Mixed Review

We are in the middle of celebrating family Christmas, so it is a bit of a challenge to write in the midst of all the crazy. At the same time, I know that you all are anxious to hear what the latest is on James, so I will write something - maybe a little short, but hopefully I can minimize the disjointedness somehow too. 

For the last two weeks James's cough has been getting increasingly worse, to the point that he now sounds as bad as when he first started treatment. Going into his latest CT scan we really had no idea of what to expect. Based on his previous, positive scan, we were fairly confident that it wouldn't be worse than, say, hearing "you have inoperable lung cancer" for the first time....but no confidence that things would actually be improved.

Long story short, James's radiologist said the scan is a "mixed review." James has a very bad case of "pneumanitis" which sounds kind of made up, but is basically inflamed lung. In James's case, his lung is inflamed from radiation. The doctor believes very strongly that James's cough is no longer a result of cancer. Awesome news. 

James will be on a crazy large dose of prednisone over the next few weeks to take care of his pneumanitis. James's first thought was "oh my, I'm going to be eating like a cow again." My first thought was, "oh my, he's going to blow up like a hippopotamus." Yeesh. Please pray that the symptoms are manageable and that it really does take care of his cough. It would be wonderful to have James be back to his quiet self again. 😀

As to his cancer, James has no new tumors (awesome!!) and all of James's tumors are in the process of death/dying/disappearing. Yeah! Except one. Boo. But the doctor reassured us, "Well, it's only grown a few millimeters." (I'm not really sure how that is supposed to be reassuring, but I guess points for being kind.)

Next step for us? We will have a follow up appointment with James's oncologist, Dr. Gupta, next Wednesday. He has had a fairly aggressive approach to James's cancer, but we don't know what he will recommend. Perhaps surgery. Perhaps more chemo. Perhaps just waiting until James's PET scan at the end of March. 

In the meantime, we are very, very grateful for how God has carried us thus far, and we are thankful that we can rest knowing that He will continue to be faithful. Thank you for your faithfulness in continuing to care for, pray for, and remember us, even in the waiting. You are a blessing and have comforted and encouraged us in more ways than you know. Thank you.

Good News

So I am China these days...I left Sunday & arrived on Tuesday. I came with the purpose to check in on everything, make corrections or tweaks as needed, and to train my staff on a few new dishes to optimize the holiday season.  (The biggie is learning how to roast a turkey.) I also hope to be an encouragement - James and I never want our staff to feel abandoned, even if our personal lives are up on end at the present. 

In short - everything is going really, really well.  I am so impressed with our staff - they are a truly remarkable group of people.  (How well do you think you'd do if James taught you how to make Kung Pao Chicken and then left you for a few months? Do you think you'd continue to nail it on the flavor, or would it start to taste like American Chinese take-out?)  Over here at The Foreign Wife, everything tastes right, everything looks good, everything is (still!) immaculately clean. It's incredible.   

It's been great to get to reconnect with our staff too.  They are some of our best friends here, and I think they've enjoyed hearing how we're really doing. It goes without saying that they are anxious for our return. 

And then, since I am here and James is there...I got an email from my husband.  I'll let him share his good news in his own words. He speaks a lot about his cough - for one, because it's an incredible nuisance (and something he's put up with for nearly a year). For two, when we asked his doctors if his cough would go away, they both responded "We hope so." (Apparently when it comes to lung cancer, asking if the cough goes away is akin to asking, "Am I going to be healed?")  

I am doing well. I feel these days my health is getting better everyday. Coughing is getting less every day and much less violent and I'm coughing much shorter. Last night, for the first time, I woke up without coughing, It was a very weird feeling. Eventually I coughed of course, but it was short and light. Yesterday I played basketball and in a few minutes I was out of breath, but this morning when I woke up I felt like I have much more energy. I took Michaela and Caroline out to walk and I chased them, didn't feel any problem to breathe at all. Today I coughed so much less than any other days. I feel God's complete healing is at hand. I'm very excited and encouraged about it. 

Thank you all, again, for your many, many prayers on our behalf. We believe that God is hearing them and is working great things on our behalf as a result. Thank you.

Hoping & Waiting in Suffering

Eugune Peterson - I love that guy. He gave us a gem of a Bible translation, The Message. Many years ago he also wrote a fabulous little book called A Long Obedience in the Same Direction which is not exactly at the top of the popularity charts at the Christian bookstore these days, but is a fabulous book nonetheless. 

In one chapter, he addresses the issue of hope in suffering through Psalm 130. There's great thoughts here to shape our thoughts around truth. We know we are not the only ones going through difficulty...and so I share. Eugene writes...

Hoping does not mean doing nothing. It is not fatalistic resignation. It means going about our assigned tasks, confident that God will provide the meaning and the conclusions. It is not compelled to work away at keeping up appearances with a bogus spirituality. It is the opposite of desperate and panicky manipulations, of scurrying and worrying.

And hoping is not dreaming. It is not spinning an illusion or fantasy to protect us from our boredom or our pain. It means a confident, alert expectation that God will do what he said he will do...It is willingness to let God do it his way and in his time. It is the opposite of making plans that we demand that God put into effect, telling him both how and when to do it. That is not hoping in God but bullying God.

...

The psalm does not exhort us to put up with suffering; it does not explain it or explain it away. It is, rather, a powerful demonstration that our place in the depths is not out of bounds from God...We are persuaded that God's way with us is redemption and that the redemption, not the suffering, is ultimate.

We are persuaded that God's way with us is redemption and that the redemption, not the suffering, is ultimate.

That's good stuff there, friends. Let's believe it. Let's pray it. And we'll see God do it. 

Learning to Wait

Hello friends...welcome back, and congratulations for finding our blog after a four-day weekend of EATING ALL THE THINGS. You're tremendous, truly, and we're glad you're here. 

Our weekend was a healthy mix of seriously good eats (it's great to be part of a foodie family during the holidays!), watching THE parade, carbohydrate induced comas, black-Friday shopping, and lots of crazy. You know how you know if you had a great family holiday? If you have to take one of your kids to the dentist following said holiday.  

No joke. That's where I was part of today - getting one of my kids dental xrays.

