Recap and New Findings on PET Scan

     I had hoped to never have to post anything on this blog again.  That it would merely serve as a reminder, memorial and testament to us of God's grace, provision and power as we looked back in future days on the ones long past.  I had hoped that this blog would be the metaphorical version of my family's 12 stone pillar – such as the one the children of Israel built after God held up the waters of the River Jordan, as a testament to future generations of His awesome power and love for his people (Joshua 4).  But it seems that God is not done with us yet.

     Before I get into the reason for the blog post let me briefly recap the last 8 months, as I have not posted anything since December 2016.

     Mom started her chemotherapy on 12/16/2016 after a clean 8-week post-Whipple CT scan and a PET scan that only included one hot spot, which several (3, I believe) radiologists concurred was related to inflammation around a staple, and not related to cancer.   Moms cancer was staged at IIb.  It was decided to treat her with 12 rounds of Folfirinox therapy.  Folfirinox includes the chemotherapy drugs: 5 FU/Leucovorin, Irinotecan, and Oxaliplatin.  This therapy is usually reserved for further advanced metastatic pancreatic adenocarcinoma – cancer that has spread to other areas of the body – which mom's had not.  Dr. McDaniel wanted to treat the cancer aggressively, but the regimen is one of the toughest chemo regimens around.




     Mom's chemo routine was this:  Go to the cancer center on Friday morning, early.  Get IV chemo infusions.  Stay at the cancer center usually totaled about 6-8 hours depending on how long it took to draw blood work, get results, pre-medicate, etc.  At the end of each treatment, they would hook mom's port up to a portable infusion pump that would slowly infuse 5 FU over all of the rest of Friday and Saturday.  On Sunday morning, even earlier, she would have to be back at the cancer center to have her port de-accessed and the infusion pump discontinued.  She would also get a Neulasta shot (SubQ injection intended to maintain mom's blood counts and prevent infections associated with immunosuppression related to chemotherapy).  Then it was back home and to bed.

    She was usually in bed from Sunday through about Wednesday or Thursday of post-chemo week.  The effects of chemo and the side effects of the Neulasta shot hit about the same time as the steroids she received on Fridays with chemo were wearing off.  This caused a great deal of pain, especially in her bones (Neulasta related), Nausea and Vomiting (Wednesdays, usually) and extreme fatigue, which got worse with every treatment.  

   After her second treatment, we had a scare, finding out that she had an allergy to Oxaliplatin.  She had an episode where her throat began to close up, while receiving the infusion, and could not talk.  Luckily she was able to signal for help from her chemo chair and was able to get quick medical help.  After an extremely large dose of Solumedrol and IV Benadryl and some other supportive treatments she was ok, but for the remainder of the 10 chemo treatments, she was unable to receive Oxaliplatin due to the risk of worse anaphylaxis.  This made her regimen Folfiri, and not Folfirinox.

     She completed the rest of her treatments with the Folfiri regimen, completing a total of 12 cycles 2 weeks apart, finishing on May 19th, 2017.  

     Throughout her chemo treatments she never missed a treatment; never had her WBC, ANC, H&H, BUN/Creatinine, etc restrict her from getting chemo; She never contracted a single opportunistic infection; Never became neutropenic; She was a BEAST.

     She started to lose her hair when she was on the Oxaliplatin, so she and Dad both shaved their heads bald.  However, when Dr. McDaniel took her off the Oxaliplatin her hair began to grow back, so she has been rocking a pixie cut for a while now.  I think it looks good!

    After finishing chemo on May 19th, 2017 the next step was to make sure that the chemo had worked.   After attempts had been made to schedule mom for a PET scan post chemo, we were informed that her insurance company denied a PET scan because her PET scan before chemo was "clean".  We were disheartened, to say the least.  We all wanted to know if this worked.  Her insurance did approve a CT scan of her Chest/abdomen/pelvis.  A poor substitute for a PET, but we had to take what we could get.  So on May 23rd, 2017 mom had a follow-up CT scan to evaluate the efficacy of chemo.  After much anxiety we got the results:  The scan was free of disease!!! The only thing that the Scan showed was some pseudocirrhosis of her liver that the radiologist stated was chemo induced, but no evidence of cancer.  Praise the Lord!

