Yesterday Kim had a Hickman line inserted at Toronto General in preparation for the stem cell transplant and also to use when getting her third round of R-GDP. Kim has always had bad veins and after all the sticking they've gotten over the last seven months they've only become worse. We were sad when her PICC line failed so it's great that they've put a new line in. The Hickman line is bigger (necessary for the transplant) and should be less likely to become blocked. Also a home-care nurse will again be visiting us regularly to help take care of the line.
The procedure for getting the line is a bit more intensive than the one for the PICC line, but it was still not too bad. We got Kim home by about 1pm only to find that Kim's doctor at St. Michael's had been trying to get a hold of us. The results from the spinal CT scan were in. In general it looked fine and there seems to be a non-cancer reason for Kim's intense back and leg pain. She appears to have a minor case of congenital lumbar spinal stenosis. This is a narrowing of the spinal canal that can cause compression of nerves and blood vessels leading to pain in the back and legs. It seems likely that some combination of the Neupogen, the chemo drugs, the lack of physical activity and the stress has caused the condition to assert itself a bit more strongly. Kim's always had minor back complaints but nothing serious enough to think twice about. It's interesting to know that there is a very specific cause. Once Kim recovers from the cancer she can look into treatments for the spinal stenosis, although apart from surgery it sounds like the best treatment is exercise and healthy living.
Anyway, the CT scan report went on at great lengths about the spinal stenosis, and then, right at the end, the report had a single sentence mentioning an extremely minor "asymmetry" in one of Kim's root nerves. This is why the doctor was calling us so urgently. Nerves are soft tissue and so they don't show up well on CT scans. You need to do an MRI. However the MRI machines at hospitals are notoriously overbooked. There was an opening yesterday afternoon and Kim's doctor really wanted to get a better look to rule out a tumour in the spine (which would be a very bad thing). Fortunately we were able to make it back to the hospital to catch the MRI opening and Kim was in and out before supper. The MRI machine is in the deepest part of the basement of the hospital and was kind of a freaky experience. Well, it was freaky for me at least, Kim didn't seem to mind.
In addition to the MRI, Kim's doctor will be giving her a lumbar puncture (ie. needle in the spine) on Thursday in order to collect some cerebrospinal fluid to test for cancer. The doctor will also inject a special type of chemotherapy at the same time just in case there is cancer present. In the worst case it will be treatment, otherwise it will have a prophylactic effect.
Kim's doctor at St. Michael's has been great through all of this recent craziness. She's explained things really well and has been super fast and proactive to make sure nothing gets in the way of the transplant. Unfortunately if there is cancer in Kim's spine it will probably derail the transplant as it is unlikely the high-dose chemotherapy would work in that case. However it's better to find this out before going through such a difficult procedure rather than doing it and only discovering later that the cancer isn't cured.
