Eric returned from hospital on Saturday morning, with a large bag of pills
of varying kinds and various appointments for follow-up clinics, more of which he will find out in the coming week.

It’s wonderful to be home, to have a long, hot bath and to sleep in your own bed again. And the food is definitely better!
Posted by Lindsay, Sunday 30th April 2006

Update, 28th April 2006

Eric is improving all the time. On Thursday, he and his catheter parted company, to Eric’s great relief. In the search for the suspected bleed which occurred a week ago, after which Eric experienced considerable loss of blood pressure, a second endoscopy was performed in the late afternoon. Nothing was found (again), but biopsies were taken.

This morning, he passed the ultimate test of walking up and down a staircase. Later, he had his first shower in eleven days. Surgeon Mr M visited and gave permission for Eric to be discharged on Saturday morning. He has been given a follow up appointment with Haematology Outpatients Department on 12th May. Delighted to be going home.
Posted by Lindsay 1.09 am Saturday morning.

Update on Eric, 26th April 2006

Eric’s surgeon, Mr M, reports that biopsies of material taken from Eric during his recent operation show that his tumour was a MALToma, which is a low grade B cell lymphoma. It’s unusual to find one in the lung, as in Eric’s case. MALT is short for Mucosa-Associated Lymphatic Tissue. These types of lymphoma are more often found in the gastro-intestinal tract. Mr M says that if you are going to have to have a lymphoma, this is the best one to have. (For further information see www.lymphomainfo.net/nhl/types/malt.html)
More good news is that there is no sign of the Maltoma having spread to his bone marrow or to his lymph nodes.
His doctors wish to double check that the maltoma has not sited itself anywhere in his gastro-intestinal tract. They will be doing another endoscopy tomorrow, and, at a later date, a colonoscopy. They are still puzzled as to the source of the internal bleed, which caused Eric to lose blood pressure on Saturday.
It is likely that chemotherapy can completely clear this lymphoma. There is also a possibility that chemotherapy will not be needed at all.
All in all, this is good news. Eric is still fairly weak, but walking a little every day and eating as adequately as you can in hospital. We hope to have him home in a few days. Posted by Lindsay. 22.00 hrs

Eric, 25th April 2006

Eric, recuperating in Victoria & Albert Ward, King's College Hospital, SE5, on Tuesday, 25th April, 2006.

Update on Eric, 25th April, 2006

Eric has improved greatly. Today all his monitoring tubes were disconnected. He sat up in a chair early this morning for 1 ½ hours. This afternoon, he was moved from the High Dependency Unit to the general ward, where he shares a side ward with one other patient. Several times, he has walked short distances along the corridor. It seems that the infection which had given him a slight fever yesterday, is now under control.

We await further news as to whether the doctors wish to investigate any further the possible source of the internal bleeding which caused Eric’s massive drop in blood pressure on Saturday, as well as the results of the biopsies. We hope Eric can come home in two or three days.

Posted by Lindsay, 25th April 2006

Update on Eric, 24 April 2006

Eric is making progress. His blood pressure, heart rate and oxygen levels are good. He is eating well enough and has stood up twice today, without feeling dizzy. He is still very exhausted and weak. He has a slightly raised temperature caused by a bacterial infection (not MRSA or Clostridium). This is being treated with an antibiotic (Tazocin). Doctors are still unsure what caused the dramatic loss of blood pressure on Saturday and may do further investigations. He was well enough to complete most of the Guardian Quick Crossword today! Posted by Lindsay, 24.4.06, 23.00 hrs.

Eric Update, Noon, 23 April 06

Eric much better today. All stats normal, ie blood pressure, heart rate, oxygen etc. Surgeon Mr M. visited and was pleased with Eric's progress. Eric eating and taking in lots of fluid. Still very weak and tired but seems to have turned the corner. More later. Lindsay. PS Family visitors only today and tomorrow. Please ring Lindsay (0207 640 2306) if you wish to visit.

Update on Eric, 22nd April 2006

Eric was quite unwell this morning. His heart rate was too fast and he had trouble breathing. His blood pressure was very low. Doctors gave him 6 units of blood and slowly his blood pressure went up and his heart rate slowed down. Doctors thought that this may be due to an internal bleed, but despite an endoscopy, ultra-sound scan and a CT scan, no evidence of a bleed was found. It's possible that heavy use of pain killers with aspirin may have caused some bleeding in his stomach. He had also been taking a diuretic and a pill for his high blood pressure. All these pills were discontinued, so we hope to see a good improvement on Sunday.

