{ "meta": { "as_at": "17 September 2026", "version": "2026-09-17", "compiled_from": "Lab report 14 Sep 2026, clinic letters 4 and 24 Aug 2026, CT report 23 Jul 2026, chemotherapy prescription chart for 30 Sep 2026, consolidated molecular summary (integrative oncologist, 17 Sep 2026), EXACTA/Astron and DATAR reports", "live_url": "https://fcancerwith.ai/open-source-me", "as_at_iso": "2026-09-17" }, "person": { "name": "Russ Read-Barrow", "dob": "2 July 1982", "location": "Bath, UK", "hospital": "The Bath Clinic, Claverton Down, Bath", "contact": "russreadbarrow@gmail.com", "allergies": "No known drug allergies", "ps": "WHO performance status 0" }, "status": { "label": "On treatment", "line": "Cycle 3 of FOLFIRI + cetuximab rechallenge", "next": "Cycle 4 due 30 Sep 2026 · CT after Cycle 5" }, "stats": [ { "label": "Stage", "value": "IV", "sub": "Metastatic" }, { "label": "CEA", "value": "50.9", "sub": "ug/L · 14 Sep 26 · ref 0–5.2" }, { "label": "Cycle", "value": "3", "sub": "of this block · 15th FOLFIRI+cetux overall" }, { "label": "WHO PS", "value": "0", "sub": "Fully active · 24 Aug 26" }, { "label": "PD-L1", "value": "<1%", "sub": "TPS · negative" } ], "diagnosis": { "primary": "Moderately differentiated adenocarcinoma, rectosigmoid colon", "staging": "ypT4a ypN1b (3/24 nodes) M1a V+", "timeline": "Treatment began Dec 2021; primary resected Mar 2022", "sites": "Lungs · mediastinal lymph nodes · liver segment VII (new, Jul 2026)", "other": [ "Smouldering myeloma (diagnosed end of 2021, under haematology surveillance)", "Gilbert's syndrome (can raise bilirubin)" ] }, "molecular": { "tags": [ "KRAS/NRAS wild-type", "BRAF wild-type", "pMMR / MSS", "HER2 IHC 0", "TMB-low · 3 Mut/Mb", "PD-L1 <1% (22C3, 28-8)" ], "mutations": [ { "gene": "APC", "change": "p.S1415Rfs*4", "detail": "Frameshift · tissue MAF 8.5% · cfDNA 0.62%", "class": "Pathogenic" }, { "gene": "TP53", "change": "p.R342*", "detail": "Nonsense · tissue MAF 9.21%", "class": "Pathogenic" }, { "gene": "PTEN", "change": "reported, not specified", "detail": "Named in my oncology letters. Exact variant, allele fraction and classification not in my records yet", "class": "To confirm" } ], "source": "EXACTA report, 1 Sep 2025", "vus": "VUS: RUNX1T1, FANCM, CIC, BCR, CYP2D6. Exploratory (Astron/ICC): MTOR and VEGFR1/2 protein positivity, HMGB1 overexpression" }, "treatment": { "regimen": "FOLFIRI + cetuximab (rechallenge, 3rd block)", "cycle_length": "14 days", "cycles": [ { "n": 1, "date": "19 Aug 26" }, { "n": 2, "date": "2 Sep 26" }, { "n": 3, "date": "16 Sep 26", "current": true }, { "n": 4, "date": "30 Sep 26" }, { "n": 5, "date": "TBC" } ], "doses": [ [ "Cetuximab", "500 mg/m²", "1000 mg" ], [ "Irinotecan", "180 mg/m²", "400 mg" ], [ "5-FU bolus", "400 mg/m²", "900 mg" ], [ "5-FU infusion (46h)", "2400 mg/m²", "5000 mg" ], [ "Folinic acid", "", "350 mg" ] ], "plan": "Plan: 8–12 weeks, then consider maintenance 5-FU + cetuximab if response is good. CT after Cycle 5.", "dose_note": "Full doses, dose-banded · BSA 2.08 m² (84.5 kg, 185 cm, 16 Sep 26)", "block_note": "This is my third block of this combination and my 15th cycle of it since April 2025.", "dose_source": "From the prescription chart for cycle 4." }, "cea": [ { "date": "2025-04-17", "value": 66.1 }, { "date": "2025-05-01", "value": 85.4 }, { "date": "2025-05-19", "value": 68.2 }, { "date": "2025-06-02", "value": 30.5 }, { "date": "2025-06-16", "value": 17.5 }, { "date": "2025-06-30", "value": 11.4 }, { "date": "2025-08-11", "value": 15.6 }, { "date": "2025-10-07", "value": 32.1 }, { "date": "2025-11-24", "value": 44.6 }, { "date": "2026-01-06", "value": 41.7 }, { "date": "2026-03-02", "value": 38.6 }, { "date": "2026-03-16", "value": 32.5 }, { "date": "2026-03-30", "value": 21.1 }, { "date": "2026-04-20", "value": 16.8 }, { "date": "2026-05-12", "value": 15.8 }, { "date": "2026-07-23", "value": 49.4 }, { "date": "2026-08-07", "value": 87.6 }, { "date": "2026-09-01", "value": 146.0 }, { "date": "2026-09-14", "value": 50.9 } ], "bloods": { "date": "14 Sep 2026", "source": "TDL / Bath Clinic, lab ref on file", "rows": [ [ "Haemoglobin", "133", "g/L", "130–170", "" ], [ "White cells", "6.64", "×10⁹/L", "3.0–10.0", "" ], [ "Neutrophils", "3.99", "×10⁹/L", "2.0–7.5", "" ], [ "Platelets", "289", "×10⁹/L", "150–400", "" ], [ "ALT", "26", "U/L", "10–50", "" ], [ "AST", "26", "U/L", "10–50", "" ], [ "ALP", "179", "U/L", "30–130", "H" ], [ "Bilirubin", "13", "µmol/L", "0–20", "" ], [ "Albumin", "43", "g/L", "35–50", "" ], [ "Globulin", "37", "g/L", "19–35", "H" ], [ "Creatinine", "75", "µmol/L", "59–104", "" ], [ "Magnesium", "0.89", "mmol/L", "0.7–1.0", "" ], [ "Potassium", "4.2", "mmol/L", "3.5–5.3", "" ], [ "GGT", "22", "U/L", "10–71", "" ] ], "note_65": "That's a fall of about 65% from 1 September, two cycles into the restart. ALP has gone 102 (July) → 165 (1 Sep) → 179 (14 Sep), with normal bilirubin, ALT, AST and GGT." }, "imaging": { "latest": { "date": "23 Jul 2026", "type": "CT chest, abdomen & pelvis", "headline": "Progression above and below the diaphragm, and a new liver metastasis", "source": "CT report, 23 Jul 2026, compared with May 2026" }, "previous": { "date": "12 May 2026", "type": "CT chest, abdomen & pelvis", "headline": "“Good response to treatment within the mediastinum and lungs.”" } }, "history": [ [ "Dec 21–Feb 22", "Neoadjuvant XELOX ×4 · good partial response" ], [ "Mar–Oct 22", "Primary resected · liver met resected (R0) · adjuvant CAPOX" ], [ "Oct 22–Apr 23", "Lung mets appear, progress · SABR 55 Gy/5" ], [ "Jun & Aug 24", "Lung ablations (1 left, then 1 left + 4 right)" ], [ "Feb 25", "EBUS confirms mediastinal nodal disease" ], [ "Apr–Jul 25", "FOLFIRI + cetuximab ×6 · good partial response" ], [ "Feb–May 26", "Rechallenge ×6 · excellent partial response" ], [ "Jul–Aug 26", "Progression during the break · FOLFIRI + cetuximab restarted 19 Aug" ] ], "protocol": { "status": "Current meds · 17 Sep", "groups": [ [ "Chemo day", "Standard pre-meds (Akynzeo, dexamethasone, chlorphenamine, atropine) · pegfilgrastim 24h after" ], [ "Supportive", "Dexamethasone ×3 days · domperidone · loperamide · doxycycline + Plazon (skin) · Laxido · antihistamine · zopiclone PRN" ], [ "Other", "Citalopram 30 mg (breakfast) · melatonin 60 mg (evening) · loratadine 10 mg" ], [ "Paused", "Mistletoe and most supplements / off-label drugs, during chemo on my oncologist's advice" ] ] }, "seeking": { "trials": [ "BNT314 + pumitamig (BNT327) + chemo · MSS/pMMR mCRC", "Botensilimab + balstilimab · pre-treated MSS CRC", "WNT/β-catenin-targeted: ST316 (NCT05848739, phase 1–2) · tegavivint" ], "ask": "Know this profile? Patients with similar disease, oncologists, scientists and geneticists — I want to hear from you. Not generic advice, please." }, "letters": [ { "date": "24 Aug 2026", "role": "Consultant clinical oncologist", "type": "Pre-assessment before cycles 2 and 3", "points": [ "First cycle done, with the expected side effects, mainly fatigue.", "Go ahead with the next two cycles, pending blood results.", "CEA to be monitored. Repeat scan after five cycles to weigh response against side effects and quality of life.", "Next review: telephone consultation before cycles 4 and 5. WHO performance status 0." ] }, { "date": "4 Aug 2026", "role": "Consultant clinical oncologist", "type": "Review of expedited CT", "points": [ "CT shows progression at the previous lung and chest lymph node sites, a new liver metastasis (segment 7) and some new small-volume lung metastases. This explains the persistent cough.", "Plan: restart FOLFIRI + cetuximab. If it responds well, step down after 8–12 weeks to maintenance 5-FU + cetuximab rather than a full treatment break.", "Mistletoe injections to be suspended during chemo, and most supplements too. Any I want to keep can be checked by pharmacy for interactions." ] } ], "scans": [ { "date": "23 Jul 2026", "type": "CT chest, abdomen & pelvis", "cls": "prog", "headline": "Progression above and below the diaphragm; new segment VII liver metastasis", "detail": "Compared with May 2026: left perihilar soft tissue up from 3.9 cm to 6.0 cm with distal atelectasis; right lower lobe up from 3.3 cm to 4.2 cm; additional pulmonary nodules new or