This week I went for one of my follow up appointments that I’ve had every 4 to 6 months for the last 11 and a bit years. On moving to London, I deliberately asked my gp to refer me to Guy’s to a specialist clinic for people with familial melanoma as my brother Paul received a good service when he was their patient. I used to oddly enjoy going, throughout medical school and especially whilst working, it gave me a chance to take sick leave without the drawback of being unwell. I’d always go to Borough market beforehand usually getting the “mothership” deal at PieMinister. Then wait for the consultant very content due to a ball of pie, mash, mushy peas, bacon flakes and gravy pleasing the insides. Then after waiting a while, to be reminded that I was free of secondary cancer plus a chance to review all my moles. Whilst going through the pictures of my whole body playing a game of spot the difference, more times than you’d expect I’d have the same boxers on. I’d stand there wondering if they think I ever change. Due to this thorough check up over the years I’ve got to know my consultants well and vise versa.

This appointment was very different they knew my story from letters from the Marsden and they’d discussed me in their MDT meeting*. So I summarised where I was at. The consultant and specialist skin nurse were very empathetic with a look of just quite how sorry they both were for me. They also looked a bit helpless after all the years of follow up we had collectively failed to find anything early. But as melanoma is so aggressive I guess this happens a reasonable amount. The consultant checked my skin for anything new and that was it, we both agreed it was pretty pointless checking lymph nodes and an abdominal examination. She offered a second opinion with their oncologists if I ever need one and a psychotherapist, but I politely declined. I’ve seen two psychotherapists now who both offered good advice and felt I was dealing with the diagnosis as well as could be expected.
Overall it made me nostalgic for what it used to be like.

*multi disciplinary team meeting it’s a broad term from a meeting with the therapists, nurses and doctors on a elderly care ward wondering how on earth we’d be able to get the long stayers safely discharged. To a cancer MDT where in my case dermatologists, oncologists, pathologists, radiologists, specialist skin nurses and a variety of others all meet, to discuss cases. It’s actually not a well advertised process that the NHS does, and it does it well, with many patients seemingly unaware that they’ve been discussed at such a meeting. As you’d expect this level of expert input improves outcome and standards.

So If you’ve been following this blog, you’ll know my first request after diagnosis was to go to good old Leicester. Well I’m a Leicesterophile if there was ever such a thing. It despite it’s reputation is an alright place to look at if you’re being very selective about where you go. I stayed near New Walk, in the Silver Fox’s flat,  a pedestrian only walk way that bisects most of the southern part of the city centre. It’s by far the nicest part of an otherwise grey city centre. What Leicester has is familiarity, I’d be able to advise anyone on a great day out, as after 6 years you really know a small place like that. 

I invited myelf up to talk at Leicester university because LUSUMA (the medical society) had done some fundraising for me and I thought it would be nice to put a face to a name instead of just being that sick guy. I was late for my speech, well I guess the speech can’t be late as my attendance was vital, but a delayed start. This is completely due to my Norfolk friend. He had over slept from his nightshift, overslept is harsh as he’d only had 3 hours sleep. But he was due to pick me up at 2 pm . I arrived at his flat, with him shouting at me, because he thought a delivery driver had woken him up, I was in my stig style scooter helmet*. I was put on to his insurance with the idea that I’d drive up whilst he slept. But to be honest I was too angry. I hate being late plus the embarrassment of delaying my own talk.

The talk went down very well, like any speech that I’ll do I asked a couple of people to critique it first. Albeit I started too quickly because I was flustered, but as soon as I clicked to slides I had practiced a lot I got into full flow. The general consensus it was informative, poignant and humorous in that order. My summary slide which said “I have stage 4 cancer –> the worst stage. I have the worst type of cancer” caused a very quiet stir across the room. After the talk we went to two bars in the second joining the final years celebrating having just finished their last medical school exams. A lot of people came up and thanked me for the talk, unfortunately I offended a couple who insisted I new them, but it had been a while! We took the opportunity to go to the union and had a great night.

 The next day a contingent of us al got our hair cut together with my old barbers (men’s haircutters on London road), the barber insisted instead of paying to donate to the cause. This was followed by Blaby mini golf cheeky hole in one by both me and my former emo friend, then meal at Chutney Ivy. On the Sunday, brunch at bar dos and a coffee and fingerprints then home. I’ve listed everywhere as they’ll some of the best things to do in Leceister but please add the National Space Centre and Bradgate park to that list. 