(As a TOTAL aside, one of the benefits/blessings of living overseas & only coming home every 2+ years is that technology jumps forward without you noticing.  So you get slammed with all kinds of cool stuff all at once, and you get really excited at each "new" introduction. (While the innocent clerk/staff person looks at you with this mix of absolute befuddlement/trained courtesy/pity that seems to say, "Where the heck have you been, lady?!  This is SO 2012!")  All that to say, I am happy to report to you all that the dentist finally got rid of that horrid cardboard x-ray film that was always the size appropriate for say, a tiger's mouth rather than say, a normal human who still possesses all their teeth. No more shredding the roof of my mouth whilst biting on a cardboard blade and the inevitable, uncontrollable tearing of the eyes. Woot. It's the little things.)

Ahem.  Where were we?

Ah,yes...family life in the midst of cancer. In terms of update, there's not really anything to report. We're in the midst of waiting which, some days, is really difficult. James doesn't appear noticeably better, and there are no guarantees for what the CT will show. As we're finding out, finishing cancer treatment does not automatically put you on a trajectory of health and wellness, even if you do have days where you feel mostly better than dead. You have a lot of days of feeling terrible, completely zapped of strength, energy, vitality. James is still coughing, a lot. James isn't sleeping very well and is often in pain. On days when he feels decent, attempts at physical activity (like shooting baskets) are often a painful reminder of weakness and loss as much as they are an encouraging mental break. 

So, we long to be on the other side of this...not just to return to life-as-normal (though hey, that wouldn't be all bad), but to be able to say, "Look what God has done - He has proven Himself as the faithful, miracle-working God who sustained and strengthened us through a circumstance that we could not have endured on our own." We know God is at work, and we testify of the many, many provisions He has made for us along the way. And God is, without a doubt, changing us for the better for going through this. But we're still in it, waiting to see how He's going to bring all this together for His glory. Because if I'm honest, some days it just seems like a big jumbled pile of crazy. (And some days I am the big jumbled pile of crazy.) 

Most days, it's just learning to wait, in the face of terrible odds and lots of uncertainty...with faith that God is working on our behalf.

So let us hold unswervingly to the hope we profess, for He who promised is faithful. 

--Hebrews 10.23

Thankful

Happy Thanksgiving, friends!  

We trust you are all having a great week.  Just a few things the He family is thankful for this year...

*We didn't buy turkey for $5 a pound this year.  A first for us in a few years. 

*On a related note, I'm thankful that my house is not cold enough to brine said turkey outside of the refrigerator.

*We are thankful that James seems to be improving every few days or so.  He slept for 8 hours without waking from coughing fits last night, a first in a long, long time. He said that once in the night he coughed a couple times, but not enough to really wake him, and he immediately returned to sleep.  Amazing.  Hopefully the first of many more to come...

*James has also been having weird sounds coming from his lungs. Like squeaks.  Or pinched wheezes. The last time we heard those sounds, it sounded to us like his lung reinflating.  (And then his lung did in fact reinflate.)  [And no, I will not tell you about how the doctor looked at us when we described what we were hearing.  But I think he might have been thinking something like, "All those years of school.  And I am still completely unprepared to deal with crazy people."] Whether or not that is what we are hearing, James is breathing deeper and easier. Maybe the sounds we are now hearing are tumors dying. 

*This last weekend we got an unexpected visit from some dear friends of ours. We went out to lunch and they took our picture. It's surprisingly good.  (Though James says he looks fat - thank you, Prednisone.)

*We are so thankful for all of you! For all of our American friends, we hope you get all of your old favorites this weekend and that you eat too many of them. Celebrate. Indulge. Take a nap. And in the midst of all the ruckus, give thanks. 

The Part Where Things Look Worse (Before They Get Better)

Hello, dear friends. Sorry for the bit of quiet around here lately. (It's not you, it's me.) 

First, the good news - James is done with both radiation and chemo! We are so thankful to have made it thus far, thankful for God's grace that carried us through such an intense treatment regimen, thankful that now our days do not automatically include things such as a 40 minute commute to the hospital, getting prescriptions filled, or getting poked with a spring-loaded needle.  

Also, we didn't realize this at the beginning (because the doctor can't say "we hope you will be strong enough for treatment, but we'll wait and see"), but James actually got an "extra" round of chemo that is a one-in-a-million kind of deal. Basically, when the doctor saw how well he was doing, he was scheduled for the third round. Something the doctor hopes for but can't guarantee or promise. Very rarely do any of his patients hold up for round three. So we are indeed very, very thankful.  

On the other hand, events over the last three weeks have meant that we really just needed to persevere, to ask for strength to endure to the end. As James's body weakened, finishing treatment definitely felt like we were crawling to the finish line rather than sprinting through the home stretch. 

For the last three weeks, James's body has rapidly declined and weakened. (Even as we hope that the present wasting away is leading us to health and healing, it is a genuinely strange reality that it difficult for me to deal with.) Imagine, if you will, James at 90 - he no longer has energy to play with the girls, leans on shopping carts to make it through shopping trips, tires easily and fills his afternoons with naps, and even lacks the strength to consistently shoot a basketball to rim height. This is the James that we now know. 

The effects of chemo are often felt two to three weeks after the last dose, and radiation keeps working for six to eight weeks after the last treatment. So it may be awhile yet before James actually starts to feel better. His cough is getting better, but also keeps him from sleeping much past 4 a.m. Also, James's blood counts were all quite low last week (yes, again, and yes, totally normal), which means he is susceptible to infection and fatigue.  (Because of how chemo works, they will likely dip down even lower than the previous low over the next couple weeks.)

Having cancer is a rip-roaring good time, eh?! =)

The next "thing" on the horizon for us is a CT scan that James will do at the end of the year. (December 29th, if you want to mark your calendars. =) )  We'll get the results from that the following day. Hopefully, hopefully, we'll see good, great, downright awesome results from that.  The CT is kind of basic as far as scans go, and can show new growth (boo!) and decreased tumor size (yeah!) but can't differentiate between tumors and scar tissue (a common side effect of radiation). So we are praying for, once again, awesome results that are better than the doctors expect. 

And then we go from there - more waiting, more days of recovering, and then a PET scan at the end of March. 