enlarging; mediastinal nodes increased, particularly subcarinal; new low-density lesion in hepatic segment VII, considered recurrent disease. Portal vein patent. No peritoneal disease, ascites, abdominopelvic adenopathy or aggressive bone lesion." }, { "date": "12 May 2026", "type": "CT chest, abdomen & pelvis", "cls": "resp", "headline": "Good response in the mediastinum and lungs", "detail": "“Good response to treatment within the mediastinum and lungs.” Compared with January 2026. End of the Feb–May 2026 block." }, { "date": "6 Jan 2026", "type": "CT thorax, abdomen & pelvis", "cls": "prog", "headline": "Further mild progression", "detail": "“Further mild increase in intrathoracic lymph nodes and pulmonary disease. Short very severe stenosis left upper lobe bronchus suggesting imminent occlusion.”" }, { "date": "7 Oct 2025", "type": "CT thorax, abdomen & pelvis", "cls": "prog", "headline": "Enlarging chest nodes, possible progression", "detail": "“Enlarging intrathoracic lymph nodes and pulmonary opacities may reflect tumour progression, though cannot exclude superadded infection.”" }, { "date": "8 Jul 2025", "type": "CT thorax, abdomen & pelvis", "cls": "resp", "headline": "Good partial response", "detail": "“Good partial response to treatment of the mediastinal and right hilar nodes. The right middle lobe nodule has resolved.”" } ], "routine": [ [ "08:00", "Domperidone (anti-sickness)" ], [ "08:30", "Breakfast with citalopram, antihistamine and coffee" ], [ "09:00", "Home-made tomato juice and raw apple cider vinegar mix (mostly because I crave it)" ], [ "09:30", "Laxido, dose 1 of 2" ], [ "Late morning", "Doxycycline (prescribed for cetuximab skin rash)" ], [ "12:30–15:00", "Bed rest / sleep" ], [ "Day 4 onwards", "Metformin 500 mg MR, building to twice daily if tolerated (new this cycle)" ], [ "15:30", "Laxido, dose 2 of 2" ], [ "18:00", "Family dinner" ], [ "Bedtime", "Melatonin 60 mg · zopiclone if needed during the post-steroid wide-awake nights" ] ], "myeloma": "Smouldering myeloma under haematology surveillance. Last myeloma markers in my records: 30 Jun 2025, IgG kappa paraprotein, free kappa light chains 22.8 mg/L (range 3.3–19.4).", "care_team": [ [ "Primary oncologist", "Consultant clinical oncologist, Bath Clinic" ], [ "Haematologist", "Consultant haematologist, Bath Clinic (smouldering myeloma)" ], [ "Respiratory", "Consultant respiratory physician, Bath Clinic" ], [ "Integrative", "Integrative oncologist (private), separate from my NHS/Bath Clinic team" ] ], "lab_panels": { "intro": "Three laboratory panels have been run on my tumour cells. These rank relative activity in a lab assay. They are not response rates, they don't predict tumour shrinkage or survival, and they are not evidence that any agent works in me. They're useful for ranking ideas and for generating questions, nothing more.", "groups": [ { "name": "DATAR / Exacta · repurposed and non-oncology agents", "items": [ [ "Chloroquine", "48%" ], [ "Ivermectin", "47%" ], [ "Doxycycline", "40%" ], [ "Propranolol", "38%" ], [ "Mebendazole", "35%" ], [ "Metformin", "34%" ], [ "Fenbendazole", "33%" ], [ "Melatonin", "31%" ], [ "Pantoprazole", "30%" ], [ "Aspirin", "28%" ] ] }, { "name": "Exacta · other agents", "items": [ [ "Dichloroacetate (DCA)", "49%" ], [ "Mistletoe (Helixor A)", "46%" ], [ "Cannabidiol", "44%" ], [ "Indole-3-carbinol", "43%" ], [ "Resveratrol", "42%" ], [ "Artesunate", "37%" ], [ "Bromelain", "36%" ], [ "Quercetin", "24%" ] ] }, { "name": "ChemoScale", "items": [ [ "Vitamin C / ascorbic acid", "50%" ] ] } ], "caveat": "On the vitamin C result: ex vivo activity doesn't establish a clinical response, intravenous and oral vitamin C reach very different levels, G6PD status and kidney function need checking before any high-dose intravenous programme, timing around chemo needs the oncology team, and it shouldn't replace a regimen that's working." }, "data_gaps": [ "Full original colorectal histopathology report", "Complete molecular report covering all tested KRAS and NRAS exons", "The exact PTEN variant, transcript, allele fraction and classification", "The