8 Clarks

Done. Praise God for:

2011-02-10T12:06:00.000-08:00

Everything. Done on time. Will not miss flights. Lots of loved ones praying. Sweet time together to reflect on whoe we are, where we are, why we are.

Oh, yeah; praise God for great results as well! The endoscopy showed many small lesions (carcinoids) but no large ones, basically nothing new. ALL other scans were clear and healthy. The head doc just calmly reassured us that she looked great, and to go home and not worry about it. He said that now that we have 5 years of regular monitoring, and everything has been stable and good, that we can stop doing the horrible scan (octreatide) altogether, stop doing the CT/MRI altogether, just do sort of an enhanced physical every year and do the endoscopy every two years. If anything ever shows on endoscopy, then we can add some of those other things back into the mix. Wooo-Hooo!

So, we're gonna grab a quick bite to eat, grab our bags, and head to the airport. We love and appreciate all of you, have enjoyed praying for you as you've commented and posted and texted and emailed (y'all are a lot to keep up with!), and are extremely thankful that God has brought us to this point. He is always showing His children more about Himself. This includes who He is as king, judge, and ruler of all things. Today, we rejoice that it also includes His nature of mercy and grace and gentle love.

By the way, next week the temp here is going to be 40 degrees, low of 20, little wind. So He also has a sense of humor!

Tony

Good morning!

2011-02-10T04:24:00.000-08:00

(In my best Robin Williams voice...) Gooooood Moorrrrrning Everyone!

So it is 6:15 a.m. here. We got up at 5:30 (not a huge deal for Dee Dee, but not my cup of tea!), and headed across the street to the the hospital. It is currently -13 degrees here in lovely downtown Rochester. Brisk! Officially awake now!

Not much to update. Dee Dee is pretty much dreading this day. I talked with her primary doc last night by phone (he called me on my cell at ~10:00 p.m.), and we feel pretty good about things being back on track. I think. Dee Dee's not saying much on that front, so maybe it is just me who feels better?

By the way, how weird is it that here in Rochester, where almost every single person we see is caucasian (and most look like vikings - tall and blonde), there are 5 Muslim television stations, and one Somali station? They have al Jazeera on 24/7, for example. There is one channel that has Muslim soap opera, talk shows, etc. Just strikes me as strange!

More later. Her test is 45 minutes, so it may be nap time.

Tony

Update, please pray

2011-02-09T13:29:00.000-08:00

Well, mixed bag of goodies right now. The morning tests went well, ended a bit early. We then came back to the room and rested a little while (as best we could given the constant renovation noise in this hotel which we are never staying in again ever).

Back over for the endoscopy. In she goes. 1 and 3/4 hours later they come out to get me, and I'm thinking, "Excellent! Finished early!" WRONG! They never started. The doc looked over her case, and told Dee Dee that he was not on board with the procedure plan as it was laid out. He did not feel that she was slated for the correct anesthesia, and that there was little point to just going in and looking. "What if I see some that are bigger, and in my opinion need to come out?" Since he and Dee Dee's main doc had not discussed her case specifically, he did not feel comfortable proceeding. Her main doc was in surgery, so he could not talk at that time. What did we want to do?

Well, they were able to reschedule her procedure to tomorrow at 10:00 a.m., which will give him time to talk to the primary doc, as well as get the better/easier anesthesia. For that we are thankful. I am also really thankful that the doc today looked at this case with a sense of ownership, a sense of doing the best thing for my wife, and not worrying about less important things. This cost him a procedure (he will not be the doc tomorrow), so it cost him some money. It cost him time, as he spent more time talking to us and coordinating her rescheduled procedures than it would have actually taken to do the procedure in the first place. It was all done for what he felt was in our best interest. We are grateful for these things.

We are also disappointed and Dee Dee is wrestling some emotional demons after today. This adds a bit of confusion to our overall understanding of this condition, and of her risks long-term and therefore treatment protocol long-term. It means that tomorrow is a HARRRRRD day. 6:15 a.m. for the first procedure. 10:00 for the next. Consult at 1:30, then to the airport. Home at 11:00 p.m. Dee Dee is really worried that after having this procedure that has been rescheduled, which usually makes her feel pretty yucky, flying is going to be difficult. This is also the first time in almost 5 years that any docs at Mayo have differed at all in their approach; there has been comfort in the fact that they have all "sung from the same page," so to speak. This guy today did echo her main doc's assertion that Duke's original approach of removing the stomach was outrageous, which was good to hear again. Every once in a while I suspect that a bit of doubt creeps in for my bride.

So, pray. Pray for hearts/spirits/emotions. Pray for strength; she is really pretty whipped right now. Fasting since last evening, with the prospect of repeating again tonight and tomorrow. Pray for a solid unity between docs once they all talk this evening, and that this consensus is obvious tomorrow. Pray that she fares well with the procedures tomorrow, and that there are no lesions large enough to remove. Pray that I am able to understand where her heart is, and meet her there. Pray that we don't miss our plane tomorrow; it is the last flight out of Rochester tomorrow, and staying another night would be BAD. All caps. As my daughter would say, "For realz." Pray that is just all goes smoothly and well, and that we meet each moment with the grace of hope, with the certainty of a loving Father and Savior.

Thank you all.

Tony

Morning of the longest day

2011-02-09T06:51:00.000-08:00

Good morning! Well, the day is underway here in balmy Minnesota. We had a good dinner last night, managed to make our way around downtown without going outdoors, where the "real feel" temp was -26 degrees. Actual was a much warmer -4, so it wasn't as bad as it might seem. (Just keep telling yourself that over and over, and eventually your mind starts to believe....nah, doesn't work. It's still cold.)

Then, Dee Dee had to drink liquid nastiness to start to purge her system of the nuclear medicine that they injected earlier in the day. There's a lot more detail that I could share here, but...I'd better not.

Today begins with a 2 1/2 hour scan, started at 7:30. For this scan, she is on her back, with large velcro straps fastened at chest, waist, and knees. The scanner is between 1/2 to 1 inch above her body. For 2.5 hours. She gets a bathroom break at the 90 minute point. Egads. She told me that my brother Randy would simply have to be unconscious, knocked out, and even then might not be able to do it. (Randy, you see, does not do well in confined spaces. At all.) By the way, Randy would have appreciated me singing Radioactive yesterday!

After she finishes the scan-athon this morning, she has an endoscopy with ultrasound today at 2:30. She has to fast for six hours before that test. She had to fast for 12 hours before the morning scan. Add it up and she has fasted from yesterday at 7:30 p.m., and will be able to drink or eat again today at about 4:30 or 5:00.

Me? Well, while she is in the scan this morning, I wandered over to my favorite Rochester cafeteria, Pannekoeken. They serve traditional Dutch food, and they are amazing. I had my daily serving of fruit (pannekoeken - think pancake/pastry cross, finished to a golden crisp on a griddle - with sliced apple and cinnamon sugar!) When you order a pannekoeken, they bring it to your table on a run, while chanting, "Pann - e - koek - en" over and over. Fantastic slice of Americana. Strangley, Dee Dee recommended that I get my Pannekoeken fix while she was otherwise occupied. She puzzles me....