In the meantime, thank you for continuing to pray for us, support us, and keep us encouraged. If you all keep doing that, we should be able to post again sooner rather than later.  Thanks! You all are awesome. =)

The Results Are In...

James got his CT scan results today - great news to report, friends. (But you're not that surprised after the blood count thing, are you?)

The doctor came in and got right to the results - markedly better than James's first scan at their office. The tumors are shrinking AND his right middle lobe (which has been collapsed since at least July) is starting to reinflate.  (Did you know your lungs could do that?!)  The tumors have shrunk significantly enough to require the radiation team to reduce the treatment field. (Think of it as a finer beam to hone in on a smaller object.)

Needless to say, we are thrilled, elated, excited, joyful. 

We are so thankful to know that chemo is working - and not just on James's hair follicles and white blood cells. Perhaps a little-known fact about cancer treatment is that treatment protocols are standardized which means that doctors "cannot" change course mid-stream.  That is, if doctors felt strongly that the chemo & radiation treatment were not working, there would be nothing to do but see it to the bitter end, wait 2 months, and then start over with a different regimen. Ouch. Nothing quite like how it must feel to "flunk" chemo.  

SO - thankfully this is not the case for James. We are blessed to see early results and wait to see what else God will do. 

Please continue to pray for his general health, complete healing (without surgery would be spectacular, as long as you're asking what we want), and perseverance to see this to the end. James is beginning to tire easily and his throat/swallowing is becoming increasingly painful due to daily radiation-to-the-trachea treatments. =)  (Another little-known fact about cancer...it is quite common for people to drop out before their scheduled treatments are over. Though we have no plans of being radiation drop-outs, I share that to say that apparently enduring to the finish can be challenging.) 

James has 11 more radiation treatments and 6 more days of chemo. He should be done with this intense treatment phase November 17th. 

Thanks for continuing to stand with us! Your love and support continue to be so encouraging. We don't always have the time mental energy to respond to all the emails and blog-comments, so please know that you all mean so much. Thank you. 

Astonishing Results

Just the other day I was thinking about how cool it would be if James and I could map out where in the world we have people praying for us. We'd put a little dot where we know at least one person praying for James's healing. It would be quite a map, just in the US alone - from Wisconsin to Texas, from Hawaii to Seattle to Boston. (And everywhere in between.) But it wouldn't stop there, as we have people petitioning in Costa Rica, the UK, Sweden, South Africa, Bangladesh, Shangri-la, New Zealand, and even East Timor. (Real quick - do you know where all those places are?)

So, by way of encouragement, so that you all will keep praying, some news. One thing you might not know about chemotherapy is, well, do you know how it works? Do you know why your hair falls out and your mouth gets sores, and your blood count goes down? Half-point if you said "because chemo is poison." That's what my answer would have been about 2 months ago, so we should all get at least partial credit for being partially intelligent. :) In fact, chemo works by targeting cells in your body that reproduce quickly...which of course includes cancer cells, but also hair follicles, red & white blood cells, the lining of your mouth, et cetera. (And by "target" we mean "poisons to death," hence the partial credit.)

Last week James's white blood cell count was getting pretty low. So low, in fact, that the nurse had to clarify with the doctor that it was still OK for James to receive his full dose of chemotherapy. (It's already low, and then we're going to give you something to kill off even more...I'd ask permission too.) 

But then we asked you all to pray, and pray you did. I think it's only fair to say the best outcome in my mind was that James's numbers wouldn't drop any lower, that he wouldn't get sick in the meantime, and that his numbers would be high enough to do his last round of chemo in two weeks.

Special shout out to any of you who prayed that God would do yet more, even increasing his white blood cell count. (Did any of you pray that audaciously?! If so, bless you!)

Today when James went in for labs the nurse came back absolutely shocked. Just dumbfounded. So amazed she had to comment. James's white blood cell count is now up to 5.5. That is not only significantly higher than last Monday's 3.3, but is even well above a healthy, normal person's (4.5 counts as "normal"). How does that even happen after a week of being pounded with cell-destroying poison?!

Friends, God is healing James, and those of us praying aren't just blessed to see it, but actually are part of this whole story in a rich, glorious way. So, thank you. Thank you for being part of our story. 

Also by way of update - James had a CT scan this morning and will get the results (most likely) on Wednesday. They need to check to see whether there has been shrinkage, or whether there are any new tumors. One doctor said he expects to see things "stable." James's cough and heart rate have become somewhat suddenly and significantly better in the last week, so personally we'll be surprised with "stable," but I guess we'll see. 

In the meantime, we continue to hope in our great and amazing God who hears and responds to the prayers of his children. 

Superman Rocks the Exam

Yesterday we had the pleasure of meeting with James's oncologist, Dr. Gupta. After his traditional "ni-hao" greeting and questions to James about whether or not he is causing enough trouble (extra points for being extra troublesome), and James's ribbing about "feeling abandoned" by Dr. Gupta (who was a good hour behind schedule), we got down to actually discussing James's condition. The highlights...

*James is officially released from worrying about his weight loss. Were James not eating, or it was closer to 15 pounds (rather than 5) that he were losing, we could have cause to worry. Not necessary in James's case. At least for now. Yeah!

*Even with the weight loss, James is still encouraged to exercise as much as he wants. "Do whatever you enjoy. Exercise is a great choice," was the doctor's viewpoint.

*James (and we) should not be too concerned about James's low white blood cell count. Dr. Gupta was even OK with James going to the Indianapolis Carrier Monkey Children's Museum. (Praying that James stays free from illness is still a wonderful way to pray though!)

Going forward, Dr. Gupta's hope is that James will be able to tolerate a third round of chemo (mid-November) as he finishes up his radiation. "I would prefer to be a bit greedy." He believes that the third round will give James the best chance at cure/recovery/remission. We can ask that James's blood work comes back (at that time) to qualify him for that last round.

Dr. Gupta also hopes that through a combination of radiation & chemo James's tumors will at least shrink enough to qualify him for surgery. Given his age and his overall great health ("You are Superman, after all, James"), James would return to the surgeon who did his biopsy & port placement to have the portion of lung that is collapsed together with lymph nodes removed.  Surgery in effect "cures" James, so this is great news to have this as a possibility. (Certainly the radiation & chemo could destroy the cancer so that surgery is not necessary...or it could do next to nothing & we in effect start over with a different chemo drug.)

