Yesterday turned out to be a three ring circus for Evan and Meghan. Evan was due to start his third round of chemo post limb salvage surgery but it didn't happen for a variety of reasons. I picked them up at their home on Thursday and delivered them and the giraffes to the clinic. Meghan let me know by text a little later that they were going to do a heart scan first to make sure that there were no surprises from the last study. This is standard procedure for this round of chemo as they want to make sure his heart is ready to take on the red devil. Protocol calls for the cessation of white lightning going forward and hopefully he is finished with this nasty drug. It will return to his regimen if he has any further cancer growth or mets to the lungs. We found out later that his scan was essentially similar to the one he had just before beginning chemo a major plus.
After the scan was complete it was off to the clinic to have his port accessed and blood drawn to determine ANC levels and to begin hydration necessary to begin the administration of red devil. Prior to access his port must be flushed of the heparin that is in the port. He has a dual port and each cup in the port must be flushed. The flushing of the upper port went as planned but when the nurse attempted to flush the bottom port Evan was in extreme discomfort and let that discomfort be known with a scream Meghan had not heard before. Meghan asked the nurse to discontinue the flush and seek out the Doctor. The Doctor ordered him to the cath lab to check port functionality. It was discovered by the radiologist that the upper port was working properly but the bottom port was fractured. In a properly functioning port the dye they inject to study the port will flow from the port through the tube that goes from port to vein. The upper one did just that but the bottom one dispersed the dye immediately around the outside of the port instead of delivering through the tube to the vein. It was extremely fortunate that this was discovered prior to the administration of red devil as this chemo drug is extremely caustic and had it been routed through to his chest wall instead of into his vein the result would have been devastating to him. The flushing drug and the dye were routed to his chest wall but all this will do is cause him some swelling and soreness in the area which will diminish over a few days, certainly not life threatening.
Blood was drawn from the top port prior to Evan going to the dye testing of his port and his ANC was 450 below the threshold for having chemo done that day. The chemo was not going to happen anyway which in retrospect was a very good thing. His white count was only 3 and red cells were 8. We met with the surgeon who is going to take out the bad port in its entirety and replace it with a single port as the dual is no longer needed. The port tube will be placed in a vein in his neck and the cup will be placed most likely mid chest. The final placement will be determined by the surgeon during the procedure. We originally thought the surgery would take place on Friday but the surgeon wanted to wait until Tuesday. I believe that she wanted his counts to be a little higher and felt that the risk of having a piece of the port break off and enter his blood stream (another disaster) was a lesser evil compared to low counts that could encourage unnecessary bleeding and elevated risk of infection. He will return to clinic on Monday to have blood workup to make sure his counts are good enough for surgery to take place.
I loaded everyone in the car and took them home. Evan is resting comfortably and is aware of what needs to happen to the port. He is handling this setback well and is looking forward to having the last two rounds of chemo (6 individual weeks with breaks in between) and hopefully clear scans at the end. I will report on Tuesday on how the surgery went and earlier if anything happens.
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