Today was a difficult day for Isobel. She ate half of her breakfast, but had a major fit later in the morning and was sick after. The nurses report that the fit only affected the left arm and left leg. These have had intermittent tremors for some time. These are the direct result of damage to the brain caused by the growing tumour. During and after the fit Isobel's blood pressure was greatly increased; this is consistent with earlier crises such as the mis-diagnosis in October 2008; the events leading to the discovery of the tumour in December 2008 and a temporary loss of the power of speech while visiting her mother in 2009. When Isobel was at home in 2009 she had three whole body fits, each lasting less than ten seconds. It has been rather surprising that further whole body fits have not occurred, but some kind of fits were expected as the damage to healthy brain tissue increased with time.

Rosemary came to visit just as the staff were cleaning Isobel up. When she saw Isobel she seemed very restful and half asleep. Rosemary sat and talked to Isobel for an hour. Because of the fits and sickness Isobel did not eat at lunchtime.

Later in the afternoon Pat Ball (Chris' mum) visited, but I have not yet spoken to her. Isobel was seen by the doctor soon after the fit and a blood test to check the level of phenytoin (the anti-fitting drug) will be done tomorrow. The dosage of phenytoin will be adjusted if this seems appropriate. I believe that Isobel has been very fortunate to escape having more serious fits earlier and that any tinkering with levels of phenytoin dosage will only stave off the inevitable for a short time. Her blood pressure medication is being reviewed. This is prudent as the blood pressure peaks reflect physical events within the brain that may well become more frequent, but this medication cannot prevent the events within the brain taking place.

To add to her other problems, Isobel has conjunctivitis and is having eye drops to counter this.

I went in to see Isobel just after 5pm. She was just about awake when I arrived. I tried to get her to eat tea, but her teeth were clamped firmly shut almost all the time. In three quarters of an hour I could only get her to eat four part teaspoonfuls of the main course and one teaspoonful of yogurt dessert. After this I switched to trying to get her to take a drink, but in half an hour she only took about 50ml - the amount drunk was rather larger but some re-appeared after being held in the mouth for some time. On a few occasions Isobel did swallow in response to spoken requests, evidence that she is still hearing and processing what she hears. She is not however able to control her muscles consistently and when she swallows the action does not fully clear the mouth.

It is difficult to describe but I felt there had been a step change in how Isobel was dealing with food and drink, she was less engaged and her eyes stared blankly for much of the time. We reached a point at which no further drink was being swallowed - anything in the mouth re-appeared after a few minutes. I cleaned Isobel up and she fell asleep. I manipulated and massaged her right arm, the extent of muscle wasting, especially on the upper arm is dramatic. The nurses will try to get further fluid down her later. I left just before 7pm.

Iona is working her last week before going on maternity leave. She is rather uncomfortable as, when they were in Mothercare, Jon dropped an exercise weight on her foot and broke her toe!