All in all, nothing bad to report (just a bit of cancer, as we like to say), and lots to be encouraged about. Without a doubt, we are experiencing the power of prayer in our lives. We know that there are literally hundreds of people praying for us all around the world. As a result, James is very nearly symptom free of chemo, and this week his cough has become remarkably better. We no longer feel overwhelmed, and I no longer need 4 cups of coffee (and a nap!) to make it through the day. So much to be thankful for as we see His grace pour into our lives, many times through you all...and certainly through the many prayers being offered on our behalf. We will all have quite the story to tell one day! Thanks for being a part of this - you're awesome!

Round Two

James starts his second week/second round of chemo today. During blood work they found that his white blood cell count is a little lower than they'd like. Thankfully, James is still able to get full doses of treatment. Though we do need to ask that James would stay healthy. Infection is everywhere, so we find comfort in knowing that God is sovereign over the big picture events of our lives....down to the smallest micro-organisms and cells. Ask too that James will stop losing weight. As they say in China, he is eating like a cow (i.e., all.the.time. In large amounts. All the high calories he wants!), but continues to lose. (Sigh. Try not to be jealous, dear reader.)

James is scheduled for his CT scan next Monday - we look forward with anticipation to the results, as it will help doctors gauge how well the tumors are responding to treatment. Those results will also determine how much more radiation James needs. (After next Monday it could be two and a half more weeks...or four.) We're also looking forward to the CT because it will be the first "sure thing" since we've started treatment. Since diagnosis, the doctors and nurses are following protocol with a big question mark over the situation. Perhaps surprisingly, you don't always get answers - any answers - because no one actually knows. It's very strange. No one knows how long it's going to take, no one knows how you're going to feel, no one knows if a condition might arise that will complicate your health terribly, no one knows if you're on the right drugs....no one knows if you're even going to get well. (Certainly no one will tell you "If this doesn't work, we start all over." Or maybe that doesn't happen. Who knows? No one knows!) 

So you show up, and give it to God. And sometimes, especially if you are fortunate enough to be getting treated for cancer in America, you even get a free doughnut. :)

James from his "office," post doughnut. You can see that the nurses have accessed his port and "plugged him in" for his infusion for the day. 

Free from Shedding!

James started...shedding. So, we took him to the best barber in town.

BEFORE

DURING

AFTER

(We had some great shots of James...that I now can't upload, so you get this sunny one from chemo.)

Something to be thankful for - having a shaved head actually makes it easier for James to sleep. His head hurt quite a lot before. This helps. Who knew?! And now, when he tells people he has cancer, he is just that much more convincing! (He really hasn't been looking the part...)

An Uneventful Week Just Passed...

Well, as you probably noticed, the best way for me to make sure I don't update in a timely manner is to say in a previous post that I will. 

Thankfully, this last week passed fairly uneventfully. James finished his first round of chemo and has continued on with radiation. This week he'll continue with radiation which is relatively easy. It shouldn't cause any new symptoms, it's painless, and helps kill cancer. And their waiting room has free Seattle's Best coffee. 

We cannot say enough good about the radiation team. (I promise it's not just the free caffeine talking!) When people come in daily to be "zapped" for 5 minutes or so, you'd think it would be pretty easy to be really mindless about what you're doing. (I mean, not to be crass, but how much attention do you pay to things you put in the microwave on a regular basis?) Instead of just going about their work, however, they are actually paying attention to James and noting if there is any change in his condition from one day to the next. 

Because of their attentiveness, James has gotten on some meds that are helping manage his symptoms, and that has obviously helped him pass through this last week fairly easily.  He's now on a daily dose of steroids to help control his cough; it works better than the cough syrup he was on, and also keeps him lucid. (Bonus!) He has developed mouth sores, a common side effect of chemo, so he now washes his mouth with this weird chemical solution that - of all things - is banana flavored. His tastes have changed too, but he is eating quite a lot - we both feel like it is a lot more than normal. (And chemo has not taken away his ability to eat really spicy foods either!) Unfortunately, he is gradually losing weight, though no one has gotten concerned about this yet. James also tires easily, which is strange for me to see. He is not nauseated nor is he losing his hair, two side effects we were expecting/dreading. James is continuing to exercise a lot too, which is fabulous (and somewhat surprising to his doctors). So, as far as cancer treatment goes, James is really holding up very well. 

Next week we'll start the second round of chemo and will move closer to the awaited half-way mark with radiation where James's cancer gets checked via CT for shrinkage/obliteration. In the meantime, we are just trying to be faithful as we walk this path. We complain less and are more cheery more often, but we get tired. We get annoyed when mentioning a symptom to the doctor means we get home 4 hours later than we planned. We find it just really weird to need medicine every day. And it's a pain to go to the doctor every day (every. day.) (No, seriously. Eeeeeevery day.), and to know we're not even half way yet. Nor do we even have confidence that any of this is actually working. That's strange, right? 

So, we need your prayers. We do have confidence that God is at work, no matter what the tumors are or are not doing. We continue to be at peace with whatever God has for us. And our hearts continue to grow in "being still" - which for us has a lot to do with just being OK with where God has us for this season. We are thankful for the care James is getting - through doctors and through you all, who continue to pray, email, and send cards and meals. Thank you so much for your faithfulness. You lighten our load, remind us we are loved, and strengthen us to keep on going. We couldn't ask for anything more! Have a great week, and we will do the same. And who knows - you might even get an extra blog post to surprise you. =)

The Verdict Is...

...only one life-threatening condition at this time. Just cancer, no pulmonary embolism. Yeah! 

I am sure we will see Dr. Gupta, the oncologist, tomorrow, where he will tell me that James just needed some extra attention over the weekend. =) 

James is asleep. In his bed. At home. No weird Cold Stone smell. Things to be thankful for. 

I will try to keep posting this week. With just one day of chemo and the other days 15 minute radiation appointments, there might not be much to report. Though we are looking forward to a lighter week. Just keep asking for health and healing. 

Thanks, all.