original Astron report, not just the interpretive slide deck", "Original DATAR/Exacta and ChemoScale laboratory reports, with methods and controls", "Whether MTOR was assessed by immunocytochemistry, sequencing or copy number", "Whether the VEGFR1/2 findings refer to tumour cells, circulating tumour cells or another population", "Any earlier broad NGS results (PIK3CA, POLE/POLD1, NTRK, RET, ALK, ROS1, tumour mutational burden)", "Current ctDNA or liquid biopsy results, if any", "RECIST measurements from the CT after cycle 5" ], "press": [ { "outlet": "Health Awareness", "kind": "Feature", "date": "2026", "title": "I have stage 4 cancer — AI is how I took back control", "note": "Written by me for Mediaplanet's Health Awareness supplement, distributed with the Guardian.", "url": "https://www.healthawareness.co.uk/digital-health/i-have-stage-4-cancer-ai-is-how-i-took-back-control/" }, { "outlet": "Business Insider", "kind": "Interview", "date": "September 2026", "title": "A 43-year-old with colon cancer used AI in 3 ways to help make treatment a little easier", "note": "How I use AI for symptom tracking, medication and my medical records.", "url": "https://www.businessinsider.com/man-with-colon-cancer-uses-ai-to-manage-his-symptoms-2026-9" }, { "outlet": "Faces of Digital Health", "kind": "Podcast", "date": "April 2026", "title": "The Agentic Patient 2: One Tool, One Job — cancer management AI toolset", "note": "A long conversation about the tools I use alongside NHS treatment, and where they help.", "url": "https://podcasts.apple.com/us/podcast/the-agentic-patient-2-one-tool-one-job-cancer/id1194284040?i=1000764804039" }, { "outlet": "Part-time Works (Timewise)", "kind": "Podcast", "date": "2026", "title": "Special episode: working with a health condition", "note": "On working through treatment, and what good employer practice actually looks like.", "url": "https://timewise.co.uk/podcast/special-episode-2/" }, { "outlet": "HIMSS Europe", "kind": "Main stage", "date": "June 2026, Copenhagen", "title": "The patient on the panel", "note": "Speaking about patients, data and AI to a room full of health-tech.", "url": "blog/himss-europe-the-patient-on-the-panel.html" } ], "tracking": { "from": "2026-08-20", "to": "2026-09-15", "cycles": "Cycles 1 and 2 of the current block", "note": "Scored morning and evening in my own words, then turned into numbers by the tracker. One day missing (28 Aug, a wedding).", "rows": [ { "date": "2026-08-20", "cycle": 1, "day": 2, "mood_am": 6.0, "energy_am": 6.0, "mood_pm": 7.0, "energy_pm": 5.0, "nausea": 0.0, "rash": 1.0, "bowel": false, "note": "Day 1 post-infusion (FOLFIRI + Cetuximab). First day without Whoop tracking. Had a rest window/nap between 1:00 PM and 3:00 PM (slept for ~1 hour). Productive afternoon doing light garden work, followed by dinner downstairs and a family movie night with the kids. No bowel movement logged today." }, { "date": "2026-08-21", "cycle": 1, "day": 3, "mood_am": 6.0, "energy_am": 7.0, "mood_pm": 6.0, "energy_pm": 4.0, "nausea": 0.0, "rash": 0.0, "bowel": true, "note": "" }, { "date": "2026-08-22", "cycle": 1, "day": 4, "mood_am": 6.0, "energy_am": 7.0, "mood_pm": 3.0, "energy_pm": 4.0, "nausea": 0.0, "rash": 0.0, "bowel": true, "note": "Day 3 post-infusion / Day 4 of cycle (FOLFIRI + Cetuximab). Started with a solid morning walk, but mood and energy dropped significantly by evening (Mood 3/10, Energy 4/10). Heavy fish and chips meal caused prolonged fullness and abdominal discomfort. Sleep was severely fragmented—waking every 1 to 2 hours with vivid dreams, a continuing theme over recent nights." }, { "date": "2026-08-23", "cycle": 1, "day": 5, "mood_am": 6.0, "energy_am": 4.0, "mood_pm": 5.0, "energy_pm": 3.0, "nausea": 0.0, "rash": 0.0, "bowel": false, "note": "Day 4 post-infusion / Day 5 of cycle (FOLFIRI + Cetuximab). Mood sat between 5-6/10 today, but energy remained low (3-4/10) following a broken night's sleep and physical exertion on the Cheese Cafe loop. Significant abdominal bloating by Sunday evening due to persistent sluggish bowel motility. Zero active nausea