Day 109 - Gathering information - UPDATED as of 10/3 @ 18:27

     Well, it's been a while since we've had a set back, but it was bound to happen.  Evan went to the hospital this morning for consultation and potential surgery.  It turns out the plastic surgeon was ready to perform surgery and finally took Evan back around 11:45.  The surgery was only focused on the cyst in his wrist.  Upon cutting it open the doctor discovered a large amount of pus, which surprised me because of how hard it felt to the touch.  All the tissue collected has been sent off to the lab for testing and cultures.
     We've also noticed red patches forming around his eyes and on his right hand.  Cristy mentioned this to the medical team and they seemed unsure or unwilling to wager a guess at this time as to the root cause.  It seems to have gotten worse since his chemo session on Friday, but that could just be coincidence.  Evan is being admitted today for observation post surgery with no expected time of departure defined yet.  After more than an hour in post-op Evan finally secured a room in the Aflac units.  While we'd prefer to be home I'm sure Evan and Cristy will look forward to catching up with some of the nurses.

Waiting on consultation from the surgeon.

     The Infectious Disease team is taking a closer look today and will likely change his anti-fungal medication or increase his daily dosages.  Keep in mind this was without having seen Evan yet, but based on the symptoms mentioned to them through the hospital's internal notes they think that adding Micafungin or Ambisome could be in order.
     Prior to being discharged back in August the CT scans showed pockets internally of what doctors thought could be more fungus.  The belief then was that the Voriconazole, combined with Evan's improved immune system, would knock out the pockets showing on his various organs.  Since nothing cultured in the lab at that time no one could say for sure.  It's entirely possible that this is round 2 with the fungi.

Watching some TV in pre-op.

     I'll likely post another update later this evening as more information comes in.  I know a few people have been texting me this morning and I wanted to get something out there.  Thanks for the prayers and well wishes.  I'm hoping this is just another bump in the road.

UPDATE
     Cristy has met with the ID team and they're putting together a course of action that will keep Evan in the hospital for the next few days, possibly longer.  Orders are being put in for a series of scans tomorrow.  It's yet to be determined now what area(s) they want to focus on.  In addition to that the doctors are going to add Ambisome to his fungal medications.
     Until the blood cultures come back the plan is to contain what's in place.  Upon review the lead ID doctor was concerned with the growths and wants to confirm it's yeast and not something more dangerous to his health.  The CT scans will also show whether the internal lesions are still there, if they've grown or if more have developed.  I don't even want to speculate on what the worst case scenario looks like, but in an ideal situation they'd see fewer and smaller pockets that could be eliminated with increased dosages.
     On the plus side many of the nurses that cared for Evan in the past have been by to visit and the music therapist brought him and Nolan each a harmonica.  Needless to say I'll have another update tomorrow afternoon, unless something urgent comes up between now and then.  From talking to Cristy it sounds like they're going to sit tight to see what the blood and cyst cultures show.  Nolan and I will be heading down tomorrow to offer our support and tag out Cristy.