 *I now drive a 2005 Vespa something which surprises some people more than my diagnosis.

I realised I haven’t actually said much about my health for a while. So here’s an update. Since starting dabrafenib I’ve improved a lot, I now look and feel better than I did the whole of February albeit I was pretty well and was able to run ten miles. My only symptom at the moment is perhaps fatigue, but this may be secondary to the lethargy of being out of work, the drug, the disease or most likely a combination of all three. In the last three weeks I’ve cycled 25 miles and walked eight only yesterday in Dartmoor. So I’m well. I’m not on any painkillers and the cough has stopped. At my last appointment the LDH was still in normal range (reminder: the marker of disease activity) , and my liver function was normal apart from a gamma GT which was continuing to slowly fall. I was concerned about being so honest about how well I am, because work might want me back, but speaking to most people from work and elsewhere they think I’m mad even considering it. I’ve got a CT next week with the results soon after. Here’s my plan, the CT is very likely to have show a good response, I say likely as medicine doesn’t always make sense, then I’ll go back to work. Personally I don’t and didn’t want to go back if the treatment was going to change sooner rather than later, which would be the case if the CT doesn’t show an adequate response. 

The bucket list is well and truly underway, from Sunday to Wednesday last week I went with my parents to Luxembourg.  Luxembourg is one of Europe’s smallest countries and is known primarily for corporate tax avoidance, with many of the worlds largest corporations situated there not for its central location. Having been to now 27 European countries here’s my trip advisor style review of the country. 

It’s capital is a lovely city built on hills two of which are sites of old forts. It’s a very fortified city with old battlements everywhere. The hills also create an upper and lower city, the lower part, built in the valley, has a village feel albeit with plenty of bridges above it. The modern part with the European Commission  mixes well with the old fort its build above. 

It’s a good place to walk around, it’s wealth comes with nice cafes and good restaurants albeit at a slightly elevated price. What it lacks is a certain edgy feel, it’s almost too pristine. It reminds me mostly of Gothenburg (Sweden) where it’s own perfection is its downfall but well worth a visit if you’re going past and would be a lovely place to visit. Order the local dishes at your own risk, I went for the bed of dumplings with pork on top. This was a base of tasteless soggy dumplings with pork scratchings on top. 

This leads me nicely in talking about a city which has it all, Budapest. I’m adding in this because it’s my favourite European city. Narrowly beating Barcelona, Prague and Tallinn. What it has is a self confidence that Prague doesn’t have. By this I am talking about the contrast between the British Olympic ceremony and the Chinese where both were great spectacles in their own right,but the British had its own character so what if we used an Eastenders reference. I digress but Budapest and the feeling it’s been cool for years and hasn’t been imported like Prague. The bars and clubs are attended primarily by Hungarians as opposed to Prague they seemed to have been built primarily to get tourists in. No where is this more apparent than Riga (capital of Latvia) which is becoming a stag location where clubs are full of strippers and foreigners have to pay more. You don’t get any of this rubbish in Budapest. 

Next stop Malta.

I was lucky to receive a lot of books, guessing people thought I’d be bored in hospital. I’m planning to read all of them, I decided to start with Mortality by Christopher Hitchens. The reason I chose to start with it, was the sheer directness of the title. The person who gave it to me said, and my opiate awash mind struggled to make perfect memories, something like he couldn’t think of a more appropriate book!

I’ve read a similar book Tuesdays with Morrie, which is about an old lecturer and general advice giver who is near death and one of his former students sits with him every Tuesday, it’s much more of a chronological narrative than Hitchen’s book. Mortality is more a collection of essays from a formidable writer, which I confess I’ve never read any of his books. He’s a staunch atheist and many religious zealots said his throat cancer was a consequence  of his blasphemy I.e. To stop him speak. His view on religion is very strong nor did he recant and become a Christian prior to his demise, making the point if there is an omnipresent God surely it wouldn’t be fooled by such an act. Personally if anyone wants to pray for this agnostic please go ahead. Although I do find it hard to rationalise why a God would take a doctor down when he’s only begun to save lives.

I found the personal side more interesting, I remember a SpR in A&E saying to me once “I never cry at work but 24 hours in A&E always gets to me”. His wife who writes the “afterword” that he was boyishly hopeful throughout his disease and he would be in the minority who would be cured, losing his more rational mind. I flit between being hopeful as treatment has started very well, to then fearing I’ve  forgotten I’m seriously unwell.

