An interesting night as Isobel refused to go to bed until 4.30am, although she was dozing for a lot of the time that she lay on the sofa. As a result we made a slow start to the day and were not dressed when the district nurse called unexpectedly at 9am. She seems happy with the slight stability we have now, at least the medication is being taken regularly and not every day is a series of emergencies.

Iona came over before lunch and went home at about 4pm. John Greenhalf, the ed psych, visited in the afternoon for an hour and a half. He has been reallocated away from Hook Lane School so he will not be able to regale Isobel with tales of her old school.

I spoke to Elaine, Dr Sadler's oncology nurse by 'phone. We discussed the meeting with Professor Hawkes and I explained the background to the two phenytoin assays - the first one probably showing a low level because Isobel had stopped taking phenytoin a couple of days earlier, the second one (the results of which had not been available to Professor Hawkes) was taken when she had been taking her medication normally for several weeks. Elaine, who sees many glioblastoma patients each week, was not completely surprised by Isobel's performance and said that this sort of thing tends to happen. We discussed Professor Hawkes suggestion for trying to reduce the steroid dose. Although previous attempts to do this had resulted in a rapid decline in Isobel's balance, perhaps the situation has changed. It was certainly the case that when Isobel stopped taking all medication for four days, there was not any disastrous reaction to the loss of steroids. In the past, drops in steroid dose have produced a marked change in Isobel's balance after two days. However, her balance at the moment is well below the levels produced by cutting steroid dose in the past. It is not clear what would be the best course, Elaine will discuss it with Dr Sadler.

Isobel had chicken arabiatta for dinner, followed by apple crumble. Afterwards she dozed in bed. Isobel's speech, walking and balance have been about the same as yesterday.