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I received a call in the afternoon from one of the haematology registrars telling me to come to hospital on Saturday to pick up some anti fungals - Voriconazloe. They'd also cultured a fungal infection from the spewtum samples I'd been giving on a regular basis at hospital called; Aspergillus. Another nasty infection to add to the GVHD and TB….

The TB drugs have interactions with certain drugs. That is to say that they increase the metabolism of certain drugs in the liver, hence a dose of some medicine may only be 50% effective. This means that twice the dose needs to be given in order to get the intended amount. I already knew that we had to increase the dose of my current anti-fungal (Fluconazloe), so I asked the doctor to check with the pharmacy about the interaction of the TB drugs for the new anti-fungal: Voriconazole. Sure enough, the TB interacts. Infact so much so that the voriconazole is rendered totally ineffective.

Voriconazole is the only tablet anti-fungal that can be used to combat the the Aspergillus. The other drugs are IV only. Since the course of anti-fungals is a minimum of four weeks, I had to come back to hospital and have a hickman line inserted.

To remind you, the hickman line, is a tube with 1,2 or 3 lumen (channels), which is inserted in to your jugular vein (the thick vein on either side of your neck. This vein leads to the heart. It means that blood can be taken from the line and IV drugs administered without having to use needles in various veins around the body.

The procedure itself isn't too painful as your neck and chest are anaesthetised. If you're not too squeamish and want too know more click here. After the procedure. the area is quite tender for a few days so you don't really use your arm on the same side. After a week, the line becomes unnoticeable, and your silent companion. You have to have the dressing changed every day to prevent the line from getting infected. If this was to happen the line would need to be pulled out.