You are currently browsing the tag archive for the ‘MRI’ tag.

Last night, after I finished entering in all the cash online and had made my final calculations, I was so excited to announce that our event raised a grand total of $112,793. Feeling satisfied and proud, I was eager to share. When I read the news of Rebecca Meyer’s latest MRI.

And it wasn’t good.

And sometimes it feels like we just don’t do enough. Like we just can’t act fast enough. All those thousands of dollars raised in her name and in her honor and what good will it do?  Sure, it may save some other child down the road and yes, of course, that’s noble and right and ultimately what we all want, but at this moment, for this child, for this family, they just want her. They’re not thinking about the new research we’ll get in two years or five years or ten years.  They need it now, they need it tomorrow.

You may be scratching your heads and thinking back to Sunday’s event and wondering, “Wait…was she there? Did I see this sick girl?” Well, yes, she was there. But no, you didn’t see a sick girl. She was well. Happy, vibrant, head full of hair, face full of light. She was very, very much alive.

She’s here last Friday, in pink head to toe, sticking out her tongue like any five-year-old should:

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And here again, on Sunday, watching with glee as her older sister shaves her head in her honor:

And again, with her bald schoolmates around her (goodness, these Fairfaxians like to stick out their tongues, huh?):
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She is alive, goddammit, and she deserves to stay that way.

A few months ago, I happened to catch part of an interview on the radio with Willie Nelson. Must have been NPR or something, I don’t completely remember, but I do know that he was asked if he could recall the single greatest moment of his life. He hemmed and hawed a bit and eventually settled on something great with a lower-case g, a relatively mundane and everyday activity like playing with his kids or walking with his wife or performing on a stage (everyday for him, at least). Now, it’s likely that Willie Nelson simply can’t remember every hazy, blurred-by-pot moment of his life. But it’s also possible that sometimes the “best” moments are just moments, the simple every day interactions we have with those we love: sitting on the porch with great friends eating delicious food, drinking wine and laughing til your stomach hurts. Or snuggling up in bed with your two sweet boys on a lazy Sunday morning. Or knowing, in a quiet, easy sort of way, that you picked the right man with whom to spend the rest of your life.

My best moments, for the most part, are small: Austin dashing out the kindergarten door every afternoon and literally jumping into my arms, half big boy with his backpack slung over his shoulders and half sweet baby who just can’t wait to get back with his mommy again. Or Braedan leaning over after a particularly long chapter of Harry Potter to kiss me on the check and say, “Thanks, Mom. You do great voices.”

But every once in a while, there is a moment. A “The Moment” kind of moment, great with a capital G. I had one of those one year ago today. I was exhausted and worried, more worried than I had ever been. I was trudging through each day, living by the motions only, trying with minimal effort to enjoy those beautiful spring days, the last before the storm of relapsed cancer and kidney failure that I felt certain was about to come. I still held on to a tiny shred of hope, planted in me by a double rainbow that appeared right when I needed it most. But it was tiny, that shred, so small I could barely grasp it.

The day, Wednesday, May 23, was long — as hospital days are wont to be. Following Austin’s MRI, we had returned home mid-afternoon and, when he seemed fully recovered, actually thought we might make it to his 6 ‘clock baseball practice. So we ate a super early dinner and I sent him up to change into his gear. When he returned instead in footie pajamas, shivering from the after-effects of anesthesia, I knew practice was unlikely. Now I have a funny sense about needing to fulfill obligations and still thought we should go.  Mark, on the other hand, is a bit more relaxed about such things and can see that a 5-year-old’s tee-ball practice falls pretty low on the must-do list in life, especially when you think said five-year-old might be dying, so our plans quickly changed and home we stayed. And good thing. Because mere minutes after the boys had trooped upstairs for baths, I went to check, yet again, for either voicemail or email containing some kind of news from our day’s tests. As soon as I walked into the office, the home phone rang and, glancing at our doctor’s cell number I picked up with a pithy, “Well, I’ve been waiting for you to call.”

“I’m on my way over,” he said, without introduction. Oh. Oh. This man has come over before. And let me tell you, it’s never been for anything good. So all I could manage was sarcasm: “Oh, you must have good news to share, huh?”

“Yes,” he said in a voice both earnest and urgent. “The best news. I’m about to pull in your driveway.” And that’s the thing that gets me now when I look back at that day and can’t help but think, What if we’d gone to baseball practice? What if we were suffering through pop fly drills on the playground at Boulevard instead of at home when he pulled into our driveway?

