Friday, 9 October 2015

My Treatment: part one.

I wanted to write a post all about the treatment I had for my AML, but when I got into it, it started to get a bit lengthy so I have decided to split it into three separate parts. 

1. Hickman line insertion
2. Chemotherapy
3. Stem Cell Transplant

Just to forewarn any potential reader, this post is a bit cancer-lingo heavy and might be difficult to chew your way through. Nevertheless I hope that is informative, particularly if you or someone you know is going through the same protocols, or is about to do so.

Hickman Line Insertion
I was diagnosed with AML on Tuesday 23rd September 2014. Because of the aggressive nature of this kind of blood cancer, I began a 10 day course of chemotherapy four days later on Friday 26th September 2014. But before I could commence the first round I needed to have a Hickman line inserted. I was scheduled to have the procedure on the Friday morning.

A Hickman line is a central line which is inserted into the jugular and extends to a big vein just above the heart called the superior vena cava. At the other end it consists of a plastic hollow tube which is tunnelled under the skin and exits somewhere on the chest, and this hollow tube is usually branched off into two separate tubes which are colour coded white and red. 

A Hickman line is used to administer chemotherapy drugs because the vein it is inserted into is so big and full of blood that it whooshes the toxic drugs away and around the body quickly. This is better that it going into, say the peripheral veins in the arms and hands, which can quickly become irritated and diminished. A Hickman line is also used to extract blood which became at least a daily experience, which without a line would badly bruise and scar the veins.

There were three of us scheduled to have Hickman lines that day, including Sylvia who I have mentioned in a previous post. I was last on the list because I needed to have two bags of platelets, a component in the blood which helps it to clot, because mine were very low and undergoing any sort of surgery without the ability for your blood to clot is a risky procedure. Around 11am, two ODPs arrived to collect Sylvia and she cheerily waved to me as she was was wheeled away in her hospital gown. Sylvia and I were diagnosed the same week and our chemotherapy schedules matched up quite a lot so we often saw each other around the ward and also in the day unit during the brief times we were allowed home for recuperation. 

Around an hour and a half later Sylvia returned, with a large gauze on her neck but still with the same cheery smile. “Absolutely nothing to worry about my love!” she beamed “it was fine, you don’t feel a thing”. I felt relieved. 

A short while later, the ODPs arrived for me and I was wheeled down to the theatre. I was hooked up to loads of machines to monitor my vital signs and blankets were placed over me because the room was very cold and I had started to shiver. Then my neck and chest was cleaned with a lot of orange iodine solution and a drape was stuck to my chest and neck which extended all over my face and body so that I couldn’t see anything. At this point I began to get a little panicky but before I could, a young friendly-looking ODP picked up the edge of the drape, attached it to a drip stand so that I could see and breathe properly, and sat down next to me. Then he asked if I wanted to hold his hand, to which I said yes please, and started chatting and continued to chat for the remainder of the procedure. It turned out that we were in the same year at Coventry Uni and he was just qualifying. We took a lot of the same modules and knew some of the same lecturers. He asked all about my engagement and holiday to Boston, and told me that he was moving in with his girlfriend. Of all the healthcare professionals I have met over the last year of treatment (and there have been hundreds) he really stands out as someone who really made a difference, just for that short period of time, he was just what I needed. I have since had two further Hickman lines due to infections, and both were horrendous experiences in comparison, largely because I didn’t have someone like him there with me. 

The Hickman line insertion itself wasn’t nice. The local anaesthetic that was inserted all over my chest and neck was painful and although I wasn’t in pain afterwards, it was a very uncomfortable and disconcerting experience. But I knew it was worth it in the long run. The worst part is afterwards when the local anaesthetic wears off and it is quite painful to move… the skin around the insertion site on my neck felt very tight and I couldn’t move my head or relax properly for a few days.

When I returned to the ward after the insertion Sylvia exclaimed “Oh my word, wasn’t it awful! I didn’t want to tell you before but I had blood gushing out of my neck! and I said to the surgeon there is blood gushing out of my neck! And he said it was fine, but I thought that’s not right!! Oh, it was horrible.” Bless her. I decided right then that I liked Sylvia very much. 

Eventually the discomfort and pain wore off though and I barely noticed it was even there after a few weeks. In the end I learned to love my Hickman line, particularly times when I didn’t have one I realised just how brilliant they are because otherwise I had to have cannula after cannula and blood test after blood test. 

While I was in hospital the nurses would meticulously clean the insertion site on a weekly basis and they flushed it with saline solution to keep it clear and flowing. During times when I was allowed home, it would be filled with a Heparin lock-flush which is a type of anticoagulant solution to prevent blood from clotting and blocking up the line. 

While the first procedure went well, the line itself was no good. While it was fine or the administration of and drugs and blood products I needed, it didn’t really bleed properly and I had to take deep breaths and move into all kinds of strange, yoga-like positions so that the nurses could get their daily samples. In the end it became infected and it was removed just before my second round of chemo and I had a new one inserted which worked perfectly and lasted much better. 

Stay tuned for parts two and three.

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