Sunday Update

Guess what? I'm sitting on a little stool in a too-cold room in...the ER (which, oddly, smells to me like Cold Stone Creamery. Is it the smell of AC or do they use the same disinfectant? Or, is there a secret stash of waffle cones and Oreo crumbs in the box we mark "linens only"?!). James is lying in the bed nearby with a too-high heart rate, a severe headache, aaaand...a cough. 

Chemo and radiation went GREAT this week. They really did! James had very few symptoms, other than a few annoying weird ones (like 72 hours of non-stop hiccups). He has been able to walk & even sometimes jog on the treadmill where he found symptom relief. He is eating great. (By the end of the week he was down a pound, though. Indicative of too much exercise, we think.) His oncologist called him Superman, and criticized him only for not giving the nurses enough grief. If we needed cause for a bit of optimism, by the end of the week James was able to sleep on his right side (where his tumors are), which doctors agreed was "a positive sign."

By Friday night though, he was unable to sleep. He spent most of yesterday bumming around, feeling not-so-great but not wanting to nap in case that would trigger another night of sleeplessness. Today, sadly, James has described as "hell." He has had horrendous head and neck pain (where even resting his head on a pillow hurts) and an unstoppable cough that has left him shaking, gasping for air. 

I was finally able to get him to agree to taking a Vicodin late this afternoon, before heading to the ER. And so, of course now, James feels much better and is actually sleeping soundly. The first rest he has had in a while. Before nodding off, he asked me how much pain medicine he has had today and looked incredulous when I said I offered it hourly but that he kept denying both pain and pain meds. He was so dumbfounded that I had to tell him a second time how today went. Just before falling asleep he said, "What an idiot (to refuse pain meds)." 

Now, sadly, since we are in an ER, we are captives until they check for pulmonary embolism. Apparently when you mix "recent" air travel with lung cancer, this is what could be threatening your life. Fun times! 

Thanks, as always, for the continued prayers. You all are fabulous! James has one last chemo treatment tomorrow (a six-hour infusion) before a two week break from chemo. His radiation will continue daily for the next several weeks. 

Have a great night and a good week!

love,

~kristen

And we laughed...

A grandma, a black woman, and a Chinese guy walk into a waiting room...

Almost the start to a really good joke, no? (Never mind the white girl who's busy spilling her coffee on the hospital couch. She's just there for comedic effect...) 

Such was our life yesterday (Friday) as we waited for James's radiation appointment. When James started coughing (somewhat violently, though admittedly we are both getting a little immune to its severity), the black woman started audibly calling on Jesus. James's cough subsided and then the four of us ended up having a rather lovely conversation about God, cancer, and life when those things intersect. We were the only ones in the waiting room, and what happened there among us is probably difficult to understand for those who are not Christians. But, we rejoiced. We exalted God and what He is able to do in the midst of our greatest trials. We brought to mind how He graciously speaks to us in the midst of our deepest fears. We praised His almighty power to heal. We expressed gratitude for what He is already doing, and reminded each other of the peace we have as His children who have already been rescued, redeemed, and bought for eternity. We laughed. We, through faith, turned a depressing, sad little corner of the world and filled it with joy, hope, and love. 

It was, by far, the nicest time I've ever spent in a waiting room. I can only hope to enjoy more like it. Altogether not the worst way to spend a Friday.

This Made Me Laugh Today

p.s. James is doing great. 90 minutes of chemo really IS easier than 360 minutes of chemo. 

One Down...

Just a quick post before I hit the sack. James went through his first BIG round of chemo today with flying colors. We are so thankful that (most) everything went well. We were in the "infusion room" for a good 7 hours today, and got to know James's nurse pretty well by the end of the day (along with the cheery septuagenarian who "fought" James for bathroom visits). James enjoyed passing the time with one of our new friends, a pastor at church and former missionary to India. 

James was first prepped with pre-meds which include anti-nausea meds as well as a diuretic (the idea being that if we flush the kidneys with enough fluids, we won't experience renal failure while killing cancer). He then went on to receive liter upon liter of fluid & chemo. The nurse did comment on how great his port is working - yeah! Will be a big deal as he continues treatment as chemo is really harsh (understatement) on your veins. 

Lest you feel too sorry for him, when the nurse told us that he could have lunch brought in, his dear wife went and got him a steak dinner to enjoy while he sat in his recliner, which he thoroughly enjoyed. I did feel a twinge of guilt mixed with awkwardness though - I figure everyone else was either made ill by the sight and smell of his lunch, or...those further down the road were all thinking, "you newbie suckers! You will live to regret THAT choice." Fortunately for James, the steak has stayed down. No regrets.

Toward the end of the day, James did start to feel nauseous, which is not (yet) a side effect of chemo, but rather the side effect of the gallons of fluid in his system. He got really pale (perhaps only loved ones can recognize "pale" on an Asian) and nearly passed out. His vitals were checked a few times, he was given time to rest, and then was wheeled out of the hospital, too unstable to walk. After more rest at home, he bounced back to more of his normal self, calling home to give an update and then walking for about an hour. He has already been asleep for a few hours tonight...just in time to wake up and do this again tomorrow. 

Tomorrow will be -should be - much simpler as James will only get 2 hours of chemo. Far less fluids are needed tomorrow, so it should be a relatively "easy" day. Of course, I don't know how he'll wake up feeling in the morning which would influence how "easy" it is. He also has his first radiology appointment tomorrow.

As you pray for us, continue to pray for my family who are providing child care, meals, and support on a daily basis. While James was getting treatment today, family member A got a flat tire while visiting at the hospital, family member B came to fix said tire, while C stopped watching our kids to pick up the two first graders, meaning family member D quit work early to watch the other 3 kiddos. I can see that without prayer, this whole situation can quickly spiral into a level of insanity we aren't accustomed to. I can also say a genuine shout out to those providing meals - it is a ministry, for which we are truly grateful. Thank you all!

Lots of love & goodnight. 

~kristen

Care Calendar - A Guest Post

This post is written by our dear sister in law, Mandy Horn, who is coordinating a lot of the care for us Hes. She wrote specifically with our church members in mind, but asked that I post it to the blog to include as many of our friends as possible. 

