It’s 19th May, 2025 and I have an appointment with an oncologist. This is to discuss potential precautionary chemotherapy following my hemicolonectomy at the end of March.
I am introduced to Dr Mutheramalingam, known as Dr Ram.
He seems to have done his homework, as he tells me all about the various conditions that I am receiving treatment or surveillance for, including Prostate Cancer, Type 2 Diabetes, and possible Non-Alcoholic Fatty Liver Disease (NAFLD). And, of course, not to forget the main event, T3 N1b Colorectal adenocarcinoma, the reason I am in his office.
Dr Ram procedes to explain the situation i.e. the positive results of the surgery and that the scan prior to surgery had not shown any signs of cancer elsewhere.
Interestingly, he mentions that the lesion on my lung seems to have disappeared. This lesion was strongly suspected to be Prostate Cancer, and is the reason I have been on course of regular Prostap injections. We discussed the possibility of my no longer needing the injections but he wanted to defer that discussion to my Urology consultant.
Dr Ram then went on to describe my chemotherapy options, which appear to one of two.
- Option 1:
Combined tablet and chemo infusion over a period of three months
This option comes with a range of potential side effects which also include damage to my liver which is already under surveilance due to the NAFLD.
This treatment offers a potential 12% increase in my survival prognosis.
The chemo infusion would be administered at the hospital and therefore require multiple trips to the Queen Alexandra hospital, parking fees, and the time spent during the infusion. - Option 2:
Tablet only treatment over a period of six months
This option also carries the full range of potential side effects with only a 10% increase in my survival prognosis.
The tablets would be self administered at home,each two week cycle being 4 tablets twice a day, followed by one weeks rest. During the weeks rest I would have a blood test and a telephone consult prior to starting the next cycle.
It seemed to me that option 1 only giving an additional 2% and also introducing the risk of liver damage was not a good deal. Also, the regular visits to hospital for the chemo infusion was not very appealing, given the many medical appointments I have had since diagnosis of the tumour.
I have therefore opted for option 2, the self administed tablet only chemotherapy.
Bearing in mind the positive results from the surgery we, the medics and me, don’t know for sure if I have any cancer in my body. This chemo, being precautionary, may not actually buy me any more time.
Since that initial oncology meeting I have started the chemotherapy regime having been prescribed Capecitabine. I have just completed my third cycle.
Capecitabine comes with a whole range of potential side effects which include the following:
Appetite loss, Diarrhea, Vomiting, Nausea, Stomatitis, Abdominal pain, Fatigue, Weakness, Hand-foot syndrome, Oedema, Fever, Pain, Headache, Hair loss, Dermatitis, Indigestion, Shortness of breath, Eye irritation, and Myelosuppression.
So far, after nine weeks, I am only experiencing fatigue which manifests itself by me dropping off into a deep sleep with little or no warning, usually when sitting quietly reading of watching the TV. Thankfully, this does not happen while I am actively involved in something.
In the first week or so I did notice, thanks to my smart watch, that my heart rate was spiking quite high. That is I was hitting over 130 beats per minute with no apparent cause whereas prior to commencing the chemo it was rare for my heart rate to go over 80 bpm. I contacted the oncology department and they told me it was probably my body getting used to the chemo. Certainly, the spiking has reduced, both in frequency and magnitude.
So here I am, cycle three completed. What now?
Well, due to a family issue I have had to travel and will be away from the UK for three months. This means that continuing with the chemo is problematic. Because of the type of drug that Capecitabine is and the need for regular blood tests, they cannot prescribe sufficient doses in advance for me to continue the regime.
Apparently taking a short break from the chemo is OK but two to three months may be too long for me to restart when I am back in the UK.
So I am exploring getting access to the local medicare here in Australian so that I can then see a doctor and hopefully get prescriptions for Capecitabine and also the requisite blood tests. There is a reciprocal health insurance arrangement between the UK and Australia but this might just be too complicated to manage.
I have applied to join Medicare and I am hoping that having been previously been accepted it will be pretty much a rubber stamp exercise.
We shall see!
WrAnTz 