Prayers for today are for strength. It is a tiring day for her, a really long day. She feels worse today than any other. If they decide to do biopsies during the endoscopy, she gets pretty sick. So, we're also praying for no biopsies. I'm praying that she is able to sleep between tests.

Listen, this whole thing reminds me that we all know a lot of people with cancer. Pray for them, for their families, for their medical teams. Pray for ways to plug into their lives and show grace and mercy to them. It's a tough road, and they need it.

We appreciate you all, and as we read your comments and FB posts pray for you as well.

Tony

Going nuclear

2011-02-08T12:52:00.000-08:00

Hello all! Well, we are about 1/2 way through day #1 here at Mayo. Some discoveries today:

1. Caribou Coffee has a pretty good Irish Cream Latte. Dee Dee got a hot tea (pomegranate oolong tea) and veggie bagel sandwich. I got the latte and an apple crisp pastry. She said that did not count as a fruit serving. Huh? Apple...hello! Also, "oolong" is not a real word. Somebody made it up, stuck it on a tea bag, and now everyone just accepts it as legit. Not me!

2. Caribou also has "homemade custom oatmeal." Ooo-kay. Then, as they prepare this oatmeal with fresh blueberries and almond slivers, they put a cooking thermometer into the oatmeal to make sure they serve it just right. I kid you not. By the way, this counted asa fruit, but the apple fritter did not?

3. When you walk around in 3 degree weather, it does not take long to realize that you're a wimp. My forehead was freezing. Who knew a forehead could feel that cold? Took about a block for our bravado to wilt.

4. I must have a unique sense of humor. Today Dee Dee had a bunch of blood work done (needle number one, if you're counting), then over to the Nuclear Medicine center. They injected her with the nuclear medicine dye, which she tells me really hurts and makes her feel quite strange. Her whole arm burned for about 2 hours after. Thankfully, Mayo still bans all medical tape, so they use cotton gauze to pressure patch all injections, and we're thankful for the little blessings. Anyhow, after her injection, as we sat in the waiting room, I started singing Radioactive by The Firm; she found zero humor in it! I thought it was perfect, borderline genius, but she informed me that I was nuts and should stop bothering her and all the other patients as well. Not one other person thought it was funny. So, either I am wrong and it actually isn't funny, or I am right and the rest of the world is wrong. Jury is still out....

By the way, Dee Dee informed me today that the Kahler Grand restaurant grilled cheese sandwich actually only hits the spot for me. For her, it was necessary calories. What's that saying about opposites attracting?

Spirits are mostly good, emotions doing well, faith holding strong. Body is coping. Hearts are grateful for all your love and prayers, and for God's mercies, new every morning.

More later.....

Tony

Well I'm not uptight
Not unattracted
Turn me on tonight
Cause I'm radioactive

A Tale of Three Cities

2011-02-07T20:15:00.000-08:00

Tonight's post will be a slightly contrived literary vehicle to illustrate the day's travels, using the three cities we have "visited" as characters. Not two cities, ala Dickens, but three.

Our story begins in lovely Cary NC, where the sun was shining, roads were clear, and it was 56 degrees. Above zero (an important distinction as you will soon see!). All was right and good in the world. Or so it seemed.... Our flight from Raleigh/Durham was delayed 90 minutes. Hmm, given that we only had 30 minutes between landing in Chicago and departing for Rochester, I quickly deduced that we had a problem. Pretty sharp for a Monday!

The agent at the gate re-booked us to fly to Washington DC, then to Chicago, missing the first Rochester flight but making the next. Then, he realized that if we just took the delayed RDU flight straight to Chicago, we'd land in time for the same Rochester flight. So, re-booked again! We left RDU, had an uneventful flight to Chicago, and landed in the midst of almost no visibility snow. I mean, all yours kids going nuts "Look at it snowing were going to miss school and build a snowman and eat snowcream and sled and then do it all again" crazy over the snow. Despite the 11 snow plows working in tandem at all times, there was at least an inch of snow on the runway when we landed. Seemed weird, but I couldn't really do anything except trust that smarter folks than me knew what we were doing!

So now we come to the first major transition in our storyline. A plot twist, if you will. We'll drag in a bit of poetry here. I remember Samara finishing in the top 5 in NC at a poetry recitation contest with "Chicago," by Carl Sandburg. Here are a few lines:

Hog Butcher for the World,
Tool Maker, Stacker of Wheat,
Player with Railroads and the Nation's Freight Handler;
Stormy, husky, brawling,
City of the Big Shoulders:

Well, that's appropriate; they may do railroads well, but they pretty much stink at doing airports! We landed, and then got moved to an area, shall we say, out of the way? The pilot announces that the storm hit about 20 minutes before we got there, and that as we landed the terminals lost power. How's that? Lost power? That seemed bad to us, but again, we're the livestock being moved from one staging area to another in the Chicago, Hog butcher to the world, part of this story. And, as mentioned, it's Monday, so what do I know. By the way, it was 56 degrees above zero in NC (did I mention that already?); we're now down to 21 degrees.

They tell me you are wicked and I believe them....

And they tell me you are crooked and I answer: Yes, it is true....

And they tell me you are brutal....

The pilot then continues: "They are unable to move the jetway portable walkways without power, so we're going to have to wait here. Relax, they tell me this is going to take a while." I'm not sure, but I think he groaned. I know everyone else did. We were seated a few feet from the flight attendant, who I think cursed and banged his head against the wall for a moment or two. Actually, he just said, "I've never even heard of this happening before." Great! Like Neil Armstrong, I'm all about being the first to do a new thing!

Well, praise God they actually got us inside fairly soon. And we hustled to our gate, and of course that flight to Rochester was delayed. And then again. And, then again. They actually just cancelled the earlier flight we were supposed to be on, so God had a plan and we didn't need to worry about it; seems like God would have put something like that in the Bible, right? They had those 11 snow plows all in a row on the runways, big fire-hose looking things de-icing planes, and lots of people wondering if they were leaving Chicago tonight or not. Many didn't.

But prasie God we did! On the only flight that actually flew from Chicago to Rochester after 10:00 a.m. today, because they also cancelled the flight after us as well, we made it to Rochester MN. Our third city. Where, when we landed at 8:15 p.m., it was MINUS 3 degrees (low tonight expected to be -15). And a wind that hadn't slowed down since it left Calgary or the North Pole (aren't they about the same?), and came in at a robust 25 miles and hour. Y'all know what does NOT live here? Snow owls. You know why? Because God gave them the good sense to fly somewhere warmer. My goodness, -3 with a 25 mile/hour wind will get your attention! The good folks here are excited about it, saying that it will be their coldest week of the winter. This week is their WinterFest as well, so we feel kinda like they rolled out the red carpet for us.

