Skype

Set up Skype on the computer to talk to family. Within minutes J finds an option to take distorted photos, (see the eye-alien in earlier post). Next time I look the webcam has gone and he's nabbed it to fix to his laptop.

Kerridge

The aim is to keep me reasonably fit. T shows me a stone flagged path in Kerridge originally used by mill or quarry workers as a dry route between Bollington and Kerridge. It's easy walking ending with a great view across the Cheshire plain.

NVQ Level 3

The induction evening for the NVQ 3 in Health & Social care is at Macclesfield College from 5pm-8pm. I'm spotted by my assessor from last year as I creak slowly across the car park to the classroom. We fill out endless enrolment forms and then do 2 x half hour literacy and numeracy tests. I'm so tired by the maths I can't work out the volume of a cube. J's doing Maths A level so he'll help his dim Mum. He's amazed I don't have an O level. Not even a CSE. I was bottom of the bottom maths group at school. But managed to do the accounts for a small business later in life. And no, it didn't go bust!

I have to do 4 compulsory units and 4 optional units. I can only find 3 optional units that fit my job - pressure care, moving&handling, medication. The tutor suggests "dealing with aggressive behaviour" but the clients I have are lovely. The girl next to me can't believe I don't have grumpy ones and wants to know who I work for. She's on duty from 8am to 11pm poor thing.

Same day - different results

GCSE results day. J has done brilliantly. 6 'A's including 2 A*s. Only a failure in Buddhism as part of RE. No worries, he wasn't planning on being a monk.

I have my MRI.
Everyone warns you about the noise. I found the background thuds reminded me of the rhythmic putt putt of a canal barge. Soothing.
Yes it's noisy on and off but I had earphones. And another IV in my arm for dye. And a contraption round my stomach which was supposed to respond to breathing. I'm too skinny for the belt and the machine says I'm dead. Enter the radiographer with padding. Still not breathing. More padding. This time it must be ok.
I keep my eyes shut as it's like being a potholer. The roof is right above my nose and my elbows graze the sides. How does anyone larger fit in?
The IV felt wrong from the moment the radiographer put it in. When I'm wheeled out of the scanner I'm bleeding all over the place. Panic - will my clotting study be bad when it's taken.

MRI results are on the system in time for the next days MultiDisciplinary meeting. No smaller tumours visible. My turn for an A*

Fibroscan

Not me in this picture!

I'm so lucky the hospital has just installed a Fibroscan. It means I don't have to have a biopsy prior to surgery.

The procedure takes 10 readings and the result is the average. I'm hoping for a reading of less than 5.5. Mine averages 12.4. Not good, (but the machine can measure up to 75, so perhaps I'm being unfairly gloomy). Tara the nurse shows me a graph which interprets the results. It ranges from F1 in green through amber, light red and dark red which is F4. I'm at the top of F3 which indicates fibrosis. The results will go to the surgeon to help him remove the area round the tumour and resect the liver.

It's been a painless procedure apart from an odd thud at one point. From today on my liver area feels bruised.

Extract from a news report from East Cheshire NHS

New Fibroscan equipment already benefitting patients
03 August 2010
The Gastroenterology Department at East Cheshire NHS Trust has been successful in its application to become a host trust for a Technology Implementation Project supported by the NHS Technology Adoption Centre.

Macclesfield District General Hospital has become the first centre in the region to be equipped with an elastrograph - Fibroscan, developed by Echosens International. This medical device is designed to rapidly measure liver stiffness in a painless and totally non-invasive manner.

The Fibroscan machine uses a probe, which is kept on the right lower chest of the patient. Just by pressing a button the ultrasound probe sends a wave into the liver. The Fibroscan measures the speed of the wave and calculates the stiffness of the liver. This data is automatically processed by the onboard computer and the liver stiffness is displayed on the screen. Ten readings are recorded. The patient lies on his/her back, right arm raised behind the head. The measurement is made on the right lobe of the liver by intercostal route using a dedicated probe with a vibrating system. The result is delivered at the end of the 10 recordings. The process takes 10 minutes and assesses the patient for liver fibrosis and cirrhosis.

The Fibroscan has been used in patients with persistent abnormal liver function tests including patients with viral hepatitis, alcoholic liver disease, fatty liver disease and many other conditions which may lead to liver cirrhosis. The result of the examination is instantly available to the patient and helps the clinician to make a diagnosis of liver cirrhosis or fibrosis and then offer specific patient management.

This new technique also allow the treating doctor to arrange all patients with abnormal liver function tests into groups of those who have a high degree of liver fibrosis or cirrhosis and therefore require intensive management and those who are at low risk and would only be rescanned in one to three years.

MDT results

The multi-discipliary team must meet early as Dr Caravan-a-nan rings me on my mobile at 10am while I'm in a client's kitchen. Luckily there's a magnetic note pad on the fridge and I borrow a sheet of paper from it.
The CT scan showed a 1cm tumour on the liver. Coupled with the AFP blood test results from July he wants it removed without hanging about doing a biopsy. I'll have a Fibroscan which will show how 'stiff' or scarred the liver is around the tumour. It's non-invasive and safer than a biopsy. I'm also to have an MRI to check for smaller tumours.

CT scan

Drink what feels like pints of gastrografin contrast medium (a dye) which contains iodine. It hints of aniseed and leaves me feeling bloated. The hospital has just opened a new CT scanner the day before and I'm one of the first to use it. The department is spotless brand new but the backless hospital gowns are as old fashioned as ever. They leave me in a cubicle for 20 mins to drink another pint of gastrografin. I could never be a binge drinker! More dye via IV once I'm in the scanner. Strange to be able to feel/taste it at the back of my throat and again in the pelvis. Not sure how many images were taken during about 1/2 hour but I do know I need the loo after all the drinking. The space is air conditioned and cold, but they can't find a blanket as the department isn't fully equipped yet. I make do with a sheet.
My inner elbows are feeling the strain now after 37 blood tests and the IV.
The gastrografin disagrees with me and I'm off work with an upset stomach.

Dr Caravan-a-nan

First appointment with the gastroenterologist at my local NHS trust hospital. His name has a whole series of a's and v's and n's and rhymes with caravan. He's no nonsense and I like him. He revises the GPs idea of an ultrasound and organises a CT scan in 8 days. He also organises more blood tests, this time a series of HBV ones to clarify the antibody/antigen situation plus a DNA one to see how quickly the virus is replicating. I'm now 'active' hepatitis instead of the 30+ years of being 'inactive'. Time to decide if family should be tested again. The specialist hepatic/pancreatic/biliary team at North Manchester hospital will look at the scan and results via video link in a joint multi-disciplinary meeting with Dr Caravan-a-nan.