I yelled up to Mark but the bath water was running and god knows the boys are never quiet, so he heard nothing until the doorbell rang two seconds later. I was right there, Jeff didn’t need to ring the doorbell at all; I’d been watching out the window for his car. And he walked in the door waving the official results in his hand and I couldn’t quite hear what he said beyond, “He’s fine; it’s nothing” and I cried and cried and cried in his arms like I’d never cried before. And Mark, hearing the doorbell, had come to the top of the stairs and could only see us down there both crying and his poor heart stopped but only until he heard laughter in our tears. Laughter in our tears because this was the best news. The best news.

And that will remain forever as my Willie Nelson moment, my best ever, stands-above-all-the-rest kind of moment. But now, as this month of dwelling and reminiscing comes to a close, I look forward to much smaller moments. If I get nothing greater for the rest of my life than swinging on the swings alongside my family at our small Point Chautauqua playground with my feet hitting the sky as the sun sets brilliant purple and pink and orange over the lake, I’m okay with that. That’s plenty big for me. I’ve had enough big moments for one lifetime.

That’s what it was. Not actually “nothing.” To be exact, “Apparent hypoechoic area described on previous ultrasonography study is likely due to echo spin shadowing from surgical clip along the left psoas muscle.” Or, in our own language, that thing we saw in the ultrasound was caused by ultrasound waves bouncing off the titanium clip that was placed in his kidney as a marker and forming a shadow. It wasn’t a mistake. There really was a shadow on the May 7 ultrasound, some new spot that measured 1.4 centimeters and that warranted further study. That was it.

The same paragraph of the official report says, “No evidence of new left renal mass lesion.” And that says it all: No new left renal mass lesion.  There is nothing new in his left kidney that could possible be a tumor.

This is the report that was handed to me in person when our oncologist pulled into our driveway yesterday evening around 6:30. (The same report Austin later spilled champagne on.) I lost it. Absolutely and completely lost it (not over the spilled champagne). I don’t think I could have possibly cried harder or louder if we’d been told he had three weeks to live.  I have never felt that degree of relief over any piece of news we’ve received in the past five years. Never. Except that poor Mark was upstairs while the boys were showering and heard the doorbell ring and then heard me crying and assumed the worst. As he whisked the boys into their jammies, he was able to discern laughter in our tears and bravely ventured down to hear the news.

Then it was celebration and laughter and more tears, champagne and sprinklers and more tears. And some wonderful spontaneous visits from random people who couldn’t resist giving a hug.

And I’ll say one thing for that Dom Perignon:
it doesn’t taste all that different but you sure don’t wake up with a headache!

So I don’t know how to account for all this craziness. Was it just me overreacting? Was it the power of positive energy, good wishes, prayer?  Was it the healing oil a colleague of Mark’s dropped off, which we rubbed on Austin’s belly Wednesday night? The double rainbows, the wishing stars, an act of God? Good luck … a miracle? Or just plain echo spin shadowing? Call it what you will, my child is two years cancer-free, a fact made extra clear by the extra clear images of the MRI. This milestone, which we’ve been so eagerly awaiting for the past five years, means several things: The chances of Wilms tumor coming back after two years are extremely extremely slim. And if, at any point in the future, his kidney should start to fail, we can set the wheels in motion for transplantation while hopefully avoiding dialysis altogether.

In non-medical terms it means this: We made it. Austin made it. We have done what we hope is our life’s hardest thing. We have done our life’s hardest thing.

Why, what on Earth makes you think I’ve had too much sugar?

Here we go again. There’s something about having a procedure postponed that takes away a bit of the nervousness surrounding it and replaces it with a feeling of let’s do this already.  It happened to us back in September/October of 2007 when Austin went in for a major surgery to remove tumors off his left kidney and we were all so worried, but after they put him under and opened him up, they discovered an infection inside him and delayed the whole thing by a week.  By the time that long in-patient week had passed, we had forgotten much of what scared us about that risky surgery and just wanted to get it over and done with.

So, I think that’s how we feel about today’s MRI. Let’s do this. Give us some information already, point out the path ahead.

