PICC Problem - No problem

Yesterday was the start of my final - hopefully - chemo session. Everything had gone well so far, but there had to be a little snag somewhere along the line didn't there, and somewhere along the line was exactly where it was.

The lovely nurse Jill had changed my dressing and drew back on the syringe to check blood flow. When she pressed to flush the line a mix of blood and saline was seen to have leaked from somewhere. So, the new dressing had to come off. A further gentle push on the syringe showed a leak on the PICC line about 1 cm from the entry point in my arm.

Before I could even think about worrying having to cancel the treatment or having to have a new line put in just for one session a specialist nurse was called. She quickly explained that a repair was possible and painless. Fortunately there was enough spare in the line inside my body to withdraw about 3cm, snip off the damaged section and fit a new valve. A cracking job, as they say, by the nurses at Weston Park don't seem to be fazed by anything.

Just one little odd event to report. At the very moment that the nurse snipped through my PICC line all the lights in the room went out! The four of us (myself, my wife and the two nurses) just looked at each other and then burst into laughter, with the rest of the ward wondering what we were up to!

Hope putting the lights out wasn't some sort of omen!

What's in it for me?

I've been asked a few times what's involved with chemo. What is the procedure? What are the drugs and what do they do?

How chemotherapy is administered varies according to the patient and to the type of cancer being treated. My first chemo course in 2010 was Capecitabine (Xeloda®) in tablet form, so could be taken at home. However stronger chemicals are usually administered intravenously. For this some people have to spend time in hospital, some can be dealt with as outpatients, and some have a combination of outpatient and home treatment. I'm fortunate enough to be having the latter so I have to spend as little time as possible at the hospital.

Using a cannula for home treatment is not practical so I have been been fitted with a PICC line, and this will be left in place for the 12 weeks of this treatment. It runs from just above my left elbow up through veins until the tip is just above my heart. The thought of having this line inserted was a bit daunting, but I can assure you it's a simple and painless process. An X-ray makes sure the nurse got it right before we start the drips. Despite there being only a tiny entry hole which the body seems to seal naturally, it is treated as an open wound and a large area around it is covered with a sterile dressing (Weston Park use a different one to that shown in the photo).

So, for six alternate Tuesdays I go to Weston Park Hospital Day Care Unit in Sheffield to start off a four day treatment. Day one is at the hospital, and the first job is to change the dressing that holds my PICC in place. Then a syringe is connected, firstly to draw back a little blood to prove the line is still connected properly and then to flush out the line ready for the next stage - a selection of drips from the main menu!

The first two drips are a steroid, which is used as an anti-sickness agent, and Piriton (antihistamine) to help ward off possible side effects of the serious stuff which now follows. So, we've done the starters and now it's time for two main courses. Greedy!

Oxaliplatin is used to stop cells producing DNA, which means they cannot grow. As cancer cells grow and divide faster than normal cells the chemotherapy will affect those most. Unfortunately the treatment can see off some normal cells and that is what causes side-effects, though when the treatment is over the normal cells recover and so side-effects are usually only temporary.The chemo is carried in a glucose solution as cancer cells attract glucose, not knowing of course that some sneaky doctor's hidden something in it to try to kill them! Along with this goes a solution of potassium and folate to help maintain the bodies levels of essential chemicaos that the chemo might damage.

After this, a saline flush clears the PICC line ready for the next dose, which is Fluorouracil, also known as 5-FU. This an anti-metabolite and is also to stop cells making and repairing DNA. This is because cancer cells need to do this to grow and multiply. All of this is known as combination therapy - two drugs which have a similar effect but work differently. After this, yet another saline flush to clear the lines.

I now have an infuser bottle containing more 5-FU connected to my PICC line. The liquid is contained in a pressurised bulb and over 48 hours this is forced into my blood. The rest of this session is at home, which enables me to go about my normal day rather than spend two days in hospital. My wife has been trained to remove the infuser, flush the line and change the dressing, so hospital visits are kept to a minimum. The next NHS visit will be to my local hospital for a blood test and quick consultation on the Friday before my next Tuesday appointment.

As well as the infusor treatment on Wednesday, Thursday, and Friday I have to take Dexamethasone tablets, mainly to ward off sickness. These being steroids make for a weird few days as they tend to try to keep me awake while the chemo tries to send me to sleep. One minute I feel on top of the world, and the next that the world's on top of me! After Friday the fatigue starts to grab hold and leaves me quite cream-crackered for the next few days.

The whole course is six sessions over twelve weeks. After that . . . . who knows?