    And so we thought that this was all over and behind us.

    Around late June of 2017 mom started having some pesky back pain in her left flank.  Sometimes it radiated into her abdomen.  Sometimes down into her groin or down into her left buttock.  It was constant and nagging.  She medicated it with pain medications she had at home, thinking that it was perhaps a pulled muscle.  

     A week went by and it was no better.  She decided to follow up with her PCP, who worked her up
for a possible UTI.  They increased her pain medication and recommended a CT if the pain did not resolve and sent her home.  A couple more days went by and still no better, pain getting worse.  Mom called the cancer center to follow up with Dr. McDaniel on the pain, who was unfortunately out of the office at the time.  The Doctor covering for him gave mom a couple of doses of oxycontin and instructed her to take one then and one before bed and if the pain wasn't better in the morning to call back and they would bring her back into the cancer center.  Mom did as instructed, pain still not better.  When she called back in the next morning the NP ordered an MRI of her abdomen, but they said it would take 48 hours to get a pre-cert for her insurance.  Dad, at this point, is completely fed up with seeing mom in pain and having to wait for things and decides to take off from work and goes home to get her and take her to the ER. This is July 6th, 2017.  At the ER she has another CT of her Abd/Chest/Pelvis.  The results of this CT are actually BETTER than the CT that was done in May.  Time off from the chemo has allowed her liver to heal.  The pseudocirrhosis that was there in May has almost resolved.  There is nothing on the CT that is concerning and everything looks clear and clean.  Nothing to explain away mom's pain.  Mom is discharged from the ER with instructions to come back if it doesn't get any better in a week.

     Meanwhile, the cancer center is still getting the pre-cert for her MRI, in the dark that mom has gone to the ER.  We all counseled mom to go ahead and have the MRI, especially if insurance is offering (we have seen how fickle they are).  They did the MRI on July 10th, 2017, and found a suspicious enlarged lymph node in mom's abdomen.  Dr. McDaniel ordered a PET scan as a follow-up, which the insurance thankfully approved this time (sarcasm).   PET Scan was done the next morning July 11th, 2017 at 6:30 in the morning.  The results of which were not as we had hoped.  The radiologist found 3 PET avid lymph nodes, 2 in mom's abdomen, one higher up near her diaphragm.  An appointment was set to see Dr. McDaniel the following morning at 9:30 am.  Mom, Dad, Kailey and I were all present.

    Dr. McDaniel was very frank in our conversation stating that these findings were extremely concerning.  It would appear that cancer was back, though we could not know that for sure without a biopsy.  The thing that made that difficult is that two of the nodes are inaccessible and only one of the nodes has the possibility of being biopsied.  The window for a biopsy needle, says Dr. McDaniel showing us with his index finger and thumb, is only about a centimeter wide and is deep in her abdomen.  There is a high risk of hitting her kidneys or aorta and causing major or even life-threatening bleeding.  A biopsy is not on the table.  He proceeded to tell us that also because of the location of the nodes and the close proximity to her Aorta (the body's main and largest blood vessel) that the nodes were not resectable (surgically removable) and that they were also not candidates for radiation.

     Dr. McDaniel gave us 3 options: 1) Do nothing, watch and wait and repeat a scan in a few months, 2) Start mom on oral chemo called Xeloda, which is oral 5 FU – one of the IV drugs she was on before, 3) Start mom on IV Chemo again with Gemzar and Abraxane.  Dr. McDaniel was frank that since the cancer had recurred, there was a low probability that it would ever go away no matter what route or approach we took.  He stated that in 80% of pancreatic cancer cases that are treated with a Whipple resection there will be a recurrence.  He also stated that we were lucky that mom was able to have her Whipple in the first place, stating that if the surgeon had known that she was node positive in the first place that they probably would not have even operated in the first place...  To say the least, we were all deflated.  Mom chose to go home on oral Xeloda, not wanting to do nothing, but not wanting to go back on IV chemotherapy just yet either.  We left the cancer center all feeling like our hope had been sucked away from us.