In one chapter Hitchen’s says everyone can be a writer as long as they’ve learnt to speak. His argument as far as I could see he felt many people don’t say anything interesting just a lot of stock phrases. On that bombshell I’ll conclude. His aim is always to write as if he’s directly talking at the reader and he succeeds.

As many of you know my life increasing/enhancing medication dabrafenib comes with some issues especially when you’re as anal as me about taking it. I take it twice a day at ten, this is because you can’t eat for two hours before taking it and an hour after. This works perfectly in the morning, I have breakfast and depending how I’m feeling go back to bed. In the evening it has proved a more troublesome, especially as I’m eating out more than ever, those three thousand calories don’t consume themselves. Early on I had to wait until half twelve, because some after dinner chocolates were on the table at home and I picked at them (old habits die hard).

After the long journey to Luxembourg on Sunday we arrived in the hotel pretty late. Tired from the journey I was eager to not wait up. We were recommended a nice Greek restaurant around the corner. Whilst sitting down I knew my mum would be eagerly searching for anything the menu without tomatoes, as soon as the waiter arrived I broke rank, left her deciding, and politely asked the waitress for a moussaka. Then directed her to go to the kitchen straight away to ask for it. I hastily explained that there was a good reason for this, but her judging eyes turned this conscientious 27 year old patient into a hungry obstinate teenager.

Considering I felt better after just two doses, I shouldn’t complain.

It’s now been one month  exactly since waking up in an adult hospital bed for the first time. It’s been quite a journey thus far. I’ve raised £30000, a picture of me has been ‘liked’ 25000 times on Facebook, I’ve spoken at Westminster abbey, flown in a plane, been woken up by a strange very well groomed man in a tuxedo, had a surprise birthday on a Monday night in a small pub in London with around 40 guests, been interviewed by the BBC, eaten out more times than I can count. I’ve had countless messages from well wishers and when I said I wanted to see everybody I’ve got pretty close already. I’ve had endless and brilliant support from my close friends, been given loads of stuff even a miniature heroes bouquet*. I’d love to note every present and thank everyone of you, but the list would be too long but please please be aware I’m grateful for everything. Lastly thanks to my family who are fantastic. The support really has been truly overwhelming and vitally exceptional.

So here comes my first piece of advice. I’ve never really been one for giving advice, apart from in a work based context, in gp (as an fy2) was the first time really I was pushed into giving life advice as opposed to medical advice that I’m more comfortable with. It ranged from very simple “should I take time off after my partner has died?” Well yes, to “should I quit my degree and return to Sweden?”. Without going off on a tangent, but this shows how difficult being a gp is, it ranges from being a life coach to being expected to know how Pembrolizumab works.

The advice is this. Be friendly.

This piece of advice moves onto the next make friends. Everyone is your friend until proven otherwise. I’ll try and explain. Everyone knows that person who goes to work and for them work is work, their colleagues and their social life remain steadfastly separate. I’ve never understood this if you’ve got mates at work, where unfortunately you spend most of your life, then works a lot more enjoyable. Also this “work is work” approach in the most boring sense isn’t very practical. Working in the NHS it can be difficult to get things done with each team and different health care professionals having their own agenda. If it’s your mate on the end of the phone it’s much harder for them to say no.

Lastly keep your friends. I sometimes feel this is easier as a man because you can not see someone for two years and no one is any the wiser, after all we forget birthdays and anniversaries so we don’t notice anything as boring as time. No one should be beyond reconciliation (unless they’re completely resistant). Every family seems to have some petty feud and when you hear a story from both sides I usually can’t decide who’s in the wrong, but even if someone is in the wrong…. Who cares, it’s petty get over it.

I say this because you have no idea what is going to happen to you in life. Everything I listed above only happened because of you (my friends). When life gives you lemons you’ll be very surprised by how great your colleagues, friends and family are at making life a lot sweeter.

*I’ve just realised that I still couldn’t spell bouquet despite looking the spelling up when I posted it on Facebook. I infamously once asked “what’s the french for crepe?” Whilst on a ski holiday… What I meant to say was “how do you ask for crepe in french?” I.e. I wanted the whole sentence. Before you ask we did German at school. Before you ask again, I was rubbish at that too.

Thanks to my friend Matt who is a teacher at Westminster School, I was invited to speak at their Abbey talk which happens twice a week. Basically a whole school assembly but with the added prestige of having them in Westminster Abbey. This is far removed from my school’s once yearly whole school assembly because it was logistically too difficult as the assembly hall wasn’t big enough for everyone to get in to. Then when we did it was in this sports hall and we all had to sit cross legged.

