Rollercoaster

The last cycle turned out to be a bit of a rollercoaster and I only got results of my scan yesterday - so thought would hold off blogging until I had all the information!  It was quite tricky to understand but I'll do my best to explain.

So after the last chemo cycle,  I was struggling with fatigue but otherwise coping ok.  Unfortunately at the mid cycle point I began to feel quite unwell - aching all over and just quite miserable.  I developed a fever and ended up back in hospital on the Sunday night with another neutropenic sepsis.  I was trying at all costs to avoid admission due to the covid rates in Glasgow, but I didn't really have much choice.  The admission itself was a bit smoother and I was moved to the CF ward on the Monday and had my 5 days of IV antibiotics.  The source of infection was again unclear but I gradually improved and was released last Friday.  I really haven't bounced back the same way I did after the first sepsis, but I think there are a number of reasons for this.   I am a bit anaemic at the moment (chemo kills of red blood cells as well) which is contributing to the fatigue and feeling more short of breath, plus the accumulative effects of multiple chemo cycles.  

I have also continued to be quite chesty and they did culture a fungus (aspergillus) from my lungs, so I have also started on anti fungal medication for this - I suspect this is giving me a few side effects.  I will be on this for at least 3 months.  Aspergillus is a common fungus present in the environment  - we all breathe in spores and our immune system just deals with it.  It is common to find it in people with CF's lungs and it is often just sitting there doing nothing.  I did have it before transplant and it didn't cause infection as such.   It's unclear just now whether it is just sitting there, not actually causing infection - but because I have chest symptoms, and am very immunosuppressed,  it was felt best to treat it more aggressively to be sure.

They managed to do my CT scan on the last day of admission, but I didn't get the results until my appointment with haemoncology yesterday morning.  The overall picture is cautiously optimistic, but the bottom line is that I will need a PET scan (in about 9 weeks from now) to give a clearer result. I'll try to explain!

The original abdominal CT scan I had in August (when first diagnosed) showed one main group of enlarged necrotic lymph nodes merged together, forming a mass.  There were also multiple other slightly enlarged lymph nodes throughout the abdomen.   I then had a PET scan 5 weeks later to check what was happening on stopping immunosuppressants and to check rest of body for nodes.  The PET scan is more useful at detecting active cancer cells because the rapidly dividing cells 'light' up on the scan (they take up the glucose tracer).  This scan showed that the big mass had grown further and more nodes had appeared in abdomen.  Because it was a different kind of scan it was hard to do direct comparison, but this is the scan that led them to start chemo a couple of days later.  I then had another CT scan after 2 chemo cycles - this showed that the main mass had reduced by nearly 50% and the other nodes had shrunk.   The most recent scan was another CT scan (after 4th cycle) - this showed that the the main mass had remained static and the other nodes were now normal size.   The consultant explained to me that although CT was good for looking at sizes and volumes, it is not good at telling you the 'activity' of the mass e.g is is actively dividing cancer cells.  After treatment for lymphoma, the treated, dead cells can lead to scar tissue  - which is indistinguishable on the scan from active cancer.  So the fact this mass reduced significantly after 2 chemo cycles, then remained unchanged, suggests what they can see now is actually scar tissue, not active cancer.   This would be an amazing result! However there is no way of confirming either way at the moment.  If I had a PET scan just now it could give a false positive - meaning that residual inflammation in those cells from recent chemo could still cause it to light up on scan - so this scan can't be done until 6 weeks after treatment finishes.

The current plan then is to finish the 6 cycles of treatment (but remove the CHOP part) - so I had another Rituxemab infusion yesterday and will have another in 3 weeks.  A PET scan will be arranged for about 6 weeks after the last infusion and will hopefully give us a clearer idea of whether I'm in remission.  The logic for removing the CHOP (chemo) part early is because I cannot risk another sepsis, and in fact, it could be that I am already in remission and don't actually need more chemo.  Of course, on the flip side, the cancer cells might start dividing again without the chemo or the residual mass might still have cancer cells when I have the PET scan - and if this was the case we would need to consider other treatment options.  However, I do feel that fact I had such a good response to only 2 chemo cycles is a huge positive and I am staying very hopeful that it will be good news in the new year :-)

I am so glad I am not getting more chemo just now as I really do feel quite wrecked (for want of a better word!)  I have been going to bed at 7pm, sleeping all night and don't feel rested in the morning.  I am finding everything a struggle just now - getting dressed, moving around, going up the stairs etc.  I am very deconditioned, but I am hoping that without the chemo part of treatment, my body is going to get the chance to recover now.  My weight hasn't increased, but again, without chemo I think I can get this more on target.  I haven't checked lung function since the last cycle as I feel I can't give it my best effort and a lower result wouldn't change the treatment, but would increase my anxiety!  I will be chatting to Newcastle team again in early January and we can take things from there.   

