Kim finished up the second part of her second round of salvage chemo on Friday. It went much faster than last time and she's still feeling OK. Next Friday we have our first meeting with the people from Princess Margaret to start learning about all the stuff that will happen with the Stem Cell Transplant. The following week Kim will get a bunch of tests done to determine if the salvage chemo has been successful enough to proceed with the transplant and if not they will give her another couple rounds of chemo before testing again. All the waiting is very hard.

Thursday was Kim's 29th birthday and obviously we kept things pretty low-key. I did bring home her favourite Gandhi Roti for supper though, and we took a short walk to the local Gelateria for some delicious gelato.

Kim's home care nurse taught me how to flush her PICC line and I've been doing it successfully for about over a week. Then, this Saturday I wasn't able to flush it anymore, it was stuck. The nurse came right away and was able to flush it using special magic of some sort. On Sunday I tried again to flush it and was only able to flush one of the two lines. Since I was able to do one the nurse felt it would be OK to wait until Monday to visit again. However, when she came today she was unable to flush either line.

So I took Kim into the cancer clinic at the hospital and they told us the line was done. It's nobody's fault, it just happens sometimes. It's not the end of the world since she only has the one small treatment left this Friday which they can do by normal IV.

Anyway, everything is fine, and now Kim can take showers without worrying about getting her arm wet.

On Friday Kim received the first part of her second round of salvage chemotherapy (R-GDP). It took a lot longer than the old R-CHOP protocol, but by 6pm we were out and on our way home. Kim's been feeling mostly OK this weekend so that is nice.

This coming Friday Kim will get the second half of the treatment and then a week or so after that she will go in for a CT scan to determine how well it is all working. If there is significant enough progress she will hopefully proceed to the stem cell transplant at Princess Margaret, otherwise they will do one or two more rounds of the R-GDP and we'll see how things are after that.

The leaves are finally coming out on the tree in our front yard and that plus the warmer weather has definitely improved my mood. Soon I can put away my jacket for the summer and things will be very happy indeed.

Kim received the second part of her first round of salvage chemotherapy yesterday. It went pretty well other than taking longer than expected due to the cancer clinic being a bit swamped. The second part is just an additional dose of gemcitabine which is not as harsh as the other stuff.

Kim's home care nurse has been great so far, coming every day to flush Kim's PICC line to keep it operational. Normally they don't flush it every day, but it was giving them some trouble in the hospital so for now they're being safe. The nurse is teaching me to flush it (it's not very hard) so that she doesn't need to come every day.

Although this treatment is stronger and Kim has been feeling the side-effects more she is still doing pretty well. Last week definitely wasn't so great, but nothing like the horror stories you hear sometimes. She's developed a little bit of a cold in the past couple days, but there's no fever so there's not much to worry about. Just something she needs to wait to resolve itself.

The doctors decided today that Kim was healthy enough to be released so we're all back at home now! Yay! A home care nurse is going to come visit us regularly to help maintain Kim's PICC line and also just to monitor her for any problems.

Looks like I spoke too soon. Near the end of March Kim started having a sore back and a mild fever. We kept a close eye on things and then on March 31 her fever spiked up to 39C and her doctor had her admitted as an inpatient at the hospital. Fortunately they got the fever under control almost immediately.

The doctor decided to keep Kim in the hospital over the weekend to wait for the results of some tests and just to keep an eye on her. She was doing well on the Friday evening (April 1) so I decided it would be OK for me to go the Blue Jays home opener with a bunch of people (Kim practically pushed me out the door). I had only been at supper before the game for 45 minutes when I got a call from Kim's mom asking me to return to the hospital. The doctor had come moments after I had left and told them that the tests revealed that the chemotherapy regimen (R-CHOP) was no longer being effective at fighting the cancer. The treatments were going so well and Kim was feeling pretty good so this was disappointing news to us.

When the primary treatment regimen stops working, the cancer is considered refractory. The doctor explained that we would have to switch to a different chemotherapy regimen and also do an autologous stem cell transplant if possible. There is still a good chance that the cancer will be cured, but the path has become longer and more difficult.

A lot has happened since we got the original news. Kim has remained in the hospital, but mainly for the purpose of expediting some additional tests. A CT scan confirmed the findings of the original chest X-ray and yesterday they did another bone marrow biopsy (ouch). She also got a PICC line inserted, which is like a semi-permanent IV line. It can stay in up to six months and it can be used to both give medicine and draw blood. This means she doesn't need to be stuck with needles multiple times a day anymore.

The new chemo regimen is being done as part of a phase III clinical trial comparing two different treatments for people with refractory Diffuse Large B-Cell Lymphoma. The two treatments are R-GDP (rituximab + gemcitabine/dexamethasone/cisplatin) and R-DHAP (rituximab + dexamethasone/cytarabine/cisplatin) and both are used extensively around North America as a secondary treatment after failure of the primary. R-DHAP is the old standard while R-GDP is newer, but many places (like BC) have already moved to make R-GDP the standard. The doctors consider them to be equally effective, but many prefer R-GDP because it is a bit less harsh on the patient. The primary reason for putting Kim on the trial was to get the rituximab (common to both protocols) paid for. OHIP does not normally cover rituximab for this usage but the trial picks up the tab (which is great since it's a fantastically expensive drug -- think tens of thousands of dollars).

