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, while the wife performed the daily PICC line saline flushes.  I reluctantly returned to the hospital for round two 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 my bone marrow genetic testing.  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.  The insertion process sometimes damages the inside of the vein, which can result in clotting.  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 inconvenience, 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 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 :).  We were back to daily pokes for blood sampling, however.  Eventually the left arm clot dissolved - as determined by ultrasound -  and they placed a second 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 only used 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.

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 didn't experience too much of the hotness when the contrast was injected, which I've heard some people claim is almost unbearable.  Instead it was just a warm feeling around the groin area each time - and had I not been paying close attention, I might have missed it during the scan process.

Partway through the second round of chemotherapy, I noticed that all my fingernails had weird growth patterns.  I consider this similar 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 my body.  

Below:  Thumbnail showing where chemotherapy started.

Below: Indications of where both rounds of chemotherapy started

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 getting pretty tired of hospital food by then as well, 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 long hospital stays, I was still not in remission :(  They define remission as no detectable leukemia cells in a bone marrow sample.

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