Interlude and Chemotherapy #2

 "Life doesn't get easier or more forgiving, we get stronger and more resilient." - Steve Maraboli

Following the first round of chemotherapy, I was out of the hospital for three weeks to recover.  The wife performed the daily PICC line saline flushes whilst we were at home.  I reluctantly returned to the hospital for a second round of chemotherapy on the 3rd week of February, 2026.  

The oncology team at Kootenai Health had meanwhile been in touch with the Fred Hutchinson Cancer Research Center in Seattle, Washington.  Fred Hutchinson provided treatment advice for round two of chemotherapy, given what was known of my leukemia's genetic mutation.  I had the ASXL1 mutation, which unfortunately has a poor prognosis.  They suggested three days of the anti-cancer drug Idarubicin, along with only five days of continuous Cytarabine, yet again.

Below:  An orange-colored IV bag of Idarubicin.  The other bags are just saline solution.

This visit was much the same as the previous chemotherapy, with the exception of hitting a few significant medical speed bumps.  The PICC line travels up an arm vein, so there is potential for clotting, because the insertion process sometimes damages the inside of the vein.  This condition is called Deep Vein Thrombosis, or DVT. 

The insertion point of the PICC line began swelling, and the team immediately sent me for an ultrasound of the vein.  Sure enough, a DVT had developed in my left arm.  The same day, they removed the PICC, put me on blood thinners to dissolve the clot, and installed a new PICC line in the right arm.  Not my happiest day, but in the interest of survival, we put up with some inconveniences, yes?

A week or two after the second PICC line was placed - and fortunately after the chemotherapy had ended - an infection developed at the entry point of the second PICC line.  This was a pretty big deal, because at that point I was very immune compromised from two chemotherapy sessions.  I was put on massive doses of antibiotics and antiviral meds.  Blood samples were taken to check for a systemic blood infection.  Fortunately it was just a localized skin infection, and the antibiotics handled it.

The second PICC line was also removed, and at that point I had run out of arms to place another PICC line.  For a while, we were back to daily pokes for blood sampling.  Eventually the clot in the left arm dissolved - as determined by ultrasound -  and they placed a third PICC line in it.  

Below:  A shunt was installed to take the place of the PICC lines, since neither arm was available for use with a PICC.  Fortunately by that time the chemotherapy portion of my stay had ended.  The shunt was used for transfusions of red blood cells and platelets.  As you can tell by the gauze pads, blood sampling had resumed by poking the arm.  The left arm was still off-limits due to the DVT clotting when this picture was taken.

I also picked up a Norovirus that lasted a lot longer than it should have, due to my immune condition.  Norovirus used to be called the "stomach flu" back when I was a kid.  It would last 1-3 days and be a bad memory for a week.  This case lasted about 10 days and I had nasty diarrhea the entire time and one instance of vomiting before it slowly cleared.  A really rough time, to be sure.

I experienced severe enough diarrhea that the physicians became alarmed.  They ran three different CT scans on my bowels at various points during my stay, to make sure there was not any leakage in either direction.  I eventually asked if they were trying to give me liver cancer :)  

The CT scans required the injection of contrast to get a good image of the soft tissue.  I've heard people claim that the contrast creates a sensation of hotness that is almost unbearable.  I didn't experience much of that.  Instead it was just a warm feeling around the groin area each time - and had I not been paying close attention and been forewarned by the technician, I might have missed it during the scan process.

Partway through the second round of chemotherapy, I noticed that all my fingernails had abnormal  growth patterns.  I consider these growth patterns to be similar in nature to tree rings, where scientists can see the effects of droughts by measuring the distance of seasonal growth rings to each other.  I used the thumbnail as a proxy for the damage chemotherapy was doing to the rest of my body.  

Below:  Thumbnail showing where the chemotherapy began.

Below: Indications where each round of chemotherapy began.

The second round of chemotherapy was a bit tougher mentally than the first.  My stay in the hospital went almost a week longer than the first round: 35 days vs 29 days on the first round.  I was pretty tired of being there, and it seemed that my neutrophil counts would never recover.  I was also getting weary of hospital food by then - although it was good, but I did my best to keep a positive demeanor :)

Shortly before I was released from the hospital, they performed a bedside bone marrow sample.  The results were disappointing:  The blast (leukemia) count in my blood was still 0.6%.  After all that chemotherapy and the long hospital stays, I was still not in remission :(  

I was released from the hospital in late March, not in remission, having already spent 64 days in the hospital in 2026.