The lab report on Dad's protein levels is in, and the news is very encouraging. When Dad was admitted to the hospital in February, they were at 3.73; thanks to the chemo, they have dropped to .91. (Apparently, when a myeloma patient hits 1, doctors start treatment. So while this new count is not completely normal, it represents a huge improvement for Dad.)

Mom and Dad are back in their quasi-domestic routine at the hospital. Dad has decided to brave the hospital food (should you find yourself admitted to HUP, our man on the inside says take a pass on the collard greens). Dad sounds good, like his old self--really a world of difference from a month ago when he could hardly muster the energy to talk. He has started to feel the intestinal effects of the chemo, but nothing too extreme, and his spirits are good.

Even the climate has been home-y: the hospital room has been quite like 225 N Easton in winter (i.e., arctic). Now, Mom and Dad are not completely literal-minded about re-creating their home environment: they'd been turning the thermostat up, but to no avail. The heating vents were blowing super-chilled air, despite the thermostat reading 85 degrees. Dad had to wear a knit cap, ski goggles, and mittens (well, not mittens). Yesterday the maintenance guy came and said that, obviously, in order to get the thermostat to function, you have to turn the heat side down and turn the air conditioner side up to the desired temperature. Reason aside, the room has since become much more comfortable.

The plan is still to release Dad on Sunday. Thanks for checking in and praying. God hears.

another go 'round

Dad left a characteristically to-the-point message on my phone last night: They're in the hospital and will be there until Sunday.

This is the second round of the CVAD chemotherapy, administered intravenously and accompanied by numerous other pharmaceutical cocktails and supplements. Please pray that this course of drugs will build on the gains that have been made over the last month. Pray that Dad's various blood counts, especially that of his white blood cells, will be at safe levels. Pray that he'll be safe from infection, and that he and Mom would have the strength to persevere, in faith, through another hospitalization.

Let me renew our thanks to everyone for your myriad expressions of love and support for Dad, Mom and the whole family. What a moving thing to know how well and widely Dad is loved!

Easter time with Dad

It was a special treat to spend some brief but meaningful moments with Dad this Easter weekend. Here are a couple of photos:

Dad with Uncle Bill (visiting from France)

Mom & Dad joining us at the Marsh Easter gathering

Wednesday's Appointment, and a New Plan

The report from the visit with Dr. Stadtmauer at Penn was good. He feels that the chemotherapy is working effectively against the myeloma. Dad's platelets have climbed up into the 80s, indicating that he really is producing his own. They've decided that Dad can stop his trips to Abington for transfusions, unless the blood drawn by the nurse who comes to the house indicates another drop. His hemoglobin (red blood cell) counts are also up, though his white blood cell count has stayed at the recently reduced level; the report on the protein levels is not yet out.

The new plan is for Dad to return to Penn on Tuesday for the next round of chemo. This is earlier than expected, so Mom and Dad will get less of a break, but the doc feels that it's best to get while the gettin's good--to capitalize on Dad's gains now.

Thank you for persevering in prayer for Dad. Please continue to pray that his white blood cell count would improve, and that he would be protected from infections over the next few days. Pray that Dad and Mom would have the endurance they need for this chemo marathon.

Dad and Mom are so glad to be home. Thanks to all those who are bringing meals; Mom reports that it has been such a relief not to have to worry about dinner every night. Dad has been feeling pretty good for the last few days. Not exactly 100%, of course, but then compared to last time he was home, he feels like a million bucks. He has been to Abington for one transfusion so far, and will return today for another. Blood tests have shown an improvement in his red blood cell count, as well as--wonder of wonders--his platelet count. For the whole time he was in the hospital Dad needed daily, sometimes twice-daily transfusions just to keep his platelet numbers hovering, weakly, in the 20s (i.e. twenty-some thousand per tiny unit of blood). Two days ago it was 60, and while "normal" would be between 150 and 400, this represents a significant improvement for Dad, especially since for a while there his body was unable to maintain even those lower levels on its own. Thank the Lord: this is a specific answer to specific prayer.

