Early this morning, the rounding melanoma team came in. They gave us a run down of the day. Steve's platelets had dropped again. They were in the low 30s. The platelet count needed to be 50 or above for the scheduled spinal tap (lumbar puncture - AKA - LP). So, platelets were ordered for a platelet transfusion. While we waited for the liquid gold to get here, Steve was seen by a slew of white coats.
The melanoma team let us know that Steve had a few spots that lit up in the PET scan. His spleen and a few lymph nodes. His spleen was very enlardged. They reviewed the scans multiple times and they do not feel that the way the scans lit up that it is a spread in the melanoma. Take the spleen for example, if you had a PET scan that indicated a tumor, it would typically show a normal sized spleen with a small (where the tumor was) spot lit up. Steve's entire spleen was lighting up. That is just not typical of cancer (usually). So, they are pretty confident that whatever is going on is some sort of viral or bacterial infection (they are leaning towards viral) and the inflammation is causing the light up. Since they do not think it is cancer related, they have cancelled the biopsy of the spine and the spleen for now.
The infectious disease team also came by. Steve was running 103 fever this morning, so they decided to go ahead and start him on an antibiotic. They had been holding out on the antibiotic because they wanted to have biopsies that were not influenced by the antibiotic. But, since his platelets and white blood cell counts are low, he is running high fevers, and his liver enzymes are still high, they figured they would go ahead and start the antibiotic now. The started him on Cefepime.
Around 12:30 Steve had a spinal tap. They will check this fluid for infection, and or cancer cells. They will also use this fluid to try and culture and see if they can pin point an infection.
The dermatology team came by and looked Steve's skin. They did not find anything suspicious looking, but prescribed some new lotions for his rash that popped up over the last couple of days. They think the rash could be cause by his high fever. It looks a lot like the Zelboraf rash, but he has been off the Zelboraf over 2 weeks now.
Steve also had a ultrasound of his 'splenic vein'. The ultrasound tech said other than being enlarged, the spleen looked good and the blood flow from the spleen to the liver looked great.
Steve was bombarded with blood tests today. They do nightly blood testing @ 4:00 am. They took 8 vials of blood and a culture bottle (we call it the hot sauce bottle) of blood. This morning they realized that whoever ran the labs failed to do the liver enzymes, so another poke he got! They also did more labs and another culture late this afternoon as well as a nasal flush which they will also be testing.
The good news is, they "think" whatever is going on is unrelated to the cancer. The bad news is, we still have no answers. The melanoma doctor said he believes the enlarged spleen, low platelet count, low white blood cell count, etc are completely unrelated to his extreme back pain. He believes the back pain is just an issue he needs to discuss with the orthopedic doctor (who should be by tomorrow). A rheumatologist will also be by tomorrow to rule out any auto immune related issues. A lot of unknowns, but they are working their tails off trying to figure it out.
We got to Skype with our kiddos tonight. That was nice! Miss my babies <3