or rash throughout the day. Took Dulcoease at bedtime to encourage a morning bowel mo" }, { "date": "2026-08-24", "cycle": 1, "day": 6, "mood_am": 3.0, "energy_am": 5.0, "mood_pm": 3.0, "energy_pm": 4.0, "nausea": 0.0, "rash": 0.0, "bowel": false, "note": "Day 5 post-infusion / Day 6 of cycle (FOLFIRI + Cetuximab). A very difficult day mentally and physically. Severe abdominal cramping hit in the morning due to a sluggish bowel, forcing Russ to stay home and miss the family circus trip. Outing to the cinema in the evening was marred by an argument with Katie. Feeling depressed, fed up, and emotionally drained. Took Zopiclone again to secure unbroken" }, { "date": "2026-08-25", "cycle": 1, "day": 7, "mood_am": 6.0, "energy_am": 5.0, "mood_pm": 6.0, "energy_pm": 4.0, "nausea": 1.0, "rash": 1.0, "bowel": false, "note": "Day 6 post-infusion / Day 7 of cycle (FOLFIRI + Cetuximab). Good uninterrupted sleep on Zopiclone set up a positive morning with the kids in town and at the museum. Needed an afternoon bed rest after energy lagged. Midday nausea cleared completely by evening. Nose blotchiness settled. Evening energy sat at 4/10, but overall mood remained steady at 6/10." }, { "date": "2026-08-26", "cycle": 1, "day": 8, "mood_am": 7.0, "energy_am": 7.0, "mood_pm": 6.0, "energy_pm": 5.0, "nausea": 0.0, "rash": 3.0, "bowel": false, "note": "Day 7 post-infusion / Day 8 of cycle (FOLFIRI + Cetuximab). Solid start to the day, but energy dipped to 5/10 by evening. Noticed new spots appearing on the nose (rash elevated to 3/10). Bowel motility remains very sluggish despite laxative support. Waking with persistent headaches, likely secondary to dehydration." }, { "date": "2026-08-27", "cycle": 1, "day": 9, "mood_am": 6.0, "energy_am": 5.0, "mood_pm": 7.0, "energy_pm": 6.0, "nausea": 0.0, "rash": 2.0, "bowel": false, "note": "Day 8 post-infusion / Day 9 of cycle (FOLFIRI + Cetuximab). Started tired (5/10 energy) after a rough night with 4–5 hours sleep after skipping Zopiclone. Pushed through to hit the gym at 9:30 AM for the first time this cycle, then spent 2 hours helping set up for the wedding. Despite minimal daytime rest (20–30 mins nap), physical activity boosted evening mood to 7/10 and energy to 6/10. Facial r" }, { "date": "2026-08-29", "cycle": 1, "day": 11, "mood_am": 8.0, "energy_am": 7.0, "mood_pm": 8.0, "energy_pm": 7.0, "nausea": 0.0, "rash": 4.0, "bowel": true, "note": "Cycle 1, Day 11 (FOLFIRI + Cetuximab). First day this cycle without needing a daytime sleep or nap. Sustained strong energy (7/10) and mood (8/10) throughout the entire day despite heavy drinking at Friday's wedding. Bowel movements returned to a normal rhythm. Rash flared to a 4/10 with visible spots developing on the nose and face." }, { "date": "2026-08-30", "cycle": 1, "day": 12, "mood_am": 8.0, "energy_am": 7.0, "mood_pm": 8.0, "energy_pm": 5.0, "nausea": 0.0, "rash": 3.0, "bowel": true, "note": "Cycle 1, Day 12 (FOLFIRI + Cetuximab). Attended a morning meeting, which meant skipping daytime sleep. Mood remained very high (8/10) all day, though energy naturally tapered off to 5/10 by evening. Rash stabilized at 3/10. Bowel function remained completely normal." }, { "date": "2026-08-31", "cycle": 1, "day": 13, "mood_am": 7.0, "energy_am": 8.0, "mood_pm": 7.0, "energy_pm": 5.0, "nausea": 0.0, "rash": 2.0, "bowel": true, "note": "Cycle 1, Day 13 (FOLFIRI + Cetuximab). Solid day overall with an 8/10 morning energy peak. Spent active time doing DIY garage work with his dad, gardening, and playing with the kids. Pre-existing groin strain flared up by evening, requiring painkillers. Noticed ongoing friction with staggering Zopiclone doses effectively. Cetuximab rash continued to resolve to 2/10." }, { "date": "2026-09-01", "cycle": 1, "day": 14, "mood_am": 8.0, "energy_am": 7.0, "mood_pm": 8.0, "energy_pm": 6.0, "nausea": 0.0, "rash": 2.0, "bowel": false, "note": "Cycle 1, Day 14 (Final day of Cycle 1). Ended the cycle in a strong position with an 8/10 mood and 7/10 energy. Rash remained stable at 2/10 with zero nausea. Groin strain managed with analgesics while monitoring