Thanks to Matt I’ve come accustomed to the Westminster atmosphere so I wasn’t too intimidated. When someone is invited to speak, they have to check it for quality and appropriateness prior to you speaking. I’m not sure what some of their more famous speakers think of this, for example the head of the Bank of England. However this suited me because quite simply my first speech didn’t hit the mark, too full of jargon and very grandiose. Fortunately one of the two reviewers, the chaplain of the school and organiser of the Abbey talk was perfectly happy to criticise it. A weird byproduct of being a “Cancer Patient” is that no one wants to offend you at any time. This has it’s benefits because it’s nice to go through life uncriticised but then again I’m quite thick skinned and will take on valid feedback. It’ll be weird if this follows me into the workplace, “Dr Sims you have appeared to prescribed ten times too much insulin”, I cough pathetically and melodramatically.  “oh actually it doesn’t matter. I’ll just change it this time”. Therefore he told me to keep it much more personal and keep the message simple.

On arriving in the Abbey the chaplain went through a quick dress rehearsal. Unlike John Cabot CTC sports hall, there’s places you can’t walk due to their value, such as the 800 year old mosaic which makes up most of the stage, so the etiquette is to creep around the edge. Then like most church services there’s specific times you’re supposed to stand and sit down…. I almost never go to church. Further to this on the podium he got  me to recite certain parts of my speech.

Me: My name is Mark Sims and I was diagnosed with skin cancer in 2003

Chaplain: I’ll stop you there, their is a D in thousand please remember this

This went in for about ten minutes or so. The other tips he gave me only pause on punctuation and sound more conversational. To be honest whilst this was going on I started to wonder what I had signed up for. Nevertheless his quick speech lesson made a lot of difference and I’ll take on his advice in the future. The speech went down very well with Matt passing on an email from one of his pupils saying how good they thought it was. Furthermore the chaplain emailed me afterwards and told me that it was only the second time since he started working at the school, 12 years ago, that their has been a spontaneous round of applause after a speaker. I made a couple of mistakes throughout the assembly I went to sit down whilst everyone was standing twice at the beginning and on the way out.

The full speech, unfortunately it didn’t seem appropriate to film the talk. But thankfully my parents, Dave, Matt, Alice and Bex were all there to bear witness.

“My name is Mark Sims and I was diagnosed with skin cancer in 2003. I never used to care much about my hair as much as I do now, it was always just a short back and sides. I went to the barbers and using the clippers he hit a lump just above my ear. Thankfully I went home and tried and tried looking at this thing in the mirror. Fortunately my Mum came in from shopping  and she  wondered why I was having a twisty head fit in front on the mirror. We went to gp and two weeks later the tumour was excised and I was diagnosed with malignant melanoma the nastiest of all the skin cancers.

This changed my life, I had an older brother going to medical school and thought well if he can do it so can I. I had a thirst to know much more about my disease for self preservation as well as to help others with in the same situation.

I stand here today, because the cancer came back.  Six days before my 27th birthday,  on pancake day, I like most of the country was sat eating Nutella soaked pancakes. Guilt free as I’d run ten miles just two days before. Whilst in chocolate and hazel nut heaven, a pain started in the right side of my abdomen, despite co codamol the pain just kept getting worse. By the morning I could barely walk, being a belligerent doctor I refused to go straight to A&E despite my flat mates best advice. After all I want to be an A&E consultant, I insisted on going to my GP first. I walked to gp got an appointment and went back at 9.20 both times I was getting weird looks from passersby. The gp took one look at me and phoned an ambulance. Both of us thinking I had an infection of my gallbladder. I saw the consultant after twenty minutes on arriving at A&E. You’ve got to get some perks from working in the NHS. He started me on antibiotics and a surgical doctor organised an X-ray, ultrasound and CT scan. Quickly things weren’t adding up the X-ray was strange, the ultrasound didn’t make sense, the CT scan of the whole body put things into perspective. The cause of my pain was tumours stretching my liver. Tumours that had taken 12 years to nestle there.

By the weekend I was transferred to the royal Marsden hospital. I Had a biopsy of my liver on my birthday and started of dabrafenib. Definitely the best present I’ve ever got. It’s a modern chemotherapy targeted  to attack  my tumours without many side effects. There’s two other treatments out there that may just give me a cure.