     Later that night, mom got a call from Dr.  McDaniel.  Apparently, he had mom's case on the brain and stated that he was reviewing her films one more time and had called a colleague of his to get a second opinion.  This colleague, Dr. Whitley, is a radiation oncologist at the cancer center in Montgomery.  According to Dr. McDaniel, after a lengthy conversation with Dr. Whitley, it was determined that mom's recurrence could actually be potentially radiated.  Dr. Whitley was also of the opinion, unlike everyone else we had talked to, that the nodes were the culprit behind mom's back pain, and that radiation therapy could potentially alleviate that pain.  This came as great news and was even just a little encouraging.  The appointment was set up with Dr. Whitley for July 13th, 2017.

     The next morning Mom and I went to the appointment for the radiation consultation.  Dr. Whitley went patiently through Mom's PET scan with us, taking us layer by layer through the scan and node by node.  There was good news and bad news.  The good news was that he did think that the nodes with the source of Mom's pain.  He said that in a majority of pancreatic cancer recurrences of this kind the nodes press on a nerve plexus at the surgical site and the patient will present with horrible back pain.  More good news was that he thought that all three nodes, the pancreatic bed (surgical area), and an area around where they took out the tumor were able to be radiated.  The bad news:  According to Dr. Whitley, the node that was farther north near Mom's diaphragm was actually considered a chest node and not an abdominal node.  This meant that it was no longer considered regional disease but metastatic.  He caveated this, however, by saying that technically it was only a matter of about 3cm.  He said if the node in Mom's chest was 3cm lower, her recurrence would still be considered regional.  

    Now, why is that significant?  He said that he would be much more hopeful if the disease/cancer was still regional, however since it had spread and was technically metastatic that could possibly lower the efficacy of treatment with radiation.  For the radiation, she will still be taking oral Xeloda, however, the dose is greatly reduced to work with the radiation.  Since radiation is targeted therapy and not systemic therapy (like chemo) and the cancer has technically become metastatic, there is the possibility that while we are trying to kill this recurrence with radiation that more cancer could crop up somewhere else in the meantime, because we are not treating the whole body, just a specific area.  However, this is just a risk we have to take, and a hope we have to have.  When it is all said and done, in the course of one day hope was taken away and then a sliver of it was given back, and while there is any hope at all, we must cling to it.    

    Mom is set to start Radiation on July 24th, 2017.   She will go for 30 treatments, Monday through Friday, for 6 weeks.  After her treatments are over we will have to wait for 2-3 months to scan her again (PET) to see if the radiation worked, because recent radiation will set off a PET and make it look like cancer is everywhere.

    Now comes the time where I ask for prayers.  The more of this broken world I get to see, and especially this last year, my prayer life has really been challenged.  Does it matter?  Does God really listen? Does he care, and if so what about? I'll be honest – I wrote this big long huge thing below what I'm currently typing detailing what I think is important on the topic, but this is not the time or place.  So this is what I know and what it is all boiled down to: EVERYTHING boils down to Jesus.  We all too often look at the world through worldly eyes and not through the Spirit's eyes.  Often times, we still pray with our human minds and not with the Spirit's guidance.  

     So I ask all of you to really spend a moment and pray with your spirit and with THE Spirit for my family.  Do I ask that you pray for earthly healing for Mom?  By all means!  But I pray that you request it of God as Jesus made His requests in the Garden of Gethsemane, saying, "Lord, if you are willing".  Because we all know He can. Sometimes the answer is yes, and sometimes the answer is no.  But regardless, Mom will be victorious, because HE is victorious! We plead like the psalmist, "Let me live that I may praise you" (Psalm 119:175) with the promise that, if not, we may say with one accord, "Where O death is your victory? Where O death is your sting?" (1 Corinthians 15:55)

      I ask that you pray that our family gets to take advantage of as much quality time as possible in the coming months.  Hopefully in the coming years!  Life is short, time is fleeting.  Spend time with you and yours as well, for we never will know when time is up.  
 