for potential bowel sluggishness. Prepared for Cycle 2 infusion tomorrow." }, { "date": "2026-09-02", "cycle": 2, "day": 1, "mood_am": 7.0, "energy_am": 7.0, "mood_pm": 6.0, "energy_pm": 4.0, "nausea": 0.0, "rash": 1.0, "bowel": true, "note": "Cycle 2, Day 1 (Infusion Day). Transitioned to a flexible, narrative-first tracking method. Discharged earlier than usual (~5:00 PM). Energy dropped as the day wore on, feeling physically shattered by evening with an early sense of feeling slightly blocked up in the gut. Ate dinner downstairs, then headed upstairs to rest. Mindset is calm and focused on pacing, hydration, and gentle movement, with" }, { "date": "2026-09-03", "cycle": 2, "day": 2, "mood_am": 7.0, "energy_am": 6.0, "mood_pm": 7.0, "energy_pm": 4.0, "nausea": 0.0, "rash": 0.0, "bowel": true, "note": "Cycle 2, Day 2 (Day 1 post-infusion). Productive, proactive day: light household admin, sorted cables, laundry, and two separate walking outings. Rested with an early afternoon lie-down (12:45 PM). Switched laptop on in the evening—a notable milestone for work engagement. Thinking about work felt logical rather than overwhelming. Shattered by evening after cumulative activity." }, { "date": "2026-09-04", "cycle": 2, "day": 3, "mood_am": 6.5, "energy_am": 4.5, "mood_pm": 7.0, "energy_pm": 5.5, "nausea": 0.0, "rash": 0.0, "bowel": true, "note": "Cycle 2, Day 3 (Day 2 post-infusion). Up early to see Lila off. Rested in bed with Rex (who was unwell), journaling in notebook and mapping future AI concepts. Walked at midday, followed by an afternoon nap (~1:30 PM – 4:00 PM). Spent 5:30 PM – 7:30 PM at the Cricket Club socializing with friends (non-alcoholic). Watched half a movie with the kids. Good day overall despite waking tired." }, { "date": "2026-09-05", "cycle": 2, "day": 4, "mood_am": 5.5, "energy_am": 3.5, "mood_pm": 4.5, "energy_pm": 2.5, "nausea": 2.0, "rash": 0.0, "bowel": true, "note": "Cycle 2, Day 4 (Day 3 post-infusion — Entering \"The Dip\"). Marked as the hardest day of the cycle so far. Heavy grogginess, lethargy, and lack of energy, compounded by warm, humid 24°C weather. Took an early afternoon lie-down. Stomach felt murky and unsettled throughout the late afternoon. Bowel movements continued to pass normally." }, { "date": "2026-09-06", "cycle": 2, "day": 5, "mood_am": 3.5, "energy_am": 3.5, "mood_pm": 3.0, "energy_pm": 2.0, "nausea": 3.5, "rash": 0.0, "bowel": false, "note": "Cycle 2, Day 5 (Peak Cytotoxic Nadir). Woke up fine, but hit by sudden, severe abdominal cramping around 11:00 AM while sorting the office. Morning smoothie went down poorly. Spent the day horizontal in bed feeling exhausted and restless, with exertional breathlessness on stairs. Dinner was very heavy and failed to relieve the trapped stomach discomfort. Highly anxious about friends visiting Bath " }, { "date": "2026-09-07", "cycle": 2, "day": 6, "mood_am": 2.5, "energy_am": 3.0, "mood_pm": 7.5, "energy_pm": 5.0, "nausea": 4.5, "rash": 0.0, "bowel": false, "note": "Cycle 2, Day 6 (Concluding \"The Dip\"). Woke at 6:30 AM and suffered 45 minutes of agonizing stomach spasms trying to process Sunday's heavy dinner. Rallied and spent the afternoon in Bath with close friends. Drank alcohol-free beers, walked around town, and stayed out the entire duration. Discovered the power of positive cognitive distraction to override physical discomfort. Returned home tired bu" }, { "date": "2026-09-08", "cycle": 2, "day": 7, "mood_am": 4.5, "energy_am": 3.5, "mood_pm": 6.0, "energy_pm": 4.0, "nausea": 3.0, "rash": 0.0, "bowel": false, "note": "Cycle 2, Day 7 (Transition to Rebound). Very broken night with only 3–4 hours of sleep. Up at 7:00 AM to help kids, back to bed after 9:00 AM for a 1–1.5 hour sleep. Felt comfortable lying still, but rough and motion-sensitive upon moving. Struggled with a sensation of incomplete evacuation and flatulence as the gut worked through the backlog. Felt guilty about not helping Katie more and anxious a" }, { "date": "2026-09-09", "cycle": 2, "day": 8, "mood_am": 7.0, "energy_am": 5.5, "mood_pm": null, "energy_pm": null, "nausea": 