After an awful night where I vomited over ten times I woke up and poured my heart out on a just giving page. I raised £5000 in five hours, my Facebook went wild. I’ve now raised £27000 for cancer research uk in just three weeks.  This is something I always wanted to do, but never got round to, but as I felt so bad that day it focussed the mind. This is money for the future, for the other 27 year olds struck down in their prime. This money is to honour those who gave their time researching these therapies which are giving me life, as well most importantly honouring those patients who over the last 12 years went into the drug trials. Some whom would have died so that I could live.

£27000 will fund most of a PhD, it was a PhD students project in 1994 which started the research for one of the curative therapies, ipilimumab, I’m due to have. This money will go to these projects. Potentially funding one of your PhDs in the future. Some of you here today will be the scientists and doctors of the future. I ask you to remember me stood here in front of you. I ask you to remember that there is still a race to be won.

Medicine is incredibly full of jargon, and I’m going through “biographical disruption”. This is the term for when someone’s personal narrative has changed. Ask Mr Bradshaw, who’s one of my closest friends, I’m a uncomplicated man, who’s life is now very complicated. Where only a month ago I was thinking, like many doctors at my stage of what to do next. Now my life is uncertain I’m advised against drinking alcohol which I enjoyed in moderation, I don’t know if I’ll be fit enough to carry on with skiing and squash. Can I start dating again? Surrly it would make a pretty awkward first date… “Erm so you might die in 18 months?”.

So  we now have the methods to thoroughly learn about cancers, all we need now is the money and great minds like those I see around the room to beat cancer sooner.”

 

Are you not entertained?

 

 

 

 

 

 

I was filmed for the BBC yesterday for a documentary that doesn’t yet have a release date. I’m not 100% sure how much I’m allowed to say about the programme so I’ll keep it exceptionally brief. However the presenter and interviewer has a terminal prognosis and they had just finished the upteenth cycle of chemotherapy. This is in part why there’s no release date because it’s finding time for them to film mid cycles. They’re also young like me.  

What I took most away from the chat yesterday, is that the presenter, after 1 year of fighting the disease, had come to acceptance. The show is planning some very outlandish things to show this, and when this was mentioned it really hit home that I had a long way to go on the road before I’d doing anything like that. I realised yesterday the diagnosis and it’s affect on me is far far too raw. Only this weekend I started to think what does it actually mean to me. Anyone who has seen me over the last few days has been subject to me discussing this. The trigger was the realisation that I can’t drink alcohol as GSK advise it may interfere with the Dabrafenib. This probably isn’t known but would you take the risk!?

Then I was thinking how can I date anyone, “so what do you do?” “erm well I have stage 4 cancer”, it’s hardly flirting. Talking yesterday with the presenter this seems to be a harsh reality that they went through. It’s also a reality I don’t think Brits talk about. I’ve never really been one for planning, happy to go with the ebbs and flows of life, but this is ridiculous. 

 The title again is a bit nerdy, it stands for Denial, Anger, Bargaining, Depression and Acceptance. I could never remember all five in an exam. It’s the Kubler-Ross five stages of grief, which can happen in any order. For me it would be interesting to meet other doctors in the same position, but I personally feel our profession denies us the chance to be in denial (repetition intended). From the glimmer of the clinical nurse specialist in dermatology badge I’d made the diagnosis, made my own prognosis and had my own ideas about treatment. Fortunately I only knew about BRAF inhibitors, the monoclonals (pembrolizumab/ipilimumab) were new to me and their efficacy was pleasantly (understatement of the century) surprising.

We didn’t discuss anger yesterday, the show wasn’t about grief at all but our emotions were definitely the elephant in the room. I can’t really see myself getting angry, but I may, I’m sure people do. I guess I’m annoyed at how unfair it is, but I’m not angry at anyone else. 

It could be very easy to get depressed, talking to the presenter it seemed that they’d had a few low points but they’d carried on through this stage, not allowing themselves to be bogged down in it because they are a very driven person. I guess I’m in the same boat, at least I hope. I’m not sure how much time I have I don’t want to spend it all in bed. 

Again almost by mistake we talked about bargaining and it was basically listing more and more outrageous people we’d have sex with for a cure. 

I’m not really sure how I’ll get to acceptance when I don’t know what it is I need to accept. Do I need to accept; the end? A reduced quality of life? Or an adjustment to my career? Some weird side effect in return for a cure? The day was very successful firstly it was enjoyable and interesting being on TV, better than last time which involved waving outrageously at the commonwealth games whilst Usain Bolt was doing a lap of honour. We spent two hours the next day to see ourselves on iplayer only to realise we’d been cut out of the highlights. Secondly and actually more importantly it gave me an insight into another cancer patient’s journey to acceptance, one day hopefully I’ll get there.

