist disease areas. I have been going to the lung group for some years, Philip will attend a cancer group and there are other groups including bone strength, heart and neurological conditions. It is hoped that Philip will be able to improve his mobility, strength and balance by following an individualised gym program. It should also act as an informal support group although we do not know if there will be other class members with the non-small cell adenocarcinoma that Philip has.
The afternoon was capped off with a visit to hospital pathology for blood testing ahead of his appointment with oncologist Dr Ali on Monday.
We both came home exhausted and Philip slept through until 11.50 am today when I came home from table tennis and woke him. He is sleeping a lot of the time, most likely due to the high dose of his pain-relief opioids. We are of course keen to know whether the cancer-targeting drug is having an effect and hopefully Dr Ali will order another scan next week.
Thank you all, dear friends, for your best wishes and assistance.
Maureen
Yesterday the morning was spent having an at-home ACAT (Aged Care Assessment) which is necessary before any form of home help can be accessed. It seems that you are assessed at Level 1,2 3 or 4 of need and then get a 'self-directed' support package -which essentially, I believe, means a monetary allowance - from which you pay a care provider a fortnightly or monthly admin fee plus service fee. It is up to you to ring around to find a care provider who has a package available. This, as with ATMs and petrol stations and self-service checkouts at the supermarket, is supposed to give you control by having you do the work of people who once would have been paid to do it.
In the afternoon Philip had another long assessment at the University of Canberra Exercise Physiology area, which has student-led clinics - they work under supervision of course - in specialist disease areas. I have been going to the lung group for some years, Philip will attend a cancer group and there are other groups including bone strength, heart and neurological conditions. It is hoped that Philip will be able to improve his mobility, strength and balance by following an individualised gym program. It should also act as an informal support group although we do not know if there will be other class members with the non-small cell adenocarcinoma that Philip has.
The afternoon was capped off with a visit to hospital pathology for blood testing ahead of his appointment with oncologist Dr Ali on Monday.
We both came home exhausted and Philip slept through until 11.50 am today when I came home from table tennis and woke him. He is sleeping a lot of the time, most likely due to the high dose of his pain-relief opioids. We are of course keen to know whether the cancer-targeting drug is having an effect and hopefully Dr Ali will order another scan next week.
Thank you all, dear friends, for your best wishes and assistance.
Maureen
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