Please continue to pray that these numbers would climb. An area of concern is Dad's white blood cell count, which had fallen as of that last blood check. Dad is going down to Penn tomorrow to see Dr. Stadtmauer and get a read on his protein levels, which, as many of you know, are a key indicator of the myeloma's activity. They will decide when to begin the next round of chemo. Stadtmauer will be away until the beginning of April, so Dad will be "off" at least until then.

Thanks for checking in. We'll keep you updated. I'm even going to try to get the Aged P's up on this thing (provided they have the energy), so stay tuned.

Home Again, Home Again, Jiggety Jig

I talked to Mom this evening and she said that they were VERY happy to be home. She also said that Dad spent a couple of hours downstairs once they arrived, and ate dinner before going upstairs to collapse. She wanted to thank whoever left a meal tonight, it was such a blessing to have a dinner waiting for them when they walked through the door. She said they have been overwhelmed with thankfulness to everyone who has helped out, provided meals, sent cards and prayed for them.

Dad was discharged today after receiving two bags of platelets. A home nurse will be coming by this weekend to check up on him, and then on Monday he will go to Abington to receive his next transfusion. Their prayer requests for this weekend is for Dad's platelet levels to remain stable, and that there will be no episodes of bleeding.

Home again 2.0

The present plan is to send Dad home this afternoon. He received a bag of platelets yesterday, and they're going to double-bag him today and hope that holds through the weekend. Whether or not his platelet production is going to recover is uncertain, but the doctors feel they can adequately monitor Dad's situation at home and bring him in for necessary transfusions as an outpatient.

Dad has been feeling pretty good, for the past couple of days going on walks around the ward, trying to get his strength back. Besides this platelet business, please pray that Dad and Mom will be able to enjoy their time at home, and be rejuvenated before they have to come back again in a couple of weeks for the next round of chemo.

According to Dad's blood tests today, the transfusion he got yesterday made no real difference in his platelet count. It seems apparent that he is still not producing his own platelets. Dad, Mom and their doctors have decided to postpone his homegoing at least until tomorrow, but probably for longer. (The strategy today was to skip the transfusion to see if his numbers will actually drop.) Mom and Dad are disappointed, of course, but prefer to stay put until Dad is no longer dependent on daily blood refills. Please continue to pray that Dad's body would recover that platelet-producing function.

Incidentally, all of this blood comes from the Red Cross, where platelets in particular are often scarce. This is because they have a shorter shelf life than other blood components and are a small proportion of any given donation, so that one transfusion of platelets typically includes cells from 5 or more donors. If anyone is interested in in a direct, "tangible" way to help Dad and patients like him, you might consider donating blood. You can find a blood drive or donation center here.

Going Home (we think...)

If all goes according to plan, Dad will be going home this afternoon. Monday night was fever-free again, though Dad had some difficulty sleeping. His white blood cell counts are continuing to recover, and the adjusted mix of antibiotics appears to be working against the staph infection without any further side effects. The platelets remain an issue of concern. It's still unclear whether Dad's body is producing its own in any significant number, since Dad has continued to receive daily transfusions, and when they tried holding off on the transfusion to see if the numbers would stay put or rise on their own, they just dropped further. But the doctors at this point believe that Dad can go home and return to the hospital for tranfusions two or three days a week, if necessary. The plan is for a nurse to come out to the house twice a week to draw blood for lab tests, and to schedule the transfusions accordingly. Of course, the more times a week Mom and Dad have to make the trek down to HUP for what often amounts to an 8 or 10 hour day, the less sense it makes for him to be home at all. There is some possibility that he will be able to recieve the transfusions at Abington Hospital; our prayer is that that would work and that the two hospitals will be able to cooperate in a timely and efficient manner.

Thank you all for the hundreds of prayers and other words and acts of love and concern for Dad during this hospitalization. By every measure, Dad is doing considerably better now than he was when he was admitted two and a half weeks ago. Given the extent of the myeloma's advance, as indicated by Dad's pre-chemo blood counts and the bone marrow biopsy, Dr. Stadtmauer has indicated that Dad will need to come back for another round of chemo at the end of the month. So we might pray now that Dad's recent gains will be preserved and increased by the next round.

