Dear Team Zachary,

Please disregard most of the details I shared with you in the previous e-mail regarding what we thought was going to happen with Zachary's surgery. Things are moving fast here at the University of Nebraska Medical Center. But to recap, on Tuesday Zachary flew by air ambulance jet from Bloomington to Omaha, Nebraska. The team here at the UNMC is really incredible. There is an extraordinary culture of excellence throughout the organization and we feel strongly that Zachary is getting the best care humanly possible.

The team was successful in getting Zachary's platelet and white blood cell count high enough so that he could undergo a fairly major open surgery yesterday (Thursday). Unlike previously reported, this was not a minimally invasive laparoscopic surgery but they opened him up substantially. They also did place another stent in him to support his kidney function. The lead surgeon was David Young, M.D. The major issue in this type of tumor surgery is excessive bleeding which they worked hard throughout to control. While the time in surgery was over 3 hours, most of that was waiting on the pathologists to analyze the frozen slice tissues to determine if they had good material for a biopsy. As with the previous biopsy, the initial material was mostly necrotic (dead material) which is what threw off the earlier efforts. So, the surgeons went deeper into the tumor and did discover what they hope is the 'smoking gun.' The pathologists confirmed that this is an "appropriate diagnostic specimen" and they are hopeful of having it diagnosed by Monday or Tuesday. This will be the key to determining a treatment plan.

Zachary, while weak, feverish and not feeling so great, is doing well and is precisely where he needs to be in the recovery process. To this point he has not developed internal bleeding from the surgery which was the major concern.

Next week we are hopeful of sharing with you a more definitive picture regarding next steps. As to what you can do for our family---be patient. We really are getting information out as soon as it is comfortable for us.

Thank you for being on the team. I believe in the power of love and support. Zachary is being nourished in yours and we are eternally grateful.

Love to you and yours,

Ann