1/11/13 Just talked to Dr. McGonigle

6:05 PM
Just got done talking with Dr. M.  Cancer was present in both ovaries and had spread throughout the abdominal cavity to many small sites, as far away as the underside of the diaphragm (the separation between the thoracic (lung) and abdominal cavities.  She said that it didn't penetrate the diaphragm, that it was just on the surface of it.  Took out numerous small pieces of cancer in the omentum (abdominal fat area), diaphragm.  Total surgery time: 5 hours, 29 minutes.

Dr. M. said that the results were "optimal" as far as surgery for ovarian cancer goes, which sounds pretty good to me.  Often, the longer the surgery, the better because that means the doctor feels that there are sites to work on whereas if things are really grim, they sometimes take a look and close up.  So we like the long surgery time!

I had previously thought that she would be getting chemo during the operation, but I was mistaken.  The plan is to get that soon, but not right away.  She has been given an access port in the right lower abdomen.  Anticipate that she will be able to get the treatments in Dr. M's office which is nearby.

So, that's it in a nutshell.  Gabrielle is in recovery right now (not the AA kind, the post surgery kind).  Anticipate she will be there for about an hour then move upstairs.  Very nice, Harvard trained anesthesiologist worked with her and has given her an epidural for pain control along with an IV for additional pain control (PCA--"patient controlled analgesia" which isn't patient controlled at this point but a regular drip).  He also set her up with some great anti-nausea measures including a nifty gizmo on her wrist that is a small electrical unit to diminish the nausea.  Dr. M. indicated that many of her patients are on marijuana tea or cookies (or other forms).  I doubt that we'll see Gabrielle frequenting the "Green Medical" clinics on Aurora any time soon, but who knows?

When asked about hospital time, Dr. M. said that since the bowel surgery was not necessary, she may be able to leave sooner than anticipated one week from now.  Said she may be able to leave Monday, but I will be surprised if it is that soon, given the extent of her surgery and all.

Haven't talked to Wonder Woman yet, but am very eager to do so.  Daniel is planning on spending the night with her tonight (go, Daniel, you rock!!!).

As an aside, Dr. M. was working with a fellow, Dr. Sato.  In this context, fellow means someone getting additional training, not the "hale, fellow well met sort of fellow".  On her lapel, she was sporting  the niftiest lapel pin: a smiling uterus and ovaries, all nice and pink.  We liked it so much that we got online and ordered 20 (and probably many more too!).  If you are interested, the little uterus can be seen on the "I love guts" website.  I don't know exactly as the kids did it.  I like the little fella because it looks like a cheerful little cyclone wearing boxing gloves (which is a better view of ovaries than the Dodge Ram logo which also looks like a uterus and ovaries).

Oh, quick update: the anesthesiologist just came out and said that he gave her a new epidural higher up.    This is supposed to control the higher pain.  The first epidural wasn't getting the most "rostral" end of the incision as far as pain control.  Rostral: toward the rostrum (nose, I think, not the platform that speakers talk from).  Caudal is the other end (a little diversion there).

Well, that's it for right now.  All in all, very relieved.  We are all spent emotionally.  Physically, that's a different story. We have been sitting on our caudal ends most of the day.

Here's to a smooth evening.

Steve

1/11/13 Surgery just finished

5:07 PM
Just got a call from an OR nurse.  Just finished surgery.  Was in there for over 5 hours.  Nurse said surgery went well and that Dr. M will be out in 20-30 minutes to debrief us.
Stay tuned!

Steve

1/11/13 "Get soon better, Gaby!"

Friends as young as age 2 are wishing Gabrielle well!  We are so grateful for the support.  This blog already has over a thousand hits from all over the country as well as Canada, the U.K., Germany, France, and Korea!  Gabrielle is feeling incredibly loved, as are we.

Thank you all for helping us stay hopeful and brave.  Her surgery should be over in an hour or so, and we can't wait to see her!