At the moment I am focussing on just enjoying being at home and spending time with my wee family in the lead up to Christmas.  It's probably a good thing that we can't really go anywhere over the festive period and I am sure we can have a lovely time at home.   Estelle finishes school on Monday and is very much looking forward to Christmas!  I'm so grateful to be warm and cosy, watching Christmas movies and eating mince pies - what more can you ask for?!

 4th Chemo down...

I had my 4th (and hopefully) final chemo on Friday.   I had slowly recovered from whatever I was fighting off the previous week and my bloods were fine for going ahead with the cycle.  Although I do feel as if I've dragged myself through this recent cycle, so hoping this one isn't too bad and nothing untoward crops up!  My chest hasn't been 100% in recent weeks but Newcastle seemed happy enough for me to proceed and the CF team are keeping eye on chest.   My lung function is still fairly stable on home monitor (still not safe to get it measured at hospital) so that is at least reassuring.  My weight is struggling - I'm the lightest I've been since transplant, although the steroids mean my face doesn't look like I've lost any!  I think once chemo is finished I will find it easier to put weight back on, so just focusing on keeping it stable with supplements.

The doctor is hoping I can be fitted in for another full body CT scan in couple weeks - enough time for cycle 4 to work but before 5th cycle would be due.  The current plan would be to continue Rituxemab infusion alone if nodes still present, but to remove the CHOP (chemo) part of "R-CHOP" in order to reduce risk of further sepsis and admission (especially with Covid rates).  I got the impression it was likely that will need to continue Rituxemab so I am just assuming that will happen at the moment and would be due 18th dec.  I am just so glad that wont be getting the chemo part, as that would just have been hitting hard by Christmas day.  Thank goodness for small mercies!!

Speaking of Christmas - we have decided to just stay here and have it with the three of us.   I really can't afford to take risks at the 11th hour when we are so near having a vaccine and I've kept myself protected for this long.   I was 100% decided after having a phone appointment with Newcastle.   The consultant has been phoning every month for a review and I happened to have appointment the day government announced about the 5 days relaxation of rules, so they did ask what I was planning to do at Christmas.   They mentioned that there have been deaths in patients with solid organ transplants and patients very unwell in ITU - especially given my total immunosuppression from chemo (which will remain for some time after I finish) they advised that anyone visiting me should really have been isolating for 2 weeks prior.    Mum essentially has to isolate in order to take me to chemo appointments (when Andrew working) and we wear masks for car journey.   It's impossible for everyone to isolate in lead up to Christmas so it's just easier for me to do my own thing and stay as safe as possible.

I am really surprised at the 5 day relaxation of rules across the UK,  being able to travel from high rate areas to low, and no social distancing indoors  - it seems completely senseless to me.  I had expected maybe a couple of days, local travel and social distancing in place.  I understand that people are fed up with covid rules and need some family time - but I just think it will prolong the whole thing and we will be back in lockdown in January with another spike in cases.  Although a vaccine is on the horizon we need to get there without unnecessary deaths.   I certainly wouldn't want anyone to be on there own (and thought bubbles helped with this) and I think people would have made their own choices regardless.   However I have spoken to quite a few people who intended to stay at home, and now feel pressured to visit family because it technically "allowed".   It's also very frustrating to hear the government is considering prolonging the school Christmas break to compensate for the 5 day relaxation of rules - as if the children haven't missed enough school as it is.   It's so tricky - although children tend to get mild illness, during the 2nd wave they have become the ones most likely to be bringing it into the home, because they can still transmit it.  So any increase in overall rates following Christmas will increase my risk from Estelle.  But this has to be balanced against her need to be in school, which is so important.  We will just continue to do our best to keep safe.

