We’ve had another eventful 24 hours. The velocity of information and new care plans is intense. Even Andrew is shocked by how quickly things move, though we are grateful for how coordinated our various doctors are and the care has been.

 

Yesterday a transesophageal echo confirmed Andrew does have a “vegetation” on his aortic valve and it (not a shunt, or hole in the heart) is what’s leading to his strokes. There’s still a debate about whether the vegetation got there from a bacterial infection or if it’s more likely to be a clot or little deposits caused by the cancer.

 

This is important because his blood thinner—crucial to control clots and strokes—has a risk of brain bleed if pieces of a bacterial infection are leaving the heart and traveling to his brain (as opposed to, say, pieces of the blood clot in his leg doing it the same). The first round of bacteria cultures came back negative, but the infectious disease team ordered another huge set of bloodwork to look for DNA fragments from bacteria. (Andrew got a run-of-the-mill round of antibiotics before a procedure a few days ago that they said could have spoiled the accuracy of the original cultures.) If the next round of bloodwork is negative, they’ll consider it about 95% likely that it’s not an infectious vegetation. Infectious disease does not deal in absolutes, so that’s as good as it gets.

 

Meanwhile, neurology has recommended a cerebral angiogram this afternoon to make sure there’s no additional evidence of infection or microbial aneurisms (which can cause bleeding and additional strokes) in the brain. This involves snaking a catheter through his groin or hand to inject dye and do an X-ray. 

 

As of now it’s possible we will be discharged tomorrow, but it depends on continuing to do well on the blood thinner and having an unremarkable head CT.

 

We also got a new hospital roommate yesterday. Chatting with Harold has been a nice social outlet for Andrew. Andrew is holding up as well as can be expected and has a lot of nursing and doctor fans.