By the end of Saturday, Eric was stable, though exhausted. Lindsay, Eric’s son Lyulph and daughter Victoria stayed at the hospital for much of the day, as well as Lyulph’s wife Sue, who is an experienced nurse. Sue was a great help as she knew the right questions to ask the doctors. More news tomorrow.
Posted by Lindsay, 23.4.06 12.25am

Eric Update 21st April 2006

Eric is making slow but sure progress. All tubes out on the 20th, including the epidural. His blood pressure is on the low side and he’s feeling very weak and exhausted. But the pain is less and he’s managing on just Ibuprofen and paracetamol. It mainly hurts when he coughs, which he’s encouraged to do a lot, to help clear his chest. His surgeon, Mr M. visited today. He repeated his opinion that Eric has lymphoma and says he saw no evidence that it had spread, which is good news. We think biopsy results may come next week. Eric is to be moved from the high dependency unit to the main Victoria & Albert ward on Sunday, and possibly home on Monday or Tuesday.

Posted by Lindsay on 21.4.06

APRIL 18, 2006, 5.0pm LATEST NEWS

Eric's operation is over and he is recovering well. Dr M reports that he has removed all of the tumour. He says that he found no lung cancer, but that all the evidence points to a lymphoma. This is excellent news, in that a lymphoma is far more treatable. Tests of the material removed will identify what kind of lymphoma this is.

Dr M also removed some lymph glands around the drain site of the tumour and they appeared clear.The PET scan showed only a mildly increased take up of the lymphoma in the bone marrow, which may not be significant. A sample of bone marrow taken from Eric during the operation will be fully analysed during the next few days, as will all the samples taken during the operation. Clearly, we'll know much more in a few days.

The usual treatment for lymphoma is chemotherapy and radiotherapy. Eric will be in Kings College Hospital, Denmark Hill, SE5, for the next six or seven days. He is in Victoria & Albert Ward on the 2nd floor of the main building. Visiting hours are 10.30am to 12 noon and 2.0pm to 8.0pm. Please ring Lindsay (0207 640 2306) before you visit. Posted by Lindsay Avebury

I was supposed to be at the hospital at 14.00, but we had to have a last game of ping-pong, 2-2, and on the series we think I'm one game ahead.

That's all for now - the next entry will be by JW or Lindsay.

Last game of ping-pong

This was New Year's Eve, with R and M, R's Mum, and baby

No real news from the PET scan yesterday. The procedure involves an injection with Fluorine 18 labelled glucose analogue, which is taken up preferentially by cancers. The F18 has a half life of 110 minutes and in decaying, it gives off a positron which is detected by the scanner (or more precisely, the scanner detects annihilation photons produced when the positrons encounter electrons after travelling a few mm), to produce an image. After the injection the patient has to wait an hour and a half for the glucose to be taken up by the tumour, and the imaging process itself takes about an hour.

This is a more accurate procedure for detection and identification of cancerous tissue than a CT scan, and enables the physician to determine whether the cancer has spread to any other organs. But as previously noted, the results won’t be available until Tuesday morning. JW has agreed to continue this blog after Monday evening and will report further.

King’s has an excellent policy of full disclosure of written opinions to patients, but they take a week or so, and those received up to now are out of date.

The Matthew yesterday evening wasn't the best I've ever heard, but the bass ws not bad, and the viola da gamba continuo was excellent.

Le fin d'une soirée Ivoirienne - tres agréable

Lindsay and T, who found the chocolate rabbit

We drank a toast to the incomparable Mr Justice Collins

My honorary granddaughter T, now 5, with P

Schlage doch, gewünschte Stunde

Mr M has now decided to go ahead and remove the lymphoma (?) next Tuesday, and at the same time take a sample of bone marrow. The risk is 2-3%, and 40% of the right lung will be removed. Meanwhile the PET scan has been arranged for 13.00 Thursday at St Thomas’s, and putting this on the blog will make sure it isn't forgotten.

Thursday evening we have Matthew Passion at St John's Smith Square. There was a St John on Friday - all booked up, but we can listen to it on the radio.

Lymphoma?

Mr M the surgeon has now had the report on the biopsy which again showed only lymphoid cells, suggesting, but not conclusively, that the abnormality is a lymphoma. Mr M is talking to the haematologist.