0.0, "rash": 0.0, "bowel": true, "note": "Cycle 2, Day 8 (Active Rebound). Woke up with bowel motility finally clearing the backlog, leading to immediate physical relief. Successfully completed an 8:00 AM one-on-one gym session with Tom—the first gym class of this cycle. Followed up with a local walk around Chelsea Road, which prompted a brief lie-down due to lingering sluggishness. Energy feels like it needs a boost, but physical capacit" }, { "date": "2026-09-10", "cycle": 2, "day": 9, "mood_am": 7.5, "energy_am": 6.5, "mood_pm": 8.0, "energy_pm": 6.0, "nausea": 0.0, "rash": 1.0, "bowel": true, "note": "Cycle 2, Day 9 (Rebound / Cutaneous Phase). Woke up feeling clear-headed and well-rested. Bowel motility has completely normalized following the early-week backlog, leading to a noticeable lift in overall baseline physical comfort. Successfully went for a 45-minute morning walk with zero exertional dyspnea or abdominal discomfort. Spent the afternoon doing light tasks around the house without need" }, { "date": "2026-09-11", "cycle": 2, "day": 10, "mood_am": 8.0, "energy_am": 7.0, "mood_pm": 8.5, "energy_pm": 6.5, "nausea": 0.0, "rash": 2.5, "bowel": true, "note": "Cycle 2, Day 10 (Rebound & Cutaneous Peak). Strong start to the day. Hitting the gym for a structured session felt great and caused no joint strain or premature fatigue. In the late afternoon, the classic Cetuximab EGFR rash began surfacing on the nose and cheeks with mild tingling. Proactively applied barrier and moisturizing cream to prevent skin cracking. Evening was calm and enjoyable with Kat" }, { "date": "2026-09-12", "cycle": 2, "day": 11, "mood_am": 8.5, "energy_am": 8.0, "mood_pm": 8.0, "energy_pm": 7.0, "nausea": 0.0, "rash": 3.0, "bowel": true, "note": "Cycle 2, Day 11 (Peak Performance Window). Entering the high-stamina phase of the cycle. Spent the majority of the day out and about with Katy, Rex, and Lyla. Energy stayed high (8/10) through the morning and early afternoon without requiring a nap. Cetuximab rash remains present at a 3/10 on the nose, but skin feels supple rather than dry or painful due to regular moisturizing. No digestive issue" }, { "date": "2026-09-13", "cycle": 2, "day": 12, "mood_am": 8.5, "energy_am": 8.0, "mood_pm": 8.0, "energy_pm": 6.5, "nausea": 0.0, "rash": 2.5, "bowel": true, "note": "Cycle 2, Day 12 (Peak Performance Window). Another strong day overall. Handled light DIY projects and home setup tasks during the morning with plenty of physical stamina. Took a brief lie-down in the afternoon to pace energy for the evening. Skin rash on the face has started to settle from its Saturday peak, down to 2/10. Sleep quality has been consistently solid over the weekend." }, { "date": "2026-09-14", "cycle": 2, "day": 13, "mood_am": 8.0, "energy_am": 8.0, "mood_pm": 8.5, "energy_pm": 7.0, "nausea": 0.0, "rash": 2.0, "bowel": true, "note": "Cycle 2, Day 13 (Peak Performance Window). Woke up feeling energetic and focused. Completed a 30-minute indoor spin session in the morning, keeping heart rate comfortably within Zones 1 and 2. Spent part of the day catching up on logical work admin and planning without feeling mentally drained. Digestion remains smooth and predictable. Skin rash continues to subside." }, { "date": "2026-09-15", "cycle": 2, "day": 14, "mood_am": 8.0, "energy_am": 7.5, "mood_pm": 8.0, "energy_pm": 6.5, "nausea": 0.0, "rash": 1.5, "bowel": true, "note": "Cycle 2, Day 14 (Final Day of Cycle 2). Ended Cycle 2 in a very strong physiological position. Energy and mood have remained stable at 7.5–8/10. Focused today on pre-infusion hydration and rest to prepare for Cycle 3 tomorrow. GI tract is completely clear and operating normally. Mindset is calm, grounded, and clear as Cycle 3 approaches." } ] }, "cycle_map": { "cycle": 3, "from": "Wed 16 Sep 2026", "to": "Tue 29 Sep 2026", "next": "Cycle 4: Wed 30 Sep", "new": "New this cycle: metformin from day 4", "baseline": [ "Citalopram 30 mg with breakfast", "Loratadine 10 mg with breakfast", "Doxycycline (moving to evening, after food, away from magnesium, iron, calcium and zinc)", "Melatonin 