Just in case you felt stupid after reading last week’s post about anesthesia versus sedation, know that I had to google the official difference between the two.  I should know, because Austin’s done both many times over, but when I tried to explain it to anyone I realized I couldn’t do it accurately. All I could have told you for sure was that anesthesia takes place in Peed Surge (pediatric surgery) on the 2nd floor and sedation takes place on the 4th floor in the let’s-be-very-clear-here Sedation Unit. I do know that Austin has more trouble coming out of anesthesia than he does coming out of sedation.  After being sedated, he usually feels groggy and disoriented for about five minutes.  With anesthesia, that grogginess and the nausea that accompanies it, can last for an hour or more.

He will also have a breathing tube inserted as is common practice with anesthesia. This is the crux of why they’ve opted for this route over sedation.  With both, your airway can partially collapse, which caused the worry over Austin’s breathing last week. Being intubated will obviously take care of that worry (and give him a very sore throat afterwards).  So, needless to say, we’re in for a long day today.

But not quite as long as it was going to be.  He was originally scheduled to begin at 2:30, after going on his field trip, which his class happily changed to a popsicle-and-jello-only event.  But just yesterday, I got the call that we should now arrive at 10:30 (you should’ve seen my face as I was listening to my doctor’s message that started with the words, “Austin’s MRI has been rescheduled again…”). So I’ll shortly be waking the boys for an above-mentioned healthy breakfast (yes, they’ll both be eating popsicles and jello for breakfast) which must be safely consumed before 8am. Then Austin will head off to the playground for one hour, with no food or drink in sight, before Mark and I bring him down.

And then, well, then it will be a long day of waiting, I’m sure.  I’ll be bringing a laptop to type more stories from the Fairfax students, which is what I’ve been doing nonstop for the past few days. Sixteen volunteers came to the Typing Party on Monday night at Lake Erie Ink and we plowed through at least half in three hours.  But that leaves an enormous half stacked here on my couch, which I’ve been foisting on innocent bystanders who are too guilty to say no to me.

And hopefully, some answers. Please go back here to remember exactly what to wish for. Being in a state of limbo has been, as you might imagine, exhausting.  But I stand by the fact that if the news is bad, I’d rather it be delayed as long as possible.  I mean, think about what limbo actually means: you’re stuck between heaven and hell, not sure yet which one you’ll be condemned to for eternity.  I’ll take limbo over being condemned to hell, that’s for sure.

But if the news is good, bring it. I’m ready for that.

Didn’t expect to hear from me so quickly, huh?

Have I ever told you that Austin is a snorer? Like a hear-him-from downstairs-snorer? He’s loud, all night long, snargling and snuffling and waking anyone around him. This is relevant because sedation can be dangerous for those at risk of respiratory failure. We’ve run into this problem before over the years, but he usually needs to be sedated for only a short period of time. For radiation or CTs with contrast, it’s a half hour maximum that he’s actually sedated and only a few minutes in the machine and out of the range of the doctor’s watchful eyes. MRIs can take up to two hours.

We went to sedation today around 12:30, after steering Austin away from food all morning. We had packed a good “lunch” for him to eat around 4pm when he would finally wake up. The nurse went through her procedures and then the doctor arrived. He looked in Austin’s mouth and quickly left the room, returning a minute later with a tongue depressor. He called me over to show me Austin’s huge and swollen tonsils, explaining how this is a problem, and all along I’m thinking he’s just pointing them out, advising me kindly to see an ENT, sharing tangential information. But no. Then he drops the bomb. “We can’t sedate him; it’s too dangerous.”

He has to go through anesthesia instead, which doesn’t hold these same respiratory risks (although is a bigger deal in other ways that I can’t quite explain). Of course, anesthesia couldn’t fit us in today and the MRI has now been rescheduled for next Wednesday. In the afternoon. On a day when his class is going on an end-of-the-year field trip to Beachwood playground that will inevitably include many delicious snacks.  Uuuuuuugggggghhhhhhhhh. I will bring him anyway that day, convince the class to hold off as long as possible on putting out the food, offer more popsicles and leave early.

I guess we weren’t quite specific enough with our wishes. Next time, we have to include the date.

Mark and I sat around for a long time last night trying to figure out exactly what to hope will come out of today. Wishing for everything to “be okay” doesn’t quite cut it, nor does my usual “I hope the worst is behind us.” We need some specifics here.

We’ve settled on four scenarios, two likely and two highly unlikely. Of course, there may be one or ten other possibilities that haven’t yet crossed our minds, but we do have a well of experience for how these things work.

