Peter Witkowski Memos

The Threat of Liver Failure: April Update 5.25.22

Editors’ Note 5/27/22: Since the posting of this blog, April has undergone another paracentesis. Doctors have removed more than 7 liters/14 Lbs of fluid from April’s abdomen during the two procedures. And still her abdomen continues to swell. April returned home on May 27 because we can duplicate the care that she was receiving in the hospital through prescription medicines and outpatient paracentesis procedures. The days ahead will be long and hard. Their outcome is anything but certain. But April is home. We rejoice in small mercies.

The last few weeks have unnerved us.

What started as a race to avoid a week or two of inconvenient breast cancer symptoms has become a race for April’s very life.

Last Week

As many of you know, April went into the hospital on Monday, May 16 because of some slight bloating which evidence the very early stages of liver failure. The visit proved to be more precautionary than essential to her care. Given the slight deterioration of her liver and quality of life, her medical team decided to respond more aggressively to her new breast cancer growth. They abandoned the Xeloda chemo pill during that hospital stay and began giving her the IV Chemo drug gemcitabine. After her first receiving her first dose on Wednesday May 18, April was discharged from the hospital. We still believed we had an upper hand.

This Week and Today

By the following Sunday, May 22, I was sneaking out of church early and running April back to the ED because she had spiked a high fever. Guessing that she had an infection (a suspicion that was empirically proven today and that is being successfully treated), the ER doctor admitted her to the hospital on Sunday night. While receiving antibiotics for the infection, April’s abdomen continued to swell to the point that she took on the appearance of a full-term pregnant woman. The other day, a well-meaning cleaning lady clumsily asked April, “You, have baby?” We chuckled at the thought. But alas, she faces something far more serious. The abdominal swelling (which has caused her so much pain over the last 48 hrs.) and her high bilirubin numbers has indicated that her liver is failing and could fail.

Though the doctors can and have performed and will continue to perform a procedure called paracentesis which removed 3.25 liters of fluid from April’s body and reduced her level of discomfort on Tuesday, May 24, her abdomen has already returned to pregnancy size as of this writing of the post on Wednesday, May 25. To cure her liver and to reverses the symptoms associated with her poor liver function, her medical team must find a medication that will shrink her tumors and not further aggravate the compromise state of her liver. This afternoon, April switched to her third treatment plan in as many weeks and received the first dose of the chemotherapy drug Adriamycin (happily nicknamed the red devil). She will take the IV chemo drug weekly. If all goes well, her liver function will begin to improve over the next 2-3 weeks, and she should be discharged from the hospital this weekend. If her breast cancer tumors do not respond or do not respond quickly enough, her liver will fail. Her race will end.

Though the stakes have been raised, April possesses a great desire even in the midst of great pain to keep running this race. As she said earlier today, “I never thought I would say this, but I want to start chemo.” She wants to embrace drugs that will punish her stomach, cause hair loss, and possibly damage her heart. Though exhausted, scarred, and worn, onward she goes…onward all of us go along with her in hopes of a better tomorrow. And yet the reality of the moment is not lost on either of us. Either the chemo will destroy the tumors, or the tumors will destroy her liver. The next days and weeks will prove decisive.

How to pray

Our prayer today is simple, “Lord help us.” Pray for God to restore April’s liver. Pray for us, our children, and our families to find our hope in the things above….in the steadfast love and faithfulness of our God and father. The days are long, hard, and unsettling, yet are God is good, loving, and powerful. May God be merciful us.

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Peter Witkowski Memos

New Growth: April’s Cancer Update 5.15.22

Editor’s Note 5.20.22:

(Since the posting of this blog on Sunday, April’s bilirubin numbers have increased and indicate her liver is slowly failing. Acting on an abundance of caution, her medical team admitted her to the hospital on 5/16. She left the hospital on Wednesday 5/18 after receiving Gemcitabine, an IV Chemo that packs more of a punch than Xeloda. We will visit with her medical team next week and post an update then, seeking to make sense of all that has happened this week.)

We do not like bad news. And yet it is once again our currency. April’s latest scans and blood tests reveal that her cancer has once again out maneuvered her treatment regimen and has begun to grow freely. To stunt this new growth, April will take a new chemotherapy pill at the beginning of next week.

What Happened?