Well, in seriousness. the story has a happy ending. This place (Rochester, the hotel, the people) feels familiar to us. They are still friendly. After nearly 24 years, Dee Dee and I still enjoy just being with each other, even on long and somewhat trying days. God has given us enough grace to see the humor in things. The restaurant in the hotel was still open, and their grilled cheese sandwich still hits the spot.

We are glad to be here, just because we know it is His plan, and it is needed, and it is for our good. Okay, stike that; glad is not the right word! Content? Accepting? Maybe those are more accurate. We are eager to get the testing underway tomorrow morning, just because we look forward to being through with the testing. While we are praying for great results and great health, we are praying that we don't find our hope in health, but in Christ. We are praying that we don't make an idol out of results, but that we remember our savior. We are praying that we would walk humbly with our God.

Isn't that the way with our God? We think we know the story ahead of time, and we really want to know the plot. We fret when we aren't in on every little twist. However, in our more sane moments, we simply sit on the plane and trust that He will land us safely exactly where He wants us to be, and we happily go along for the ride, all for His glory. May it be so with us, and with you.

More later!

(You know, Dickens wrote many of his novels in serial format as well... I'm just sayin'!)

Tony

Super Bowl (and getting ready to fly North!)

2011-02-06T12:21:00.000-08:00

Greetings! On this amazing, 56 degree sunny day here in NC, we are busy packing, getting things ready to head out tomorrow, and wondering why on earth people voluntarily live in places as cold as Rochester, Minnesota. High tomorrow: 5 degrees. Tuesday? 3 degrees. Wednesday? 4 degrees. Low each night between MINUS 12 - 15. Astonishing. Simply hard to fathom for folks like us. I know people live there and do well for their whole lives; the question is WHY? Maybe they don't know about better weather? Dunno.

Anyhow, packing is thankfully keeping our minds off the upcoming Steelers triumph (please, please, please...) over the team from a similarly cold place whom shall remain nameless. Nervous, nervous! All us Clarks are fully decked out in our Steelers jerseys, shirts, hats, etc. Terrible towels are ready to fly. Voices are rested, ready for the yelling and screaming. Food is ready for consumption. Hopefully, they'll give us great memories and moments to think about as we dwell in the land of airports all day tomorrow!

Thank you all for your love and prayers. No testing tomorrow (other than patience as we travel), but everything starts up bright and early Tuesday morning. Dee Dee will start fasting for that first round of testing beginning tomorrow evening. Basically, every day she has tests done that make her sick, she recovers enough to feel like eating anything around dinner time, and has to start fasting again for the next day by about 8:00 or 9:00 p.m. In the past, while she was in a test or scan, I would run across the street to grab a sandwich from Jimmy John's (first place I encountered them; glad there's one in Cary now!). Given the temperature, I am going to have to pretty stinking hungry to just "run across the street" to JJ's!

Take care everybody! Root for the Black and Gold, and I'll post later.

Tony

Again?

2011-01-31T17:23:00.001-08:00

Greetings All! After quite an absence, I am back at this blogging business. Some have asked why I did not continue; I guess since there was nothing going on with the carcinoid cancer stuff, I did not have much to say.

Well, those of you who know me know that statement is blatantly false! I ALWAYS have plenty to say! However, most of my musings have been on my FB page, and any time you want to know about my theological rants, my political observations, movie recommendations (go see True Grit - now!), just check me out there.

However, we have reached a point where it is time to once again travel back to Mayo Clinic, so Dee Dee asked that I fire the ol' blog back up. We thought about using FB for this as well, but this format seemed a bit more private, more like family. Dunno, maybe we're a bit nuts, but it's our thing to deal with, so there. (Kidding!)

We fly to Rochester Minnesota one week from today. I am painfully aware that Minnesota is not exactly tropical this time of year. Please, don't remind me. Please. I am slightly in denial at this point! However, the docs wanted to move things up a few months, we felt that it fit life schedule chaos issues better, so we are just going to brave the frozen plains of Minnesota in February. (THIS, by the way, would be prayer request number 1!) One day a week or so ago, the high in Rochester was 2 degrees F; the low was -21. That is MINUS 21 degrees. That, friends and neighbors, is stupid. I know, I'm not supposed to use the "S" word, but c'mon. I still, for the life of me, do not know why reasonable people choose to live in such a place. Other than ice fisherman, every other job there can be done in places where you don't run the risk of death just by going to the mailbox. And in fact, every downtown building is connected by underground tunnel, just to lower the demands on the E.R. at Mayo Hospitals.

So, we fly up on Monday, the day after the Steelers win yet another Super Bowl. That will be number 7!!!!!!! (Count 'em - that's 7 exclamation points; I may have been away for a while, but this is not my first rodeo!) Her testing starts Tuesday morning bright and early. She was originally scheduled for Monday, but that would have had us in a hotel in MN during the Super Bowl, which would just be wrong. I made that decision before the playoffs even began, just on the hunch that the Steelers would be playing. Whew!

Testing will take place basically all day Tuesday, Wednesday, and half of Thursday. Most of the morning tests require 12 hours of fasting, so she will basically eat after lunch every day, and stop by 7:00 p.m. Most of the tests are basically horrible, with lots of injections of vile substances that make her quite ill, nuclear medicines, etc. Another prayer request here! Pray that she has little nausea, and that when she is given the opportunity to eat, she is actually able to do so. Pray that the tests gather all needed information as well.

If everything goes well, we will be back in NC very late Thursday night. If history is a judge, she'll be pretty wiped out for a few days after. We are supposed to do some things with a marriage conference at church that weekend, so pray that we are able to do and to enjoy those events.

Also, our prayer is that if the cancer is not miraculously cured, that at least it is stable. She has had 22-25 tumors in her stomach when viewed in the past, all fairly small. Our prayer is that neither the number of tumors nor the size of any individual tumor will have grown since last evaluation. We pray that there are no tumors of any description anywhere else in her body. And, we pray that no other cancers have "piggy-backed" onto her existing condition. This is actually the greatest risk, according to the Mayo docs.

Mostly, pray that we would learn anew the goodness of our great God, and the fullness of His mercy. Pray that He would be sufficient. Pray that Christ would be our aim, our fervor, our goal; not health nor long life, but the cross. We pray for long life, but pray that we would do so as grateful servants who desire to serve Him here longer.

Thanks, and we'll keep in touch!

Tony

Somewhere between Dante's 7th and 8th circle of hell...

2008-06-05T06:32:00.000-07:00

is Chicago's O'Hare Airport. What a day (and night!) we had getting home yesterday!

Our flight from Rochester was supposed to leave at 3:45, but the plane from Chicago didn't arrive until 4:15. We left Rochester at 5:00, landed in Chicago, and as we taxied to our gate I could see our plane from Chicago to Raleigh still at its gate. We hustled from G21 to K15, and it was gone. Missed it by maybe 10 minutes!

