Sunday July 10th

Review of the week:
Friday - Audiology - no change/decrease in hearing! Very good news as I was anticipating an ongoing decline after his comments on our last visit.
Monday - Oncology. Results showed no progression of brain metastases (although there are actually 2 - 1 frontal and 1 cerebellar). Bloods showed recurrence of hyponatraemia (low sodium) with a level of 127. Discussed what to do next - options included more radiation to the brain - NO; more IV chemo- NO; change to a related but different oral chemo to Iressa - no; restart Iressa - maybe; do nothing - maybe.
With regard to the sodium the only treatment option is to restrict fluid intake again and the doctor suggested would be good to keep her below 1500ml per day.
Other major issue was whether to continue on the 2mg Dexamethasone daily (oral steroid medication). On discussion with her GP a week earlier we had decided to go on with this, but today it was suggested that weaning her off them is definitely worthwhile.
Feet are looking much better. The oncologist Dr K still thinks the problem may have been an Iressa side effect although the overall thinning of the skin is definitely due to the dexamethasone.
In the end we decided to try the fluid restriction, begin to wean the Dex (slowly) and stay off Iressa for another 2 weeks (and in the meantime use lots of emollients on her skin). Blood tests every 2 weeks then another review on the 8th August.
Tuesday - Palliative Care Review. Dr M was as lovely as ever. She was very impressed with Helen's overall physical state and supported the suggestions from oncology - in particular to try to wean off the Dex if it is possible.
Thursday - Podiatry. General foot care - nails, callouses etc.

Friday Helen had a very bad day - weak, sleepy, confused and really not able to walk very well. Jo reported that it took half an hour to help her to the toilet in the morning and that after a small amount of exertion she was very breathless, pale and sweaty.
In the end I discussed all this with Palliative Care and was offered/encouraged to bring her in for a hospital admission. The only limitation being that there are no beds available in Hospice and she would have to go in to the main hospital via ED. In the end I decided to defer taking her in and just see how she went. Saturday whe was a little better. Sunday (today) she is great! So...hard to say.
Interestingly we haven't been able to decrease her fluid intake as when we started to record it we realised that her current fluid intake is <1 L a day in any case.
So...possible culprits include electrolyte disturbances or our old favourite the UTI. Having said that she is much much better now and I'm going to wait til the working week starts again and then just ring up and talk it over with the doctor again.
We have begun to wean the Dex - alt 2mg with 1/5mg - but we hadn't started this when she first deteriorated.