Day 159 - Back to Go. Do not collect $200 - UPDATED as of 11/22 @ 19:53

     Our appointment yesterday didn't go quite as planned.  We noticed Evan's ankle was looking more red and swollen on Saturday evening.  Sunday it looked even puffier.  When Cristy got to the clinic on Monday morning she mentioned it to the medical team.  They moved forward with his spinal tap, but held off on the other chemo drugs scheduled.  There wasn't an opening at Scotish Rite so Evan was sent to Egleston for an MRI of his ankle.  As Cristy and Evan were pulling into the driveway last night after a long day the doctor told her he would need to come back in for surgery.
     It's about 10:40 a.m. on Tuesday and Evan is still awaiting a time for his ankle clean-up.  The Orthopedic surgeon said the MRI showed pockets of fluid and that his bone might be infected again.  If that's the case they'll need to drill in again essentially resetting our physical therapy progress.  They're also going to install a drain line similar to last time to allow for mucus and other material to clear out of his system.  The doctors don't know if his lowered immune system allowed this infection to grow or if the Keflex we were on before was keeping it at bay.

Taking his mind off of the hospital visit.

     The medical team is giving mixed information on what happens post surgery.  Cristy and I are preparing ourselves for spending Thanksgiving in the hospital.  This isn't the worst thing in the world.  We had already planned on spending Thanksgiving at the house to protect Evan so we won't have broken any commitments.  Additionally having him under watch while his counts bottom out gives Cristy and I a bit more piece of mind.  Guess we'll have to wait and see.
     While he's under for his surgery they're also going to change out his PICC line.  Both lumens have become occluded again preventing us from administering medicine through them or drawing blood.  Because of the infections the medical team isn't comfortable going with a longer term solution, such as a port.  I'm hopeful that we caught this early enough to prevent an extended stay and that his body rebounds quickly.  Cristy and I are both a little shaken by this, but we knew this was a strong possibility during his nadir.  His situation is pretty dynamic right now so I doubt I'll have another update until this evening at the earliest.

UPDATE
     The surgery team came to Evan's room around 12:30 to prep him and took him back for surgery around 1:30.  While under the doctor focused his clean-up efforts on the bone, ankle joint and surrounding tissue.  I was hoping for better news.  The report he gave Cristy was that the bone was infected as well as the joint.  The doctor applied antibiotics to the affected areas and put the drain line in to help with healing.

Recovering from surgery.

     Tonight the doctors are going to administer Zosyn as a catch-all antibiotic until the cultures come back.  They're working hard to put together a plan of action by the end of the week, which means we could be here through the weekend.  When I see the doctors tomorrow I'm going to try and get an idea of the severity of this infection and what risks there are short and long term.

PICC line dressing change.  The nurses were able to clear the occlusion.

     Besides the infection Evan seems in good spirits.  I'm frustrated and concerned for a number of reasons.  One of my concerns is this could potentially jeopardize the progress we've made in his physical therapy and set us back to square one.  The Ortho team didn't get us much in terms of marching orders so for now I'm going to keep Evan off his feet with his ankle elevated.  He's on Morphine to manage his pain and he's happy as a clam playing Minecraft on the Xbox.  I should be able to get more answers tomorrow and get a few more pieces of his healthcare puzzle.

Playing with Daddy.

Nolan re-familiarizing himself with the CHoA exhibits.