Being a vampire has come a long way since the days of Nosferatu. I spent Tuesday afternoon receiving two units of blood at the BC Cancer Agency. Two elderly vamps and I sat in reclining chairs in a room with an en suite, regular nurse checkups, hot blankets and lunch provided.  I was astonished to find that it takes around four and a half hours to get the full transfusion.
 
I finished the series of five radiotherapy treatments of my right hip on Monday this week. The treatments went without any hitches and caused minimal discomfort. Now, I have my fingers crossed that both these and the abdominal radiotherapy treatments did the trick and knocked the tumours back! I am still getting pain from my right hip but am hoping that this is a result of the treatment rather than the tumour.
 
On reporting my very low energy to my radiation oncologist after the last treatment (I'd almost passed out after walking about half a mile last Sunday!) he tracked down my blood samples to announce that my haemoglobin count was 84. I'm not sure of the units, but he maintained that normal was around 150 and that he tended to give transfusions at 100! Meanwhile, I've also lost about 15 lbs. and weighed in at 128lbs. today. I suspect this has largely been the result of my pain management plan and the mix of drugs I've been taking. I hope I can pick up on this lesson and track my own indicators more thoroughly, though have yet to understand why I was not offered a transfusion when I was back in hospital.
 
Yesterday, after another night taking rather too much morphine to control hip pain (not an entirely unpleasant experience - but a bit unsustainable), I spent an hour or so with the amazing pain management doctors at the cancer agency. They have changed my whole regime again. I'm now using a morphine slow release patch (ratio-fentanyl 25mcg/hr) for general pain control, 2mg hydromorphone tabs, for breakthrough pain and injectable sufentanil under my tongue if the pain comes on quickly.  While I was suspicious of the regime and any change at first, I now recognize that these people really know what they're doing. My nausea is disappearing, my appetite returning and with all that blood, I have more energy too. This is of course all relative, I was in a pretty rough state, and I'm still sleeping a lot but feeling so much better.
 
I've talked to my doctor in Edmonton and have now confirmed officially that I am no longer eligible for MIBG treatment on two grounds. First and foremost, they recorded tumour progression after the past two treatments and usually terminate the treatment after just one observation of growth. They apparently gave me the benefit of the doubt with the first in the hope that it might turn around. Also, as I had suspected, my blood counts are way too low for such an intrusive treatment, possibly the result of damaged bone marrow.
 
This means that the landscape has changed considerably. I can expect radiotherapy to tackle pain where I experience it and have started looking at chemotherapy options with my medical oncologist today. None of the traditional chemo looks particularly inviting but a new (perhaps still experimental) type of epigenetic treatment using tyrosine kinase inhibitors may offer some hope. I will write more as I explore my options.
 
I heard that some of you couldn't see some of the recent postings at http://viewcourt.vcn.bc.ca/peter so I'm listing the most recent three below. Let me know if any of these are missing from your view of the main page and I'll try to sort the problem out:
 
New Instability (image of water drop splash) Dec. 22
http://viewcourt.vcn.bc.ca/peter/medicalized-life/new-instability#uthzA38cBpfcAx1uEqc4hA
 
Home again (poppy field and US contractor) Dec 13
http://viewcourt.vcn.bc.ca/peter/medicalized-life/home-again2#Usoyw50sLdfxTU58vzdaLA
 
A vacation week at Vancouver General Hospital (VGH) (blood cells) Dec 9
http://viewcourt.vcn.bc.ca/peter/medicalized-life/a-vacation-week-at-vancouver-general-hospital-vgh#A_JkP60f4zbGNNTkR_uIeQ