Thank you for continuing to pray for James and Kristen along with our family as they begin cancer treatment! I promised to pass along a care calendar once we had a better idea of what the next few weeks hold. While we are still waiting for James’ radiation appointments, we have put together some initial needs, mostly meals. We will continue to update the calendar as we better know the schedule.

http://www.carecalendar.org/logon/193011 and enter 
the following information in the appropriate spaces:

    Calendar ID  :  193011
    Security code :  9557

Right now, we have meals set up for “the family” as a whole, which includes James and Kristen, Kristen and Steve’s parents, and Steve and myself. This allows all of us to more easily cover the other care needs (school, James’ appointments, child care, etc.) and rest on the heaviest schedule days (Mondays in particular). It would also be a blessing simply for us to get to eat and be together as a family. We know that is a lot of food…we have already had some families partner together to do a meal and that has worked out really well. For those uncomfortable cooking for a crowd, we are also easily able to use Costco or Meijer gift cards to pull together easy meals that don’t really require much on our part. Because we don’t live on the northside, we are happy to pick up meals or things at church so that you don’t have to get your passports to come visit us. J(Though it really is usually only about a 30 minute drive…)

Some of you have asked for ideas just on how to bless James and Kristen. Gift cards to Costco, Meijer, Target, Amazon, and Itunes are the easiest and allow them to get special treats for themselves or the girls. They would also love to hear from you and see you. As we settle into the schedule, they would love prearranged visits during some of their long hours at St. V's hospital.

Thank you so much for your continued support and love for our family. We greatly appreciate each of you.

Ever in His loving care,

~Mandy 

Prepped and Ready

James has spent this week getting prepped for cancer treatment. On Tuesday we met with the radiologist who first expressed sympathy for James's diagnosis and then continued to be upbeat about James's treatment. (Truly a special breed of people who are a) brilliant enough to be doctors b) compassionate enough to deal with cancer patients and c) "odd" enough to be upbeat and positive among people who are often scared, depressed, or even, sometimes, dying.)  We all had a good laugh together when the power went out. The three of us were sitting in complete darkness while we waited for the doctor to get out his phone-flashlight. I told him it made us feel really at home to have the power go out and that we'll remember our "China-moment" with him for a long time. 

James came home from that appointment marked up with Xs all over his chest, back, and stomach and special instructions printed in bold on his discharge notes, "DO NOT WASH OFF MARKINGS." (I am still trying to imagine the special kind of person that reminder/rule was written for.)  

The radiologist will finish mapping out James's tumors early this next week (not to be a jerk to radiologists, but this is apparently a very complicated process...shows how daft I am), and then James will be scheduled for those daily treatments.  James will have at least 33 radiation treatments. The radiologist believes that thankfully, James will not have symptoms from radiation until about half way through. After 20 treatments, the radiologist will reassess (via CT) and determine how much more radiation James needs.

Yesterday James had his port placed for chemo and blood draws.  It involved two small incisions in the upper left corner of his chest. The port is placed under the skin with tubes feeding into his veins.  Right now it's just a big bulging lump under his chest, but starting Monday, it will allow for quick hookup to chemo and keep him from having IVs put in, or having to be poked for routine blood draws. It is very painful, though James is not one to complain.  He seemed to be doing so well this morning that I asked, "Does it hurt?"  He responded, "How could it not?!"  Good point. 

We continue to be thankful for all of your prayers and emails, daily reminders of God's grace to us in this time. We are all trying to adjust to this new normal - not only of spending a great deal of time at the hospital meeting doctors, getting poked, sliced open, or drawn on, and/or drinking bad coffee with bad TV...but life in America too. So much has changed that it's truly hard to believe that just a month ago I was drinking genuinely delicious coffee in our restaurant made by our staff while my kids played with their toys in our house with their friends. Most days it feels very hard on most of us to have given all of that up, at least for the time being. We find ourselves continually surrendering ourselves to God and His plans for us, trusting Him to bring very real good out of this bizarre and difficult season of our lives. We know He will and wait expectantly to see more of Him.

Heading Towards Treatment

I apologize for the delay in letting you all know the latest.  I know that many of you are praying daily for us and knowing the latest helps you pray more effectively. Thankfully God is outside of time, so you can "backorder" some of your prayers now.  Ha! It took me a couple days to a) get some sleep and b) figure out the best way to keep everyone updated across various churches, time zones, states, continents, languages, et cetera!

It has been about a month since we first started planning our trip to Bangkok which led us to James's initial cancer diagnosis. Throughout this whole process, God's hand has been so evident, especially in who we see for treatment. It was true in Bangkok and has continued to been true in Indianapolis. Orchestrating who we see has been one of God's many kindnesses to us, and it brings us great peace. From Dr. Yongyudh, the Chinese pulmonologist who had dinner with us so we would "feel at home," to one of the top thoracic surgeons in the nation performing James's lymph node biopsy, to the nurse who was a former missionary to India...these are not coincidences. They are planned events, orchestrated by God's great lovingkindness. We are thankful.

Thanks in great part to your prayers, on Friday we saw Dr. Niraj Gupta, an oncologist and our new best friend. Dr. Gupta's approach is a perfect fit for us - he is incredibly compassionate while at the same time on top of the latest research in oncology. He is also not overly cautious in terms of giving James a lot of restrictions ("play with your girls!" "go for a run" "eat what sounds good to you"). Not having to second guess yourself ("Is this going to kill me?") will be incredibly freeing. He stated that we will be treating James's cancer in an "aggressive and expedited" fashion. Like all the other doctors, he commented on James's great overall health and strength, which naturally influence what one is able to endure. So here's the plan (it's a doozy!)...

James will have chemotherapy together with radiation. All previous doctors have said, "and probably radiation." We are truly thankful James will get radiation together with chemo, because that gives the best outcomes with this type of cancer. Chemotherapy is on a 3 week rotation (1 week, every day, and then 2 weeks off.)  Four of the six chemo infusions will be about 90 minutes; 2 of them will be 4.5 hours.  Radiation treatments will last for approximately 15 minutes every day for the next 5-7 weeks. After the 5-7 weeks of chemo/radiation, we will wait for 2 weeks with neither chemo or radiation and then check on the state of James's cancer. And then we go from there.