The two most realistic possibilities are that we clearly see the lesion and 1) are able to easily reach it with a needle biopsy or 2) aren’t able to reach it. The first is obviously the most desirable. Then we could schedule a biopsy and get real information. At that point, we know exactly what to wish for: that the “thing” is not cancer.  And not only not cancer, but defined with certainty as something else so we don’t even have to worry about it. Then we’d finally pop open that champagne. If we’re unable to reach it with a needle biopsy, I think the next step would be to watch and wait, with repeat scans. I don’t think any of us (parents or doctors) believe that the need to know outweighs the risk of surgery.  If it grows or changes on repeat scans (probably monthly), then we could justify going in surgically since growth almost always equals cancer.

The two unlikely scenarios fall on opposite ends of the good-bad spectrum. One is that the “thing” has disappeared.  I know that sounds like the best option, but it would also raise many questions, like what was it saw last week and where the hell did it go?  I imagine we would also end up with more frequent repeat scans if that was the case, to make sure it doesn’t magically reappear. The worst possibility would be that it’s grown considerably since last week, forcing us into quicker action (since growth equals cancer).

So, for all of you who’ve sent me lovely messages saying you’re wishing, hoping and praying for us today, now you have a specific request to send out into the universe: That we can easily reach it with a needle biopsy and that’s it’s ultimately defined as something other than cancer.

Okay … got it? Now get busy.

Austin will have an MRI on Thursday afternoon.  It took some juggling to get this scheduled because we were initially hoping for a morning slot, since he can’t eat before being sedated. But the next available morning slot was on May 31 and none of us (neither Mark and I, nor Austin’s doctors) were comfortable waiting that long. Turns out he can have clear liquids until noon and, lucky boy, popsicles count as a “clear liquid,” so the snack at school that day is settled and I’m not dreading the slow ticking by of the hours that morning.

We’ll see his oncologist after the scan and I imagine we’ll have some results to discuss before we leave that day. But it’s important to note that we don’t expect to get either good news or bad news out of Thursday. We simply expect to get more information. I know, now you’re all going, “Whhhhaaaaaattttt??” But here’s the deal: the MRI cannot tell us if what’s inside him is cancer. It also can’t tell us if it’s not cancer. The purpose is solely to get a good, clear image of the “thing,” its size and, especially, its location.  We may be able to see if it’s filled with fluid or not (both of which could be Wilms tumor, so that isn’t terribly relevant either). Barring some bizarre turn of events, like if the thing has doubled in size since last Monday (which would obviously be very very bad) or if it has disappeared completely (which would be good, but confusing), we hope to walk away from Thursday with enough information to help us determine what to do next.

If we want to know definitively what the thing is — and, as of this moment at least, we most certainly do — then we have to biopsy it.  The MRI will let us know if the radiologist can attempt a needle biopsy instead of having to do a surgical biopsy. If the thing is located in a spot that’s easy to reach with a needle, without having to go through too many other tissues or organs or what-have-you, then that will be considered good news.  If it’s not reachable, then we’ll have to decide whether we move ahead and do a surgical biopsy, which is the more aggressive approach because it poses many risks to the kidney and his insides, due to the excessive amount of scar tissue they’d have to cut through to get there. Or if we take the dramatically less aggressive approach and “watch and wait,” by doing repeat scans more frequently to monitor the “thing,” without taking any action until it grows or changes.

It’s confusing, I know (as so much of this has been), but the MRI is really just a first step toward what will ultimately be either good news or bad news. Like we’ve done so many times before, this is a take-one-tiny-inch-at-a-time kind of deal.  One tiny inch is about all I can handle right now.

I know that every time this happens, there are a zillion questions running through everyone’s minds that send you all scrambling through the blog archives and even to other online sources. “But wait, … what about that time three years ago when …?” I noticed on my Stats page yesterday that someone was directed to my blog after  searching the words “3rd relapse Wilms cancer.” At first, I thought, “Huh, how ironic,” but then it occurred to me that it might have been one of you out there looking for reassuring information.

Well, you won’t get it. I just typed the same words into my search engine to see what would appear and it’s all old articles I’ve read before, some many times over, one from 1987 with (hopefully!) outdated data. The survival stats according to those studies fall in the 30 to 40% range … and that’s for the first relapse. Nobody really mentions another relapse and nobody seems to be talking about bilateral Wilms or what was once rhabdomyomatous Wilms or any of the other variations that make Austin’s case so ridiculously one of a kind. So, we’re just going to ignore all those and go with what we know about this specific child at this particular moment.