  Collectively:

- Where there is Anxiety – Quell it.
- Where there is Fear/Doubt - It will be driven away
- That "The Lord would bless us and keep us, the He would make His face shine upon us, that He would be gracious unto us and give us peace" (Numbers 6:24-26)

    For Mom:

- Pain relief is much needed right now.  It is affecting her daily life and ability to do things.
- Nausea and Vomiting as a result of pain and/or improper pain management regimen – please pray that pain management plan begins to become effective.
- Emotional, Mental, and Spiritual health in dealing with recurrence of cancer we were hoping was gone.  Also having a hard time having to resign from a job that she loved fiercely.  Mom has been an RN for 30 years.  A lot of her identity was tied up in that title and in helping people.  Now not being able to do that has left an empty spot.

    For Dad:

- It's been a roller coaster of emotions.  Pray that God grants him a "peace that surpasses all understanding" (Philippians 4:7).  Pray for his mental, physical and emotional health in dealing with an illness that has affected the 30-year love of his life every day since October 2016.

    For Kailey:

- It has been a rough last couple years for Kailey as a lot of you know.  She is getting married in November and this news comes as another stressor to the bride-to-be.  Kailey and Mom are extremely close.  Pray for a seamless and beautiful wedding, that she and Austin can enjoy with Mom in exceptional health.

     For Sheila:

- She is there for all of us in some capacity at all times.  I know it gets draining, especially keeping me level headed and sane and being a new mother.  She is my rock, and for that reason alone I ask that you pray for her.

    For Austin:

- I ask that you pray for the groom-to-be, because dealing with a situation such as this would be a tall order for a veteran husband, much less entering a marriage having to help your new bride through what could be a very tough first few years.  Prayers for guidance, leadership, love, patience, and empathy for my brother to be and my brother in Christ.

     For Me:

- It is both a blessing and a horrible curse to know too much.  Prayers that I will know in the months and years to come when to let my medical side out and be inquisitive/intellectual, and when to just be a son.  


Thank you to those of you who care enough to finish reading such a long post.  May God bless you and yours abundantly.

In Christ,

Luke Barkley  
 



         
     
   

Minor Setback with Chemo Start

Update as of 12/3/2016
   

     I hope this finds all who read it well on this cold, rainy night. I wanted to give an update on mom for all who are interested in her continued fight!
  
     On Monday, 12/1/2016, Mom was scheduled to go in to Montgomery Cancer Center (MCC) for a teaching session on the chemo drugs that will be in her regimen. However the night before she had a bad headache and wasn’t feeling well and decided to lay down early.  On waking, she found that she had a temperature of 100.4.  She took 2 Tylenol and went back to sleep, waking later in the night with a temperature of 101.6. 

     In the morning she contacted MCC and informed them of her fever and her generally not feeling well. She had a headache still, some lower right sided back pain, pain along her surgical incision and nausea.  They decided to bring her in Thursday morning for a full fever workup, seeing as how she was scheduled to start chemo on Friday morning (12/2/2016) and could not do so if she was acutely ill.

     I went to MCC with her Thursday morning where she received a full set of lab draws and blood cultures as well as a urinalysis.  She also had a chest x-ray.  We went after all this to talk with one of the nurse practitioners, Melissa English (of whom I could not speak more highly about). 

     After all of her tests and talking with the Nurse Practitioner we were here:  Mom had a fever with all the before mentioned symptoms to go along with it, WBC count was 9.2 which is normal, but her potassium was low at 2.9 and her bilirubin had gone up to 2.2 from 1.1.  This seemed to indicate to Melissa that mom had some sort of obstruction possibly in her common bile duct.  She thought that it could possibly be cholangitis, which is an infection of the bile duct.  She said that this was not normal after the Whipple procedure but also not uncommon.  She recommended a CT of mom's abdomen and pelvis and also to start IV antibiotics at the cancer center for a course of 5 days.  She stated that as soon as the CT was back that she would let the surgeons in Birmingham know what was going on in case they wanted to see mom again or if there was something there that would require additional intervention.