Last night was Dad's best night in a long time, since even before he was hospitalized. Every night for a couple of months now he has endured chills and sweats--he typically soaks through his pajamas, sheets, and the towels placed under him. But last night he slept through the night without any serious issues, and he was basically fever-free today. Add to this his slowly rising white blood cells counts, and tentative reports that his platelet count may be stabilizing, and you have a pretty good day for Dad. Mom reports that all the nurses have been commenting on how good Dad looks. Both Mom and Dad sound really upbeat, which is a great sign, too. They were actually able to relax--not merely to "rest," but to enjoy themselves, to have a bit of normalcy, a space to breathe, the wonderful sensation that they need not, right now, defend this particular inch of ground against the cancer. Dad did a few sudoku, Mom did some crossword puzzles. Dad was not hooked up to a single machine this afternoon. No, we're not out of the woods, but this was a kind of sunlit clearing. We are thankful to God that the fevers have, for now, left Dad, and his "vital signs" are good.

Yesterday evening before bed one of the nurses whom Mom and Dad have gotten to know came into the room and broke out into a gospel song for their benefit, and when she left Mom and Dad found themselves looking at each other in delight and gratitude.

Our hope now is that this progress will hold, and will be the pattern for the future. Our prayer continues to be that the chemo would be effective against the myeloma, and that Dad's blood counts would rise. The platelet numbers continue to be the most immediate concern; they seem to have stabilized but the prognosis remains uncertain. The doctors have suggested that, if the platelet situation proves stable, making the risk of more bleeding low enough, Dad could be released from the hospital in two or three days.

Mom and Dad wanted me to thank all of you, their brothers and sisters, and to tell you that the Lord is listening to your prayers.

Sunday

Cara and I visited this afternoon, and not surprisingly were treated very hospitably by Mom despite her fatigue after another long night. Thankfully, her cold has greatly improved and, while Dad rested, Mom shared several tangible ways she saw the Lord’s sustaining grace carrying her throughout the morning. As always, her steadfast faith and encouraging spirit in the midst of this suffering really ministered to us.

In terms of Dad’s health, the good news is that his white blood cell count is starting to rise. He is, however, still experiencing chills and fevers several times a day and through the night.

Please pray:
1. that all of the blood counts (white, red & platelets) would rise. The platelet levels continue to be at the lowest level among the three.
2. that the doctors can identify all of the specific bacteria that are implicated in Dad’s fevers. They have pinpointed one and are tailoring the antibiotics accordingly. There is another bacteria that has not been fully identified.
3. for ongoing faith, perseverance and good rest for both Mom & Dad.

Thank you again for all of your support expressed in your blog postings, cards, practical help and prayer. Mom & Dad feel so loved and blessed by you all.

Saturday Afternoon

Mom wanted me to pass along the word that Dad's latest fever has broken. This afternoon he had been struggling with chills, sleeping fitfully. At one point he woke up and said he wanted to go for a walk. They took his temp and it was down to 98, and he and Mom walked around the floor while the nurse changed his sweat-soaked sheets. This was a small moment of reprieve for Dad and Mom, an answer to prayer.

Saturday Midday

Last night and today Dad has had a 103-degree fever. Thankfully a chest MRI they took last night came out more or less clear. The fever is consistent with the chemo, so nothing too out of the ordinary, but please pray that it would be brought under control and that Mom and Dad would continue to be sustained and encouraged.

Sat Morn

Dad has clearly entered that 7-10-day-after-chemo period where he feels, and is, the most wiped-out. For the past couple of days Dad has continued to struggle with a fever and its effects, especially chills and sweats. The fever seems to be due both to the sinus infection and to the daily transfusions he's been getting, to which his body often reacts as a foreign substance. One "bag" of platelets may have blood cells from five different donors, some of which will be less closely matched to Dad than others. It is the classic cancer scenario, isn't it? Battling the host of baby or pseudo- "cancers" caused not by the actual cancer but, precisely, by our best efforts against it. Medicines levied against medicines, the side-effects shuffle. That which we hope will cure us may yet kill us.

