We are experiencing a tremendous answer to prayer! The lab reports were very good and Lois was able to get her first infusion of the new (for her) Folfiri Chemo regimen. This is a wonderful surprise because Lois has been nauseated, had very little appetite, and has generally felt sick since getting home from the hospital one week ago. Tuesday morning, as we drove to Iowa City, I prepared myself for what I expected would be a decision not to do an infusion – but God is at work and His will is being done.

Infusion # 22 was the first on a new regimen called Folfiri and includes Leukavorin, Avastin, Irinotecan, and Fluorouracil. The Irinotecan replaces the Oxaliplatin and the Fluorouracil will continue to be delivered via a “fanny pack pump” which is started at the hospital and disconnected 46 hours later by home health care. The other change is that Lois no longer has the Fluorouracil bolus prior to being hooked up to the fanny pack pump.

In the middle of all this, Lois fell Monday night and sprained her ankle. So we’ve done the Emergency Room routine in between lab work, consultations, and the infusion, to get x-rays and deal with that injury. Her left ankle is really swollen but it’s not broken! Treating this has been frustrating due to the neuropathy which made putting cold on the ankle more painful than the injury! Waiting for x rays and getting them read by the radiologist took an extra four hours yesterday. We left at 6:30 am and arrived back home at 11 pm.

We are watching for the expected reactions to this new Chemo “cocktail.” The Oncology pharmacist instructed me to purchase a package of 42 Imodium capsules before leaving Iowa City. Diarrhea can be severe and we were given a stern warning to ignore the instructions on the Imodium package and follow a set of directions they gave us. They are very concerned about the possibility of dehydration. So far, Lois has had very little problem with this but she has also experienced a great reduction in appetite and is not eating as much. In fact, yesterday she ate more than in the previous 5 days and that’s not saying much.

We had a long discussion with Dr. Halfdanarson’s nurse and his PA (Physician’s Assistant) to determine what to do about controlling pain without a lot of drowsiness and lack of appetite as well as controlling Lois’ blood pressure which is still high. We changed a number of medications, again, and we now have a spreadsheet to help manage all the prescriptions.

Again, we praise God that Lois is doing so much better than last week and that she was able to begin the new Chemo regimen. Thanks for praying! God is faithful!

We arrived home on Tuesday at 11 pm. Transfusing the two units of blood took a long time; and to extend the wait even further, the last unit finished at the same time as shift change!

Lois is sleeping fairly well at night. The steroid spray in her nose seems to have helped with congestion – she just wakes up with serious dry-mouth. Our biggest challenge is pain management. It’s not that Lois has a lot of pain – she describes it more as discomfort in her belly and sides– but the oral medication requires a lot more time before it takes effect. Extra Strength Tylenol to gives her a lot of relief in between the long acting morphine. We’re learning the routines of medication including the Lovenox injections to prevent more blood clots.

Lois moves between the recliner and the couches most of the day. Her temp is close to normal and her blood pressure is not as high as it was on Monday. She is resting and eating and resting some more as we trust God that she will have the strength to receive a Chemo infusion on Tuesday, May 12.

Unless something unusual happens, I’ll wait until after the infusion before sending the next update.

We know God is leading and guiding – His will is being worked out in our lives. Thanks for praying.

We have had a most interesting and productive day:

First of all, Lois is feeling much better. Last night she slept the best in a long time. She has not had a temp over 101 today which is a major improvement.

Secondly, we’ve continued to work with Palliative Care on managing pain and the Chemo “cold” – the almost constant sinus drainage. We’ll begin using a nasal steroid tonight which should help a lot with that. Last night Lois started taking a long-acting morphine which will help with the achy pains that will certainly increase if the liver tumors continue to grow.

Third, we transitioned all Lois medication to be taken orally as part of the process of preparing to go home.

