BEP Cycle 2 Day 9

Wednesday 3 July 2019

Today was another day chemo day. My arm was still bothering me a lot in the morning, so I called my oncology team’s emergency number. They asked if there was any redness, or if my arm was hot or firm. There was no redness and my arm felt more soft and tender than hot or firm. They said I didn’t need to come in and see them, but that I should be sure to mention the issue to my day chemo nurse in the afternoon.

My day chemo appointment was at 14:00. I was very tired on the drive to Bristol and I wasn’t very talkative. We arrived on time and I checked in for my session. I was called in almost immediately.

I explained how I was feeling to the nurse. She had a good look at my arm and asked a number of questions. Then she got one of her colleagues to come and have a look. They were concerned that one of the veins in my forearm was popping out a bit, which could indicate too much pressure in the area. That particular vein has always stuck out a long way so I wasn’t sure that it was telling us much, but I’d been feeling that my forearm was a bit heavy and wondered if it was slightly swollen. The nurse had a quick chat with someone from the PICC team and they arranged for me to go for an ultrasound scan as soon as my chemo had finished. This would be to see whether there were any signs of blood clots in the area of the PICC line, which can easily occur.

Having the dressing on my PICC line changed

I had some blood taken and the dressing on my line was changed. My treatment then proceeded with half an hour of saline, some hydrocortisone, half an hour of Bleomycin and fifteen more minutes of saline. That all went smoothly. We then legged it down to another part of the hospital for the ultrasound.

I only waited a few minutes to be seen. The sonographer started by checking a vein in my neck, then moved into the shoulder area and continued down my right arm, along the PICC line. What they do when checking for blood clots is to press on the suspect vein in several places. A healthy vein should be able to squish flat and bounce back to its normal shape easily, whereas a vein containing a blood clot will not flatten when pressed.

The ultrasound scan started with a vein in my neck, then proceeded down my right arm, along the PICC line

At the end of the scan, I was told that there was a clear clot along the length of the line in my upper arm, which would need some attention. I headed back to the day chemo unit to let my nurse know what the outcome was. She took me upstairs to the acute chemo ward. This is where chemo patients would visit after calling the oncology emergency line, if there was an issue that needed immediate attention.

I waited a short while and then saw a doctor who asked me a number of questions and had a look at the sonographer’s report. I wasn’t sure what the remedy would be for my clot, but I half expected that my line would be removed.

Instead, I was prescribed blood thinners: two subcutaneous injections a day of the anti-coagulant medicine Clexane, of which the active ingredient is enoxaparin sodium. Like filgrastim, these were to be self-administered. I’d take the shots twelve hours apart. It wasn’t clear exactly for how long I would need to continue taking them, but the doctor indicated that three months is fairly standard. That sounded like overkill to me, but the doctor said that I’d be able to figure it out with my consultant.

I mentioned to the doctor that I was still getting fairly severe stinging when urinating. For this I gave a urine sample which was checked for infection, but none was present. I wasn’t sure whether the chemo was damaging the lining of the urethra or whether perhaps the stinging was due to the intense expulsion of toxins, but either way it seemed like something I’d just have to put up with.

The doctor sent a prescription down to the pharmacy for me. I left with a sharps bin and Pia and I headed to the collect the prescription, which contained two weeks worth of injections.

The ultrasound and visit to the acute ward and pharmacy had lengthened our stay in Bristol somewhat and it was around 20:30 when we got near home. We collected our younger daughter from a friend’s house on the way home. Then Pia headed out again to collect our older daughter from another friend’s house. I was feeling quite worn out and sick by this point and my arm was hurting. I didn’t waste much time in getting into bed.

My temperature started to rise a little in the evening, which worried me as I was so tired and didn’t fancy another emergency trip to hospital. We checked it a couple of times and it was under 38 celsius. I couldn’t stay awake any longer so let myself drift off to sleep. Later in the night we checked my temperature again and it had gone back down, so panic over.

Background – Diagnosis

My journey began in August 2018, a couple of months after turning 40, when I noticed that one of my testicles seemed a bit larger than it was supposed to be. Quite a bit larger. There were no discernible lumps, just more overall mass. I didn’t pay too much attention to it to begin with and waited to see if it might go back to normal after a week or two. However, it didn’t go back to normal but rather continued to increase in size.

I visited my GP who was concerned that the growth had been completely painless and that there were no obvious signs of infection. In case it was in any way related, I mentioned to him that I’d also had a couple of episodes during the previous few weeks in which I had become slightly faint and disoriented when standing, for several hours on each occasion. For this I had my blood pressure checked and an ECG to monitor my heart activity, both of which reported no issue. The doctor referred me for an ultrasound of my testicle at the Royal United Hospitals (RUH) in Bath, which I attended the following week.

During the ultrasound, the sonographer noticed a number of dark patches within the testicle in question. There was also evidence of angiogenesis – a profusion of new blood vessels that were entering the testicle. It looked to be a fairly textbook case of testicular cancer, with no real evidence for any alternative condition, such as an infection. The good news was that the other testicle, my bladder and kidneys all looked in perfectly good health.

Following the ultrasound I was referred to a urologist, who I saw a week or two afterwards. I was made to do a “flow test”, which involves peeing into a glorified bucket with a sensor attached to measure the rate of flow. This is a standard test for any patient passing through the department of urology, regardless of the purpose for visiting. My flow was very good, unsurprisingly.

The urologist was a fairly serious chap who didn’t smile much. He gave me an inspection, having already reviewed my ultrasound results. He suggested that I get booked in immediately for an orchidectomy operation, i.e. the complete removal of the testicle. I didn’t commit to the surgery straight away, but said that I would give them a call after I’d had the opportunity to talk it over at home.

I had bloods taken to check for tumour markers: AFP, HCG and LDH (of which HCG was significantly elevated). I also got to sit down in a brightly coloured room with a comfortable sofa and chairs for a while to speak to a specialist nurse. This was clearly the room they use to try to make people more at ease when giving them bad news. At this point, perhaps unusually, I wasn’t feeling the slightest bit fazed. In fact, I’ve not really been worried or fearful at all during the entire episode. I’ve just taken everything in my stride knowing that it will all turn out for the best, whatever happens.

A few days later, I was booked in for surgery in early October.