Kim was randomly chosen to get R-GDP (the newer one) and she was given the first dose today. A week from now they give a second dose of just the gemcitabine, and then two weeks after that she repeats this process. It's expected that she will feel the side effects more with this regimen than with R-CHOP as it is higher dose and harsher. She was already feeling sick to her stomach this evening so it looks like the expectations were justified. She'll also have to take an injection each round to help boost her white blood cell count which will be made very low by the treatment.

After the R-GDP protocol is complete, Kim will be tested again. If the cancer responds well to the treatments then she will undergo an Autologous Stem Cell Transplant at Princess Margaret Hospital. This is similar to a bone marrow transplant, but it uses her own stem cells (so no chance of rejection) and it is much less invasive. It is still very serious though and would likely require an extended hospital stay (up to a month).

Finally, after the transplant, Kim will enter phase two of the study and be randomized to one of two test groups. One group continues to get maintenance rituximab treatments every two months for a year and the other group is merely observed closely (ie. they are a control group). There is some small evidence that maintenance rituximab treatments help prevent relapse, but nothing conclusive. This trial will help determine if there is any justification in such treatments.

In addition to all the information and tests and procedures, Kim was also kicked out of her fancy private room earlier in the week when a sicker patient needed it (Kim has actually been totally healthy since the fever left). Her new room was a semi-private which she shared with someone who appeared to be in the end stages of her own fight with cancer (in the bad way...she couldn't talk or move much on her own). Although it felt wrong to feel this way, it was really hard on for Kim to share that room. It was like a constant reminder of the potential future and it was hard to not let that get to you after a couple days. Again we feel bad to complain when Kim is currently in a much better state but it still shook us to the core.

Kim was moved to a new private room for her treatment and will remain there until she is discharged. If she does not have too strong a reaction to today's chemo she might even get to go home this weekend!

Kim's 6th treatment is complete, two left to go. Is it weird that the whole process is becoming routine?

Treatment number five is done and gone and things are still going well. They kept the Vincristine at 75% again and Kim's fingers are mostly back to normal now so that is awesome.

My employer ordered me up a developer laptop so that I can work from home and it finally arrived last week! Originally I requested it because I did not know how hard the treatment would be on Kim and thus how much I would need to stay home. It's great that I don't absolutely need to stay home because that means Kim's doing well. However it's nice to have the laptop now so that I have the ability to work from home when I feel like it. Kim's looking forward to having me around sometimes just to help stave off the loneliness.

At the beginning of 2010 I posted a set of goals for the year. Now that the year is over, I should probably review those.

I'd say the biggest accomplishment of last year was finding, buying and moving into our new home. As I mentioned in the original post, the process of buying a home would quite possibly conflict with many of the other goals. The house plus Kim's cancer diagnosis did kind of put a hold on most things in November and December, but overall I'm really happy with how last year went.

Anyway, last year I managed to blog 65 times while my goal was to blog once a week. I didn't quite manage to accomplish that frequency, but I did far surpass the implied quantity so that is pretty good.

As for climbing I did get out a bunch and I did do five times a month for more than half the months of last year. However I did not get out as much as I would like. I managed to place second in my division at a bouldering competition at John's new climbing gym. I was really happy with that and am looking forward to competing in another comp at the same gym next weekend.

I had a lot of fun taking photos last year and am happy with the results. I haven't really even picked up my camera since last October though so I really need to get back on that.

I did a lot of new cooking last year and as a result I feel much more confident in the kitchen now. This is another area of my life that I have neglected recently though and I mainly blame the new house for that problem. I tend to get home later at night now so I don't do as much cooking during the week. I think I need to shift to cooking more on the weekends so that there are delicious leftovers for week nights.

I started a personal programming project last year, a web-based recipe storage app as I suggested in my original goal list. I did not finish it, but I had fun playing with databases, AJAX and the Prototype library. I also did a lot of good stuff at work so I'm not too worried about missing this goal. The point was to do some new software dev stuff and I certainly did that.

Although moving to a new house has had a negative effect on some of my goals, it has definitely improved my reading. I've finished almost two dozen books since moving in December and I'm so happy to have done so. Yay for the TTC!

My travel last year didn't involve any fun Canadian trips, but I did go to China which was awesome! Our travel plans this year are obviously going to be affected by Kim's recovery, but I think we'll ease back into the travel stuff with some smaller trips within Canada so I'll get to do the Canada thing eventually after all.

The other big deal from last year was Kim's diagnosis and original hospitalization and treatments. I can honestly say I wasn't prepared for anything like that, but I guess it was one of those "life is what happens to you while you're busy making other plans" events. It definitely provided me with new perspective on life and my own long term plans for it.

Anyway, that's my review of my 2010 with respect to my goals. I plan on posting again soon with new goals for 2011.

Kim had her fourth round of chemotherapy Friday and it went as well as usual. The only new thing to report is that they've reduced her dosage of one of the chemotherapy drugs (Oncovin also known as Vincristine). A common side-effect of this drug is numbness and tingling in the fingers and Kim's had that since she started treatment. The concern is that this side-effect can sometimes become permanent. They didn't want to reduce the dosage initially due to concerns about the efficacy of the treatment. Now that they are comfortable the treatment is working they are slowly reducing the dose (she got 75% of her usual dose this time). Kim says that she can already feel the difference in her fingers so that is very promising.