Fourth, in consultation with the Staff Dr, the Resident Dr, the Palliative Care Dr, and our oncologist, Dr Halfdanarson, we are moving ahead to get Lois ready for a Chemo treatment on May 12. There is a lot of hope that we can slow the growth of the tumors with a Chemo “cocktail” generally known as Folfiri and that’s what we will begin next week. In order to accomplish this Lois needs to be stronger.

Even though her numbers from the lab work have been consistent since Saturday, they are all on the low side of normal or just a little below the established benchmarks. So, as I am writing this, Lois is getting the first of two units of blood. Conventional wisdom is this will boost her system and bring all the numbers up so we can do the first infusion of Folfiri.

When the blood transfusions are complete – about 8 pm – we anticipate Lois will be discharged. Getting home is a key component in helping her body be ready for Chemo next week.

God continues to be faithful and trustworthy! Being able to go home this soon is a great answer to prayer! Undoubtedly, we face more road bumps in this journey, but we are confident as we place our dependence and hope and future in God’s hands that He will never give up on us! We are trusting God to be God.

Lois is feeling better today; the fever is not spiking as high (102 right now), pain control has been much more successful, and appetite is slowly improving. We were able to have a productive conference with the medical team and, even though we don’t have a lot of answers, we do have better questions.

Here are some bullet points of information:

· Pain is under control but it has taken the combination of delotid, morphine and Tylenol. We are working on methods to deliver pain control at home

· Lois will have daily injections to prevent more blood clots

· Dr Halfdanarson, our oncologist, is not overly concerned about the right kidney since all the labs and cultures have not indicated any infection. It’s something to watch . . .

· There is a trace of blood in Lois’ stools but, again, not enough for alarm.

· Even though the temp continues to spike, they are pleased that it’s on a downward curve.

Lois has been considerably more alert today and has fully participated in the discussions with caregivers. We have made it very clear that our goal is to control pain and get Lois home. The medical team has agreed to try to accomplish this in the next couple of days by moving to pain control and antibiotics that can be taken orally. We had a good discussion with the Palliative Care team and will begin doing more to make sure we are preparing for managing the pain that will come with the expanding liver.

We do appreciate your prayers, visits and calls.

Someone said to me yesterday that they were trusting God for a miracle. God is certainly able to do that and all of us would welcome a miracle and give Him all the credit. However, we are trusting God to be God no matter what.

Lois is resting more comfortably and she is not complaining of as much pain – medication seems to have that under control. She is still sleeping a lot but is a lot more alert when she is awake. After 36 hours of broad spectrum antibiotics, Lois is still spiking temps but not as high as 104 – that alone is a great answer to prayer! Her appetite is slowly coming back but she is still sticking to simple foods. Peter, Joy, and Kari are here with us today.

We have more questions than answers but here is what we are learning from yesterday’s CT Scan:

· The tumors in Lois’ liver have all grown since April 1 when the last scan was done. None of them have grown considerably, but since there are more tumors in the liver than we can count, all of them growing just a little have significantly increased the overall size of the liver.

· Since the liver is growing it is pressing into areas where its meeting resistance which causes fibrosis. The fibrosis has caused some blockage in the ureter – the tube that carries urine from the right kidney to the bladder.

· Some of the medical team thinks the infection causing the fever is from the right kidney which looks somewhat inflamed. There are three options: One is to insert a stint in the ureter which has a fifty percent chance of working. Another is to do a Nephrostomy, an external drain inserted through the back into the kidney and attached to a bag worn on the leg. The third option is to do nothing and see what happens and even though that poses risks that is what we have chosen to do at this point.

· There may be some kind of mass in Lois’ lower abdomen or it might be where some of the liver has actually broken through the sack in which it is normally contained.

· The scan shows a blood clot in the lower right lung in an area where it’s not causing a lot of alarm, although Lois will have daily injections of some form of heparin for the next few months.

We still have a lot of questions: We don’t have any long term plans for continued treatment. We know dehydration was one of Lois’ problems when we went to the ER on Friday night we still don’t know why she was dehydrated. Is there anything we can do to attempt to slow or stop the growth of the tumors?