     So we started her antibiotics and potassium replacement on Thursday.  Mom's CT came back Thursday afternoon and showed that there was not cholangitis to be noted.  To everyone’s best guess, mom had the beginning of an abscess near her bile duct.  However, Melissa was happy to report that mom had had no changes in her CT from the last one a couple weeks ago. Everything still clean. This was good news! 

     (As an aside, while we were at the cancer center mom had the 3rd radiologist that had read her PET scan to sit down and go over it with her, and he concluded, like the 2 others, that mom's PET scan was clean with no metastasis and only a small area of inflammation along her incision line. Praise the Lord!)

     So, since Thursday mom has been going to the cancer center everyday for IV antibiotics through her port. She is recovering Vancomycin and Invanz as well as IV potassium chloride.  She will be finished with the antibiotics on Monday the 5th.  She is feeling much better than she did on Thursday!

     Because of the infection, mom was unable to start her chemo on Friday and will now, instead, start her chemo on Friday 12/16/2016. 

     Prayers that her infection will clear up, and for her appetite to increase and for her to find some foods that she likes and tolerates are appreciated. Also, prayer for increased mental and physical strength to handle this chemo when she does receive it. 

Thank God for all of you who have cared and loved us all deeply.

- Luke

First Oncology Appointment

Good evening everyone. Today Momma had her very first oncology appointment at the Montgomery Cancer Center with Dr. McDaniel. Dr. McDaniel was, in my opinion, excellent today as he walked my mom and dad through what the upcoming months will hold. However, Dr. McDaniel had news for us that was more somber than any of us were anticipating. We got to the Cancer Center at 7:15 this morning and after several stacks of paperwork and visits from some of momma's favorite coworkers, we were finally in the back waiting on Dr. McDaniel. Dr. McDaniel introduced himself and allowed my Momma the opportunity to tell her side of this awful story before he dove into what the charts and paper had to say about it. Then, Dr. McDaniel started to give us the news that science and medicine had presented to him. Dr. McDaniel confirmed that Dr. Christien at UAB did get all of the cancer and negative margins to the naked eye. Dr. McDaniel informed us that momma's tumor was roughly 2 inches in size. Dr. McDaniel then went on to talk about the lymphnode involvement that Dr. Christien had told us about. Dr. Christien removed 6 of momma's lymphnodes and of the 6, 3 lymphnodes tested positive with cancer. Dr. McDaniel then told us that cancer is rated on a scale of aggressiveness 1 to 3. 1 is that least aggressive form of cancer and 3 is the most aggressive form of cancer. Unfortunately, we found out today that momma's cancer was rated at a 3, and with the lymphnodes involved, Dr. McDaniel wants momma to have a PET scan so we can see more in depth what we are dealing with and if the cancer has spread elsewhere. With this shock still weighing on us, Dr. McDaniel kept pressing on with more information. Given that momma's cancer is at a stage 3 aggression level, Dr. McDaniel wants momma to have the most aggressive form of chemotherapy possible. He listed 3 different chemotherapy drug names, and please forgive me because this teacher has no idea what the drug names are, and said that he wants to start momma off with the drug that is used on patients that have stage 3 and 4 cancer. Momma's cancer is staged at a 2, so Dr. McDaniel seems to think that this drug will be the best bet for momma in giving her the best chance at "survival". Momma will start chemotherapy sometime between mid December and the beginning of the new year. Dr. McDaniel told us that momma would be coming to the cancer center on Mondays for 6 to 8 hours worth of chemo. Momma will then go home with more IV administered chemo through Tuesday and she will return on Wednesday to turn the IV chemo off. Momma will get a week's worth of rest and the the process with begin again. Chemotherapy will be done for at least 6 months. Dr. McDaniel said that this chemotherapy drug is tough on the body. He warned momma that she would be weak, sick, and fatigued and that she will also have weight and hair loss as an affect of the chemo. He also did not sound very hopeful about Momma being able to work during her time of chemotherapy. Dr. McDaniel was very matter of fact, but he was also very thorough. He did not rush his time with us, and he made sure that all questions were answered before he left the room. Prior to leaving, Dr, McDaniel joined hands with us and lead my family in a prayer. We all thought very highly of this, and it meant a great deal to us. Upcoming prayer requests include: -Momma's PET scan tomorrow, November 18, 2016 and results of this PET scan -Momma will be having an IV port put in on Monday, November 21, 2016 -Momma is concerned about not being able to work during chemo -Lifted spirits for momma and this family -Strength for momma as she begins the road with chemotherapy -The doctors and nurses that will be taking care of momma during this time ahead I saw a quote today that read "If there is a Goliath in front of you, then there is a David inside of you". My momma has a David inside of her and a GOd that will fight FOR HER. She needs only to be still. More updates to come in the following days. As always, thank you for the prayers and keep them coming!! Exodus 14:14 -Kailey