60 mg in the evening", "Zopiclone for sleep when needed" ], "rules": [ "Rest 12–3 PM daily. Weekends are zero work.", "Hydrate hard: water plus electrolytes.", "Stop before the fatigue hits, not after.", "Laxido titrated: 2 on day 1, 3 from day 2, daily through day 7.", "Domperidone as needed, 30 minutes before food or meds." ], "days": [ [ 1, "Wed 16", "Infusion day", "5–7", "Hospital and a lot of sitting. Short local walk after discharge if I need to move.", "1 hr max, admin only.", "Bed ~10 PM. 6–8 broken hours on steroids.", "Break the 24-hour fast gently: broth, soft eggs, light soup." ], [ 2, "Thu 17", "Steroid phase", "5–7", "Walk plus a short garden exercise session. No gym.", "Up to 2 hrs at the desk, in short blocks.", "Bed 10 PM. Nap 12–3 PM. Early waking likely.", "Low-carb and soluble: soups, eggs, cooked greens, lean poultry." ], [ 3, "Fri 18", "Steroid washout", "4–6", "Light walk and brief movement. Watch for sudden fatigue.", "~2 hrs, urgent tasks early.", "Bed 9:30–10 PM. Horizontal 12–3 PM. 8+ hrs.", "Ultra-gentle: warm soups, poached eggs, avocado, soft fish." ], [ 4, "Sat 19", "The dip · fatigue wall", "2.5–4", "Cellular fatigue. Minimal movement, garden air only.", "Zero work. Strict weekend boundary.", "Bed 9–9:30 PM. Priority rest 12–3 PM. 9–10+ hrs.", "Pureed and bland. Metformin starts, but only if eating normally." ], [ 5, "Sun 20", "Peak nadir", "2–3.5", "Lowest capacity. Possible breathlessness on stairs. Complete pacing.", "Zero work. No stressful comms or deep thinking.", "Bed 9–9:30 PM. Afternoon sleep 12–3 PM. 9–10 hrs.", "Light and warm, small frequent portions plus electrolytes." ], [ 6, "Mon 21", "Gut transition", "3–5", "Slow stabilising. Light stroll as the cramps settle.", "1–2 hrs max, light admin.", "Bed 9:30–10 PM. Lie-down 12–3 PM.", "Clear soups, poached eggs, plain rice, cooked lean meat." ], [ 7, "Tue 22", "Rebound boundary", "4–6", "Motility waking up. Light walking and stretching.", "1–2 hrs. Clear the backlog.", "Bed 10 PM. 45-min lie-down. 8 hrs.", "Solid whole foods again. Last Laxido day." ], [ 8, "Wed 23", "Active rebound", "6–7", "Gym return: first session back, strength or Zone 1–2 bike.", "1–2 hrs. Good clarity for planning.", "Bed 10 PM. Post-workout lie-down. 7.5–8 hrs.", "Normal solids. Skin care on: the rash starts." ], [ 9, "Thu 24", "Stamina rebuild", "6–7.5", "Strength training or outdoor exertion, 1–2 hrs.", "2–3 hrs. High clarity: client delivery, business ops.", "Bed 10–10:30 PM. 7.5–8 hrs.", "Full diet, high protein. Rash peak: creams on." ], [ 10, "Fri 25", "Peak building", "7–8", "Structured cardio or strength. High capacity.", "2–3 hrs. Finish deep work before the weekend.", "Bed 10:30 PM. Optional 20–30 min nap.", "Full diet. Hydration and electrolytes. Keep moisturising." ], [ 11, "Sat 26", "Peak performance", "7.5–9", "High stamina. Family outings, walks around Bath, DIY or gym.", "Zero work. Normal weekend with Katy, Rex and Lyla.", "Bed 10:30–11 PM. No nap needed.", "Full and social. Keep alcohol minimal." ], [ 12, "Sun 27", "Peak performance", "7.5–8.5", "Active family day, outdoors or DIY.", "Zero work.", "Bed 10 PM. Early wind-down.", "Balanced whole food, high hydration." ], [ 13, "Mon 28", "Pre-fast · peak output", "7–8", "Spin bike 20–30 min or active garden work. Final exertion day.", "3–5 hrs: peak output. Clear the backlog before infusion week.", "Bed 9:30–10 PM. Deep restorative sleep.", "Normal early day. Prep for the fast from midday Tuesday." ], [ 14, "Tue 29", "24-hour pre-chemo fast", "6.5–7.5", "Rest or gentle movement. No strain while fasting.", "3–5 hrs: prep and clear.", "Bed 9:30 PM. Zopiclone if needed before the early hospital start.", "24-hour fast from midday: water, herbal tea, electrolytes." ] ], "ahead": [ "This week, for day 4: metformin MR 500 mg.", "Before cycle 4 (Wed 30 Sep): mebendazole 100 mg, pharmaceutical grade.", "Cycle 5 onwards, only if liver function allows: atorvastatin.", "Bloods gate the next agents: liver function and magnesium every 2–4 weeks; renal function before metformin; FBC and LFTs before mebendazole." ] } }