We will try to keep you up-to-date as we learn and make decisions. We appreciate all of you and especially those who have communicated over the past 24 hours that you are praying for Lois and the whole family. We are certain that God worked and will continue to do so.

Thought you should know . . . Lois continued to experience symptoms that were strange even after the Doctors decided not to do Chemo this past Wednesday. Yesterday afternoon she had a growing awareness of pain which increased in intensity in the evening. She slept most of the evening.  Several times when I touched her forehead I wondered if she had a fever. About 11 pm she got up from the couch with the intention of going to the bathroom and then on to bed but she could hardly walk the pain was so intense.

We looked up some information and decided this was not normal – not even the “new normal” so we made the decision to go to the Emergency Room at the Sigourney Hospital. There we discovered she had a temp of 104, was dehydrated, the white cell count was high, the hemoglobin was down and the liver enzymes were out of whack. (That’s medical terminology!) The physical exam confirmed the area of the liver to be extremely sensitive – Lois recoiled when it was simply touched – and the liver is enlarged.

The Sigourney Hospital called the Oncologist on-call in Iowa City and together we decided that Lois should be transferred to the University Hospital so they can do tests to determine exactly what’s going on and suggest a possible treatment protocol. Lois got to ride in an ambulance since they wanted to keep her IV fluid drip going and manage the pain with morphine. Fortunately she didn’t have to go through the ER but was taken right to a room. She arrived in Iowa City about 3:15 am and I was an hour behind her since she gave me a list of items to pick up from home.

As I write this it is noon and she just had a CT scan. We expect them to do an ultra-sound and a chest x-ray within the next couple of hours. It’s still a challenge to stay ahead of the pain and keep the fever down – right now her temp is 103.1. She has waves of pain – she might have very little for a time but then it just rolls and tolls.

All the doctors who have examined her (and there have been many – this is a teaching hospital) seem to think the tumors in the liver are growing faster than anticipated. They are also very concerned about the fever. So now we wait for answers.

I was supposed to leave this morning on a six day trip but that is now cancelled and I’m working the phone and email to stay in touch.

We really appreciate your prayers on our behalf and ask that you join us in thanking God for the miracle that in 11 months, this is our first encounter with these kind of consequences from the cancer that is growing in Lois!

Watch for more updates as we learn more!

We traveled to the University Hospital in Iowa City this morning for what we anticipated would be Lois’ 22^nd Chemo infusion – but it didn’t happen. The lab work showed a significant decline in Lois’ overall health. The outward symptom is that she is exhausted. The blood tests indicated a drop in hemoglobin and white blood cells; the liver function has decreased and her kidneys are trying to make up for what the liver is not doing. There is also physical evidence that the tumors in the liver are firmer and a little larger. The lab work today did not include a CEA “tumor marker” evaluation.

Based on this, Dr. Halfdanarson and his team of oncologists decided to give Lois a two week rest from Chemo. Hopefully her body will regain some strength instead of dealing with the onslaught of Chemo chemicals again. On May 11 we will have a CT scan in the late afternoon; we’ll stay in Iowa City overnight so we can be back at the Hospital by 8 am on Tuesday the 12^th. The medical team will look at the scan and lab results and then we expect a recommendation for a new “Chemo cocktail.” They gave us some ideas of drugs that might be used but its all speculation right now.

We accept this as part of the adventure. God has not caused this to happen but He is certainly in charge! We ask you to continue to pray for and with us that God’s plan will be worked out in our lives.

Psalm 139:14-17

I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be. How precious to me are your thoughts, O God! How vast is the sum of them!

Yesterday, April 15, Lois had her second infusion with the added Oxaliplatin. Because she was on this chemo regimen from July – October 2008, we knew the side effects and were prepared. Sensitivity to cold is the hardest one to cope with. Lois wears gloves to touch anything from the fridge or freezer. She pours milk and juice and lets it get to room temperature before she can drink it. Even the “minty cool” taste of toothpaste is too much so she uses baking soda to brush her teeth. These symptoms are intense for the first few days and gradually wear off so she can break eggs and have a jello salad in the few days prior to the next infusion.