We know that, for all intents and purposes, Austin is well. His labs are steady, which means his body is not under assault and whatever may be in there right now isn’t causing any measurable harm. And he certainly, without a doubt in anyone’s mind, seems well. And that is worth something, both psychologically for all of us but also diagnostically.

We also know that the “thing” they’re seeing on the ultrasound is 1.4 centimeters in size and of an ill-defined shape. The radiologist went back to the two previous scans and, while he can’t rule out with 100% accuracy that it wasn’t there before, he did not and can not see it on any images prior to Monday’s. The official report labels it “new,” which is always bad, but they also say it’s “nonspecific,” and that an “underlying lesion cannot be excluded.” In other words, “We see something in here we haven’t seen before. We can’t tell what it is but we can’t rule out that it’s not a tumor.” Further imagining is recommended.

That’s all we’ve got. But we also have history. We’ve been down this road before, where we see something and can’t define it. First, in December 2008, we began to watch a “something” on his scans which we then biopsied in March 2009 and discovered was cancer. That was removed in April 2009 and turned out to be “old cancer,” all of which coincided with the launch of this blog. Then in October of 2009, we again began to watch another “something.” This was the one that we followed, on pins and needles, throughout that fall, finally deciding to ignore in November, before it doubled in size (“You will not ignore me,” it seemed to be saying) and turned out to be relapsed cancer in December. (Consider yourself warned before you go back and read all those linked posts because, oh my, they contain a lot of drama and a lot more f-bombs.)

Those are really the only “somethings” we’ve watched, except for the “something” in his liver (good god, what a stupid word, something something something). That something did appear on Monday’s ultrasound, unchanged in almost two years. The doctors have contented themselves with the fact that this thing never grows or moves, but will be happy to get a better look at it during the MRI. I consider that thing somewhat different because, 1) it’s in the liver, not the kidney and 2) it’s been there for a good long time without doing any harm.

So, that’s what we have and that’s where we are. I personally feel better today. Not for any specific reason, but just because it’s less raw than it was twenty-four hours ago. We carry on as we always have, because, you know, that’s what we do. Braedan had baseball last night and Austin swung across the monkey bars nearly the whole time. Then we took the troops to Sweetie Fry for treats and didn’t get to bed until well past 9. The boys both know that there is something there that might be cancer, but neither has much wanted to talk about it.  Austin did say the first night, “But I don’t want to have cancer again,” and, oh, if it were only as simple as what we want and don’t want. Since then he tells me to “Shut up” with a slight smirk on his face every time I mention it, so I’m backing off.  Braedan has sporadic questions but will only talk about it on his own terms and his own timing and otherwise sticks his nose in a book and carefully ignores the conversations going on around him. Oh, the child psychology of all this is sadly fascinating.

We have read and listened to all of your very lovely messages and, as always, they bring us strength and comfort. I am not in the mood for returning all your calls and will simply see and speak to each of you as time goes on. We do deeply appreciate the small acts of kindness directed our way (the boys were especially thrilled with the surprise delivery of Dunkin’ Donuts this morning, Ruppes!).  And it did not go unnoticed that all the kids at Austin’s preschool wore their St Baldrick’s shirts yesterday. As I said before, the many offers will be accepted over time, especially if we end up with two-plus years of dialysis.

Oh, that brings up another joyless question I’ve heard too many times in the past three days: If he does indeed lose this kidney, when could he receive a transplant? Well, if this is truly cancer, then the “two-years cancer-free” clock is reset. And it wouldn’t start ticking down until he was completely finished with whatever treatment (chemo or radiation) he might first require. So we’d likely be looking at two-and-a-half years of every other day dialysis. But you know I can’t quite bear to think of that right now. For those of you who have made the ultimate offer — one of your kidneys — I  say (I mean, I shout while jumping up and down), “Yes, yes, thank you very much,” but we can’t even begin the pre-match testing until we’re much much closer to transplant. So just stay healthy and don’t disappear from the online universe.  I will be calling!

You know how this goes. First I’m in disbelief, then I’m angry and sad and scared, then I grasp at something to hope for. Then there comes (or not) a reluctant acceptance of the ugly truth, followed by that well of strength that has been tapped too many times. Back and forth, up and down, over and over. The roller coaster ride has begun.