Lymphomas are generally difficult to diagnose, though Antonio Giordano and others of Temple University, Philadelphia have developed a test which looks for cyclin dependent kinase 9 (CDK9) and a molecule attached to it CYCLIN T1, in lymphoid cells from a blood sample, which is claimed to identify the type of lymphoma and its stage of advancement.

Not my day

Today I was supposed to have the MRI scan, which I thought was at 13.30. I had tried to confirm the time yesterday evening, but the appointments office was closed. At 10.00 this morning I called again, and was told that I had missed the appointment, which had been arranged for 09.00, and they couldn’t fit in another one until 10.00 on April 20. Presumably this will have a knock-on effect on the timetable for the operation, unless Dr L can persuade the MRI to fit me in earlier, depending on what comes out of last Friday’s biopsy.

But I did beat JW 4-0 at ping pong yesterday.

Ping-Pong April 8

I was beginning to think I'd become too decrepit to beat JW, having lost 4-0 the last two outings, but today I beat him 3-1!

The CT scan shows a series of horizontal cross-sections of the chest. This shows the abnormality (the light grey ellipse just to the left of centre) at its maximum diameter 

Another biopsy, April 7, 2006

Many thanks to the splendid team at King’s, and specially to Dr C, Nurse M from the Philippines, Nurse S from New Zealand, Nurse M from Sierra Leone and Nurse P from Nigeria.

The procedure takes about an hour and a quarter, including preliminary CT scan, injection with dye, giving local anaesthetic, and finally, taking the samples. The biopsy needle is hollow, with a solid rod in the middle. When the needle is positioned so that the end is in the abnormality, the rod is withdrawn and replaced by an 18-gauge tube (1.2 mm diameter), into which a sample of 10-20 mm is drawn.

Afterwards the patient has to lie still for 3 hours and an X-ray is taken, particularly to look for pneumo-thorax, pockets of air at the site of the biopsy which may lead to collapsed lung. On this occasion Dr C said there was a small pneumothorax, but he didn’t think a further stay in hospital was needed. So it was, as expected, just over 6 hours total at King’s.

Back in recovery, with Nurse M from Sierra Leone and Nurse P from Nigeria 

One of two samples transferred 

Dr C inserting the biopsy needle 

Dr C gives local anaesthetic 

Into the scanner for the first time 

X marks the spot, and a good deal else by the look of it 

Getting ready at the CT scanner 

Waiting for the biopsy in the recovery ward 

Consultation at King's April 3, 2006

The chest physician Ms L and the surgeon Mr M were both present, plus two third-year students.

The biopsy showed lymphocytes but that doesn’t indicate the nature of the abnormality. The histopathologist at first thought it was lymphoma but that seems unlikely. Mr M said it was ‘a fairly meaty lung cancer if that’s what it is’, but the best approach would be a further CT-assisted biopsy, now arranged for Friday April 7.

Mr M would also request a PET scan, (positron emission tomography), which is only done at St Thomas’s. Many cancer cells are metabolically active and take up radioactive glucose which is injected into the body an hour before the scan, so that the cancer shows up on the image. A whole body PET scan may also detect whether the cancer is in one area, or has spread to other organs. (The CT scan hadn’t shown any sign of spread).

There were likely to be significant adhesions in the lung from the 1995 bypass, making surgery more difficult, but lessening the risk of pneumothorax or collapsed lung.

The MRI scan is scheduled for April 13. This would give a clear view of the nerves and blood vessels at the top of the neck. It produces a more detailed picture than a CT scan, and allows the images to be taken from almost any angle, as opposed to the CT scan which only displays a horizontal section.

The likely end product is surgical removal of the abnormality within a week of the MRI scan, ie by April 18

Note dated March 16, updated March 25

Chest X-ray March 10 revealed an abnormality at the top of the right lung. Monday March 16 I saw consultant Dr Rebecca Lyall at King's who ordered blood tests an a CT scan. This was done Tuesday March 14 and confirmed that there is a tumour, which Dr Lyall had discussed with Dr Marrinan the chest surgeon with a view to its removal. The good news was that the scan didn't show any signs that the tumour had spread to other parts of the body.

Dr Lyall has ordered a MRI scan for April 11 which will show more detail and in particular, how near the tumour is to nerves.

Lung function tests were done on March 17 at 12.00 and after that, a pre-assessmeny for the CT-assisted biopsy which is scheduled for 09.00 March 24,

The consultant's note read 'Looks like R apical lung cancer. No other evidence of spread. Waiting histo'. Jf this is confirmed by the biopsy they probably won't hang about.