Dad has continued to struggle with headaches from the sinusitis, and his nights have been difficult, while he sleeps through most of the day. I spoke with him briefly last night and he sounded, to be frank, utterly low and exhausted. But his characteristic pragmatism, and courage, remained. Not a trace of complaint. In fact, Mom has said that it is sometimes hard for her and the nurses to know what Dad needs, because he doesn't complain. At its best, suffering is this sort of refining fire, in which the incidental and inessential are burned off, and the essentials of character emerge hardened, clarified, and in relief.

I was talking with Mom yesterday and she shared a story with me of God's faithfulness, and special care for her. On Wednesday, when things were so uncertain and the outlook so grim Mom was feeling especially vulnerable and alone. Dad was going to be going in to see the ENT specialist, and if he required emergency surgery, she would have no one by her side to pray with her as she waited. She just prayed to the Lord for his presence.
The orderly who came to wheel Dad down to the clinic immediately started a conversation with Mom and Dad. Within a couple of sentences it became clear that he too was a Christian. For the 10 minutes that it took to walk down he quoted scripture to them and just encouraged them in such a way that they felt the arms of God were wrapped around them. And then of course, the result of the examination was that the infection wasn't fungal, so my mom ended up not having to sit alone through the surgery.
My mom said that this was just one example of the way God has provided people each day they have been there who have either been Christians, or who have taken special interest in Dad. They have expressed repeated thankfulness that Susie is on the nursing team, and it is such a blessing for them to see her, and also the way her family has shown their love to Dad and Mom in this time. Even today Mom had to be away from the hospital for a period of time to go home and replenish supplies. It is hard for Dad when she is gone, but he had a special nurse who was very kind and attentive to his needs, and was able to care for him while Mom was away. These are just a couple of specific ways that they have been encouraged through this trial, and I know that each and every comment they get here is a blessing to them, and a way that you too, are God's arms of love around them.

Friday Morning

It turns out that Dad's infection is a staph infection, which is a bit more serious than previously thought, and will require a stiffer antibiotic regimen. Please pray that Dad will be able to hold up under both the illness and the cure here--which is of course our general petition in all this: that Dad's cancer would be defeated, and that the he would be able to endure the treatment.

His blood counts are still sliding. The platelets continue to be a big concern, and he received yet another transfusion yesterday. His white blood cell numbers are also extremely low--he is in fact just about neutropenic. The prayer is for protection against other infections now that his immune system is essentially non-existent.

The plan is for Roger and Karen to remain at the hospital through the weekend, so that the doctors can continue to monitor this infection and Dad's blood situation. Mom has full-blown cold now; the hope is that she will recover quickly and not pass it along to Dad. Both of them are obviously exhausted at this point. Pray for the deepest possible rest and for a special grace to uplift them.

Let me renew our thanks to all of you for your prayers, help and love. My parents have been sustained and heartened by it.

Briefly,

Dad had a test for the flu yesterday, which, thankfully, came out negative.

Mom has been fighting a cold. Please pray that she would kick it, and that Dad wouldn't get it.

Our main prayer continues to be that the chemo would effectively destroy the myeloma cells and that Dad would recover the ability to produce his own blood cells. Pray also that the antibiotics would effectively combat the sinus infection.

More tonight...

Good News!

Mom & Dad just returned from their visit to the ear, nose, and throat doctor at HuP. When they cleared out Dad's nasal cavities, they found no evidence of a fungal infection. His sinuses are inflamed & swollen, but fortunately can be treated with antibiotics, a far more desirable option than emergency surgery!

Dad is now resting, and he also went for a stretch of time today at a lower, more stable body temperature (he's had periods where he runs at a higher level).

Praise the Lord; Mom wanted us to convey her thanks and encourage you to keep the prayer support coming!

Some pictures to share...

Here are a couple pictures I thought you might enjoy of my parents and some of our family, this past October, at my cousin Megan's wedding reception. The reception was at Normandy Farms in Blue Bell. It was great to see both of my parents so relaxed and happy and my dad had enough energy to last through most of the night, with some energy to spare for dancing!!