To be honest, after hearing how overwhelming the initial oncology appointment can be, I expected Dr. Gupta to be very clinical and grim. He was not at all.  We laughed together several times and we were encouraged by his upbeat, confident outlook.

This week James will meet with the radiologist (who "just so happens" to be a friend of a dear friend of ours who has visited us in China) who will map out James's tumors so they can radiate them all.  (I don't know if I ever updated you all to say that James has several tumors, the largest two being close to ping pong ball size.) James will also return to the biopsy surgeon to have his chemo port installed.  "Real" treatment starts a week from Monday, on September 29th.

As you pray for us, pray that James would get some relief from his cancer symptoms. His cough has only gotten worse over the past month, he has back pain (lower back from coughing, upper back from tumors), and has killer headaches at night. Dr. Gupta is optimistic about these symptoms subsiding as James undergoes treatment (to be replaced by others, perhaps...but hopefully less painful ones).

Thank you, all!
The Lord your God who goes before you will Himself fight on your behalf, just as He did for you before your eyes, where you saw how the Lord your God carried you, just as a man carries his son, in all the way which you have walked until you came to this place.
                                                                                                                       --Deuteronomy 1.30, 31 

Clarifying the Diagnosis in Indianapolis

Writing from my parents' kitchen table. We made it safely back to Indianapolis a little over a week ago and are now mostly over jet lag. Since we've been back the girls have all been to the pediatrician, Lydia has started school, and James has had a lymph node biopsy (a fairly significant surgery).

The doctors were hopeful that James's lymph nodes would be clear of cancer, as 50% of the time they are benign (even though they look malignant on the PET scan).  Knowing the state of the lymph nodes is key as it not only diagnoses James's cancer stage but also dictates the treatment regimen he needs. 

The surgeon just called to let us know that, as suspected, James's lymph nodes are malignant. The biopsy results do not appear to have changed James's cancer staging.  They did biopsy lymph nodes from the left side and, thankfully, all cancer is contained to his right side and mid-line. The surgeon's office will put us in touch with an oncologist who specializes in lung cancer so that James can start treatment. He will need chemo and most likely radiation.  We will have a lot more questions answered when we meet with the oncologist. 

We are all doing well - we have expected "the worst" as we believe God is going to be most glorified in miraculously bringing James through this. We are thankful, though, that the biopsy doesn't appear to have changed James's cancer staging to a worse stage! =)

We so appreciate your prayers & encouraging emails. We do hope to start treatment sooner rather than later, so please pray towards that end.

If you're in the area, James (and I) are up for visitors - contacting us via email is a pretty effective way to get in touch. 

"This Adventure is About to Get Interesting..."

As James has said today, this adventure is about to get interesting. =)

We had several more doctors appointments today and were hoping to get a clear answer on where James should have surgery. Then we met with the doctors, and it became very clear what we need to do. James has been diagnosed with Stage 3a lung cancer. Surgery is actually not an option at this point, according to the doctors we are meeting with. James's best treatment option is a combination of chemo and radiation. We can be thankful that treatment is an option, even though it is not the treatment we expected or wanted.  (The surgeon drew a very fine line between where James is and where treatment stops. We can give thanks that we're on the right side of the line!)

We did receive some good news today - James's bones are free of cancer...his bone marrow looks great, which means he can handle the chemo. That was our last appointment today which was nice, since the previous three went from bad to worse. (I joked that we best stop seeing doctors, since each one told us something worse than the previous one!) Good to end on a high note. =)

James is in the process of getting all of his hospital records and will leave Thailand on Thursday morning. He will arrive in Indianapolis on Friday. I am leaving tomorrow, heading to Dali where I will pack up and pick up the girls. We are working on flights and hope to leave on Friday morning. 

I had a chance to skype briefly with the girls and as they were hugging each other, jumping up and down that I am coming home tomorrow...I then told them that when I got home we needed to pack up to go to America. Lydia said, "Oh, mom, thank you for planning a trip to America for us!" So they are excited. 

We don't yet have details regarding James's treatment plan, so it's hard to guess how long we will be in the States.  I am sure we are looking at months, anyway. We hope to start meeting with doctors next week (folks in Indy are working to track down a great thoracic oncologist & set up appointments). Treatment needs to start within the next two weeks.

I am sure your creative minds can think of many things to pray for regarding this whole situation, so I'll not write them out (and return to packing instead). Thank you for praying for us! 

We rest in the hands of our Savior and Father, who alone has the power to raise the dead.

Diagnosis - Lung Cancer

Hope this finds you well. We so appreciate all the kind emails, prayers, and love on our behalf. Certainly makes it easier to go through this sort of thing. We feel very much upheld by God's grace on our behalf. 

Things are moving forward for us. We had lots of doctors appointments today. Long story short - James has been diagnosed with non small cell lung cancer (squamous cell, poorly differentiated, for all you medical people! =) ). It is a little unusual, as this is not the type of cancer you usually find in young, male, non-smokers. This type of cancer is somewhat aggressive, but not as bad as some others. 

The amazing thing is that because of the location of the tumor - in his bronchi, which resulted in a cough and a collapsed lung - we were able to get this diagnosed while the tumor is still small. Many times, this kind of cancer would be on the lung tissue, growing for years before symptoms materialize. (And then, obviously, prognosis is not as good.)

The plan is for James to have a full body PET/CT scan, an MRI of his brain, and a pulmonary function test. This morning he had a bone marrow biopsy as well. (Thankfully a lot less freaky than that one they did on House a few years ago!) This is all the doctors being proactive, making sure that James is a good candidate for surgery and that the cancer has not spread. The doctors are hoping that everything will be clear, and are believing that we caught it early. It is possible, though, that the tumor metastasized to his brain or other organs. (It would be very rare for an endobronchial tumor to be metastasized from somewhere else though.)  Obviously we can pray that the cancer is contained!

James will be getting tests over the next 3 days and will be getting results by next Wednesday or Thursday. Our team of doctors want to operate as soon as possible, performing a lobectomy. (The pulmonologist said "For you, I choose the best surgeon." I asked if he was sure he didn't want to find someone off the street, just for fun. He stopped smiling and said, "No, no, we must have good one. I choose the best.") (Sorry, couldn't help myself.) They will remove James's right middle lobe (FYI the best lobe to lose, if you ever have to choose). 