I'll try to blog in couple weeks once I know more about what's happening next, as I am expecting to be pretty wiped out in coming days.   On a positive we did get our Christmas tree up (early I know) as I didn't think I would be fit by next weekend.  It's looking lovely and festive  - nothing nicer than some twinkly lights to cheer you up :-)

Hanging on in there..

I'm just passing mid cycle again and hopefully it will be smooth sailing between now and chemo next Friday.   I was feeling not bad after the last chemo - bar the usual nausea and sore mouth.  I seemed to have a lot of nervous energy though (I think steroid induced) and was finding it hard to be inactive - I kept sorting through drawers and trying to organise the playroom, in anticipation of Christmas.  It's good having the energy to get some things done but to be honest the internal feeling of restlessness is quite unpleasant.  I find it hard to sleep and switch off during these periods despite knowing my body probably needs to slow down.  On stopping the steroids after the 5 days I then did crash energy wise and more or less ground to a halt!  I have piles of clothes sitting out mid sorting that I didn't have energy to finish - will have to wait until my next steroid boost haha.

I have actually feeling quite rough this week and have had a borderline fever, headache, achiness and a general feeling of being unwell.  I honestly thought I was headed for another sepsis as that's how it started the last time!  I spoke to the Beatson and the CF team - as my temperature was borderline and seemed to be settling,  they were keen for me to stay at home unless worsened.  Thankfully my temperature has stayed down and I've certainly not got any worse.   This decision not to be reviewed unless really necessary was influenced by the covid situation locally and weighing up the risks of attending a hospital when rates are so high.  For this reason, I am more than glad we have moved to level 4 in an effort to drive down numbers.  I could argue that the restrictions in level 4 maybe don't even go far enough - a lot of places will still be open and it's nowhere near the measures taken at the start of lockdown, but I really hope it will be enough to bring things a bit more under control.  It would certainly help make me feel safer going for treatments.

On a similar note, I am not sure how I feel about all the ongoing discussions about relaxing the rules for Christmas.   I understand how desperate people are to see family at this time of year, but it does seem really counterintuitive to relax the rules for the sake of one day - and possibly then have an increase in cases mid winter when hospitals will already be under strain.  I think people will make their own decisions anyway but if the government gives the green light for family gatherings, will people then feel under pressure to meet up, when they might not be completely comfortable?  I wouldn't like to think anyone would be on their own, and would hope the bubbles idea would make sure this wouldn't happen.   I am honestly not sure what the answer is  - I guess there isn't one!  I love Christmas and I feel sad thinking of not seeing people - but I have also spent so long shielding, coping with hospital admissions alone and making hard decisions about protecting myself, that it would seem ridiculous to throw that away!  I guess we will just have to see what happens in the coming weeks..

The emerging vaccines is a great positive in the news just now.   At the moment we don't know how long the immunity from them will last, or if they are effective in various patient groups...but it's still a huge step forward!   I was reading the government website detailing the interim advice on vaccine priority and was quite surprised to see that people with underlying health issues are actually quite far down the priority list (I would be no. 6 group)  - read here.  Obviously care home staff and NHS staff are first in line, then those over 80; over 75; over 70;  over 65 ...then high risk adults under 65.  It's interesting to note that age really is a huge factor in covid risk -  simply being over 65 is more risky than people realise.  Hopefully once vaccines are approved, the programmes can be rolled out quickly so that we all can get a degree of protection and start getting back towards some normality!

In other news Estelle is getting excited about Christmas and having a hard time deciding what to put in her letter to Santa haha.   It will be a much quieter build up this year, but Estelle is happy just doing things at home  - especially a bit of Christmas crafting, baking and just enjoying having mummy and daddy playing lego and playmobil.  In some ways I'm quite glad not to have so many commercial events - the year before last we saw so many Santa's that even Estelle was getting oversaturated....and also wondering why none of them looked exactly the same!  You can get quite caught up in booking all these 'magical' events, then run yourself ragged trying to fit everything in.  Maybe we can benefit from slowing down a bit this year :-)

3rd cycle down!

