Today's good news

Steve's platelets have risen to 92,000 (up from 77,000 two days ago)! This means a few things:

• The clot in his right leg does not seem to be hogging platelets and therefore doesn't require blood thinners.
• He may have built resistance to Heparin. (Results from that blood work won't be ready until tomorrow, probably.)
• He can't have chemotherapy and Avastin yet, but he's headed in the right direction.

We'll return to the cancer center next week for another round of labs. If the platelets have reached 100,000 or more, we can then schedule the next dose of Carboplatin and Avastin.

He won't get a repeat Doppler of his right leg unless symptoms warrant the test. Right now, we're all hoping that the clot has finished growing and won't cause trouble (symptoms like swelling, redness or heat).

Dr. M is pleased with how much more mobility Steve has today compared with a month ago. She raved about the compliments she heard from the Zale rehab unit. (I wrote about Steve's awesome attitude in my column today.)

We're also setting up outpatient physical and occupational therapy appointments so that Steve can continue his progress and maintain his strength.

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Check back soon for details on a fun Damm Spot fundraiser being organized by a group of dear friends!

Procedure finished

Steve is back in his room on the eighth floor. The filter was placed without trouble.

He's eating a Nova lox bagel (thanks, Mary!) and watching television before he naps. ("Deal or No Deal" is on. We've never seen it before. Do contestants just choose a case to open?)

If all goes well, Steve will be able to resume physical therapy tomorrow.

Wheeled away

Transport just wheeled Steve (in his bed) to Interventional Radiology, where they'll prep him and get the filter placed. I'll update when he returns.

Waiting on procedure

Steve is still in his hospital room. We're waiting to learn what time his procedure will be. He's starting to get hungry -- he's not allowed to eat or drink anything until after the filter is placed.

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Yesterday I reported that the clot is in his left leg. We all thought it was, based on Steve's swollen left leg. But the resident, Dr. C, triple-checked the radiology report that identifies the clot in the right leg.

We're shocked. There are no visible symptoms on his right side.

We are especially thankful that Dr. N ordered a scan on both legs.

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UPDATE: Dr. G, the doctor who will place the filter, just visited with us. The procedure will begin around 11:30 a.m. and will last about an hour.

He will be under moderate sedation; the incision will be in his neck. A catheter will be used to move the device to the correct place in his groin.

IVC filter for DVT

Sometime tomorrow Steve will undergo a procedure to have an inferior vena cava filter (IVC filter) placed in a vein in his groin area.

The IVC filter will serve as a sieve to stop a blood clot from reaching his lungs. (That would be a pulmonary embolism, and that could be deadly.)

In most cases, a blood clot like Steve's is treated with blood thinners. Blood thinners aren't an option with Steve, though, because of his need for Avastin.

Avastin is the bio-agent that has been used in conjunction with chemotherapy to stop the Damm Spot from growing. We need it to continue to extend Steve's life.

Avastin and blood thinners don't mix. The combination could cause the tumor to bleed, and that would be devastating.

So, the next logical option is the IVC filter. Its placement is not without risks, but we have to take the risks to keep the DVT away from Steve's upper body.

The procedure itself, which will be performed at Zale Lipshy, is fairly simple. It won't require general anesthesia. But there will be an incision and therefore a wound that needs to heal. Avastin slows the healing process.

The timing of this is actually as good as we could get. Steve's last Avastin treatment was two weeks ago. If he hadn't been admitted to rehab yesterday, he would have had an Avastin treatment today, making a surgical procedure much more difficult.

One of the big questions after the procedure tomorrow: How long will he need to wait until the next Avastin treatment?

The balance will be taking care of the clot and healing while also treating the tumor as aggressively as possible. Both needs are urgent.

Dr. M is in the loop with the physical rehab team and the interventional radiology team. We've defined the main goals:
1. Take care of the DVT.
2. Continue whatever physical rehab (most likely OT and upper body PT) is possible while healing from the procedure.
3. Secure another seven days of rehab at the end of this seven-day allowance.

*****

Steve is tired but in good spirits. He's on complete bed rest at least until the procedure tomorrow. (We don't yet know what time he'll be taken to radiology.)

Almost every time a new caregiver comes in to meet Steve, they ask a series of questions including, "What kind of work did you do?" They're always impressed when Steve answers in the present tense -- he tells them what work he's doing today.

Every morning when he wakes up, he thanks God for another day. I know that he'll do so again Thursday morning, thankful the gift of another day, thankful for intervention, thankful for skilled and caring hands, thankful for you all.

A new wrinkle: DVT

A blood clot (or DVT, for deep vein thrombosis) was discovered today in Steve's left leg.

Yesterday when Dr. N was examining super Steve, he noticed Steve's swollen left leg and foot. We told him that the swelling has been an issue for a few months. I told him that two sonograms revealed no clots in his leg.

Dr. N ordered a sonogram of his leg anyway, just to be cautious. (Obviously it's a good thing I'm not the one ordering -- or not ordering -- tests!)

After Steve's first physical therapy session this morning, he returned to his bed and was wheeled off to imaging. He returned an hour later in good spirits.

About 30 minutes later, Steve's nurse told us the news.

We haven't spoken with Dr. N yet to learn how the clot will be treated. The usual course of treatment is blood thinners, but I'm not sure if that will be complicated by Steve's Avastin history.

One of the side effects of Avastin (the bio-agent that Steve has been taking since late 2008) is increased risk of DVT. Steve had been scheduled for another Avastin treatment today, but we canceled that this morning, before we knew about the clot, in favor of continued therapy at Zale. I've e-mailed Dr. M and her nurse to make sure they are aware of this wrinkle.

We do know that he's on bed rest for the remainder of the day. No more physical, occupational or video game therapy (Wii-hab!). No shower.

Insurance approved seven days of rehab yesterday. We used one Tuesday just by checking in. We're using another today, in which Steve received about 30 minutes of physical therapy. (That session was great, by the way! Steve was able to walk, using parallel bars and some help from the PT. He felt some discomfort in his lower back, but he powered through and impressed the PT and me.)

One of our concerns now is that Steve is going to burn through rehab days without really getting much rehab.

When I update later, I hope to be able to report:
1. How the clot will be treated
2. What happens to Steve's precious rehab days

We take great comfort in the many prayers on Steve's behalf. And we're cheered by a new catchphrase, courtesy of Julie: Out Damm Clot!