Two side effects of the increased potency of the chemo therapy are the need for a lot more sleep and greatly reduced stamina. Lois spends a lot of time napping while watching TV or trying to read. She has short bursts of energy to do a simple project or spend an hour with grandkids but then she needs to rest. None of this compares to many we know who have severe reactions to chemo – some of which are simply debilitating. The chemo cold, the need for more sleep and avoiding cold for a week are relatively minor reactions – for this we are very grateful.

We are convinced that the ease with which Lois is dealing with Chemo is a direct answer to prayer! God is faithful in the little things – even when we don’t deserve it, He lavishes grace and mercy on us! We appreciate all the notes and cards as you express your care and concern. Thanks for praying with and for us.

I realize we haven’t done reports for Lois’ Chemo Infusions 18 and 19. There really wasn’t much to report. We didn’t even see the Dr prior to those infusions because we’ve all been playing the waiting game. The CEA number has been on the rise since December 2 and conventional wisdom indicated the best course of action was to stick with the plan and wait a few more weeks to see if there was any sign of cancer on the scans. (CEA stands for Carcinoembryonic Antigen and is a type of protein molecule that can be found in many different cells of the body, but is typically associated with certain cancers.)

Today, April 1, 2009, we left home early to travel to the University Hospital in Iowa City so that Lois could start drinking “glow juice” at 7:30 am for a CT Scan at 8:40 am. From there we moved to the Cancer Clinic for lab work and then we waited for the Dr. to get the results of the scan and labs. We learned the tumors in Lois’ liver have grown – the CT Scan clearly showed the increase. The CEA number has also risen from 14 four weeks ago to 16.7 today. It was 4.8 the end of October.

You might recall that the end of October the oncology team decided Lois was doing so well they removed one drug: Oxaliplatin. Today they decided to add Oxaliplatin back into the “cocktail.” (This drug’s main side effect is a serious sensitivity to cold!) We will have three more infusions of Oxaliplatin, Avastin, Leucovorine, and the “fanny pack pump” infusion of Fluorouracil which lasts for 46 hours. In eight weeks there will be another CT scan and a full set up labs and we’ll re-evaluate the response of the tumors. Dr. Halfdanarson assures us that if this doesn’t work, there are some other drug combinations we can try.

We do not consider this “bad news” or even sad news. It’s just news.

Recently, Lois and I were at a church where someone asked, “How is Lois’ battle with cancer going?”

Our answer: “We are not in a battle! The battle is already won and we know how it ends! Cancer is just part of the adventure right now.”

“Just think—you don’t need a thing, you’ve got it all! All God’s gifts are right in front of you as you wait expectantly for our Master Jesus to arrive on the scene for the Finale. And not only that, but God himself is right alongside to keep you steady and on track until things are all wrapped up by Jesus. God, who got you started in this spiritual adventure, shares with us the life of his Son and our Master Jesus. He will never give up on you. Never forget that. (1 Corinthians 1:6-8 The Message)

Please continue to pray that we will be faithful in “this spiritual adventure.”

On Friday, February 20, the home health care nurse arrived at our house to disconnect the “fanny-pack” pump which completed Lois’ 17^th infusion of Chemo drugs. Of course, that all started on Wednesday at the University Hospital in Iowa City where Lois received three doses of drugs before they hooked up the 46 hour drip. The lab work was encouraging! The CEA tumor maker did not go up but decreased by one point. That is another answer to prayer. We continue to pray that the liver numbers will improve although Lois is not experiencing any negative symptoms from the less than optimum liver function.

Lois is doing exceptionally well. She deals with the “chemo cold,” the need for more sleep, and is careful about pacing herself. If you were to observe her from day-to-day for a week, you would most likely conclude that Lois is not limited by the cancer or the treatments. She spends a lot of time with our six grandkids, cleans, does laundry, cooks – all the things she loves to do. Although cancer has impacted her life, she has not stopped living!