I stayed over at the hospital last night with Kim (on a reclining chair) so I'm a bit tired now. However Kim managed to get a good sleep. She was pretty nervous for today, the first day of treatments.
Rituximab is essentially an antibody that targets and destroys B-cells, thus helping to treat conditions where B-cells are problematic (like Diffuse Large B-Cell Lymphoma). The first time it is given to a patient it must be given slowly as there is a relatively high risk of adverse reaction while it is entering the body. By starting slowly the doctors can react to any problems before they become serious.
Before beginning the Rituximab today, Kim was given Benadryl and Tylenol to pro-actively reduce the symptoms of any reactions to the drug. She was also given Allopurinol to help combat the possibility of "Tumour Lysis Syndrome," a problem that occurs when cancer cells are destroyed and break down releasing toxic material into the body which can ultimately cause kidney failure.
For the most part the administration of the Rituximab went well. The only problem occurred when the flow rate was increased the second time. Kim starting shaking uncontrollably. This is a common side-effect and so the nurses were ready to deal with it. They temporarily stopped the Rituximab drip and gave Kim Demerol intravenously and within a couple minutes she stopped shaking and actually started feeling pretty good (Demerol is a synthetic opiate after all). They were able to restart the Rituximab after the Demerol and get it up to the same flow rate as when she started shaking. There were no more problems after that and she was in good spirits the rest of the day.
I'm at home now so that I can try to get a good rest tonight. Kim's mom is staying with her at the hospital. The nurses are going to get her a stretcher to sleep on instead of that awful recliner so that should be nice. Just before I left I got an update from the fertility clinic. As of today we have five embryos. This is less than expected, but apparently it is enough to work with. Many of the eggs were still immature because we had to rush a bit and because Kim had to start the steroids before the fertility doctor wanted her to. However they might still be able to create embryos from the remaining eggs through a process where they inject a single sperm directly into the egg. This is not ideal since it may not be the "best" sperm (survival of the fittest and all that) but they label the embryos and so when we go to use them we will obviously try to use the natural ones first. At this point we're happy to have anything really.
The other update is that Kim's potassium levels are low, so they are giving her some of that tonight so that she'll be nicely prepared for the rest of the chemotherapy tomorrow. The doctor also said she might be able to come home as early as Saturday!