03/21/2014

This will be a day I never forget!  It started with a wake up buzzer at 2:00 AM and the start of the trip to All Children's at 3:00 AM.  We arrived safely in the dark at 5:15 AM.  We decided to do this as opposed to staying the night in St. Petersburg as all we do is fret and stare at the motel walls.  It turned out to be the best idea as Evan slept all the way to the hospital and was never once bothered or worried like he was last night.

The staff at the hospital were absolutely amazing and completely geared to kids and family.  From check in, admit, preop, operation waiting room, postop and finally the room everyone was caring and concerned not only for Evan but for the family.

One of the nurses that was assigned to the case and was in the operating room with Evan made us a promise that she would come out and give us a brief summary of how the case was proceeding and she did that for 8.5 hours without fail.  She wouldn't tell us much but she did let us know how he was doing under sedation and how the procedure was progressing.  I believe it was the 2:00 PM hour when she came out to tell us the tumor and surrounding bone had been removed.  That was an amazing announcement and quite a relief even though we don't know how much of the tumor was destroyed.

Around 4:00 we met with the surgeon and he let us know what had happened and what the future holds but the future doesn't have a time frame as it depends on how well Evan heals and how well the top portion of the graft holds up.  Here is a synopsis of what occurred:

• The lower portion of bone was removed about 2.5 CM from the elbow joint as planned.
• The upper portion of bone was removed to just above the growth plate leaving a partial ball in place.
• The bone that was removed which included the tumor was cut in half lengthwise to reveal what the tumors appearance was.  There is a picture below.
• The surgeon stated that upon visual inspection by the pathologist it appeared that a great portion of the tumor had been destroyed.  His analysis will determine the percentage.
• There were definite clear margins when the bone was removed.  No muscle tissue needed to be removed as the tumor was contained in the bone.
• Instead of simple screws at either end, two plates were placed along the graft and across the natural bone and secured with three screws.
• There is some concern about the ball end as there is no growth plate and the ball is mostly cartilage.  Time will tell how long this will last.  The hope is to have Evan grow enough to place an expandable prosthetic device in place of the allograft.
• The nerves that needed to be moved in order to facilitate the removal and allograft implanted.  The nerves weren't damaged and time will tell if they will be problematic.
•  The muscles that attach to the ball are intact on the ball and therefore will give him greater range of motion.
• We opted for a shoulder nerve block to give Evan 8-16 hours of pain free time.  This should get him over the initial healing and regular pain meds should do the job.  he is receiving IV Tylenol as well.

Evan is resting comfortably in his room right now and his mom just told me that he is active enough to request dinner and he is actually eating it.

I will report tomorrow on his recovery process!  Thank you all for your prayers, thoughts and concern.


 This is the allograft in a sterile sealed pouch.  a portion of this bone was used.

 This is the piece of bone that was removed from Evan and cut in Half.  The left side is the ball end and the right is the elbow end.  you can see clearly that the tumor is basically blown up from the chemo.  We are hoping that this means a 90% or better destruction of the tumor.