Good Morning Team Zachary,

Last night Zachary developed a hernia around the incision from his most-recent surgery. This event precipitated the decision to move ahead on Tuesday night with an additional surgery to repair the area prior to beginning chemotherapy. His surgery went very, very well.

The pathology report from the initial surgery has now been received. The surgery was successful in producing a viable biopsy. Zachary has been diagnosed with an advanced and aggressive non-Hodgkin's T cell rich histiocytic diffuse large B-Cell lymphoma. It is likely that this is a cancer that transformed from the Hodgkin's lymphoma for which he has been treated over the past 8 months.

Now that a diagnosis is in place a plan has likewise been constructed. Zachary will require about a week to recover from the most recent surgery. He will then receive a minimum of 3 cycles of a new chemo regimen (ICE), which is designed to shrink the tumors. If this is successful, he will then go through a stem cell harvesting and replacement (transplantation) procedure that will take about six weeks. Before re-implanting the healthy stem cells, Zachary will undergo a very-high dose chemotherapy. If all of the above is successful, there is about a 50% probability that the cancer will not recur in the next 2 – 5 years.

Julie Vose, M.D. will be managing the treatment phases that occur at the University of Nebraska and she will work closely with Jackie Joyce, M.D. who will manage the Bloomington oncology care while Corinna Repetto, M.D. will continue to serve as Zachary's primary care physician. We are confident that these three will continue to facilitate the best medical care that is humanly possible.

Clearly this is a sobering diagnosis and a fairly radical plan to deal with it. The only thing we can determine to be more risky than this path is not pursuing it.

The arduous marathon Zachary has endured over the past 2 and a half years (Iraq and cancer) now appears to have been just a warm up for the next challenges to come. Through all of this he remains affirmative of his life circumstance, peaceful in his demeanor, grateful in all things and trusting of the outcome, whatever it is. His example is one by which we can all be lifted.

I don't know what else to say……..

Good night

Ann