Additional point:

 They also said the line “I proved the doctors wrong when they said I’d be dead within…” a line which I’ve always disliked as a doctor and I like even less now, quite simply it sounds too negative. The Prof wants me to respond to treatment very well* but when he’s given me any idea of prognosis it’s his best guess from all the papers he’s surely written and read and the patients who’ve been under his care. It’s a guess that is there to be helpful, it empowers people to use what time they have left in the best way that they please. 

 *they’re are signs that this may be the case my LDH (lactate dehydrogenase) a measure of cancer activity has fallen from 1234 on admission to 171 which is now normal

As a doctor I’ve prescribed a lot of drugs but what’s it like to actually take them. Here’s the list and my opinions on all of them – completely unfounded as I was taking so many all at once so really I have no idea.

Non opioid painkillers

• Ibuprofen
• Paracetamol – IV is a lot better
• Paracoxib – a cox 2 inhibitor (read super ibuprofen) worked very well but was discontinued by the Marsden

Anti emetics (anti sickness

• Levomepromazine – the antiemetic which works on every receptor works to stop you being sick, but subcut knocked me out for 12 hours, fell asleep with the light shining in my eyes. Received some in my TTO should be prescribed as an anti insomniac
• Cyclizine – orally didn’t do much, subcut worked but I was told it stung on the way in, literally took my epidermis (top layer of skin) which is still healing today. I finally have non allergy to annoy doctors when I’m next in hospital. (What I’m describing is an intolerance to a medication not an allergy… Point on this once a patient told me they were allergic to caffeine… I asked her what happens “well my heart beats faster, I feel anxious and I can’t sleep”)
• Ondansetron given IV and oral – works well but constipating
• Metoclopramide – the best but at beginning didn’t work much. The point was I was given a little bit of all of the anti emetics but not a decent dose of any, so they put the meticlopramide into the syringe driver (which I flooded)

Miscellaneous 

• Pregabalin (for weird pain)- seemed to work moderately well at reducing my shoulder tip pain*
• Dexamethasone (strong steroid) – taken from liver capsule pain worked really well, definitely wakes you up in the morning
• SandoK (potassium replacement) – tastes crap eat a banana instead

Opiates (to give you an idea heroine is an opiate)

• Oramorph (oral morphine) – works slowly tastes nice
• Morphine IV – could definitely and worryingly see why people abuse it, with enough of it you don’t care about pain then when you get past that point you literally don’t care about anything
• Fentanyl IV – given when having the liver biopsy – as above but fast really fast. Worked though, while I was being stabbed in the liver I didn’t give a damn.
• Fentanyl patches – good but annoying can’t have hot showers as they increase the speed of release, all these things you never find out as a doctor.

The laxatives 

• Lactulose – tastes rubbish does nothing
• Laxido – 6 satchels in a jug and you’re away
• Senna – keeps you ticking over
• Glycerol suppository – just doesn’t do the job
• Phosphate enema – need I say more

Anti cancer drugs

• Dabrafenib – the braf inhibitor and the biggest pain reliever as it is hopefully attacking the cause of the pain.

Antibiotics

• Amoxicillin – part of the Kingston protocol for acute cholecystitis (infection of gallbladder)
• Gentamicin – as above, despite its reputation tolerated one dose well
• Metronidazole – as above, tolerated well
• Tazocin – for a query chest infection as I was feverish, and couldn’t tell from CT due to the tumour whether there was an underlying infection. 
• This seems like a lot of antibiotics especially as we are trying to reduce the amount of antibiotics we dish out due to antibiotic resistance. But this is when we are stuck between a rock and a hard place. For example we know giving antibiotics in the first hour for sepsis (whole body inflammation caused by an infection) improves survival, but convincingly diagnosing an infection within one hour can be tricky. So when someone is as sick as I was, it is worthwhile treating as if they have an infection without  confirming it because it may help. However the fevers stopped after 2 doses of dabrafenib and the antibiotics were subsequently stopped.

 

*the source of my pain was that the tumours within my liver had got so large they were trying to rip it open. The liver is in a tough capsule which stops this but the tension on this capsule was causing me the unbearable pain. As the liver is inflamed at this point due to the damage it rubs against the diaphragm which is just above it, the diaphragm when irritated refers pain to the shoulder. For reasons which are beyond the remit of this blog.