16/12/19 (2)

A very medical day today, with appointments with both my GP Dr.Ku and my haematologist Dr.Ch, now returned from his holiday and myeloma conference in Florida.
The GP called the first one, which was a "Cancer Care Review". It turns out that this isn't so much a review of cancer care as an opportunity to deal with any other medical issues that might get overlooked because cancer tends to push everything else into the background. So we covered quite a lot of ground on both sides. Amitriptyline going up from 30mg daily to 40 (for the long-time right thigh nerve pain problem, which is gradually coming back again). I'm warned to watch out for signs of "serotonin syndrome":
"Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. Body temperature can increase to greater than 41.1 °C (106.0 °F). Complications may include seizures and extensive muscle breakdown.Serotonin syndrome is typically caused by the use of two or more serotonergic medications or drugs."
He also included euphoria etc.. Any of that and I drop the dose back to 30mg. NB amitriptyline also good for any nerve pain originating from the myeloma side of things.

We talked about BP, which has gone up a small amount since coming off Felodipine a few weeks ago but is still in perfectly good territory. I think I'm getting more unexplained variation in both directions than I did before but he doesn't seem bothered by that. He's asked for a record of readings over the next couple of weeks. I'd be happy to go on 2.5mg - low enough dose to make barely any difference, but enough to deal with the slight vulnerability I feel being off the stuff after so many years on it.

On the constipation side of things (I just can't get away from that, much as I'd like to!) he advised combining Laxido with Senna (different modes of action). Just when I thought I was getting on top of it, I have to change the routine...

Foot / ankle / calf oedema - he's concerned that 40mg Furosamide might lead to dehydration  no mater how much water I drink, which would not be good for me at this stage. So he's cutting it from 40mg to 20 and ordering more bloods to check kidney and liver function plus a leg blood pressure test - all with a view towards compression stockings. I don't particularly look forward to that but can see the logic - keep the hydration up but stop it accumulating at the bottom.
While organising that blood test I remembered that I had forgotten my last cholesterol numbers and he looked them up. A couple of years ago 3.67 and a good HDL/LDL balance - all fine. Will do the cholesterol again this time.

On to Springfield and Dr.Ch. Nothing much to say except that he's pleased with the way things are going and still anticipates transplant after four cycles. Asked about the time between end of cycle 4 on Feb 6 and starting the transplant process - we had been assuming three weeks but he says no need for that - probably go straight in, would expect to be writing the referral letter during Cycle 3. Which starts next week...

Also - fairly obviously - no heavy lifting. I had worked that out for myself. So the Roccbox will stay where it is in the garage until I'm recovered from the transplant. Too heavy for me at the moment, as are the gas cylinders. The first post-transplant pizza and garlic bread night will make a good target to aim for.