I forgot to mention a couple things that we can be thankful for:

1. My dad is now free from his excruciating back pain due to the various painkillers he is on that are able to properly target the pain.

2. The doctors thought to do a catscan which found the sinusitis, so now they can determine how to treat it, once they figure out what kind of sinusitis it is.

3. The support and love of our many friends and extended family during this time. It really does mean a lot.

THANKS!

Today was a hard day for my dad. He had a high fever during the day and his platelet count was still very low, so he received two bags of platelets. Due to my dad's repeated battles with fevers, the doctor decided to do a catscan to determine what might be causing the fevers.

The catscan came back positive for sinusitis. The "good" news is that one kind of sinusitis is a lot less serious than the other. Bacterial sinusitis is the less serious kind of sinusitis and may only require antibiotics. The "bad" news is that the other kind of sinusitis, Fungal sinusitis, is more serious than Bacterial sinusitis, and could require surgery. The doctor told my mom that if my dad has Fungal sinusitis, it is an emergency situation. At this time, we still do not know what kind of sinusitis my dad has.

So, the ear nose and throat doctor came to my dad's room tonight to see if he could determine what kind of sinusitis my dad has. He stuck a probe up my dad's nose, but because my dad has had repeated nosebleeds and the nose pack [technical term?] was in his nose before they did the probe, there was "crusting"in his sinuses and the doctor could not determine anything. Consequently, he decided to have my dad sleep in a vaporizing mist tent overnight to try and loosen up the dry patches, so that, come morning, he might be able to determine what kind of sinusitis my dad has.

Also, several patients in the cancer ward on the same floor that my dad is on, have the flu and because my mom has been spending virtually all of her time in the hospital, they are concerned about her contracting it and passing it on to dad. So, she is wearing a hospital gown and mask to prevent any kind of possible infection.

So, I guess you know how to pray - 1. that the vaporizing tent would loosen up the dried patches of blood so that the doctor can determine the kind of sinusitis, 2. that the sinusitis would be bacterial and not fungal, 3. that neither my mom or dad would contract the flu, 4. that if my dad does have fungal sinusitis, that the surgery would be successful and my dad would be sustained during it, and 5. that my parents would have a constant sense of peace from God as they anticipate this next cancer hurdle, and that we would know how to support and care for them in the best way, that would really be a blessing to them. Thanks for your support.

Mom and Dad found out today that the doctors now want to keep them in the hospital at least until Wednesday (that's a de facto "them," as Mom has been living and sleeping there for the past 9 days). The doctors' most immediate concern continues to be Dad's low blood counts, especially the platelet numbers. Because of the recurring and persistent bleeding due to the low platelets, they are considering giving him a blood coagulant, but this would carry with it a risk of life-threatening blood clots. As it is, Dad has required daily, sometimes twice daily, transfusions, and it is hard to see the value in sending him home only to endure trips down to Penn every day, plus the risk of more nosebleeds that won't stop. So Mom and Dad are actually happy to stay put for the time being. Too, Dad's energy level is so low that a long trip home through the cold hardly sounds tempting.

The doctors are also concerned with the state of Dad's immune system as the cumulative effect of the chemo becomes increasingly manifest. (As I understand it, the expectation is that Dad's system will be at its weakest--and he'll feel the worst--about 7 days after the end(?) of the chemo--i.e. this weekend.) Dad has struggled with a low-grade fever for the past few days, and had another rough night last night with chills and sweats. A test for a urinary tract infection came out negative, thankfully; we are waiting for the results of a chest X-ray to check for signs of pneumonia, a particular danger for myeloma patients on chemo. Dad is already on a course of antibiotics as a preventative measure.

So. Please pray for wisdom for the doctors in deciding how to handle the platelet deficiency. Pray that Dad would be safe from blood clots if they decide to go ahead with the blood coagulant; regardless, pray that Dad's platelet count would stabilize and begin to climb. In general, our prayer is that all of Dad's blood counts--red blood cell, platelet, white blood cell--would rise--that is that Dad's body would again begin to make its own blood cells. Pray that Dad would be protected from infection on account of his weakened immune system.

