The Hickman Line, also known as:
    Leukaemia, Chemotherapy, and the associated treatments involve drugs and blood samples flowing into and out of my body.  In the old fashioned IV way each of them would have involved a needle into a vein somewhere.
     Now imagine the first few days of my treatment. Apart from the leukaemia I had a fever and was dehydrating. For a few days I was was receiving two or three IV antibiotics, two chemo drugs (one injected, one IV), Saline solution, Glucose solution, and I'm sure there was something else but with the fever and the rest I've forgotten.  Coming out were blood samples. It felt like all the time, but was probably only once a day.
    Enter the Hickman Line. Insertion means a minor surgical procedure (local anesthetic) involving a couple of small incisions in the skin of my chest. A plastic tube was inserted in the first and pushed up under the skin to the second cut, just above the collar bone on the right hand side.  From there the surgeon cut into the large vein in my neck (not the artery, not the artery!) and the tube was pushed down several inches until the end was sitting just outside my heart.   The external part is about 30 cm long, and splits into two halfway along it's length so it hangs like an inverted 'Y' (or a snakes tongue) down almost to my navel.  There are clamps and screw caps at the ends to seal the tubes.
    Now, when it's time for a transfusion (blood, chemo, platelets) or a blood sample, all that they need to do is pop the clamp, unscrew the cap and plug me in. Well there's more to it than that, involving a lot of alcohol wipes, saline, heparin flushes and the like, but you get the idea.
    And believe me, if the alternative is multiple needles and IV lines out of my arms, I'll take the Hickman line any time.  On the downside it means no swimming or volleyball for the next few months.
Maintenance is a daily chore. There's the daily cleaning routine and dressing change. Taking a shower becomes a bit of a performance. I need to wrap the tubes and the entry site in something waterproof and tape the bundle to my chest each time - but like anything else, I can get used to it.  And when its not in use I keep the tubes wound in a little cotton pouch hanging round my neck. The pouch is actually a mobile phone bag, and Deb has bought me a colourful selection.. :-) 

Oh yes - the dressing sometimes itches like anything. I found that shaving half my chest makes changing the dressing much less painful.  And since one side effect of the chemo is that it has my hair growth  - I haven't had to shave it again in the past 6 weeks....

Well - I'm out of hospital again, having completed my second cycle of chemotherapy. A cycle lasts a month, and consists of a little action and lots of boredom. My cycles start at the beginning of the month and go something like this:

    Days 1 - 5    Chemo and daily blood samples.  I receive two drugs: one injected and the other transfused directly  into my bloodstream via the Hickman line (aka a Central Venous Catheter or Central Line - more on that another time). 
    Days 6 -7     Observation. Daily blood samples taken via the Hickman line and checked for the levels of various blood cell types.  The cell counts for red cells, white cells and platelets are all expected to continue dropping for several days after the chemo is finished.
    Days 8 - 12     Home leave! During this window the cell counts continue to drop but are not yet at a dangerous level.  I'm limited on what I can eat, and where I can go ('No restaurant, no cinema, no karaoke! OK "?) and I need to wear a mask when I'm out in public.
    Day 13 -14    Back to hospital where I check in to the day ward for a blood test.  If my cell counts have dropped to a level where I'm anaemic, suseptible to infection, or my blood is unable to clot properly - then I'm readmitted to an in-patient ward. Otherwise home again for a day or two.
    Day 15 - 25   Back in hospital in an isolation room. This is the tedious bit. By now my cell counts have all dropped to dangerous or near dangerous levels.  The high points are visitors, phone calls, and my daily blood test results.  The doctors give me a copy of the printouts showing the various cell levels, reference ranges etc, and then we discuss why I dont *feel* ill...  The low points are the other 22 hours where I have to entertain myself.
    Day 25 or so - back home! Still have to be careful about what I eat and who I see, but less so than at the beginning of the cycle.

And for the interested:
    Low red cell counts:    My blood carries less oxygen to my various organs- can be short of breath, or dizzy when I stand, and I tire very easily. Chemically induced anaemia.
    Low white cell counts:    I'm unable to defend myself from infection.  A bit like the effects of AIDS - but I'm hugely thankful that in my case it only lasts a week or two. Hence the isolation. 
    Low platelet counts :    My blood cant clot easily so any cut or wound remains open and oozing for much longer than usual - a bit like haemophilia. Unpleasant and an easy target for infection. Luckily I've only had one episode of this where my gums bled and I spent several hours sucking ice-cubes, waiting for them to stop.
    Isolation :     I'm confined to a single room with attached bathroom, and an antechamber. Its all air-conditioned at slightly positive pressure so no bugs waft in from the ward. No windows to the outside world.  Visitors need to scrub up and wear masks before entering, On the most critical days I have no visitors and the med staff all wear disposable paper gowns.
So I spend my time reading (a book a day is easy), watching movies on the laptop (but no internet access - hence infrequent postings), playing Freecell ( I win on average 76% of the time),etc. There's a TV but this is HK - there's little on to watch, except reality shows and hospital dramas (which I avoid for some reason).  I also tally the number of cancer references in the news, newspapers and books - surprisingly frequent once you start looking for them...

And while I remember - other posts to come: Chemo, Hickman line, Restrictions, Other peoples reactions. Oh yes - the future...

Feel free to drop me an email : malcolm AT morris DOT hk  
But remember my access is limited so replies may be delayed...

I've posted a new photo to Photos.
Wed -Oct -2006 (HKT)

For those few of you who pop in from time to time - here's an update om my life:
Last month I was diagnosed with Acute Myeloblastic Leukaemia.  Not good.

Immediately after the diagnosis I was admitted to hospital, and started my first session of chemotherapy.  That lasted a week, after which I had 3 weeks hanging around waiting for my blood cell counts to recover - after which I was allowed home for a weeks R&R.

That week is just about over and tomorrow I check back in for my next chemo session. The good news is that I appear to have responded well to the first session, family and friends are being wonderfully supportive and I'm in a good place mentally.

Within the next week I'll have some test results that will give us an idea of how things are likely to progress in the next few months and what the long term prognosis is. But as I dont have internet access in the hospital (Pamela Youde Nethersole Hospital, Chai Wan, HK) you'll need to talk to Debbie, or send me an email, which I will answer on my next home visit, which is likely to be around the end of October.

Malcolm