We were re-booked onto the next flight, went to that gate, waited 75 minutes, and it was cancelled. We were re-booked, went to the next gate, waited an hour, and it was cancelled. We were re-booked (familiar?) went to the next gate, and this one was delayed 45 minutes. This is, by the way, the last flight of the day to Raleigh. We finally boarded, and sat on the runway for an hour. Kids were all at home, alone, hoping to see us before bed (obviously did not happen). Rides from the airport have been called and re-worked several times (thanks Mike and Warren!) Did I mention that there were somewhere around 18 children under the age of 8 on the flight? Including the three age 5 and under directly behind us? We finally took off, arriving in Raleigh at 2:20 a.m., and got to bed at 3:15 a.m. My first patient today: 8:00! Welcome back!

Thank you all again for praying for us and the trip and her appointments and her health. All went very well, and we are very grateful. I posted an excerpt from Dave McCarty yesterday or the day before, in which he started by saying that "Today is perfect." I guess God wanted to see if I really believe that or not with the whole airport trip through Dante's Inferno and the crossing of the river Phlegethon!

Tony

Heading Home

2008-06-04T09:18:00.000-07:00

Greetings!

We just finished meeting with the Dr. Thompson substitute doc (Porterfield?), and the results of everything were, to summarize, "excellent." Praise God!

We continue to learn more about the disease with each encounter, so there was some education this time as well. The over-arching disease that has caused everything else is "atrophic gastritis." This autoimmune disease erodes the stomach lining, prevents B12 uptake, which leads to pernicious anemia; this perfect storm then gives rise to gastric carcinoids. The carcinoids are not the primary disease, they are merely the result of the cascade.

As such, they are expected to wax and wane over time. Some years will show less tumors, some years more. Some years the tumors will be larger, some years smaller. This year: smaller tumors and less of them. So, while that is obviously better than more and larger, it shouldn't be that huge a thing if next year there are more, or if some are larger. It is expected that they will sort of come and go a bit.

The only thing new this year was that her stomach lining overall seemed a bit more irritated, so they are putting her on a short course of a medication to calm that down. Again, not unexpected with the underlying atrophic gastritis primary disease, and no one is that terribly worried about this.

The other revelation, which we probably heard in the past but it just didn't register (I really need to concentrate on great patient education in my own office!), is that the carcinoids themselves are not the main reason for the yearly testing. They really are not worried about them doing anything "bad" at all. The reason for routine and close follow-up examinations is that the atrophic gastritis elevates the risk of adenocarcinoma, a truly bad cancer of the stomach. SHE DOES NOT HAVE THIS! They just want to watch closely due to the elevated risk. They did not have a good estimation of the % likelihood of this cancer, but it was not high.

So, another year here in charming Rochester is complete. It was 58 degrees here yesterday and today, so we're bracing ourselves for the 97 degree NC that will welcome us home later today. Thank you all for your continued steadfastness in lifting us before the throne of grace. His mercies are new every morning, and this morning that feels even more evident than usual.

It is a wondrous thing to be a part of the body of Christ. Thank you all for your prayers and love and care for us and our children. Let us know when and how we can be His hands and feet for you!

Tony

I love Dave McCarty

2008-06-03T13:26:00.000-07:00

Every few days, amybe once a week, my friend Dave McCarty of GospelFriendships.com, sends me (and many others) an email of his thoughts concerning our relationship with a holy God. I had not intended to blog again today, but this was just so stinking perfect that I had to give you all at least a taste of it. He is one of the godliest and most humble men that I know, and has the ability to routinely point out the idols that my heart creates as I try to establish righteousness through effort and self-strength. Thank God for people in our lives, sent by God, to encourage us and to challenge us and to convict us through the Holy Spirit's leading!

"Everything about your life today, is perfect.

Nothing in your life today, could be more perfect. You do not know how to go about improving on things, changing things, for the remainder of this day, week, but He does, because He is perfect, and knows you perfectly, and has a perfect plan for your day, week, month, year, rest of your life....

He is the Lover of your soul, pursuing an intimate relationship with you. Perfectly. He has never made a mistake, and He never will. Suffering is His instrument, His gracious tool, to train you to bask in His unconditional love. So you operate more and more in out-of-character ways: instead of your normal idolatrous ways. Others wowed, you wowed."

You can check out Dave's site at gospelfriendships.com, and the emails are free (although he is entirely support-based in ministry). He is a great guy, and consistently hits the gospel of grace squarely on the head.

Tony

Tuesday afternoon

2008-06-03T13:09:00.001-07:00

Greetings all! We are here in rainy Rochester, and Dee Dee is sleeping comfortably after finishing today's tests. Biggest was the whole-body CT scan with dye. She had a little residual stomach discomfort, probably from yesterday's procedure, although it could have been a reaction to the IV dye today. No results yet.

I did email her original primary doc, Dr. Geoff Thompson, and offered our prayers and concern for whatever he and his family are going through, and asking if he would be willing to review things and at least email me his thoughts. He emailed back today, and after apologizing for his absence, promised to review everything and call me late this week or next week. We are very appreciative of his willingness to do this!

We don't have any big, "Wow Mayo did another amazing thing" stories this time, but continue to marvel at their consistent, determined excellence. Even down to Dr. Thompson's very quick response to my email (I half wondered if I would get the generic "I am sorry that I will be unavailable ....." automated response), and his offer to work for his patient's behalf even when he is supposedly "off duty." They have a large plaque in the lobby of the Charleston Building, quoting John Wesley:

“Do all the good you can,
By all the means you can,
In all the ways you can,
In all the places you can,
At all the times you can,
To all the people you can,
As long as ever you can.”

What a great sentiment and ideal for us all, and one that, thankfully, Dee Dee's doctors ascribe to wholeheartedly.

We meet with the substitute doc tomorrow morning, and then fly home in the early afternoon. No more tests are currently scheduled. We are thankful that the yucky stuff is over, and eager to hear good news tomorrow. Thanks for standing with us!

Tony

Monday Afternoon

2008-06-02T14:42:00.000-07:00

So all the tests for today are complete. Dee Dee did well with the endoscopy, and I had an opportunity to discuss the procedure with the gastroenterologist (Dr. Mangam) afterward. He was very reassuring, which was great for both of us. He did remove 6 tumors, and so Dee Dee is having some pretty solid discomfort now.

Another good thing was that the blood work, scheduled for sometime after the endo procedure, and in another building altogether, was done in the recovery area after the endoscopy. They did this so that she would not have to fast longer, and to make it easier for her. Mayo just consistently gets it right!

Now for the disappointment. I got a call from our primary doc's secretary an hour ago. Dr. Thompson is unexpectedly not going to be seeing patients for the next two months, and that unfortunately includes Dee Dee. We do not know the reason, but due to the length of his absence I suspect it is pretty big, so our prayers are with him and his family. However, we are disappointed! Geoff Thompson is a big part of why we spend the time and money and effort to come to MN in the first place, so this has (temporarily, we pray) knocked us a bit off-center.

