Vivi Lost her Pipes

 Vivi Making an Oxygen Mask Look Glam

(Note: TWO DAYS AFTER SURGERY!)

 Rocking Scrubs in the ICU

 Dad Making Scrubs Look Even Better

 Aaron and Kelly Enjoying a Surprise Canine Visitor! 

Hi Everyone,

I apologize for the delay in my post-operative update. Things have been changing by the day, so I wanted to be sure I was giving full information before I sent out a proper update on my mother's status. At the very least, I am happy I was able to let you all know that she made it out of surgery alright.

Now I am happy to report that Vivi is recovery beautifully from, what turned out to be, a rather extensive surgery. As I told you before the surgery, we knew that Vivi had multiple intestinal blockages that were likely caused by growing tumors, however, we were also aware that we wouldn't really know the full scope of the situation until the surgeons opened her up. 

As mentioned above, the surgery turned out to be quite a bit more extensive than anyone had expected. This was due to the presence of excess scar tissue - both from her previous surgery and  extensive chemotherapy - as well as the fact that Vivi's cancer has, in fact, spread quite a bit around her entire abdominal area. These were the two culprits causing the blockages in Vivi's intestinal track. Due to the placement and nature of Vivi's blockages, the surgeons had to remove a significant amount of Vivi's colon and small bowel. While this may sound daunting there are two really positive take-aways from this:

1. They were able to perform the surgery in the first place. Many people in this condition are deemed inoperable - an outcome which would have not been very hopeful. However, we are lucky to have one of the best surgeons in the country, and Vivi's operation, although long and extensive, was a success!

2. The entire point of the surgery was to clear Vivi's intestinal blockages so that she could start eating again. When that much bowel is removed, there is always a risk that the patient will not have enough intestinal track left to actually absorb food. However (MORE GOOD NEWS), Vivi has plenty of plumbing left over and is already back on soft solids and holding them down well! Vivi will now need to be on a highly modified diet, but we are increasing her food intake by the day...and so far, so good!!

Unfortunately, due to the nature of my mother's cancer and the way in which it has spread, most of the metastasis was inoperable and will need to be addressed with further treatment. However, for right now, we are focusing on the tasks at hand - helping Vivi continue her nothing-short-of-miraculous recovery from the surgery, and making sure she continues to eat! From there, we will discuss what the next steps are in terms of her continuing treatment.

This has certainly been a long road - as we are heading into our third week here at the hospital - and have, what seems to be, quite a long road ahead. However, more immediately, if Vivi continues her speedy recovery - it looks likely that she will be able to go home on Friday!

Until then, we are finally back up on the cushy 19th floor in room 1928 - after spending a good portion of the last week in the ICU, followed by the SACU (Surgical Acute Care Unit). So I apologize I was not able to offer a room number until now, but they kept moving us around!

There are, per usual, many entertaining stories to tell from the last week or so, but I will need to leave that for another time. For now, I know that everyone was anxious to know how Vivi has been doing and wanted to make sure I offered an update. I promise to provide more color once we are a bit more settled.

Additionally, per usual, the outpouring of love, thoughts, wishes, and prayers has been nothing short of overwhelming. Even during our most trying of moments during this process, my mother and our entire family remain nothing but grateful for all of you and your incredible support. We are so incredibly lucky to be surrounded by such truly amazing friends and family.

As always, please feel free to reach out to me with further questions or concerns.

I'll be in touch soon (and do promise to include some more entertainment in my next post)!

All my love and gratitude and Happy October!

Aly

The 19th Floor

Hi Everyone,

I know I am long overdue with an update, but I wanted to let everyone know that Vivi will be receiving surgery tomorrow to correct two bowel obstructions that have developed. There are many outstanding questions that will only be answered once the surgeons are able to take a look inside and truly assess the situation. However, I will share with you as much as we know currently:

As many of you already know, Vivi relapsed for the third time this last May and began a new chemotherapy called Doxil. While Vivi was able to enjoy much of her summer - swimming in her pool, riding her horse, spending two weeks in the Hamptons, and even exercising (gulp) - she struggled with, what we believed, were the side effects of the chemotherapy throughout the entire summer.

