I know many of you are interested to hear updates as I have them, so you get two in one day.

I felt frustrated this morning with the lack of coordinated communication across Andrew's medical team. Each specialty came to visit individually and sometimes contradicted another. It didn't feel like anyone was in charge behind the scenes.

I texted Andrew's cardiologist to make sure he got looped into the discussion about whether to do surgery because he manages Andrew's blood thinners and stroke risk. He was rounding in the hospital and came by. He then spent the day reviewing Andrew's records in detail, calling the oncologist, and advocating for Andrew with other doctors. He came back in the evening to give his opinion that things were more positive than he thought at first.

Infection source
After a lot of back and forth, doctors generally agree that the gallbladder infection is the infection source. The leak into Andrew's liver resulted in a 7cm infected fluid pocket. Based on the location, it could easily get into the bloodstream. Interventional Radiology originally said it looked like a new tumor, but Andrew's oncologist and a surgeon convinced everyone that it was an infection and needed draining. Andrew got a platelet infusion and is now in the procedure.

He will have a tiny tube sticking out of his side for several weeks. It won't empty into an ostomy bag, but he'll need to keep it covered and dry to avoid another infection. It's likely that he'll have a high fever, chills, etc. tonight but they think he'll feel much better in the morning.

Heart vegetation
Andrew's cardiologist reread the echo that was done yesterday and thinks he sees something suspicious, so Andrew will get a trans esophageal echo on Monday. For those who have been following along for a whole year, this is the same situation from June 2024: There could be something on Andrew's heart—is it a blood clot, or a buildup of bacteria? This time, they're leaning toward bacteria. The antibiotics Andrew is already taking will treat it, but if confirmed, it will extend the amount of time on antibiotics. The doctor also thinks the new pulmonary embolism could be related to the sepsis and not cancer progression.

Cancer progression
Many tumors are significantly smaller than the last scan before restarting chemo. There may be a new tumor in the adrenal, but if it's the only one, Andrew could get radiation on it.