That's about it for today. Pray that our emotions and attitudes toward this doctor change would be God-centered and not man-centered. In other words, pray that we remember that our "hope is built on nothing less, than Jesus' blood and righteousness. I dare not trust the sweetest frame, but wholly lean on Jesus' name." He was not surprised by this last-minute change; He ordained it for our good. So, we are praying that this head-knowledge of His promises to us, and His faithfulness to His own glory would quickly transform our hearts as well.

Amen? Amen!

Tony

Monday Morning

2008-06-02T07:10:00.000-07:00

Well, I hope that you all had a great Lord's Day yesterday, and are enjoying the start of a new week today.

We had a great Sabbath yesterday. We:
*Rested - just hung out in the hotel, read, napped, took a walk kind of day.
*Reflected - talked about God's goodness and provision for her regarding the cancer, but also concerning our whole family over the 20+ years we've been married.
*Read - Desiring God (Piper) and The Hidden Face of God (Michael Card), as well as Psalms.
*Ran - we had a nice 2-mile run along the river here in Rochester.
*(I need an "R" word for watching a John Piper sermon on the computer!) - we watched Piper's first sermon in a series he is doing on the intellect and emotion of God as seen in the Psalms. Great stuff!

Dee Dee is back in the labyrinth of hallways and procedure rooms in the Gonda Building here at Mayo, having the first big test of the week. In essence, this is the big test of the trip - endoscopy with ultrasound. This 2-1/2 hour procedure allows them to directly look at the tumors, and to measure their size, number, and depth into the stomach wall. We pray that the number of tumors has either lessened or remained at 22; that their size has decreased, particularly the one larger one that was almost 2 cm on the last visit (above 2 or 2-1/2 cm would point to the stomach surgery); and that they arenot projecting any further into the stomach wall.

She should be done by lunch or thereabouts today. I am praying that she feels well, and that she tolerates the procedures today without nausea. She has fasted since last night, so hopefully will be able to handle some food when we are done here today.

Thank you all for praying for us as we are here. My prayer this morning was not that God would remove our valleys, but that He would give us grace and faith and courage to walk through the valleys as children of the King would walk through the valleys of the Kingdom - without fear, and with a great sense of purpose. Psalm 23 does not say, "The valley of the shadow will be done away with." Rather, it says, "Yea, though I WALK through teh valley...." We all have valleys to trod; let us fear no evil, for He is our guide, He is our comfort, He is our shepherd.

Tony

Update

2008-05-31T20:17:00.000-07:00

Okay, before most of you even had a chance to read the last post about Samara, we just got the call that she is doing well and heading home. God is good! She was surrounded by friends, received quick care, and all seems well.

Our day, other than this recent excitement, was fairly uneventful. The flights were smooth, we got here and checked in with no problems. We found a new restaurant her in Rochester, a tapas place called Sontes. Very good, and would be a great success back home!

So, thanks for your prayers and love, and I'll write again tomorrow.

Tony

PRAY!!!!!!!!!

2008-05-31T19:24:00.000-07:00

PLEASE PRAY! After an uneventful day, we just got a call from our pastor, Warren Harvey. The Harveys and all the Clark kids went to the NC State Baseball game tonight, and Samara has had a pretty bad asthma attack. The EMTs at the field treated her, and feel that she is unstable enough that she is now on an ambulance to the hospital (Rex or Western Wake, we have conflictng reports). Warren is with her in the ambulance. We don't know any more right now, and that is NOT GREAT!

So, pray for Samara and her health and her emotions; these episodes are quite scary for her. And, pray for her Mom and Dad here in Minnesota, worried and wishing that we were there and not here for about 1000 reasons. It is already an emotional time for us here, so pray for Dee Dee's heart as the cancer prevents her from being "Mother" during a true Mother moment.

Thanks,

Tony

'Twas the night before....

2008-05-30T21:50:00.000-07:00

Okay, I know, it is actually very early the morning of, but let's not be so picky!

Just a quick note as we pack up for our next Mayo Clinic voyage. Maybe it's just another excuse to put pics of our N. Africa trip on the blog! One of these is the pic of our whole GAiN (Global Aide Network) team, and the other is of Dee Dee, Samara and me with one of our favorite translators, Achraf.

Due to the quirks of air travel in the US, we were not able to get a flight on Sunday; so even though her testing does not really begin until Monday, we fly up north tomorrow (er, today). We'll do some version of John Piper church Sunday morning (still trying, vainly, to find a ride to Minneapolis), and then everything starts on Monday.

Please pray:
1) That our children would be well, and that the worry does not affect them too badly. Nerves have been a bit frayed here in the Clark house this week, and sleep not so good for some.
2) That Dee Dee tolerates all the tests very well. She has endoscopy (anesthesia on empty stomach); multiple blood draws; full-body CT with and without contrast (nasty nuclear medicine stuff on an empty stomach); and maybe MRI. The octreatide scan, which is her least favorite, is only going to be done if other tests indicate the necessity.
3) That she is healed (which I still have trouble praying for myself).
4) That in absence of true healing, she will be perfectly stable. She was at 22 tumors last year, with the largest being just under 2 centimeters. We need no significant increase in number, and no progression in size to over 2 centimeters; otherwise we will have to do the stomach-removal surgery.
5) That there would be NO SPREAD! Any spread is, we have been told, terminal. Worst would be liver/lungs/pancreas. Let's have none of that!

Thanks everyone!

By the way, our new niece (Lainey - adopted from China by my baby brother and his eternally patient and understanding wife) had surgery yesterday (Thursday) for her cleft palate, and things are going well. While you're praying, why not pray for her as well? God won't get confused, so go ahead - try it!

Tony

Here we go again

2008-05-27T13:55:00.000-07:00

Hello all! The time has come for us to head off to Mayo again, and so I thought I'd kick-start the ol' blog again. This one will be short, and more will follow.

We leave NC on Saturday 5/31 for Minnesota, and return on Wednesday 6/04. Basically the same run of testing that Dee Dee has had before, with one deletion (yay!). Ongoing prayer is for little-to-no change in tumor number or size, and no spread. Dee Dee had two friends die in the past two weeks from cancer, so it is made more fresh and a bit more scary for us because of the reminder of how things can change, and how painful this walk can sometimes be.

One of the reasons that the psychological/emotional impact has been lessened this year, or at least deferred until now, is that Dee Dee, Samara and I went to North Africa on a humanitarian aid trip recently. We saw over 1000 poor children, dispensed nearly 600 pairs of glasses, and diagnosed several serious diseases (one was life-threatening). We also joined with 28 other brothers and sisters, and were privileged to serve with them for these folks who need it so badly. It was a life-experience trip, and we'd love to talk more with you about it sometime. Here are some pictures to whet your appetite!

Because of grace,

Tony

Greetings!

2007-09-25T18:05:00.000-07:00

And you all thought I had finally disappeared! No such luck. After a very hot summer, I thought I'd write a follow-up post to let everyone know where we're at, how things are going, etc.