My excellent news for this week is that the CT scan showed a significant reduction in the abdominal lymph nodes after 2 cycles!! I am beyond thrilled!  I think they are pretty much back to where they were in August at time of diagnosis (in fact I think smaller than this!) so we have managed to get control of the rapid growth that had occurred just prior to chemo.  This would be consistent with my pain - over the last few weeks I have only been taking my long acting painkillers and not needing the short acting for node pain.  The EBV levels are not detectable anymore which is also fantastic.  Given the good response to the 2 cycles, the plan is to hopefully stop chemo at 4 cycles. I will get scanned again after the 4th.  The aim of treatment is for complete remission but if nodes were still present after 4th cycle then remission might still be possible by continuing the Rituxemab infusions alone, which would be easier to tolerate and much less toxic.   I think treatment plans would be much more straight forward if I didn't have the chronic lung rejection, as this is obviously a huge factor.  - we are trying to balance risks (infection, covid rates, side effects) against benefits (quicker response from chemo, protection of lung function). The chemotherapy, although putting me at risk of infection, is ironically also protecting me from rejection.  It's a case of taking it cycle by cycle and making the right choice for me at that time but it's all looking very positive and we are making excellent progress!

I had my third chemo yesterday - getting the chemo itself is the easy bit, so I'm not looking forward to the next couple of weeks but at least I know more what to expect.  The most important thing is avoiding infection again - I managed last cycle so fingers crossed I can avoid it this cycle.  It's quite tricky with Estelle being at school as she is being exposed to all sorts of winter bugs (never mind thinking about covid!) but I'm am trying to keep my distance mid cycle when my white cells are at their lowest.  The biggest worry about needing admission for infection at the moment is the covid situation in Glasgow - the hospitals are getting pretty full and obviously my usual respiratory ward will have numerous patients but I have to just keep going and keep as safe as I can.

In other news, Estelle had a lovely Halloween.  She dressed up as Mildred Hubble from Worst Witch and was really pleased with her outfit.  She is most particular about getting it exactly right - I even had to dye a school shirt grey and laminate a badge for the outfit!  We did some dooking for apples and I made a Halloween treasure hunt in the house.  We had lots of decorations up (mostly thanks to my lovely cousin Sarah!) which Estelle loved.  I did also paint my face and bald head white to look like Uncle Fester, which was rather amusing - but I'll maybe not post the photo here!  We put glowsticks in decorated milk cartons (great idea via facebook) and decorated cupcakes.  I was exhausted but worth it for Estelle - who said she had the best halloween but maybe next year I could hide 50 things on the treasure hunt instead of 8 haha!!

I'll try and post again once the initial side effects of this cycle have passed.  Lots of love to all my family and friends down south who are currently in lock down again.   Keep safe x

 Mid Cycle

I have hopefully now passed the critical part of cycle where most at risk of infection (I'm scared to speak too soon!) so hoping it's smooth sailing until round 3 at the end of next week.  My mouth did become quite painful again but has eased up now - although I still can't taste anything which is frustrating.  I'm packing in the supplements though and think my weight has steadied out.

My CT scan was changed to next week, as the doctor felt it was too close to 2nd cycle so wouldn't have allowed enough time to see impact of that on the nodes.  It also would have fallen at my most vulnerable point and given the covid rates in Glasgow, it would have felt very risky going for scans at that time.  So the appointment is now on Tuesday.  I will have outpatient clinic on friday 6th before my chemo, although I don't know if the scan results will be available that early.   I must admit that I feel anxious even thinking about it!

I've been trying to keep myself occupied with some more crafting and some early Christmas shopping - I feel that need to be very organised in case I am unwell nearer the time!  It is going to be a very strange year for everyone with the covid situation.  I really can't see things improving much before Christmas so it might just be the three of us at home this year.   I can't take any risks travelling or breaking rules for the sake of one day.  My planned chemo would also be on 18th Dec, meaning that Christmas would fall at the time I would be most at risk of infection.  We will just have to see what happens and do what's best at the time.   There will be plenty time for celebrating when I recover from this and when covid is a more distant memory for us all.   Estelle will be happy as long as Santa knows where we are :-)

In other news, Andrew managed to break his big toe last weekend!  He was running up the stairs because Estelle was shouting from her bed - and cracked his toe into the stair.  I did feel very sorry for him as it did swell up immediately and went black and blue!  He has had it x-rayed and there is a wee fracture, but thankfully not needing any further treatment.  He has managed to hobble along to the bus stop with Estelle all week and it is starting to heal now.  Just what he needed in the middle of looking after both Estelle and myself!  Estelle thought it was a great story of course and has told everyone in her class (of course she has also told them all that I am bald!)

