May 30, 2007

Team Zachary, 

After spending months researching, watching, discussing and talking about cancer I have come to the conclusion that it is a 1/3 science, 1/3 art and 1/3 right above throwing leaches on someone.

With Zachary's original diagnosis of cancer and subsequent treatment nothing has ever been routine or normal.  This theme continues. 

The clinical update is as follows.  After Zachary's last surgery to repair a herniated portion of the previous surgery, the medical team had hoped to allow the incisions to heal before starting chemo.  However, the most pronounced tumor was applying too much pressure to the wound and it could not heal until the tumor shrunk which would only potentially happen after chemo.  Catch 22.  So, chemo began over the weekend and continued through Wednesday.  His non-Hodgkin's Lymphoma is being treated with a regimen known as ICE.  The E and the C portions are actually administered first and these went according to plan.  The I (which stands for ifosfamide or ifex for short) proved to be more challenging.  Somewhere during the administration of the drug Zachary began to move into a semi-comatose state.  This drug apparently overloaded his kidneys and as he became increasingly unresponsive the decision was made to discontinue the application after about 80% of it had been administered.  Zachary remained semi-comatose and mostly unresponsive for most of the next 24 hours.  Other drugs were administered to reverse these side effects of the chemo.  Over the past 24 hours he has begun to regain his normal faculties and is now eating, drinking and walking with assistance.  His ability to verbally interact is also coming back and will hopefully be fully returned within the next 48 hours.  The reaction he has experienced to the ifosfamide is a possible side effect in about 15% of the patients who receive this treatment.  Needless to say, these are some very powerful drugs.

Even with the challenging side effects, the initial lab assessments are that the chemo has had a beneficial impact.  Zachary's LDH is coming down to an acceptable range and this shows that the cells are dividing normally and the lymphoma is responding to the treatment.  

The plan from here is that within the next few days Zachary will be released from the hospital into a minimal care facility for a few days of monitoring while still in Omaha.  Hopefully, he and Dara can return to Bloomington sometime next week.  Because of his reaction to the first chemo, the second round will also be at the University of Nebraska Medical Center and will begin on June 19th. 

Dara remains a steadfast and highly competent primary caregiver throughout some very trying challenges over the past 3 weeks of hospitalization.  Through this time she has seldom left his side for more than a few minutes.  24/7 she has been and is there to provide Zachary love, encouragement, nurture, companionship and a voice to the outside world.   She remains an inspiration. 

If you have been following these e-mail updates, you will quickly understand that one of the most insidious and potentially cruel creations of the human heart and mind is the reality we call hope.  At best it is a roller coaster of human emotions and at worst a torturing seductress that beckons us to believe the unbelievable.  Nonetheless, we hope. 

After being mostly vegetative for 24 hours and scaring the wits out of all of his family, as the countering drugs began to kick in and Zachary started to regain his functions, Dara started playing some of Zachary's John Anderson country music off of her computer to see how he would react.  His head started bobbing, soon the bed started gently rocking and Zachary began to sing all of the words almost perfectly.  Smiles and laughter filled the room.  The hard wiring was still there and hope does indeed spring eternal.

We remain more positive than ever about the University of Nebraska Medical Center and the extraordinary care that Zachary is receiving here.

We are hoping that Zachary will be home in the middle of next week. 

My next e-mail will address the question I hear most people ask which is:  how are you doing??

Keep the love coming.  We can use all you can send.

Signing off,

Ann & Michael