Delays

Starting with the good news: Andrew's cerebral angiogram was unremarkable yesterday. They did not find any evidence of infectious aneurysms in his brain, which supports the hypothesis that the heart vegetation is not caused by a bacterial infection. This is the first time he's had a test that came back totally normal.

Not as good news: Some of Andrew's doctors still cannot give it up that it's a sneaky bacterial infection. Even though a cancer-related clot or deposit makes much more sense, they won't rule out bacterial becuase 1) the location of the vegetation on the aortic valve is suspicious and usually where a bacteria would set up shop and 2) the consequences of being wrong are potentially catastrophic. For one, an unchecked bacterial infection could make him very ill once he starts chemo and could create damage in his heart that cardiologists cannot fix.

The plan is to complete a 14-day course of heavy-duty antibiotics. We're already a couple days in, and this can be done at home. However, now that it's Saturday, we're stuck in the hospital until they can contact the at-home IV vendor to get things set up. It's extremely important to not get behind on the medication schedule. The worst part is that staying on IV antibiotics delays starting chemo. He cannot do both at once.

The plan for now is to repeat a transesophageal echo in two weeks in an outpatient setting. We'll hopefully have bloodwork results by then too that doesn't show evidence of a previous bacterial infection. Between antibiotics and his blood thinner, it's possible the vegetation will look better or even disappear by the next echo. This is our prayer.

If it's the same or even worse, I think we'll have several doctors advocating to continue antibiotics for another month. His oncologist will likely fight that, and we'll have to weigh the risk of being wrong about a bacteria that is hiding so well it doesn't definitively show up on any tests with the very real risk of not treating an aggressive cancer for that long.

Andrew's roommate Harold left last night, and someone new moved in. Andrew's currently getting a head CT, and I just arrived at the hospital and am waiting on him to return to his room. I overheard the new roommate telling his friend about Andrew—how much he enjoys talking to him, how nice and smart he is, how heartbreaking his situation is. Of course he is right about it all.