My lovely bride and I just celebrated two anniversaries. Our TWENTIETH wedding anniversary was in August! After two decades, I can honestly say that I married up! We are foolishly happy with what God has wrought in our lives and marriage. We celebrated by spending 8 nights in Carmel and Sonoma, CA. What a blast! As we drove around Carmel/Monterrey/Big Sur, we were awed by God's majesty, His splendor, His creativity, and His imagination. We glorified Him with every turn as we drove Pacific Coast Highway 1. We stayed at amazing places, ate amazing food, saw amazing places. We simply enjoyed each other and revelled in the one-ness that only God can grow.

While we were there, we marked the one-year anniversary of Dee Dee's cancer diagnosis. What a year! We have been up and down and all around. Thank you all for going through it with us! You have truly blessed us richly with your love, your prayers, your notes, just being part of the body of Christ with us.

Dee Dee continues to feel great. As has been the case throughout the year, she has felt no real physical symptoms. I will say that occasionally the emotional side jumps up and bites her, as it does me. Sometimes there seems to be no reason, but other times there are obvious culprits. For example, if she feels sick for a few days she may start wondering if it has started to spread. Not always, but sometimes. Recently I was diagnosed with a small skin cancer on my right cheek/eyelid (surgery 10/29), and that sort of brought up some emotions about her cancer for both of us. Maybe because hers will never go away we may always have these episodes; we pray that they lessen in frequency and in duration.

We have seen scary moments aplenty. When it was first diagnosed, there were a few weeks in which we did not know if it had already spread and was therefore already terminal. She had thoracic surgery. We've hugged through tears alone in Rochester Minnesota, and spent frightening moments at Duke. There have been plenty of difficult hours. Y'all know that already, and we praise God for His faithfulness and yours.

BUT! Even more than the scary times, the sad times, the alone times have been the amazing times of praise and glory in His goodness and grace. There has been wonderful growth in closeness and unity in an already fantastic marriage. There has been great maturation in already great kids. There have been multiple opportunities to witness and share our reason for hope with unsaved folks. There have been more occasions to mentor and help other folks who are struggling. In short, God has done the God-thing and worked all to His glory and our good. Ain't it grand? Our certainty and assurance in His faithfulness and goodness have been affirmed and strengthened. Praise Him!

We will go back to Mayo next Spring. Hopefully the interim will be BORING. Honestly, I have prayed for mundane as this has gone on. Feels weird, but nevertheless true. Between now and then, I probably will not write too much on the blog. It has been nice to not think about cancer on a routine basis, and as much as this blog has meant to us, it does sort of force me back into that cycle of thought. I feel a bit like a novelist who has gotten to the end of his story and doesn't really know how to wrap it up!

Thank you for being such an important part of our lives, before September 15, 2006, since that date, and prayerfully for many years to come. God bless you all, every single one of you! Praise Christ for His blood shed for our redemption; praise God for adopting us all into the same family! As unreal as "You have cancer" seems to us, the truly unreal thing in this whole equation is that God has intended everything for our good; that He has given us grace where we deserved wrath; and that He intends for us to reign with Christ in eternity. Hallelujah!

Tony
Psalm 4:8

DONE!

2007-05-31T09:56:00.000-07:00

Got the CAT scan done (10 minutes from request to test, then 1 minute wait to get back in with our doc), Dr. Thompson talked to radiologist and bone doc while we were getting everything done (there was a spot on L4 vertebra) and all say NO PROBLEMS!!!!!

Radiologist said that the chest thing is "absolutely secondary to the surgery, and will eventually go away." NO NEED TO FOLLOW UP AT DUKE! That's how confident they are that everything is okay.

Bone guy/radiologist says the L4 thing is nothing to worry about at all, unless you have metastatic cancer, which Dee Dee doesn't have.

That's it folks. Done. See you in a year for routine follow-up. She still technically has cancer, but in the best imagineable scenario. We'll never truly "forget about it," but we'll come pretty close.

We'll talk more later, we're still processing now. And after we eat at Pannekoeken one more time, we're coming HOME!

Tony (smiling from ear-to-ear)

(Mostly) Good news

2007-05-31T08:13:00.000-07:00

Good morning! Due to timing, I've got to keep it brief, which as you all know is not the easiest thing in the world for me!

Blood tests: good
Stomach/abdomen CAT scan: good, no signs of spread
Endoscopy: good. No evidence of increased tumor growth, no signs of other "normal" cancer

Praise the Lord! Her doc is really very pleased, very encouraged that this is the ultra-rare form of gastric carcinoid that will still be here, pretty much just like it is today, 45 years from now. He has agreed to have it followed on a yearly basis, instead of every six months. He does not think that she needs yearly CAT or octreoscans, just endoscopy. If that looks suspicious or different, then the other tests would be done, but only if the endoscopy has changed adversely.

So, since nothing can ever be perfectly simple, there is one wrinkle. The ultrasound showed a well-circumscribed 3 cm X 3 cm lesion in her mediastinum (Chest), basically in the area that the chest surgery was done down at Duke a few months ago. He does not think it is cancer, but thinks that it is either a reactive lymph node to having had the surgery, or that they did not get all the lesion during the surgery. Since Duke did all the CAT scan stuff on the lesion before, he does not have much baseline info to use for comparison.

Mayo being Mayo, however, he picked up the phone and got her worked in for a chest CAT scan, which she is having done right now, then he will see her as soon as she has completed that test. We should still make our flight on time. I do not think we will have any firm answer on the lesion today, but rather will have Mayo forward the results to the surgeon at Duke so that he can compare. Also, we will have his surgical notes and operative reports, CAT scans, etc. sent from Duke to Mayo, so that everyone has everything. Duke was supposed to have done this months ago, but either they didn't or we didn't sign the right forms, who knows. Over the next few weeks we'll get this sorted out.

I will leave you with this quote from Dr. Thompson, who again impressed us: "(Pending the chest issue) I think that you are really pretty healthy."

That, friends and family, is good news.

We look forward to being home soon!

Tony

G'night

2007-05-30T20:58:00.000-07:00

Okay, I know I was supposed to write earlier, and all I can say is that it has been a good, but tiring day. We finished testing this afternoon, and then slept for a while. We did some walking, ate at Pannekoeken again, and slept some more.

So here's the update:

NO SICKNESS! None for Dee Dee, none for me, none at all. She never got nauseous, and that is a true blessing. I felt weird until early afternoon, but then it just sort of went away (strangely enough, about an hour after I posted that prayer request - coincidence? I think not!). Was mine sympathy, or fatigue, or stress? Probably. Why was hers so much better this time? Prayer. No biopsies during the endoscopy. I don't care right now, I'm just happy she did so well.

GREAT PROCEDURE! Out of all the endoscopies she has had, she felt that this was the easiest of all. They put her under so slowly that she felt alike she was just talking to the nurses and then was out. She never felt anything during the procedure, simply woke up after it was all over. She didn't even have a sore throat afterward. Beautiful, simple, done right. And a good thing, since I wasn't allowed to be with her, even in recovery. Bottom line is that she was really pleased with the physical aspect of all her testing this trip.