I'm feeling very tired now, which is exactly what happened at this time last cycle, so planning to just have a quiet week.   The school are having some halloween games tomorrow but unfortunately they can't go in fancy dress this year.  However she is planning to dress up at home and we will do some fun games with her - dooking for apples anyone?! 

I'll probably not update until after next chemo unless I have any news about my scan.

In the meantime, Happy Halloween.......!

 Round 2

After my last blog I did start to feel gradually better following the infection.  It was nice to have a few days of feeling more like myself.  It was a busy week with a number of different hospital appointments, which was tiring.   I found during the hospital admission my hair had started rapidly falling out and by last week it was only straggly and awful looking.  I decided it would be better just to get Andrew to shave it off - yes, that's how much I trust him!   We snipped it short then used the electric hair trimmer to shave the rest.  It was a strange experience - I was ok at the start, became emotional mid way then felt better after it was done.  It actually didn't look as bad as I expected and my head was also not as big as I thought it was haha!  It felt a bit tender afterwards but feels fine now.  I also noticed how chilly it can be without hair!  Estelle was there for the process (at her choice) as I felt it was better for her to be involved and see what was happening, rather than getting a shock seeing it all gone.  We had been discussing it a lot in the lead up and she had been helping me choose scarfs and hats.   She also has grasped the concept that the chemo is killing the cancer cells but at same time has killed the hair cells, so she has a good understanding.  She mostly thought it was quite hilarious and said I looked like a cute wee troll!  She also took great delight in shouting "night night baldy!" on her way to bed.  In the house I am not bothering wearing scarfs etc as I might as well be comfortable!  I have now received an NHS wigs to try but following chemo haven't had a chance to try it properly.  It looks very like my hair colour and style but I need to get it sitting in the correct parting, which is proving trickier than I thought. It's a shame I can't just go into the hair dresser and let them sort it.

After pre assessment clinic last week it was decided that my 2nd chemo would go ahead as planned.  This was as a day patient, so much better than having to stay in hospital.   The day unit was nice, with individual rooms and comfy big recliner chairs to sit on.   The rituxemab could go quicker this time (as had no reactions last time) so only took an hour, then I had the rest of the chemo.  I had a clinic appointment at 10.30am before chemo, so was actually there until 5pm, so was a very long day.  However I passed the time easily with netflix and a chat with my friend Nicola who works at the Beatson (very handy!)   We had a bit of trouble finding a vein but managed in the end - I hope they hold out for the following sessions!

This time I felt more prepared for the side effects.  I have been using both anti sickness on regular basis and although felt really quite nauseated the first 2 days, it does seem to be easing now.  My mouth hasn't been as sore as last time (as of yet!) although unfortunately my taste is altered, so everything tastes a bit weird!  This is making eating more of a chore but I have increased my supplements after losing weight during last admission.  I start the injections to boost white cell at end of week and am not looking forward to the bone pain - I am hoping that last time some of that was due to infection. Overall I feel I am coping better this time round, so hope that continues!

I will be getting a CT scan at end of week to see if nodes have started responding to treatment, although not sure if that will be reported before my next chemo.  I know I will be very nervous getting the results but am trying not to think about it just now.

In other ways life continues as usual! Estelle enjoyed her October break even though we couldn't go anywhere other than the park.  She is actually very easily pleased though and loves being outdoors!  She also loves crafts and drawing, so I was able to do some Halloween crafts - we painted conkers to make Halloween decorations and she loves if I will sit and draw with her.   I am also trying to do some crafts to keep my mind occupied - although finding my dexterity is a bit off so the outcomes are variable.

My next chemo will be 6th November so I will just focus on getting to that point in one piece and hopefully avoid any admissions before then!  Thank you for all the kind messages I have been receiving - it really does help keep me going!

 It never rains but it pours!

After my last blog I haven't been too well and just escaped from hospital again last night, after being admitted last Tuesday with an infection.   

I had woken last weekend with an awful migraine and felt pretty grim all weekend, spending most of it lying down in bed.  I had also started the injections to stimulate my bone marrow to produce more white cells, as this is the point in the cycle where I would be most susceptible to infection.   I felt really achey and generally miserable, but thought some of that was due to the injection itself, which can cause bone and joint pain.   I had  a review at the Beatson on Monday, and again, we put a lot of my symptoms down to the migraine, plus injection side effects. I didn't have a fever at this point but had been checking it frequently as my body felt the way it does when I have a fever.