~Renee

"Be at peace once more, O my soul, for the Lord has been good to you." Psalm 116:7

1/11/13 in surgery

Steve here.  1:54 PM

Has been in surgery since 11:38 AM.  That's the time on the fancy electronic progress board.  She is actually Patient 4131 or something like that on the display.  It is confusing as there is a surgeon working  in the OR with last name of Dudley, so first glance makes it look as Gabrielle is all over the place.  But she is in just one OR.

Had phone call from one of the techs about 10 minutes ago.  They have proceeded to the open surgery, so up till now, has been getting laparoscopic evaluation, surgery.  In my mind, this is good news, getting the open surgery and all because it means they are going to be aggressive today and get all the concerning areas out and that she won't have to come back in a week or two for a second procedure.  Have not heard any word on intraoperative findings.  Am assuming the rapid pathology report showed cancer of the ovary, but pure conjecture.

Clarification of a prior entry.  Someone called to ask about no cancer elsewhere.  I meant to say that all the other studies were reassuring and that there was no evidence of metastasis: bones, brain, lungs, etc.  However, that doesn't mean that she is free of ovarian cancer.  That's what they are going after right now.  Well, more later.  

1/11/13 Pre surgery update

Steve here.  10:45 AM
Dr. McGonigle (hereafter referred to as Dr. M) just came in.  She said that she has reviewed biopsy reports and various imaging studies with the radiologists, pathologists and says no evidence of cancer anywhere so far.  There was some inflammation on the bowel and a small concern that the ileum has some inflammatory changes that would preclude surgery.  However, she has also consulted with a colorectal surgeon (who is winding down a case in the OR right now).  Has asked him to pop in and look at the bowel while Gabrielle is in surgery just to have his perspective, in case it is Crohn's.

So the plan for now is to proceed with surgery and get the colorectal surgeon to provide some assistance with the bowel part and then GO FOR IT!

Gabrielle is in very good spirits.  Is cheerful and taking one last gander around her "hotel" room at the wonderful flowers, cards, balloon, etc before she is wheeled off to the OR.  Has had a burst of steroids to help with the inflammation and may get an epidural for post op pain.

Gotta go!  her chariot awaits!
STeve

1/11/13 HIPPA violation!

Steve here with an update. 
Here's the "cut to the chase, spare me all the medical details" version:
Had colonoscopy and spine MRI yesterday which were promising for no spread.  Today she is set to have surgery, most likely late morning which could last three or more hours.  Plan is to take uterus, tubes, ovarias, some of the abdominal fat (omentum) and possibly a portion of small intestine, then off to recovery.  That's pretty much it.

Here is a tad longer version (HIPPA?  Dunno what that is):

The procedures yesterday, as noted above were for the following reasons: spine MRI due to some pretty severe neck pain.  Doctors wanted to make sure there was no metastatic involvement anywhere in the spine.  Were fairly sure going in there wasn't as it is very rare for ovarian cancer to spread to the spine, especially the cervical spine.

Colonoscopy was because on the CT scan, the terminal ileum was quite inflamed and the lumen (opening in the middle) was almost entirely blocked.  No way to tell what was the cause, so Dr. Tobin had to go in and have a look to see if she was dealing with something like inflammatory bowel disease as a separate entity or if there was cancer which was doing the blocking.  Fortunately all he saw was some mild inflammation and no lesions that were suspicious for cancer, though he did indeed take many biopsies (results pending).

We had a long meeting twice with her surgeon, Dr. Kathryn McGonigle who is a gynecologic surgeon with a specialty in oncology.  She is quite well trained, which is like saying that Michael Phelps knows a little about swimming.  In short, our impression so far is that she is the best.  Spent a lot of time with us, wasn't rushed and yet very focused on what she (and Gabrielle) needs to do during the planned surgery and beyond.  She said that she cannot even say that she has ovarian cancer for sure till she gets a piece of tissue and sends it off to the lab, but that everything is suspicious for it, and if it is indeed ovarian cancer, it is most likely Stage 3.  This is because it has already spread beyond the ovaries (some suspicion of involvement in the aforementioned omentum (abdominal fat).  If that is the case, she will be looking at chemotherapy which could start during the operation with instillation of the agent into the peritoneal (abdominal) cavity.  She would take the organs I mentioned above, but would most likely start with a laparoscopic approach first to see what she was dealing with then proceed to an open ("unzip") incision from just above the belly button to points south.  This is to allow her to be very thorough in exploring the entire abdominal organs for any hint of anything that doesn't look right. 