Now we wait for tomorrow and the summary appointment with Dr. Thompson. We have no results from anything yet. All tests are completed, and we meet with the docs to talk Thursday at 9:00 Rochester time. Our prayers now are focused on the results and our discussion tomorrow.

I will try to blog after the appointment tomorrow, but it will be tricky from a timing standpoint. I'll do my best, probably around noon eastern time.

Thank you all for everything. Almost over, and that's good.

Tony

A bit ofter 10:00 a.m. in rainy Rochester

2007-05-30T08:07:00.000-07:00

Part one of the octreoscan is over, thankfully. She is tired and sore (this test is a bit like my brother's idea of torture!). Yesterday the CAT scan lasted ~45 minutes. She was in the tube, with the machinery about 1-2 inches from her face, with her arms and legs strapped down to prevent movement. She said that she kept thinking that Randy would have to be sedated first (he really dislikes tight spaces!). Today, the octreoscan required her to lie on her back with arms stretched fully over her head for an hour, and will probably require more of the same later today.

Currently she is in the endoscopy procedure. They knocked her out (I assume) about 30-45 minutes ago, and she should be in the procedure now. It will last at least 45 minutes, then an hour or more in recovery before the anesthesia is fully gone and she will be clear to leave this unit. This is my first bout of real anxiety this trip. This was the test that they asked me to come and observe last time, and where I was confronted visually with this amazing field of tumors inside my sweet wife. I am in the waiting room today, and all I can sy is that waiting rooms are boring, lonely places not terribly conducive to prayerful, worshipful waiting. I have read a good bit, prayed a good bit, talked to strangers, paced, stretched and prayed some more.

By the way, please pray that I am not getting sick. I have felt pretty queasy this morning, and am praying that this goes away quickly. Dee Dee suggested that I go back to the hotel, given that she was going to be behind the secret doors for 2-3 hours, but I couldn't leave. Thanks.

I'll write later today, after she is done with all the tests.

Bod bless y'all!

Tony

Early morning, Day 2

2007-05-30T05:43:00.000-07:00

Well, good morning! We made it through the night without real nausea, so Praise God! She is in day two octreoscan right now, at least part one. She will do this scan for about an hour, then we go for the endoscopy/ultrasound, then back for more octreoscan. The only other time she got nauseous last time is with the endoscopy, due to the high number of biopsies. We do not expect so many biopsies this time, so remain hopeful that this trip will pass without one of the chief miseries of the past trips.

It seems to me that the tests can be divided into two categories this time. One category is for those tests designed to tell us if the cancer has spread. These include the octreoscan and CAT scan. The likelihood is that these will be normal. The second group, the endoscopy and ultrasound, are to look specifically at the known cancer in the stomach. So, while all of it has been worthy of prayer, the test at 9:00 (Rochester, MN time) today is the one that has the greatest likelihood of directing our course of therapy as we go forward. I'll post again after I see how things are going.

Our kids seem to be doing well. They are definitely having fun with their friends! Caleb, Gabe and Anna Grace are with one family, and Samara, Micah and Josiah are with another (THANK YOU Comptons and Shearins!). Micah has summed up their overall attitude well; every time we talk he says, "Mommy, I hope you don't die, and I hope it doesn't hurt very much." We had a sweet time of tears and prayer with them on our back porch before we left. Great kids, and we realize how much God has blessed us with them all.

We'll talk/post again soon.

Tony

Quick prayer request

2007-05-29T17:10:00.000-07:00

So we're nearly done with today, and I have one request remaining for day one. She has just started drinking the truly horrid "Drink of Misery" that she believes has been the chief culprit in her nausea in times past. If you could pray that the next few hours pass with no nausea, and that she would sleep well. Thanks.

By the way, Randy, thanks for the anecdote, and for being a lifelong best friend.

Tony

Update

2007-05-29T12:12:00.000-07:00

Well, today got busier! As Dee Dee and the doc from the first test today looked at her schedule, it became apparent that she had a 5-hour gap today, but chaos tomorrow. One test, the full-body CAT scan, requires fasting the day of the test, and it was set for tomorrow at 2:00 p.m. So, despite the protests of the receptionist at the CAT waiting area, I called her primary doc and his office sort of pulled rank and got Dee Dee in for today. This is good, since she is already fasting, and it loosens up tomorrow's schedule as well. Please pray that the two tests this afternoon (CAT scan at 2:30, octreoscan at 3:30) will go off without a hitch. The timing of the two tests is pretty tight, so they are all acting like we are really taking a big chance. She had the octreoscan injection at 11:30 a.m., and they have to start the actual scan almost exactly 4 hours after the injection, so the CAT really has to go smoothly.

Also, pray for us to have patience. She is so ready to get past this, and has so little control over the disease itself, that the machinery of the medical system is frustrating.

Thanks,

Tony

Mayo, Day One

2007-05-29T08:39:00.000-07:00

Well, I am writing from the same waiting room from which I posted months ago, and I must say that familiarity does not offer much in the way of solace. We have really not done too much medically as yet; it is 10:40 a.m. here, and no official tests have been completed. She is getting the nuclear medicine injection for the octreoscan first, then bloodwork, then day one of the octreoscan is this afternoon from 3:00 - 6:00. Tomorrow is the big day, at least from a medical procedures standpoint.

Travelling yesterday was fairly uneventful. Planes were crowded, but airports not too bad. When did the airlines decide that pretzels or nuts should be sold, not included?!?! Rude......

We found a new place to eat here in lovely Rochester last night. Pannekoeken, a traditional Dutch restaurant, serves this cool Dutch-version pancake with fruit, called (you guessed it) pannekoeken. It made us think of our friends the Newbranders, who were missionaries in Amsterdam for several years.

Not a whole lot of anxiety right now with either of us. More a sense of resolve, with a bit of trepidation. Just ready to be done with the next two days. I actually think there will be a bit more anxious thoughts prior to the Thursday appointments with the head doc as we review all the results.

Thank y'all for praying and loving us, and I'll write more later.

Tony

Less than a week....

2007-05-22T22:10:00.000-07:00

not that anyone is counting! We fly up to Rochester on Monday of next week, and the testing begins on Tuesday. It will last all day Tuesday and Wednesday, then we meet with the docs to review everything on Thursday morning. We are scheduled to fly home on Thursday afternoon.

Thank y'all for praying for our hearts the past couple of weeks. I would say that we bottomed out shortly after that post was written, but have noticeably rebounded some since then. Praise God! (I know our kids praise Him that we've rebounded!!) And as the trip approaches, and we get a bit more tense, we have not gotten angry or loud or whiny or any of the things that would have made it miserable. At least, not yet! I have plenty of time between now and then to sin mightily against my kids and my wife!

I am praying for wisdom as we go on this trip. I want to understand more fully the 40-50 year scenario. I know that there are three possibilities from the testing, and I want to understand them better. First, there is no change at all, and we get another 6-month reprieve. Second, the cancer is still confined to the stomach, but has changed in such a way that even Mayo says we should do the surgery. Third, it has left the stomach and gone to another organ. Well, I want to understand the second scenario better; what exactly would have changed to make them feel this way?