Tuesday arrived and I felt even more grim than before.  I did then have an obvious fever, so had to phone the Beatson helpline (there is a 24hr number to call if you get a fever).   Normal protocol would be review at the Beatson immediately, however due to Covid, they can't see people with a fever in case it is coronavirus, which would be catastrophic to introduce to a cancer hospital.   So they arranged for me to be seen at the QE through the emergency route, with the plan that haematology would review there.  I wont go into all the details, but it didn't work out as smoothly as hoped, and there was a bit of confusion when I arrived at the assessment unit.  The bottom line however was that my neutrophils (white cells - fight infection) were zero, so my body had no way of fighting off infection.  I was therefore admitted and started on IV antibiotics immediately.    This is called neutropenic sepsis, and is a common complication of chemotherapy.   There was no clear source of infection but they treat with antibiotics that cover a broad spectrum of bacteria, so it doesn't really matter where the infection is coming from.  In fact, in these cases you often never work out the source.   Thankfully the fever settled quickly and I started to feel much better.   I was moved to the CF ward as they are best placed to co-ordinate my care between my CF issues, haematology and transplant team.   I had a few days of IVs, continue the injections to stimulate my bone marrow and thankfully my white cell count came back up.   I got home last night on oral antibiotics to finish at home.  

Although I was aware this is a potential complication, it is a bit unfortunate it happened after the first cycle.   It might happen again but at least I know what to expect, and in future then plan would be to be admitted via the CF team, which should be a smoother process.   They also managed to clarify that I was able to tolerate an antibiotic I previously had a reaction to - so this is useful for future management!   It was tough being in hospital again so soon, as I still wasn't allowed any visitors.  Although I know this is the same for all patients at the moment and at least I had my phone and could make video calls with Estelle.   She found it difficult coming home from school to find I was back in hospital, but she is coping really well and is such a trooper.  

Unfortunately, my hair started to come out during my hospital stay.  It's more like when I brush it that huge amounts come out on my brush.   I have managed to speak to a hairdresser in Glasgow who deals with NHS wigs, so they have ordered one that looks most similar to my own hair (from photos I sent her).  I have a phone appointment during the week with them to discuss the hair loss and next steps.  I think they will be able to just send me the wig as opposed to be risking going into the shop - I don't think any extra risks are worth it just now! I do have the option of buying my own wig if I want something fancier, but I've heard really good things about the NHS ones, so makes sense to go down this route first, or at least until it feels safer to go into a shop.  My mouth has been a lot better this week, as has the nausea.  My appetite isn't great but I'm managing to eat small meals and take the supplements.  

Due to having a fever, I obviously had to have a covid test.   Although this didn't affect me directly, it meant that Andrew and Estelle had to self isolate until I got a negative result (even though they were well). It meant Estelle had to miss couple days of school, as is took 48hrs to get result back, and they were both stuck in the house.  The bottom line is though that if you have either a fever, new cough, or loss smell/taste then you have to assume it could be covid until proven otherwise.  There is absolutely no way of knowing from symptoms alone - the type of cough, whether you have a runny nose,  how high the fever was, whether it was a one off fever - it really doesn't matter - they all count as covid until you get a negative test.  The rules are there to protect everyone, and although its annoying being stuck at home, it's not that much of a hardship when you might be helping prevent the spread of covid.  We all need to be thinking of each other during this pandemic and follow guidance, whether we agree with it or not.  It's the only way we will ever get out of this situation.  I know people think its their right to take a risk with their own health - that's fair enough in theory - but it's not right when that's at the cost of putting other people at risk.  We need to keep community transmission rates as low as possible over winter in order that the NHS can cope with a rise in covid cases (as well as the normal winter rise in admissions).    There were major issues with beds when I was admitted and we are only in October.  Hopefully we can all work together to get through this and, like everyone, I can't wait until life is a little more normal!

I have clinic this week before my next chemo, but I think as long as white cells are ok, then chemo will go ahead on Friday as planned.   I know what to expect this time with regards the nausea and painful mouth, so hopefully will be better equipped to deal with that.   I've read that the first session can be the worst for some side effects due to higher tumour load, so maybe it wont be quite as bad this time.  I imagine the tiredness probably builds with sessions, like it did with my radiotherapy, but I can cope with that.  I can't believe 2 weeks have passed already - I'll be half way there before I know it!