Thank you, all of you, for yet again stepping up and offering to walk this tortured path with us. Today was an emotional day as at every drop-off and pick-up and at several places in between, there were long hugs and inevitable tears and many many f-words. I hear and appreciate every offer of help (and I hear and appreciate every f-word). At this moment, there is nothing we need (save that magic pebble), but the time may come when we will accept all the meals and playdates and everything you’ve all given so many times before.

Nothing is certain. This is not yet the worst news. It is simply not the good news we had so fervently hoped for and so completely believed we’d receive. But we have many more steps before we can say for sure that this is cancer and before we know at all what any of this means for Austin’s future.

His oncologist is taking a surprisingly calm approach, considering he usually wants to do more and do it faster. After discussing the situation with Austin’s nephrologist, they now say we can skip the GFR. The fact that his kidney function has remained steady for two years pretty much guarantees a GFR result of 60 or greater. So that’s one small thing off the table. We will instead do an MRI in the next two weeks, perhaps Wednesday, May 16. Mark and I had been thinking we’d do it the week after that, but everyone I mentioned that to gasped in horror and said, “Why can’t they do it sooner?!” I think they probably can do it sooner (they’re working on scheduling it right now), but the truth is that Mark and I don’t really want to deal with the results any sooner than we have to.  Usually I’m the one who believes everything will be alright and this time, I feel fairly certain that the next step will involve removing his kidney and I just don’t want to get to that step one single second sooner than we have to. Then there’ll be the chemo issue — which could push the start of the two-year countdown clock back by several months. Of course, none of this is certain, but I can’t stop it from going through my mind.

So, first things first and that’s the MRI, which poses no danger to his kidney and is expected to give us at least a good look at what’s there.  Of course, a clear image is not the same as a biopsy, so even that won’t define the “thing” with certainty. But we’ll just take things one day at a time and make the next decision when it comes.

I feel an incredible sadness and a huge weight upon my shoulders. I look at this vibrant boy zooming ahead of me on his bike down the street and it seems impossible. But it’s seemed impossible before. Not ever, not for one minute of one day did having a child with cancer ever seem possible or normal or expected. I feel like we’re piecing his life together, buying snippets of time here and there. Trading in one surgery for three good months. Or twelve rounds of chemo for half a good year. Stitching together these ridiculous pieces, in-treatment time with non-treatment time, a bit of sickness here with a bit of health there, mixing the living in with the dying. Or the dying in with the living. A patchwork quilt of life, held together by a thread of hope so thin that it at times appears invisible, and yet so strong that it proves unbreakable.

It must be unbreakable.

Of course, all this hemming and hawing about what to do next could be quickly rendered null and void if something suspicious shows up on that kidney.  Austin has an abdominal ultrasound this Thursday morning, which, as you may or may not remember, is all we’re allowed to do with a GFR under 30.

His kidney isn’t functioning well enough to filter out the contrast he’d need to drink for a CT scan or the gadolinium needed for an MRI. In fact, for patients in end-stage renal failure — which is several steps beyond where Austin is — MRIs are associated with this horrific condition that causes thickening of the skin and organs . . . and has no treatment. Basically, your organs keep thickening, leaving you completely debilitated, until you just die.  Not something I’m prepared to sign my okay to on a routine consent form.  So that leaves only ultrasounds which are good because they don’t expose him to unnecessary radiation but aren’t quite as precise in finding small or hard-to-detect growths. We’ve arranged for all of our ultrasounds to be done by the best doctor possible, one who knows Austin’s kidney very well, so that makes us feel confident that this method of “watching” is good enough.

That will take place this Thursday and then Friday Austin needs yet another eight-hour blood transfusion. His kidney is not making something called erythropoietin which stimulates the production of red blood cells, so his hemoglobin can’t fully recover from the effects of chemo. (Anybody have to consult an online dictionary to get through this post? I did, to triple-check my spelling!) This will be the first time he’s had blood since the removal of his PICC line so we’ll see how he does with a peripheral IV in his hand.  Hopefully one will do the trick and not be “blown” by the heavy volume over the course of the day. Inserting a second IV halfway through might just be too much for the little guy.

So, we’ve got a few days that will feel like we’re back on the hamster wheel of treatment. And then it’s off to Chautauqua for a weekend of boating and fireworks. Start countdown now . . .

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