I spent an hour with Nate before I nearly fell out of my chair, and was kindly escorted to a couch in some distant waiting room where I woke up four hours later.
Forgive me for such a late update. My brain feels pretty mushy, and I haven't had many coherent thoughts over the past two days. Thank you for letting me know that you're all still waiting and watching for news. Once again, Nate and I are overwhelmed with all the support we feel. Hopefully, I'll be able to write something here that makes sense!
At 10:45 pm, after 16 hours waiting in the same spot in the OR waiting room, we were thrilled to see Dr. Lambert walk into the room. This is always an anxious time as I try to assess the situation/news by watching the body language of the messenger. We've learned a lot by watching Nate's doctors over the years, and find that they usually give a lot away through their body language. As I watched Dr. Lambert, I could clearly see that she had a lightness to her step. Amazing in and of itself since she'd been on her feet since at least 8:15 when we first saw her! I'll admit that I allowed a spark, maybe even a flame, of hope well up in my chest. She sat down on the couch and flashed a smile that I won't soon forget.
She reported that they had just started the HIPEC perfusion, and since the treatment takes 90 minutes, she was taking a break to update us and to grab herself a drink. She said she was very happy with the surgical team and she felt like they all made really good decisions and took their time. She felt that Nate had the best possible outcome from the procedure. Music to my ears!
She explained that both of the other surgeons had a tough job to do because of the location of the larger tumors. They were very tricky to get to, which lengthened the procedure time. Dr. Movahedi (liver) had a challenge "taking the liver down" from the abdominal wall as it was "stuck" from all of the adhesions and scar tissue from prior procedures. It took extra time to carve the tissue away so they could get the liver free enough to remove the tumors. Dr. Lambert said Dr. Movahedi did a "great job" and was very careful as he proceeded.
Dr. Maykel spent a lot of extra time trying to preserve any and all tissue possible in the lower pelvis. The tumor was rather large, and sat next to some major mechanics and blood supply. They spent a lot of time trying to carefully dissect what they could to free up the vital tissue around the tumor, and also trying to prevent nerve damage to the major nerve centers in the pelvis. They spent an extra long time around the colon trying to free it up from the tumor, but ultimately decided to remove more colon because the blood supply was so compromised. Both Dr. Maykel and Dr. Lambert agreed that it was "the right decision to take it out", as the ultimate goal was to remove the tumor. Dr. Maykel said that Nate still has a very good amount of small intestine and colon left. I'm sure he sees some pretty crazy stuff in his line of work! I guess it's all about perspective!
After both surgeons were done, Dr. Lambert stayed behind to finish up. She examined every inch of colon and small intestine, freed them up from adhesions and scar tissue, and removed other smaller tumor nodules all around the abdomen. She noted that these tumors peeled off the tissue verily easily. When she was satisfied that all the tumors were out, she looked at the latest CT scan again, and noticed an area below the liver that she wanted to look at and work on a little more. She did find tumor there, and was able to remove it. At this point, she felt confident that they'd been able to remove all visible tumor. Miracle! By this time it was about 8:30 pm, and we were hopeful that she'd be done soon. They say that patience is a virtue...we didn't see her until 10:45!
It was great to listen to Dr. Lambert describe the operation. As with any surgery, especially abdominal surgery, scar tissue and adhesion are a major concern when there have been prior procedures. Although she didn't come out and say it, she was very worried about the possibility that when she opened him up that there would be too much disease and/or scar tissue and adhesion that may have prevented her from accomplishing anything. She said this was a major concern for her coming in to the day, but that she was "very encouraged and impressed by Nate's amazing attitude about everything in pre-op". She said his demeanor and ability to joke around and be so cheerful helped her feel better about the day.
There were more than a few remarkable things about the day, here are the highlights:
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| Nate got to talk to the kids on Thursday! |
*She mentioned twice that Nate's small intestine looked "really good", and much healthier than the last time she saw him.
*There was also a positive difference in the tumor in the lower pelvis. During the last HIPEC in June 2012, there was also a large tumor in Nate's lower pelvis. They had to leave a "postage stamp size" piece of the tumor behind which they hoped the HIPEC would take care of. In subsequent surgeries, there was no sign of it. After we saw tumor growing in the same area, we assumed that it was the same tumor. However, this tumor was a bit lower, or deeper, in the pelvis and it looked like more of a low grade tumor than the other one. She suspects, and will be interested to see what the pathology says. This would be good news because low grade tumor cells have a better prognosis than mid to high grade cells. She said the liver tumor looked similar as well.
Because the tumors, and tumor nodules looked more low grade, it makes us think that Nate has responded really well to all of the chemo he's endured. It seems that the treatments have kept the mid/high grade cells at bay. It's nice to know that some big benefits may have come from all of the chemotherapy and suffering Nate's been through. Since the low grade cells don't respond well to iv chemo, these low grade tumors grew.
*During the last 14 hour surgery Nate was given 23 liters of fluid to keep him stable. This time he only required 8 liters so he isn't nearly as puffy! This also gives the kidneys a bit of a break. He did really well and was very stable throughout the entire procedure. Isn't it amazing how "otherwise really healthy he is"? (Still one of my favorite lines!)
*Dr. Lambert was so pleased with the outcome. She said that she's more encouraged than after the last HIPEC, and is very happy. She was glad we chose to do the surgery now, rather than waiting. She said he had far less disease than before, but it was much harder to get to this time. Hence the almost 18 hour procedure.
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| Nate is settled in the ICU and we are so proud of him! He looks amazing! |
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| So grateful that Nancy and my sister, Genn could be here with us. |
I'm so grateful for all of the blessings Nate and our family received on Wednesday. Both Nate and I have had a very peaceful feeling about the surgery and decision to have it now. I think that feeling came less from feeling like it would go our way, and more from the knowledge that we are all in God's hands, he has a plan for us, and he will always take care of us. We're very humbled by this knowledge, and by the miracles we've witnessed.
Thank you for the prayers, thoughts, good vibes, faith, friendship, acknowledgement and love you've sent our way. Nate is undoubtedly one tough cookie, but we have no doubt that these efforts result in continued blessings and strength for Nate and his family. Love to all!
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