As the pictures on our various social media platforms make clear, this news blindsided us. Though April has had a few bad days this past week, she had regained increase mobility and strength over the last few months. She has played chauffer to our kids, cooked meals, fixed hair, helped with homework, and done many of the things that give her and all of us a taste of what life was like before cancer invaded. Perhaps even more remarkably, April completed her main physical therapy goal of walking more than a mile at a historical site. A few weeks ago, she toured Jamestown, Yorktown, and Colonial Williamsburg like a pro. She never showed the signs of extreme exhaustion and fatigue that defined her while she was on her intravenous chemotherapy regime. Despite some digestive issues (which could be noticeable at times), April seemingly had reached one of those restful plateaus within her cancer journey.

Given our most recent experiences, both April and I anticipated that her May 3rd scans would bring tidings of health. But as we all now know; those scans and the ensuing blood work would cruelly shatter our expectations. First, the scans came back showing shadowy images which suggested that the breast cancer tumors in April’s breast and lymph nodes had grown, and that a new tumor had formed in the kidney closest to her liver. To bring clarity to these images, April’s Oncologist ordered new labs to be drawn. The results of her blood work which measure tumor markers and liver function revealed that the shadowy clouds in her scans are most likely not illusions but the very thing itself. If the cancer has not grown in the spots identified in the scans, it is growing somewhere with enough force to bring deadly harm. In short, the breast cancer cells that have brought so much harm to April’s body and our lives since 2019 have once again begun marching forward bent on even greater destruction.

Thankfully, the effects of this new invasion have only just begun to materialize. This week, April’s liver produced the first signs of abdominal swelling and pain. Though the threat of additional symptoms remains forever real, they have not yet arrivied. Seeking to begin the new treatment before those effects poke significant holes into April’s quality of life, her medical team decided that she should begin taking the drug Xeloda at the beginning of next week. If the drug works, April will take three pills twice a day for two weeks. She will then take a week off. The two weeks on and one week off cycle should be able to combat April’s cancer for the next 6-8 months.

How Are We Doing?

In one sense the news of tumor growth has not shocked us. Intellectually, we both know that April’s cancer will spread, and that each treatment has a limited shelf life determined by the genetic composition of April’s cancer. And yet in another sense, the news does carry with it a certain amount of shock value, forcing us once again to think about this evil disease and the fragileness of life. Moreover, transitions between treatments prove to be an unsettling experience. Neither the medicine’s effectiveness nor its side effects come with full prove guarantees. The first 2-4 weeks of these transitions often contain a series of surprises and unanticipated twists. Few of them are good. For example, one Xeloda’s more prominent side effects is hand and foot syndrome which produces large sores in one’s palms and the soles of their feet could. April could soon struggle to walk and do simple household tasks. Though expected, the transition between treatments wearies our souls. We’d rather not go through the process of deconstructing today’s normal for the purpose of constructing a new normal that promises to be at least a little more difficult than the one we just tore down. We dislike such devolution.

And yet we remain hopefully. From a medical standpoint, April still possesses many other treatment options. Though life may get harder faster than we had anticipate, this news does not point to the end of April’s life. Her overall outlook remains unchanged.

Most importantly, our God has not changed. We know from Psalm 86 that the effectiveness of our prayer comes not from our power to persuade but from our need. The psalmist writes, “Incline your ear O Lord and answer me for I am poor and needy.” Thankfully our God who controls the stars and determined the fate of the dinosaurs still cares deeply about April, having numbered every one of her regrowing hairs. At times this week, our hearts have been very low. And our souls have felt the stresses of the moment. But our God has remained forever great. There is no one like him among the gods. Thus, we turn to him afresh, trusting that he will help us and comfort us even when we feel surrounded by cancer. Our God is gracious and merciful today just as much as he was yesterday. We look to him for hope afresh.

Prayer Requests

As always, we invite you to pray for us. Pray that the new chemotherapy pills will shrink April’s breast cancer tumors. Pray that Xeloda will last the full 8 months. Pray that the drug takes effect before April’s new cancer symptoms settle in and that her side-effects will be minimal. Pray that the Xeloda pills provide April and me with a new normal that will allow her to freely walk, do housework, and homeschool our kiddos for at least one more semester. Pray for God to give us patience with our children when the days are long, and the cancer symptoms are present. And pray for God to bless us with the wisdom that we need to navigate these times of uncertainty that begin with April’s cancer’s and yet possess the power to shape most every aspect of our lives. Come talk to the God of mercies with us.

Thank you!

Other Frequently Asked Questions

Contact Info

EMAIL US AT: BIBLEFIGHTER@GMAIL.COM 

SNAIL-MAIL: P.O. BOX 158/ AMISSVILLE, VA 20106

CALL US AT: 540-937-6159.