After surgery, James will be hospitalized for about a week and then he'll be able to return home a few days later. (Assuming everything is clean & contained.) The hospital is helping James extend his visa (Chinese only get 2 weeks on arrival; Americans get a month). The visa extension will not be a problem. We are looking into the possibility of living at a mission organization's guest house. And our insurance is working beautifully. James has been able to communicate with his family and miraculously, even though he told them he has cancer, they are doing OK. ("Cancer" is a death sentence in China, so extreme anxiety would be normal.)

Currently our most pressing need is that we need wisdom to know what to do with our girls. I don't yet know enough to feel comfortable leaving James here on his own. But being away from our girls for 3 weeks seems a bit insane/intense for us, our girls, and our friends/family taking care of them. Please pray for us, our girls, and our help as we sort this out. Lydia starts school Monday.

Sorry for a somewhat boring update - a lot of details. But we are so thankful. God's protection, provision, and kindness can be clearly seen through every circumstance of this ordeal. We are amazed. 

"Prognosis is Excellent"

Made it back to the hotel after an afternoon spent at the hospital. 

After yesterday's good news, here's impetus to keep praying. 

James has a lung tumor. There is a 90% chance it is malignant. (Whew, that is tough to write; I am sure it is not easy to read either. Sorry!)

Dr Yongyudh, the pulmonogist who did the bronchoscopy, has sent the biopsy to pathology. He called me to his office to show me pictures from the bronchoscopy and to tell me the diagnosis & treatment. I asked, "So, the prognosis is...good?"  He said, "The prognosis is excellent. EXCELLENT. Do NOT worry." Then he asked me about James and I, and told me about how much time he had spent in America to reassure me of his skill, I guess. He later found me in recovery to reassure me again that everything is going to be OK and to please not worry. (Such a kind doctor.) 

He is recommending that James's right lobe be removed. He is also recommending a PET scan and MRI to ensure that the tumor is contained, which he believes it is. (Why prognosis looks so good; cut it out and move on, apparently.)  James's lungs will expand over time to regain capacity. 

He says treatment will be 2-3 weeks. Not so bad, but I told James this was really poor planning on his part. It would have been much better if he had gotten sick last year when we didn't have much going on. =)

Oh, for trivia's sake - I asked whether this was normal, Dr Yongyudh says this kind of problem is not to be unexpected given the pollution/second hand smoke James has been around his whole life. Jeepers. 

We will meet with the doctors on Saturday and will have a lot more information on what the exact course of treatment is. 

Again, thank you all for praying, especially as we sort out what to do with our lives for the next few weeks! 

Reasons for Optimism

First, thank you all for your prayers, they have truly strengthened and encouraged us during this time. We are doing well; we understand the girls and the restaurant are also good. :)

We met with Dr. Theera this morning for some good news. First, he had been very concerned about James's x-ray bc it looked like lymph nodes were already affected. Great news - all clear on the latest x-ray. Awesome news.

Additionally, James's blood work is clear - no cancer markers present. Fabulous.

Finally, pathology says nothing to indicate cancer from the first biopsy. Sweet. All they can see is chronic inflammation.

Dr. Theera was so happy to see James's work come back looking so good. If possible, he was smiling even more than the first time we saw him.

We just saw a pulmonologist (who incidentally escaped from Ch!na in 1950, fascinating story, and spent 30 years in Cincinnati, less fascinating, LOL). He has James scheduled for a bronchoscopy tomorrow where he says, "this time we won't miss it. We will get a great sample." 

We asked what the possibilities are. He said we have no way to know until they get in there. Cancer remains a possibility, and our old friend TB is back on the table bc of where we life. Then he said, "Whatever it is, we can treat it for sure. It is so small." (Dr. Pulmonology shares Dr. Theera's buoyant optimism.) It does sound like surgery is most likely in James's near future - Dr. P wants to cut out whatever it is. Fun times. 

James will have the bronchoscopy on Thursday 3pm Thai time. Pray that they really do get a great sample for pathology to work with.. The bronchoscopy will most likely make James's coughing worse. It's very hard for James to get over his back pain with the cough. Ask that it doesn't make his coughing/back pain too severe.

We will return to Dr. Theera on Friday at 9am. Let's continue to ask that this is something weird and simple to treat - either with drugs or a knife. Let's continue to ask that it's not cancer. 

And, just because God can handle our selfish requests, I would like to be back in Dali on Sunday night at the latest; Lydia will start first grade on Monday morning at a local school. If our other prayers are answered, this one doesn't seem that outlandish. :)

Thanks so much, everyone. We so appreciate each and every one of you!

Towards a Diagnosis

I am sitting in Bangkok, having just left Bumrungrad Hospital with James. We visited today with Dr. Theera Umsawasdi, a thoracic oncologist.  He is a lovely man, quite upbeat for someone who deals with cancer patients for a living. (Maybe they are all that way?  But I would be sooo depressed.  =)  ) 

James has not been diagnosed with cancer, though there are a few things that make Dr. Theera suspicious. James has RMLS (which is a partially collapsed lung). He also has a small growth in his lungs (less than 1cm).  And his X-ray has a bit of cloudiness that makes him concerned.  (He was more concerned with the Xray than the CT scan.)  He has has had a persistent cough for 8 months.  

Given James's age, gender, and non-smoking history/health, there are lots of things that don't add up to cancer. So, as Dr. Theera says, "It is still quite early" (with a beaming smile).  

So, we are doing some additional tests.  Today James had blood work done and urinalysis.  He also had a chest X-ray.  Dr. Theera sent James's biopsy slide (which he had done in Kunming) to pathology.  He would like to see if they can get a definite positive or negative read for cancer based on the slide.  If not, James will have another bronchoscopy. 

James will see Dr. Theera on Wednesday at 10am Thai time and we'll go from there. 

In the meantime, please pray for us!  Pray for a quick diagnosis.  And golly, we would love if it was not cancer, so you can pray for that too.  =)  Pray for our girls, they are all in the care of friends/relatives back in Dali.  And pray for our staff, that they will all work together well in our absence.