Surgery Goes Well

First things first...Madelyn went into surgery at 9:04 AM and as of 12:10 PM is out of surgery, through recovery, and is comfortable in room 913 at Palmetto Richland Hospital. Sheila, Kaitlyn and I are accompanied here by Ron and Patty Chrestler (Sheila's parents), Betty Lunsford (my Mom), Ron Chrestler (Sheila's brother) and Liz Nield (Ron's girlfriend). Friends of the family April Braswell and Jim Selbee stopped by to offer support (THANKS!).

Now that you know that she is OK, I must tell you about what has happened so far today. For those of you have prayed for Madelyn, please read this post in it's entirety. The effects of your efforts and God's grace (get it, Grace?) can be seen today.

We left a little late for the hospital, but considering we got everything done yesterday as far as pre-registration, we had some time to spare. We arrived at 5:40 AM and went to the designated area on level 3P.

We proceeded as planned and everything went smoothly as we were moved around 6:20 to the pediatric holding area. We remained there waiting for anesthesia to come by and explain their role and the plan for sedation and then for Dr. Adkins and Dr. Reddy to come by and discuss the preliminary plan going in to the OR.

We had a little friction with the anesthesiologist due to some of our questions regarding Madelyn's care during the procedure. I take some responsibility for this. I am a details guy. Its what I do. My questions may sometimes be rhetoric to help me gain a comfort level with someone. The point is, we were looking for some assurance that everything had been covered. During the winding down of this conversation, Dr. Adkins came in to, as he said, "Complicate things a little". Having not heard the results from the bone scan, we braced for the bad news.

Dr. Adkins had taken last evening as an opportunity to review the MRIs again and consult a colleague from Memorial Sloan Kettering Cancer Center named Dr. Michael LaQuaglia. According to Dr. Adkins, he is widely known as one of the premier pediatric oncology surgeons in the country. We learned this morning that the bone scan showed no evidence of bone involvement. This most likely puts Madelyn as a stage 4S. Any bone involvement would have made her a level 4 and a high risk patient.

So, having learned this and taking into account the negligible gain made by attempting to biopsy/resect the tumor in her chest, Dr. Adkins and Dr. Reddy felt it was best to biopsy the liver rather than perform a thoracotomy (open chest). The primary tumor is near the aorta, but no evidence exists to suggest that the tumor is involved with surounding tissues. We would be looking at a lower risk, equal reward biopsy as the liver shows multiple lesions and is considerably more easy to access. This less invasive procedure gives us a calculated improved risk over the thoracotomy. That is the facts.

The truth is that the last minute deviation from the strategy we discussed not 36 hours earlier took us for a loop. We talked it through as we do, verbalizing the pros and cons to both. We accepted Dr. Adkin's recommendation and they got with anesthesia to change the sedation plan accordingly.

Madelyn moved to surgery at 8:45 and her procedure began at exactly 9:04. Plametto Richland uses a paging system similar (exact) to those in most popular restaurants. We knew where she was the whole time.

Funny thing happened next. Surgery was over. It took about 10 seconds for you to read the words above "and her procedure began" and that her surgery was over. It seemed that quick to us as well. This was good news. She was still waiting for Dr. McRedmond (Pediatric Oncology) to perform the marrow biopsy. Dr. Adkins came out to see us, and we met with him with no idea what we were going to here. This man had just seen my daughter's liver. Not on a scan, but up close and personal.

From here to the end of this post, read it very carefully because if you are a person who has lost faith, prepare to get it back.

Dr. Adkins described the tumors on Madelyn's liver as nodules he expected to find similar in size to blueberries, but instead presented more like macadamia nuts. having never had the disposable income to throw $9/lb on NUTS, I asked him to simplify it for me. Well, macadamias are larger. So, as you read, you're thinking that larger is bad. You are thinking wrong.

Cancer cells act, as describer by Dr. Adkins, as juvenile delinquents. As they grow, sometimes they mature. This is what we are looking at. Cells that are maturing into less delinquent cells, ones that are less harmful. To summarize, in Dr. Adkins gross (eyeball) examination, it was better than he expected. Aggresive neuroblastomas do not do this.

We still have to wait for more definitive results to come in on the MYCN gene amplification, hyperdiploidy, cell histology, etc. The current prognosis as stated by Dr. Adkins and Dr. Neuberg is:

Assuming the bone marrow biopsy shows no neuroblast tissue and the histology of the liver biopsy tissue is favorable, we will most likely be in a "wait and see" pattern. The liver tumors are not very vascularly involved (veins and arteries), and appear to be maturing. We will watch the tumors closely using imaging tests (X-Ray and MRI) as well as urine levels of VMA and HVA. What we expect is going on is that the tumors are maturing and may spontaneously cease growth. If this is true, as Madelyn grows, the tumor in her lung may go away on its own. That means no chemotherapy, no resection, no radiation.

Reality check: Madelyn still has active neuroblastomas in her body. It has metastasized from the primary location in her chest cavity to her liver. She is 3 months old.

We will earn more this week as the results of the bone marrow biopsy come in. I expect those to be negative. Regardless, I believe I am in the presence of a miraculous works by my Lord Jesus Christ.

Thank you for your prayers for Madelyn. She continues to recover. We are by no means out of the woods. Madelyn has cancer. I also believe these doctors are telling us honestly what they see, and they see a disease that appears to be yielding to a stronger force.

More updates to come.