Let's Play Catch Up

Good afternoon to all! Please let me start by apologizing that this is the first blog post in the past few weeks. Things have been crazy in the Barkley household, but I am happy to report that things with Momma are going great! A few weekends ago, the weekend of October 21- October 23, I was at school anxiously awaiting 3 o clock so I could come home and see momma. I had been texting her off and on throughout the day and Momma had said that she was feeling great, almost back to her old self. Unfortunately, mom was having some issues with her JP drain. The drain was essentially draining everywhere except for the actual drain. Momma ended up going to our family doctor and was referred back to UAB where she was admitted for the weekend. Once momma was finally able to come home, she had taken a complete 180 in the way she was feeling and her spirits. She made some comments that Sunday night that scared me tremendously, and Luke, Sheila, and Daddy were all uneasy as well. Throughout the next week, I stayed home with Momma. I finally felt like I was able to do something helpful throughout this whole ordeal. It was extremely difficult to feel helpful when I was living three hours away in Huntsville. I am happy to say that Momma has improved tremendously in the past couple of weeks. Momma is actually looking like MY momma for the first time since this nightmare started. Momma's strength is improving everyday. She is able to do more with each passing day. She is getting her sense of humor back, and her spirit is the best I have seen it since this whole ordeal started. Thanks be to God! As always, we ask for continued prayers. Pray that her spirit stays positive and that the strength keeps improving. Most specifically, we ask that you pray for her appetite. The surgery has done a number on her taste buds and she says that nothing tastes good to her. The surgery also had an end result that left Momma without a fourth of her stomach. She is eating very small portions because it is al she can handle right now. In my mind, Momma has had a significant weight loss. Please pray that we can keep the weight loss to a minimum so that she will be strong and ready to fight once she starts her chemo. We love you all and are so incredibly grateful for the love, support, and prayers that you continue to pour out on our family. Please keep the prayers coming! "Though she stumbles, she will not fail, for the Lord upholds her with his right hand." Psalm 37:24 -Kailey

Day 3 Post Op Update

     Mom is doing a lot better today!! She has done a total of 3 or 4 laps around the unit (today WITHOUT a walker), which is probably at least 300 or so feet per lap, she got an actual shower and she climbed some stairs with PT!  They pulled her foley this morning, kidney function is within normal limits.  No more fever to note.  I am unsure of what her WBC count is down to, but im hoping it has come down and if the way she is doing is any indication, then it has!

     Dr Christein rounded a little while ago and seems to be more concerned about the amount of drainage still coming from her drain than anything else.  He reiterated that she will probably have to go home with a drain.

     Otherwise everything is going as planned. They did move Mom to a different room late last night, so anybody visiting this weekend, she is in room S748.

     Thank everyone for continued prayers.

- Luke

Day 2 Post Op Update

     Mom is awake and more alert even than yesterday.  She is still in some pain but it is better controlled today.  She is a little down today because she feels like she is not “doing as well as she should”.  She stated she wants to get up and walk more but that its all she can do. (Occupational therapy came to see her this morning and made her stand up in the room for 30 minutes!)

