Yesterday, we encountered words that every soul dreads, “Do you want to continue treatment?”
Last week, April began her second chemotherapy treatment plan in as many weeks. According to the results of April’s latest blood work, her cancer has responded positively to her one dose of Adriamycin. However, the drug has not improved her liver function. The high bilirubin numbers that came in around 8mg last week have risen to 17mg this week. April has acutely felt the deterioration of this vital organ. She has faced a daily onslaught of constant nausea, rapid swelling in her abdomen, and jaundice eyes and skin.
Though the odds of April wining her race against time remain precariously slim, April’s oncologist still believes April could receive some benefit (however minimal) from another week of chemo. Ever motivated to care for me and our three kiddos, April resolutely decided to endure another round of chemo yesterday afternoon.
The chances of this latest round of treatment succeeding reside somewhere in the 5-10% range. We stand in need of a miracle, a suspension of the rules of nature. If April does not improve, she will die within a couple weeks’ time. If her health continues to deteriorate in the days ahead, we will shift her care from oncology to hospice.
This decline will cruelly afflict both April’s body and mind. Her nausea, pain, and fatigue will become more pronounced, requiring ever more powerful nausea and pain pills. Poor liver function will also produce some mental confusion. The days ahead promise to be hard.
In this time of sorrow, we find great solace in the love of our family and friends. Though April may lack the energy needed to respond to every message and card that comes her way, please know that she sees and appreciates all of them.
We find even great hope in the heavens above for we know our God can and does rescue men and women from the depths of Sheol. Still, we do not know what tomorrow will bring or whether April’s deliverance will take an earthly or heavenly form. A miracle could occur. We pray for life. Yet prudence demands that, we plan for death.
Our eyes and those of our dear children now burn red with the tears of sorrow. We grieve not because we fear tomorrow. Our God, who is faithful today, will be faithful yet again when we reach the next horizon. Tomorrow is not our great concern. Rather, I grieve the threat of losing my dearest of friends and our children grieve the threat of losing the bestest of mommies. We grieve the possibility of having to go through life’s milestones with a bride and without a mommy. Indeed, those who find a good thing should not surrender it lightly.
Our prayers remain simple: May God help us and comfort us (Ps 86:
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.
(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.
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