Reflection: talking of Aces…

I have come to realise there is a real, wonder-full, positive aspect of where I “am” now.  I am so lucky to benefit from the miracles of science (Sean the memory metal stent), medicine (my chemo regime and Paddy the Portacath) and engineering (Peter the pump) that are available in 2014 here in the UK.  I have a truly outstanding level of medical care.

I’ve marvelled at Sean the “memory metal” Stent before – the amazing way it is packaged into a long incredibly thin mesh tube that can be guided into the smallest of openings, where, once it is released from its case, it shortens and expands until it is an inch wide and 8 cm long (sorry for the mixed units!); completely opening the bowel and transforming my life, literally in seconds.

But that’s not all.  The advances in the way my drugs are given are incredible – not “by mouth” as they once were (allowing the digestive system to do it’s worst before they got anywhere), but directly into the “superior vena cava”, getting it directly to where it needs to be (thanks, Paddy the Portacath!).  And the manner of their infusion, particularly the 46 hours taken to infuse fluorouracil (5FU) is just as amazing…
 
Do you remember “half life” in chemistry at school?  The time taken for the concentration of something to half?  The effectiveness of any medicine is directly related to its concentration in your system, so its “half life” is critical to its efficacy.  In other words, if 5FU was infused for just a few hours, it’s effectiveness would immediately begin to decrease.  

So, first the nurses administer a “bolus” (the initial infusion) of 5FU, quickly getting the drug’s concentration to the right level. Then I have a much, much slower infusion to keep the concentration of the drug topped-up to the right level, replacing that which is naturally used up or broken down in my body.  So rather than “just a few hours” of effect, I get over two days worth!  

Enter the third star of the show – “Peter the pump”.  In a way, this is the really clever bit – without Peter, there would be no practical way of accomplishing that extended period of efficacy, without keeping me in hospital for 2 days.  And it’s such a simple device – imagine a coke-can sized bottle, partially filled with balloon full of 5FU; and the bottle is pressurised.  So, over a long period of time, the balloon’s contents are gently squeezed out, down a tube and into Paddy…  quite brilliant.

(Sorry, I must not forget why I need Boris the bag:  Peter has to be transparent (so we can see the deflating balloon), but 5FU is light sensitive.)