Thanks for checking in.

Pictures

Here are some pictures to supplement Julie's entry.

Dad with Mom


...and Nana

....and Julie

...and Katherine

Clark Cafe- "Can I offer you some more coffee? How about some scones? Wait! I have some donuts here, or maybe a muffin?"

Visiting from Texas

First of all I want to thank God for making my visit to Philadelphia happen so quickly and smoothly. I was able to fly up on the red eye Friday. I visited with Dad and Karen a couple of hours then. I was also able to come back Saturday with my sister, Katherine, and Dad's Mom in the morning. Then I visited later in the evening by myself to say bye. After that, I caught my early flight home on Sunday.


My visit was very short but productive. I was able to see Dad at his best this week. At the beginning of the week he had been very sleepy. When I got in, he was already on 4 chemos and steroids. One of the perks of the steroids was that he was awake when I visited. I was blessed to spend such quality time with Karen and Dad. They were in good spirits in spite of the seriousness of his condition. They are taking his illness day by day. We were able to visit, talk and eat together. Daisy was right that room is truly very welcoming in spite of it being in the hospital. I felt like I was in the kitchen at home.


I was also so blessed to see the overwhelming amount of support our parents have received from friends and family. They are so thankful for and are so blessed with the prayers, cards, calls, snack, work details etc... Thanks for your continuous support.


I was truly glad to see Dad on those good days. By the time I left Saturday, the first round of Chemo was done. The doctor was trying to regulate his platelet levels in order to prevent future nose bleeds. His white blood cells were down. Karen wasn't sure at that point when or if he would be going home soon. However, we all felt that he was in the right place for the time being. The days ahead are going to be very hard. Next week is going to be a very tough week for him since he will be experiencing the effects of the chemo. Please pray that the chemo will work. Pray that his body will be strong enough to handle the chemo and replenish itself. Please pray for Karen as she cares constantly for him. Pray for her to have strength and endurance.

We love you Dad and are proud of you. You may be physically weak, but we know you are spiritually strong. Hang in there. Karen we love you too. We are so thankful for your love and devotion to Dad. We know he is well taken care of.

The Weekend Edition

Thanks for your patience, folks. I know you're all eager for more information on Dad's condition. I've been experiencing some technical difficulties on my end, but am miraculously back online for the moment.

Dad suffered another nosebleed on Saturday morning. Thankfully they were able to stop the bleeding more quickly this time, but his platelets were obviously low again, so the doctors gave another two "bags" of 'em. The blood levels initially responded, but were flagging again at last count; his white blood cells are also showing reduced numbers.

All of this is clearly due to the activity of the myeloma in Dad's bone marrow, preventing the proper production of blood cells. The results of the bone marrow biopsy confirmed this, indicating (as Mom explained to me) that 95% or more of the cells in Dad's bone marrow are tumor cells.

In light of this sobering news--the gist of which Dad, Mom and the doctors had already more or less grasped, but the hard data confirmation is still difficult to hear--our prayer is that Dad's bone marrow would recover the ability to produce healthy blood cells, especially, at this point, platelets. The hope is that the chemo would destroy the cancer cells while preserving the bone marrow's capacity to regenerate and begin to function properly. Please pray for this, and as always for peace and strength for Roger and Karen. Pray that their perspective would be that of eternity, and that their confidence would be not in drugs, doctors, bodies or antibodies, but in the person and promises of Jesus.

I talked with Julie, who was back home in Texas tonight, and she said that her visits with Dad this weekend were a real blessing. She, Nana (Dad's mom) and Katherine were able to be with Dad during times when he had the energy to talk, look at pictures, and crack a few jokes.

Thank you again to everyone who has called, emailed, sent cards, snacks and gifts, shovelled snow, given rides, fixed meals, prayed, and otherwise demonstrated love and concern for Dad and the rest of us, especially over the past week. We are all deeply grateful for every such act, even if we haven't been able to acknowledge your kindness personally and individually. We'll do our best to keep the news reported; y'all keep them prayers comin'.