Next steps

Steve is home!

We arrived just as Cooper was coming home from school and have been settling in ever since. Steve is navigating the house well in his new wheelchair, and we hope he's able to sleep comfortably in the new hospital-style bed. The oxygen machine is pumping, providing a constant respiratory boost.

Our departure was delayed a bit today because of last-minute labs and an MRI.

First, the amazing MRI news: The Damm Spot is a little smaller than it was on April 17!

Woo hoo!

According to the report, the cyst (the middle part of the tumor) is slightly diminished, and the enhancement is slightly less. And there is no bleeding. This is all excellent news.

The labs reveal a bit of a concern. Steve's platelet count is dropping. Yesterday it was 88,000. Today it was 77,000.

Dr. M has two theories on the drop.
1. Steve could have developed Heparin-induced thrombocytopenia (HIT). As Fancy Nancy would explain, that is a fancy way to say that he could have developed antibodies to the blood thinner Heparin.

Heparin is used to flush Steve's PICC line, to make sure there is no clotting in the line. He received Heparin twice a day while at Zale. If he has developed HIT, his body is unable to produce the normal number of platelets.

2. His platelets could be gathering at the blood clot in his right leg. I imagine the clot as a big, fun party that all the platelets want to attend. They hang out there too long and then can't get moving and therefore aren't a part of Steve's general blood flow.

So now we work on diagnosis. (This is where a flowchart would come in handy.)

On Thursday, we'll go to the cancer center for labs. By then he'll be about 48 hours without Heparin. They'll check his platelets and also draw tests for antibodies.

If the test reveals he has HIT, then he'll just stop using Heparin. There are other drugs that do the same work.

If the platelets haven't recovered and he doesn't have the HIT antibody, then we'll head to the St. Paul imaging center for another Doppler of his right leg.

Based on lab results and possible Doppler of his leg, we'll determine the next course of action.

If the clot is worse or causing the platelet trouble, we'll have to treat the clot -- after his platelet counts recover. (This may require a transfusion.)

If the clot is better, we can work toward the next chemotherapy and Avastin treatment -- again, after Steve's platelet counts recover. Dr. M is most comfortable when the count is in the 100,000 range.

So, Steve gets a full day off from medical providers, and then we'll take the next steps on Thursday.

Dr. M shared with me how much the eighth floor enjoyed Steve as a patient. He never lacked motivation, and he impressed the team with his progress.

"They loved him!" she said.

Don't we all?!