However, Vivi was not showing signs of the normally reported side effects from Doxil - which, in most cases, causes skin toxicity. While Vivi did have to stay out of the sun for the most part this summer (well, more than usual), her skin was not her main concern. It was her stomach that was giving her the most trouble. My mother, who generally has a ferocious appetite, and more importantly, has been on a specialized diet since she was originally diagnosed - which she has not only thoroughly enjoyed, but we believe has likely been one of her best medications - started to lose her desire to eat, when she did want to eat, it was generally "easy" comfort food such as white bread, began to complain of stomach discomfort, and felt generally weaker as the summer progressed.

By August, Vivi was feeling so depleted that she was needing to delay chemotherapy treatments, and was finding even the simplest of tasks to be a challenge. Additionally, her stomach discomfort continued. However, after two CT scans and several CA-125 blood tests (for new comers, CA-125 is the marker in the blood that measures the growth of ovarian cancer cells), the cancer appeared to be reducing.

Fast forward to a week ago - Tuesday, September 18th - Vivi's birthday...

Vivi had received yet another positive CT scan the Friday before, but had to delay treatment again, as she was feeling sick. Come Monday, she started vomiting throughout the entire night and her body was officially rejecting any food or liquid. By morning, Vivi was admitted to the emergency room, not only vomiting, but complaining of sharp pains in her stomach, and bloating. All signs of a possible bowel obstruction, which was, in fact, the diagnosis after a long day of testing. So they admitted her to the hospital, and that's where she has been residing ever since. Luckily, since Vivi's past cardiac complications have not reared their ugly heads for some time, she does not need to be on a floor with telemetry (heart monitoring equipment), and can be on the posh 19th floor here at MSK, which feels more like a Hilton than a hospital (pictured above).

This is also where we, unfortunately, ended up celebrating Vivi's birthday. Although, it is moments like the one pictured above when you realize that it doesn't matter if you are enjoying a nice meal in a fancy restaurant, or eating cafeteria food and cupcakes out of a box - as long as you are with your family. Or so we keep telling my mother.

Some information about bowel obstructions and ovarian cancer:

Bowel obstructions are, unfortunately, an extremely common complication for Ovarian cancer patients. This due to two factors:

1. Most ovarian cancer patients undergo a major abdominal surgery early on in their process. This is called "debulking", as it removes the bulk of the cancer that is present near the onset of the diagnosis. However, the surgery leaves behind massive scar tissue on the inside of the abdomen - which can eventually press on, or even wrap around, the intestines - causing an obstruction.

2. Unfortunately, ovarian cancer tends to spread itself around the entire abdomen, and tumors are often found on the walls of the intestines. When Vivi was first diagnosed 2 1/2 years ago, the cancer was very far spread within her abdomen, and much of it was on the intestinal walls. So it is not surprising that during a relapse, her cancer has likely found it's way back there and is now pressing on the intestinal walls -  causing the blockage.


The cause for Vivi's obstruction could be one of these two scenarios, or possibly a combination of the two. In any case, obstructions are a complication as food cannot pass through the body and nutrients are no longer absorbed. Generally, and in Vivi's case, the protocol for treatment for a patient with a bowel obstruction is to put them on "bowel rest" (aka no food or liquids) and see if the problem will resolve itself. If it does not, which I'm sure you have guessed - Vivi's did not, then they must operate to remove the section of the bowel, colon, or intestine that is obstructed.

Unfortunately, we will not know for sure the extent of the surgery, or even the cause, until they actually take a look inside tomorrow. So I am going to hold off on that information until we know more as to not cause too much unnecessary speculation.

Things I can tell you:

The surgery will take place at about 2pm tomorrow here at MSK, and will take about 2 1/2 hours. Depending on the extent of the surgery needed, Vivi will likely need about a week of recovery, and then they are hoping to start her right back on chemotherapy. Whether she goes back on Doxil or on a new drug, will also not be determined until after surgery.

How is Vivi?

Right now - she's texting away - so I'd say she's pretty much normal! In all seriousness, it is moments like this when I am in true awe of my mother. She is just about as calm, cool, and collected as I could imagine anyone in this situation could be (especially after being cooped up in the hospital for a week). She never ceases to amaze me with her ability to stay focused on the challenge in front of her, and just deal with each step as it comes along. She is also being her feisty self - gossiping with the nurses, trying to set me up with any male doctor that enters her room, dancing along with her IV pole (pictured above), and doing everything and anything she can to ensure she keeps her cushy private room post-surgery.

What now?

As I have said several times over, we will have much more information after the surgery tomorrow evening, at which point I will make sure to send you all as thorough an update as I can. In the very least, I will let you know that Vivi came out of surgery alright!

We don't expect flowers or cards, but knowing the group I am writing to - we fully anticipate receiving them. So, to make things easier on our far-to-generous friends and family, the address here is:

Memorial Sloan-Ketting Hospital
1275 York Avenue
New York City
(Room for tomorrow unknown - I will send it out once I know)

I believe that is it for now. I apologize for my lack of usual humor and light heartedness, however, I wanted to make sure everyone was clear on the information - and, well, it's been a rather long week over here!

I promise to keep you all as up to date as possible. In the meantime, thank you for your continued love, prayers, thoughts, and general support. It's what keeps us all going and is something for which I fear we will never be able to properly express our gratitude.

All my love,

Aly

The Latest and Greatest on Vivi

Hi Everyone,

I am sure you can guess why I am writing a new post, as, this is the most efficient way for me to share news on Vivi - and there is, unfortunately, news to share. About a month ago, we found out that Vivi had relapsed for the second time. While the relapse is to be expected, as this is just the nature of ovarian cancer, per usual, we were all saddened and a bit taken back by the news - especially as this relapse happened quite quickly. I also think that even though Vivi's illness is taking a rather textbook course when it comes to timing, there is just nothing textbook about Vivi (in any way, shape, or form). Only Vivi can be in the middle of a battle with an extremely aggressive cancer and manage to remain as strong and vivacious as ever. Besides the fact that she happens to have a terminal cancer, Vivi is, by all other means, completely healthy. Something that I think makes all of this a little harder to wrap our heads around.

However, the reality is that the cancer is growing back again, and Vivi will, once again, begin chemo this afternoon. After an extensive search for alternative treatments, which included meetings and calls with doctors from literally all over the world (an effort lead by my incredible father), it has been decided that the best course of action in Vivi's case, which is technically, Stage 2 recurrent ovarian cancer (which means she has relapsed twice now), is to put her on a new chemo called Doxil. In the case of recurrent cancer, it is important to keep introducing as many new drugs to the body as possible, as the sheer fact that she is relapsing is a sign that she is already showing resistance to the other drugs she has already been given - and the more often she is given the same treatment, the more resistant her cells will become to that drug. So it is important to keep the therapies rotating, and give as much time in between the start of repeating a drug she has already received.

So Doxil is the clear best next step as she has not yet been given this drug, and it has also proven to have good results with Ovarian cancer if and when the patients take to it. However, there are some risks with Doxil. The drug takes about three months to start working, and can actually make the patient more symptomatic before it starts to attack the cancer. So we are hopeful (and have all reason to be), that Vivi will remain strong and healthy through the summer and that the drug will begin to work in three months time - at which point, we will have a better idea of where everything stands.

The new regimen: Vivi will now recieve chemo once a month (which is a much more manageable treatment schedule that those from the past). The side effects, while quite mild compared to some of the other chemotherapies Vivi has received, are not particularly "summer-friendly". The most prominent side effect of Doxil is that it causes toxicity in the skin. This can come in many different forms, but most importantly, Vivi will have to keep her skin out of the sun as much as possible, which will be a challenge for someone who so loves to spend her time outdoors - especially during the summer. Does this mean that Vivi will be on home arrest? No. She just has to make sure she is well covered with clothing and 85 spf if she does go outside (something that is likely routine for most of you, but if you know Vivi - she is a bit of a sun goddess). In any case, she will still be able to swim, ride, and enjoy the summer to the fullest she can manage in her long sleeve shirts - which have already been bought by the bulk! As you can see from the pictures I have posted, she has already managed to make the most of the start of summer, so we hope for a great summer ahead as well!

Per usual, I will keep all of you as up-to-date as possible. It is always hard to have to deliver these bits of news rather than the entertaining Vivi stories that are so much more fun to tell (and I promise I will be sure to offer up at least a few of those along the way).

Thank you all for the continued love and support, as it is both Vivi and our family's life line!

I hope you are all enjoying the start of summer as well and I will be in touch soon.

Aly