Wow, I know it's been a long time since I've given an update on Gabe, but I did not realize it's been THIS long!  My apologies.  A lot has gone on in the last six months, that's for sure.  It's just another reminder (as if we needed another one) of what a cancer diagnosis takes from you-time.  It takes time away from family, work, projects, hobbies, sleep, sporting events, school functions, housework, yard work, your entire to-do list, and the list goes on and on and on and on.  It changes every aspect of life and affects everyone around you.  No one expects this and it comes as a complete shock.  I used to see the Facebook posts about prayer requests for people suffering from cancer or going through treatments.   Honestly, I didn't really think a whole lot about them or the people behind them.  Sure, I would think how awful it was for someone I knew, or a friend of a friend going through it, but it never really hits you until it's you or someone very close to you that you love.  Those posts sure read differently now.  

Another unexpected side effect is just that-side effects.  Side effects from chemo, from surgeries, from the daily mental stress it all causes.  A lot of these things go unseen to those outside our circle, but we live them everyday.  This is why this update has taken so long.  At the end of each long day, if there's enough energy left to do much of anything, these unfortunately have taken a back seat.  But nevertheless, I know Gabe has so many loving friends and family and I know you want to know how he is doing.

Going all the way back to January here, Gabe did in fact get his hernia surgery.  All went well with the surgery and recovery, however, it did not fix what we hoped it would.  Despite sticking to a low-fiber diet, he has wound up in the emergency room several times since in excruciating pain.  At times there's been a partial intestinal blockage, other times nothing they could find.  He is sent home with some pain meds and eats a liquid diet for a day or two, and then feels fine again for awhile. This last time a couple of weeks ago, however, things were a little different.  The pain was different, and one very scary thing-jaundice, was evident in the whites of Gabe's eyes.  Several tests and a CT revealed his liver was not functioning properly and his white blood counts suggested severe inflammation or an infection.  Additionally, an enlarged lymph node was pressing on a bile duct, causing bile to build up in the liver (hence the jaundice).  So, off to another surgery we go...

I guess this one is more of a "procedure" you could say, and the time and recovery in the hospital only a couple of days, so at least it was nice and quick, and relatively less painful than previous surgeries.  What needed to be done was stent placements in Gabe's bile ducts, in which they placed two.  Much like ones placed in heart vales, these keep his ducts open to allow the bile through.  After a night in the hospital and a couple days of rest, Gabe now feels much better.  His pancreas was a little agitated from the procedure and caused him some pain of course, but that has mostly subsided as well.

On April 24th, we headed back to Rochester for Gabe's routine three month scans and blood work.  The timing was actually a good thing as his previous ER visit and scans revealed enlarged lymph nodes, some elevated white blood cell numbers, and some concerning elevated liver enzymes (most of this due to the blocked bile duct).  The week in between the stent procedure and the scans would hopefully give Gabe's body enough time to sort of "calm down" and hopefully get his levels back to normal.  Due to the concern with the enlarged lymph nodes, his scheduled CT was also changed to a PET scan, which would really light up any suspected areas of cancer recurrence if there was any.

Our visit with the oncologist the next day gave us mixed results and feelings.  Blood work revealed a lower bilirubin level than what it was the week prior, thankfully.  This was to be expected since the stents were placed and doing their job, but was also great to see because it means the liver is functioning properly.  Gabe did have a couple other liver enzymes that were still on the high end, but again, that wasn't totally unexpected being only a week out from the procedure.  A couple white blood counts were also still up, but again, that can also be contributed to the slight pancreatitis.   Areas of concern on the PET include a clustered area of portacaval lymph nodes (in the liver near the portal vein) and a margin of the right liver lobe.  We of course read this report before the appointment and really feared the worst going in, but the oncologist was not convinced that this could be the cancer returned.  Again, the lymph nodes could still be inflamed or "reactive" as it's noted from the bile duct constriction Gabe had, and the CT the week prior did not show any evidence of any suspected cancer on the right lobe that the PET possibly shows.   Additionally, Gabe's CEA (his tumor marker) which has been super reliable thus far about jumping up for a recurrence like it did last summer, was actually LOWER than the week before, and even back into the normal range!  Of course he didn't want to put Gabe back on chemo or undergo radiation unless he was absolutely certain that this is a recurrence.  So, right now the plan is to wait about a month and redo blood work and scans to see what they reveal.  The oncologist did discuss treatment options if it turns out that the cancer does return, but we can't be sure about that plan unless we are at that point (fingers crossed, prayers, and positive vibes that we won't have to worry about that).  

So, unfortunately we are in limbo with everything for a bit here.  Unless Gabe has to return to the ER for any new symptoms or pain, a PET/MRI will be done in about a month to reassess.  Doctors tend to switch up the types of imaging used from time to time to get different images as each type of test provides different types of information, and depending on the circumstances, some are more appropriate than others at different times.  For instance, PETs can give false positives due to a chemical imbalances in the body or patients not following through with the fasting requirements that a PET requires.  PETs also do not show microscopic cancer cells very well.  MRIs tend to be more sensitive to cancer in earlier states (including an early stage recurrence).  A combined PET/MRI will be a much better indicator to see anything that has changed, and if so, we will have a very clear picture of specially where and a treatment plan.  

In the meantime, we will continue on with our busy lives, and enjoy everything the spring and soon-to-be-summer has in store for us.  We are just getting into the busy baseball and soccer seasons, and this year Peyton is starting as well, so it will be a very fun but busy time for us!  We have some fun camping trips lined up for this summer, have Parker signed up for summer school and basketball, soccer, and football camps, and are planning a family vacation for next spring or summer.  It's hard to believe that it'll be three years since Gabe's diagnosis this coming July.  Some days are hard to get through thinking about that and everything we've been through and continue to go through, but we are also grateful at the same time that we've gotten a chance to really reevaluate what's important in life and make time for those things, let the small stuff slide, and try not to get stressed out about the things in life we can't control.  Easier said than done sometimes, but if we fail to remember that one day, we strive to even more so the next.

Well happy Spring to all of you, and I promise to have a quick update after the next set of scans.  If you are inclined, please pray for Gabe that all will be well and that his doctors continue to use their vast knowledge to help him continue to be healthy and on the healing path.  Thank you all for your continued support, well wishes, and prayers.