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