March 18, 2014

Evan went to Moffit Cancer Center yesterday to finalize plans for his upcoming limb salvaging surgery.  Evan had at CT and MRI scan last week here in Fort Myers at the Health Park Hospital and we took those results to the Surgeon in Moffitt.  The ride up and back was not a pleasant one as it was raining (quite hard in some places) and I-75 is a difficult drive in dry weather; in bad its a white knuckle nightmare.

The CT scan of his lungs were clear with no evidence of disease process; a HUGE milestone!  The MRI results of his arm showed there was an encapsulation of the tumor by the growth plate repairing the fracture in his upper arm.  This means there is no soft tissue involvement of the tumor and it is completely contained within the bone.  The surgeon explained that when necrosis (death) of the tumor is occurring, it will sometimes shrink or possibly expand a bit.  Evan's showed expansion so the surgeon is confident that the tumor is being destroyed; to what extent is up to pathology once the tumor is removed.  Evan will have approximately 9.5 CM of bone material removed.

I was able to read the results of the MRI prior to going to Moffitt and it was apparent from the results that the upper growth plate is not affected by the tumor.  The surgeon's plan last time we were in Tampa was to remove the entire head of the humerus and take the bone to about 2.5 CM above the elbow joint.  I had intended to ask the surgeon about the recent MRI findings but he beat me to the question.  He told us that since the growth plate is not involved there is a chance that he will be able to preserve: some of the growth plate; none of the growth plate; some of the ball or none of the ball.  He will not know until he is in surgery and is able to visualize and make a determination with pathology.

When I posted last night on facebook about hope this is what I was referring to.  If the surgeon is able to preserve any portion/combination of the ball/growth plate it means that Evan should have more functionality of his shoulder and arm in both movement and use.  He explained that the more muscle tissue he can leave intact on the ball/cuff assembly, Evan will have more motility.

Evan is scheduled to have surgery on Friday 03/21/2014 at approximately 7:15 AM and should last 3.5 to 6 hours.  The surgery will take place at All Childrens Hospital in St. Petersburg and he will recover on the Oncology/Hematology floor there.  Meghan and Frank will stay with him during this recovery and Sherie will take care of the rest of the Hampels through Monday.  He is scheduled to be in hospital for approximately 5 days, however if the recovery is speedy he could be released as early as Monday. Evan will be outfitted with a sling that will immobilize his arm by way of a chest strap.  I think of it as a one arm straight jacket; as the arm must not be moved much during the healing process.  Evan will have at least 1 screw at the lower site to attached the allograft to the natural bone and if the surgeon is able to salvage some of the ball, he will have another screw there as well to attach the allograft to the ball.

The removed tumor will be analyzed by the pathology team at Moffitt to determine percentage of necrosis and the hope is that more than 90% of the tumor has been destroyed.  The original slides that were taken during the biopsy of the tumor in December were sent from Health Park to Moffitt to assist the pathology team in making that determination.  It should be about two weeks from surgery before we know the results.  If  the tumor is 90% or better the current Chemo treatment will be restarted with, I believe, 3 more rounds.  If it is less then there will be more drugs added to the stew.

I am asking that the prayer teams; positive thinkers, white light believers and anyone else that are out there be informed of what is about to happen to Evan and to collectively send the power of that to Evan and the surgeon for the following reasons:

1. The surgeon has the strength and knowledge to perform the surgery to the best of  his ability.
2. The surgeon is able to preserve some of the growth plate/ball
3. The tumor has been destroyed by at least 90% (hopefully completely)
4. Evan has a quick and as much as possible pain free surgery
5. Recovery is swift.

I will be writing after the surgery to let everyone know about the outcome.

I thank everyone for their support and thoughts/prayers during this stressful time.