Hello Team Zachary,

I am learning that people want to know:

1. How is everyone doing?
2. What course of action is being taken?

Zachary and Dara are back in Omaha and doing very well. Gosh. Sometimes I am left speechless with how overwhelming the task of healing is for them. Although his prognosis hasn't changed, the treatment is working. The tumors are shrinking. We remain grateful for the care he continues to get from everywhere! Our attorney and his office keeps an eye on his paperwork, his brother brings in his mail, their grass is cut for them, they receive funny text messages with the sole purpose of making them smile, I made sure that they had lots of photo books to fill and puzzles to do and DVD's to watch in Omaha, their plants are watered for them..... They know they are loved and that just has to help.

Zachary had his most recent PET scan in Bloomington under the supervision of his Bloomington oncologist, Dr. Joyce. The test showed that the tumors were shrinking AND there was still some cancer. With that information Dr. Vose, who is managing his total treatment plan, decided to have him do one more round of chemo before they started the stem cell transplant.

Zach started chemo on Tuesday July 31 and will be done Saturday night. After this chemotherapy (ESHAP), they will test his blood and give him a growth factor shot of Neupagen daily. They will be watching for his stem cell production to boost (probably about 10 days after chemo ends). They will remain in Omaha during this six(ish) week process of which half(ish) of this time will be spent healing.

You may be asking, why does he need Stem Cell Transplant and what is it??

Chemotherapy generally affects cells that divide rapidly. They are used to treat cancer because cancer cells divide more often than most healthy cells. However, because bone marrow cells also divide frequently, highdose treatments can severely damage or destroy the patient's bone marrow. Without healthy bone marrow, the patient is no longer able to make the blood cells needed to carry oxygen, fight infection, and prevent bleeding. SCT can replace stem cells that were destroyed by treatment. The healthy, transplanted stem cells can restore the bone marrow's ability to produce the blood cells the patient needs. Zachary will be using his own stem cells.

This is a 'not-not-nice' procedure. Zachary's immune system will be completely wiped out and all of his blood counts will be low. He will be very fatigued and generally not feeling well. They will try to control nausea, etc. with medications. Zachary will be scheduled to return to Omaha 100 days after his transplant (with periodic checks at home with Dr. Joyce in the meantime).

Michael and I think that it was in the month of August a year ago that we learned he had cancer. I know this is a loooooooonnnnnnnnggggggggg process. We appreciate your continued thoughts.

We hold YOU in our hearts,

Love,

Ann