SUPPORT US AT GOFUNDME.COM: APRIL WITKOWSKI MEDICAL FUND

Peter Witkowski Memos

An Appreciation of Mr. Sam Ruble

My first conversation with Mr. Sam Ruble revolved around the topic of cows and stoplights and how the cows outnumbered the people and the people the stoplights in Rappahannock county. In the four years since that first meaningful conversation, I have come to realize that our brother truly knows more than a thing or two about wrangling cows, taking down bucks, and rebuilding limbs. Sam knows the outdoors well, but he knows people even better. 

He knows how to make the forlorn and neglected feel welcome. He knows how to love those who have lost a loved one and readily sheds a tear here and there for the many fishing buddies, family members, and friends who have already transferred their membership to heaven. He also stands ready to rejoice with those who get good medical news or who take the first steps towards adulthood or career success. A large hug, a quick joke, and a warm smile are never more than a moment away. Our brother loves us well.

 I can say this as both his pastor and his friend. It was Sam who drove us around when April and I first came to the hills of Rappahannock county. It was Sam who took me on my first hospital visits. And it was Sam who helped my son catch his first fish and visited us when cancer raged in April’s body.  

In one sense, the loving character of our brother and of his bride, Mrs. Karen, needs no description. Without fail every new member going through our membership classes since I arrived has made reference to you guys. Some perspective members struggle to recall your name. But once they start talking about how this one slightly older couple welcomed their family the moment they walked in the door and how this couple was so nice, friendly, and kind, I need only say, “Oh, you mean Sam and Karen,” before I hear, “Yes that’s the couple, I really like them.” Sam and Karen, thank you for loving us well. 

I know that your love for us has cost you a few gray hairs. If nothing else my inability to spell your last name correctly in the bulletin and on official church documents has surely added at least one extra gray hair. 

You have also weathered some of the darker days of this congregation’s history. But instead of leaving, you both stood firm and do what you do best. You loved fiercely. You faithfully made phone call after phone call, brought meal after meal, pumped out water system after water system, visited member after member, and went to doctor’s appointment and after doctor’s appointment. Whenever the phone rang, you stood ready to serve. Undoubtedly, you earned some of your grey hairs at ABC. But these little reminders of times past are not a curse but a sweet blessing, a testimony of how well you have loved the men, women, and children of ABC. Proverbs 20:29 reminds us that,

The glory of young men is their strength, but the splendor of old men is their gray hair.

Sam and Karen we are thankful for those gray hairs that crown your head. I am here because you guys loved well. Pretty much everyone at ABC today and watching online is here because you loved the Lord your God with all your heart soul mind and strength and your neighbor as yourself. Thank you! 

Thank you for pressing on and for making the most those opportunities to do “good to everyone especially of the household of faith (Gal 6:9).” Sam and Karen as you look out on the congregation today full of happy faces, I believe you are seeing the first fruits of your labor. Our church is what it is today because hundreds of people have been able to identify you with the hands and feet of Jesus. Thank you!

Though Sam is stepping down from our deacon board today, I still affirm that he possesses the heart of a deacon. He has not grown weary either of us or of our great God. But our Lord has placed physical limitations on our brother that prevent him from continuing on as a deacon. No ministry is forever. We are all but stewards. We must all step aside at some point.  Brother you have steward your time on this deacon board well. You leave behind a legacy of care and compassion. We will miss you.  

Yet, we will not leave you adrift on the pond of boredom to watch the Sunset. God still has much for you to do and we will look forward to ministering beside you in the days ahead. The parameters of your service will change. But I fully expect you both to go on deaconing and serving the church until Jesus calls you up yonder. Sam, I also suspect you will rightfully be one of our deacons most trusted advisors in the days ahead as you know both this congregation and our Lord and savior well. As Paul told Timothy,

For those who serve well as deacons gain a good standing for themselves and also great confidence in the faith that is in Christ Jesus (1 Tim 3:13).

Brother by God’s grace, you have achieved such a standing at ABC.

Thank you for standing firm in the faith. Thank you for loving my family well. Thank you for loving all of us well.  

Brother, there may be more cows than people and more people than spotlights in Rappahannock county, but I would be hard pressed to find either a cow, or stoplight or even another person who has loved us as well as you and Mrs. Karen have. 

Thank you, Sam and Karen for your 18 years of faithful ministry. May God bless you richly in the days ahead!