The Waiting Game

Infectious Disease team came in early today to discuss what may be going on with Brendan.  They are still working on getting a c. diff toxin test done, but everything is on hold until they get results back from the bone scans.  (They are doing bone scans, not a PET scan today.  They will see if further scans are needed later.)  In fact, everything is on hold until the bone scans are read -- whether to continue antibiotics - whether Brendan can go home - and what will be the next step in his treatment.

It looks like there are four things they are looking to the bone scan for answers to:
1) Whether the spots on the MRI on the bone are caused by limited blood flow.
2) Whether the spots are caused by an infection.
3) Whether the spots are metastasized tumor.
4) Whether the spots show up again or are an "artifact"- an anomaly in the machine that shows spots one time, then nothing when it is re-tested.

At 11 a.m. they came to give Brendan the radioactive material through his IV that would show up on the bone scans.

At 1:30 p.m. Brendan was wheeled down to Nuclear Medicine for his bone scan.

Four different scans were taken.  A full body scan, a pelvis scan, a head scan, and a chest scan.

 The scans took about 45 minutes all together.  Brendan watched Wall-E while he was being scanned.

When Brendan got back to his room, he enjoyed soaking in the sunshine for a few hours while he received two units of blood.  He slept very deeply while he was getting the transfusions.

While Brendan slept, the doctors came to discuss the scan results.  With Brendan sleeping, we moved to the tiny conference room where Shaun and I first heard Brendan's initial diagnosis.  I can't say I felt very good talking there, but there are not many quiet places to talk.

Once again, Brendan has baffled the doctors.  His results are highly unusual and they are not sure what they are seeing on the scans.  Brendan shows a lot of unusual spots on every bone in his body.  It doesn't look like anything they have seen before.  

The first thing they want to rule out is bone metastatic disease (where the tumor has moved into the bones).  Tomorrow they have scheduled 4 bone biopsies in his hips -- two in the front, two in the back -- one on each side.  While the radiologist said they could take the biopsy anywhere and not miss a spot, they want to make sure they are not getting a false reading.

If this was bone metastatic disease they would expect that Brendan would be in excruciating pain since it is so widespread.  And Brendan is not experiencing any pain right now.  And none of these spots have been noticed on previous scans he has had.  They wouldn't expect it to be this widespread this fast.  

So another idea is that this could have something to do with his adrenal glands and maybe something to do with parathyroid or other hormone issues.  We know that the radiation messed with these processes and continues to affect his sodium and possibly cortisol levels.  But this will be looked at only after the other is ruled out. 

Afterwards I went for a walk.  This is one of my favorite spots.  I'm not sure what to think.  Like every other day of this journey I've realized I just have to take every moment as it comes and not think too much about what lies ahead.  It's impossible to guess what tomorrow holds.  Results from the biopsies probably won't be available for several days.

Brendan was told he might be able to come home if he is doing well in every other aspect.  But biopsies first.