Surgery is following one case that is about two to three hours long.  Dr. McGonigle thinks that she will start with Gabrielle lat morning or early afternoon.  She couldn't give us an estimate on time other than to say that it "may be long".  Fine by me, take all the time you need, Doc!

Although talk of chemotherapy is a little premature as we don't know: a) if she does have ovarian cancer and b) what it is if it is cancer, but here is what we were told yesterday:  she is most likely looking at chemotherapy for about 18 weeks.  I was told at least three times the cycle length and such but for the life of me cannot recall.  Dr. McGonigle said that chemotherapy is a completely separate discussion for later after she is through with surgery, which I think is wise as focusing on one thing at a time is best (like the upcoming surgery).

Yesterday, we had a pretty restful day once the above procedures were over.  By early evening, Gabrielle was pretty sick of looking at me so she sent me home (strongly hinting that I needed a shower and a better night's sleep than I had gotten the night before on the roll away cot in her room).  Daniel came home with me and we both hit the sack about 9:00.  We'll be heading back to Northwest soon (and I will indeed have showered by then).

I can't end this without saying how overwhelmed we are by the kindness of everyone who has rallied so quickly to be of support to us.  It has been so humbling to see so many kind and caring faces, and to receive gifts of flowers, food, cards and such.  It is very clear that Gabrielle has a wide circle of people who love her and that makes me delighted.  In the midst of the shock of this news, especially its suddeness, my one dominant emotion is that of thankfulness.  I am so thankful for all of you, for the great care she is receiving at Northwest Hospital (nurses, CNA's, LPN's, doctors, etc...all first rate), and for my fantastic children.  It is a delight to see Daniel and Renee ministering to Gabrielle as much as they have (Renee got the cot last night).  They are AMAZING children and I am so proud of them that I am bursting at the seams (or perhaps that's the mint brownies I just polished off for breakfast...one of the food gifts). 

Till next time...Steve signing off (or whatever it is bloggers do).

1/10/13 It Begins...

Gabrielle Dudley is a wonderful wife, mother, sister, daughter, and friend to all. She is a strong Christian who loves the Lord with all her heart. Her family, friends/coworkers, and church community are extremely important to her. Gabrielle loves gourmet food, exercising, spending time with friends, watching TV/movies with her family, reading great books, and taking family trips to Cannon Beach and Hawaii. Although she has been battling lupus for 9 years, she remains optimistic, confident, and good-humored. Everyone of us can learn from Gabrielle's humility, generosity, compassion, selflessness, and courage. 

After going to the ER on the night of January 8th for severe abdominal pain she had a CT scan which showed inflammation of her ileum (the terminal part of the small intestine), and two masses on her ovaries. She was immediately admitted to the surgery/oncology floor of Northwest Hospital where she has been meeting with a team of highly trained and compassionate doctors, nurses, etc. who are doing everything they can to treat her. On January 9th she had an MRI and a colonoscopy. The results of the colonoscopy showed that the small intestine did not have cancer, which is very good news. In fact, it is a good thing the small intestine caused such severe pain that she went to the hospital (where she hasn't been since she had Renee and me in 1988 and 1990 respectively), because she was able to get the CT scan she may have otherwise not gotten for some time. She is scheduled for surgery with a highly trained oncology surgical team on Friday January 10th. The surgeons believe they will be able to remove all of the cancer, and after she heals from that surgery for about 4 weeks she will begin chemotherapy. 

Gabrielle and her family would appreciate your prayers and notes of encouragement. This is a big battle for her to face, but the prayers and support from friends and family will be very beneficial to her fight against this awful cancer.

If you would like to visit Gabrielle, please contact Steve, Renee, or myself to find out when would be a good time. It is also great for us to read her notes and kind words that people have been sending. Please leave any comments, prayers, or well wishes below. If you prefer to email, you can send an email to Steve, Renee, and Daniel and we will relay them to Gabrielle: