Brody's CT scan today showed he has a large bowel obstruction, the tumor has gotten significantly larger and is also now in lymph nodes

Brody had a very long and painful day on Tuesday which fortunately improved dramatically Tuesday night.   His pain was finally much more controlled.  He even had some moments of zero pain.   I was starting to get optimistic he was making a recovery.      He was still having good bowel sounds,  he was swallowing capsules with small amounts of water and keeping it down,  and passing some gas.   These were all good signs. 

Unfortunately Wednesday morning it was obvious he wasn't really getting better when looking at his belly.   The distention was obviously worse.   He was still needing his morphine often. He was finally feeling better due to all the medications but he certainly wasn't well or in reality getting better.   A CT scan was ordered.   

Unfortunately,  the CT scan results are beyond devastating.   It showed he has a near complete bowel obstruction caused by his tumor.   Also the tumor is significantly larger and now in his lymph nodes.   Previous scans did not show lymph node involvement.  

Normally a large bowel obstruction requires emergent surgery to correct the situation to avoid bowel perforation.   The pediatric surgery team in Toledo was ready and willing to perform surgery to place a colostomy.  They were not willing to consider surgery to debulk the tumor which is actually causing the problem.  Maybe a colostomy would not be necessary if at least part of the tumor could be removed.   Also,  the tumor is very close to infringing upon many blood vessels supplying Brody's one and only right kidney and it's putting pressure on his kidney and ureter.   If the tumor cannot be removed away from the kidney,  we could soon lose Brody to kidney failure.  The tumor is putting great pressure on many,  many areas and slowly just crushing everything.  We don't have a magical chemo or treatment option that will reverse/shrink the tumor nor prevent it from getting larger.   If surgery cannot be done to remove the tumor or at least debulk as much as possible,  then we are down to extremely limited time left with Brody.  

We opted not to proceed yet with the colostomy procedure in Toledo and instead transfered to Nationwide Children's in Columbus via ambulance today.   The surgery team at Nationwide Children's have reviewed Brody's case before and previously felt that surgery to remove the tumor was not impossible.   It's doable but extremely risky with odds of about 50:50 for Brody to even survive the surgery.   This risk was obviously why we previously decided not to proceed with surgery and opted to enter the HSV trial instead.   Also,  the surgeons were not willing to actually perform the surgery at that time but stated that they would consider performing the surgery as a very last resort.  If we were left with no other reasonable options then surgery may be possible.   I think we have now arrived at this point. 

I don't know if surgery is still even doable anymore.  The tumor has gotten larger,   his bowel is distended,  he is very weak from all he has been through these past few days.   These all complicate surgery to remove the tumor even more.  

We are now at Nationwide Children's.   Brody had an NG tube placed to help prevent further distention.   He is not allowed anything by mouth.    His medications are keeping him comfortable here right now.  

We will be meeting with both the oncology team and surgery team at Nationwide Children's tomorrow to discuss the options and decide finally the next steps.   He  will soon be having surgery of some sort but I do not know exactly what type yet.   It could be surgery to place a colostomy,  followed  by later surgery to remove tumor,  followed by later surgery to reverse colostomy.   Or simply place colostomy.   Or debulk tumor.   Or some other option.   We will have to wait and see tomorrow.   For now,  Brody is comfortably sleeping and his belly distention is remaining stable.