What now

What is the next step for Ruby's treatment?  I don't know.

I went in with Ruby, just to talk, to Dr Holly last week.  They took her vitals as usual, but I assured Ruby this would be just a talking visit.

We have a couple options. None of which are cures, all of which are guesses as to if they may stabilize the tumors in her lungs, and unsure of the side effects.

I don't know yet if will try one, some, or none. I plan to try one of them.
I don't know how Ruby will feel on them, that may indicate how long or short she can try them.

-Everolimus-oral drug, not typically used in melanoma, but a genetic mutation she has indicates it may work. (denied twice by insurance, may be able to get directly from the drug company)
-Pembrolizumab-like the Nivolumab she tried, not likely to work since Nivo didn't, but possible
-Ipilimumab-not proven, maybe bad side effects, but possible

For the most part her doctor has been able to tell us what to do. Now its up to us to decide.  I've spent the last few days asking opinions to a few people who have more expertise than I.
We definitely want to do another CT of her lungs to see how the disease is looking, trying to schedule that for next week. I'd like to meet with the Rainbow Kids team that does palliative and hospice care when, or in case, we get to that point in the future.

We are not and will never give up on trying to get her well. 

We will always do what we think is best for her.