My CALIBRATION Trial

A not unreasonable night for most of last night, spoiled only by a minor incident of reflux at bedtime (midnight), and a major one at 0800 where i threw up half a litre of fluid, blood clots and probably some undigested fruit. (Bear in mind please i hadn't eaten since 1900 the night before). The pattern of these episodes is fairly common. I'm lying down asleep or dozing, I get a tickle in my throat, I cough, the tickle remains so i cough again. Eventually the coughing starts reflux, and i vomit, which repeats until i suspect my stomach is substantially empty. Then I can doze off again. Hopefully a new adjustable bed will help by getting me sleeping at a steeper angle than that achieve d by pillows. That should arrive next week.

Friday and Saturday were reasonably stable. I'm still finding it difficult to get comfortable enough to sleep, still have no energy during the day, and still don't feel like eating much. Sunday night though was bad. Having dozed off lying on my left side, I woke with a mojor reflux incident around 2.00 am which developed into a coughing fit (aspirate in windpipe,) with what looked like some digested blood clots. This reoccurred at 4.00 am except the vomiting was much more violent and greater quantity of aspirate/blood. I estimate about half a litre. I didn't get to sleep after that, just dozed. Still have the pain in my right shoulder when i lie on that side. PICC line problem? New adjustable bed on order, should reduce the reflux. 

Eventually, it was decided there were two options. Keep treatment as is with the aim of reducing the pulmonary embolisms. Reduce the anticoagulant to reduce the bleeding, which would have the side effect of leaving the embolisms untouched with consequent risk. First option was chosen. (I understand Bruno da Paula was party to the decision). For my part I have shifted the anticoagulant injections to the morning in the hope of minimising bleeding at night. I was discharged by NNUH in the afternoon.

Not a good night. Reflux led to vomiting around midnight, and i noticed tha vomit had a pale pink tinge to it. Wondered if there was food colouring innthe morphine - that being the last thing consumed. However, around 5.30 i awoke and vomited again and this time it looked like there might be fresh blood in the vomit. Checked temperature - 37.5 - checked again 10 minutes later - 38.0. Rang Norfolk & Norwich AOS, who said to go in. (Addenbrookes' AOS is too far away for emergencies). NNUH Acute Medical Unit best guess was that the primary tumour was bleeding, and encouraged so to do by the anticoagulant. Will talk to Dan Holyoake my NNUH oncologist. Meantime the nurses have suggested I go nil by mouth in case someone wants to look down my gullet. By lunchtime I hadn't been sick again, and my temperature was down again. I was allowed lunch as the chances of a gastroscopy today have much receded. Eventually i was debriefed by one of the oncology consultants, who arranged for me

No significant change. Spent most of the day asleep on only 2 spaced doses of morphine. Maybe I shouldn't drive while on it. Don't feel like eating or drinking much. Probably losing weight due to dehydration. Still constipated, maybe because there's not much in there!

Still feeling rough. Drove to Addenbrookes for blood tests and the next tranche of iron infusion. They gave me a detailed going over and revealed the blood tests showed a significant infection somewhere, so gave me antibiotics to take away, plus oral morphine to take as needed (max 1.25mls per 4 hours). Didn't feel up to driving afterwards and anyway don't know how I react to morphine.