     I think that mom thinks she should just hop out of bed and be running laps around the unit, though I have assured her that she is doing much better than most people do.

     Significantly though, it seems that she could possible have contracted a UTI and has had a low grade fever as well. White Count this morning is up from 11 to 14. This could be normal after surgery of this magnitude or could mean something else, like infection, though we hope not.

     Additionally, her JP drain has been having to be emptied every hour because it is putting out a good deal of what the residents think is bile.  Dr. Christein (surgeon) came in a few minutes ago and said that she probably has a leak from one of the artificial connections that were made during surgery.  As a result, he hooked her JP drain to wall suction and it has pulled a good deal since.  He stated that these types of leaks usually heal on their own, but she could possibly have to go home with her JP.

   The only residual jaundice that I see is in her eyes, only mildly yellow. Her face, as opposed to yesterday, has a pinkness back to it.

     Continued prayers for pain control and also additional prayers today for: the leak in her stomach to dry up and heal, and for her to have  a sense of accomplishment for the work she has done with PT and OT and not a sense of failure for what she cannot yet do.

     Thank you all.

     In Christ,

- LUKE

Day 1 Post Op Update

    I arrived at the hospital about 11:00am this morning.  I found mom a whole lot more lucid than yesterday! She is still pretty doped up on her PCA pump, but in between dozing off she is able to wake up and have a meaningful converstaion.  This is in stark contrast to yesterday, in which she was also doped up but was being comical in her speech rather than meanigful (unknowingly, no doubt).       

     At one point yesterday she went to awkwardly touch dad's face, and when asked "what are you doing" she stated... "I thought there was a fly on your face, I wanted to get it off" - No fly ;)...  I was rubbing her head yesterday and scratching her scalp and she stated, "That feels good, but I'm sad, because Kailey and Sheila don't let me play hair with them..." - we are all unsure what this means ;).  (And if you are reading this later, mom, I had to put it. We have been through a week of worry, and its nice to smile!)       

     

     But back to today, pain control is still a prayer request. The way that her pain pump is set up, she does not recieve a scheduled pain medication and the supplements it with pushes of her pain pump.  She only gets pain medicine when she pushes the button for the pump to give it to her in her IV.  The doses are small and the pump is regulated so that she can't overdose herself. So after she pushes the button for some pain medication, it will not let her push it again for lets say 10 to 15 minutes.  Because of this, it takes a little while to get the pain under control and when she is finally comfortable she goes to sleep.  During her sleep she obviously can't push the button to stay on top of her pain, so she ends up waking up miserable and havjng t start all over again pushing the button multiple times until pain control is achieved, and back to sleep she goes.  It is a circular pattern and she probably just needs some adjustment in meds, however prayers for pain relief are much appreciated.     

     As far as mobility, mom was able to stand up on the side of the bed with physical therapy this morning and walk around to the other side of the bed.  This was a great accomplishment to me, seeing as how this was before 24 hours had even passed since surgery.  While Dad and I went off campus for lunch, occupational therapy also came in and worked with mom. And, just to show off, she walked with them all the way tobthe bathroom, brushed her teeth, back to a chair, sat and stood a couple of times and walked back to bed. We were so excited for this!  I told her at this rate she would be doing triatholons in a couple months!      

     As far as pathology reports and talking with the surgeon about the surgery, those things have not happened yet.  However, her color has brightened up a good bit.  She still has some mild yellowing of the face but her hands, arms, neck, and chest have all returned to a normal pink color!      

     They pulled her NG tube early this morning, which was quick. This would lead me to believe her output was low enough to do so. Hopefully gastroparesis will not be an issue mom faces, as so many with whipples do. Prayers for no gastroparesis and for all the anastomotic places that were created in surgery to heal strongly so that she can get back to eating quickly are also appreciated.    

     Thank everyone for continued prayers and I promis to keep everyone up to date and informed. 

     To God be the Glory! 

 -  Luke