I want to talk more about diet. With traditional cancers, it is believed by the holistic medicine folks that eliminating red meat, doing the whole juicer thing, and more of what I used to call voodoo will lower cancer risk. Is that true with carcinoid cancer? Dee Dee has eliminated red meat and poultry from her own diet, and her Mother's Day gift this year was a professional-grade juicer. Certainly these may be healthy regardless of the cancer, but is there any impact? I know that at the very least it has given her something concrete to do, to feel that she is exerting some proactive effort against this disease.

Another question that I plan to ask is why do we do such frequent follow-up? Given the emotional toll, and the fact that we are most likely going to see no change, can we spread the visits out? Also, there was mention in one article that I read in one of the gastro journals that suggested that long-term carcinoid, when associated with pernicious anemia (which we know she has) and chronic atrophic gastritis (which will be investigated at this visit), carries greater risk of traditional cancers of the gut. Does she have the atrophic gastritis? What are the ancillary risks? Can they be lessened? Is there risk of such frequent nuclear/radioactive medicine tests?

So, lots of tests to take, and lots of questions to get answered. Thanks for praying for clarity of mind, and for wisdom, not only fro the doctors but for us as well.

What else, what else....

You notice that in my listing of medical possibilities above, I did not list "God healing her and taking away the cancer." I don't know why. I know it represents some degree of lack of faith in the grand power of God, and of His love and mercies for us, but I don't know why I am struggling here. I have seen God save my son when we were told there was no hope. I have seen my children recover from concussions with amnesia and life-flight helicopter rides. So why the...hesitancy... to pray big?

Partly I think it is because I am a product of my profession. For almost 20 years I have had patients refuse to do what we told them to do, because they "trusted God to heal them at a prayer service," and they have invariably lost vision. I have become skeptical of the whole line of thought, at least to a degree. I think this represents amazing arrogance on my part, and I am praying that the Spirit would convict me of this and lead me to repentance.

I think another part of it is fear. When we counsel young married couples on basic marriage skills, one of the topics we cover is sharing honestly your desires and needs. This is often scary! It is one thing if your needs are unspoken and unmet. But it is far worse if they are articulated and then unmet! I am a bit afraid of God saying, "No." I think this is a lack of trust in His genuine love for me, and a belief that He might withhold a blessing. I am praying that the Spirit would convict me of this and lead me to repentance.

I know that Dee Dee is praying that it will be healed. I am scared silly about this. If it is unchanged, which is her doctors' "best-case", then they and I will be happy. I am afraid that Dee Dee will be crushed. Her faith is bigger than mine, her understanding of the renewed mercies of our God every morning is deeper than mine. I want to protect her from further disappointment, and I suspect that this shows some desire on my part to be God for her. In other words, to provide/protect/heal her, because I am not so sure that He is doing a good enough job as God in her life right now. I am praying that the Spirit would convict me of this and lead me to repentance.

And yet, even as I sit here with tears, typing at nearly 2:00 a.m. because once again this trip is too big to allow sleep (or my faith is too small...), I have hope. My dear friend Scott posed a hypothetical question sometime before the cancer was diagnosed. "Tony, if God told you that in about 5 years you and He were going to be amazingly close, in a level of communion that just blows away your notions of that relationship, would you say yes? And what if He told you that first, He was going to take you down some very dark and difficult roads. Would your answer be the same?" If I truly trust in the God of Scripture, then my answer must be a resounding "YES! Yes God, I will follow where you lead, and go where you ask. I will endure the difficulties, because you are my shield and my fortress. I will persevere, because you strengthen me. I will run well the race you have set before me, because I love to bring you glory, and it is only through you that I run at all."

I was talking to a Jewish physician yesterday. She was in for an exam, and we talked about Dee Dee. This is a wonderful woman, and an excellent, caring physician. She said that she will never understand the unfairness of illness. I responded that I absolutely do not question the fairness of this; God ordained it and that makes it fair. I told her that I believe that the same God who decreed that my wife would have cancer decreed all the days and events of our lives, and that He has prepared us to run this race well. And I told her that as He girds us for this battle, He proves His love for us anew. She cried a bit, and said that the Jewish God, the God of the Old Testament, is not a God of love but of severity. She said that the normal life for a Jew is one of cyclical cowering before the fearsome throne of an angry, somewhat capricious God. I sensed a longing in her for the God I described, an Abba Father God; but she closed that door quickly. I thanked her for her concern for us, and she closed by saying, "Well, I don't pray, but I will think very positively for you both." How sad! My heart broke for her, and breaks now for everyone who thinks of God in that way.

I guess, however, that all the fears and lack of trust that I mentioned for myself a few paragraphs ago reflect that my heart goes too easily back to the desert, to wander with the Israelites. I, too often, cower; when God is offering to hold me in His lap, I quake at His feet. Just as the Israelite nation, when provided with manna, I ask to go back to Egypt. Just as my Jewish physician friend/patient, who thinks that it would be great if God were genuinely loving, but fears that it is not so. Are any of us that radically different or immune to the Israelite sin of doubt? Thank You, Spirit, for this fresh conviction. Make me believe your Word, as you tell me to boldly approach your throne; a throne not of arbitrary judgment or fear, but of grace.

Thank you all for approaching the throne of mercy and grace on our behalf. There are times when I realize that many of you have greater faith than I, and I am glad you're on our team.

Tony

Musings on Bruce Willis

2007-04-23T16:54:00.000-07:00

Okay, I'm back! Bear with me for a moment as I make a bad analogy....If you saw the movie "Armageddon", which was roundly panned by critics, you will remember that Earth was about to be destroyed by a giant, angry asteroid. Enter Bruce Willis to try to save the day. As this knowledge became known, you may imagine the emotional hole that the citizens of this fine planet began to feel.

I bring this up because, while we have known that as this Mayo trip approached we would fall into some degree of emotional hole, we didn't really know when the "fall" would begin. We had hoped we would have a month, and that in the future it would be of shorter duration and more shallow depth with each passing trip to the clinic.

We did not get a full month.

The trip is in about 5 weeks (May 28th), and we realize now that we began the descent about 2 weeks ago. The general feeling of impending yuckiness, if not all-out misery, seems to have begun, and has really sapped our strength and joy for the last few days. Dee Dee has been feeling tired, short of patience, somewhat-to-very sick (colds, etc.), and we think it has a lot to do with the stress of the coming trip. I find myself thinking about the cancer more regularly than in the last few months.

One of the weird things about her cancer is the fact that we never will be "cured." We'll never say, "Dee Dee had cancer back in 2007, but has been in remission for 5 years." She is simply always going to have cancer. So we know, as we head to Mayo, that they are going to find cancer, again. [Barring, of course, a miracle from our God, who is certainly able to do exactly that!] We also know that the tests are pretty rotten. Each time that she has had this particular series of tests, she has gotten amazingly ill. The extreme nausea has lasted about 24 hours, with residual weakness and milder nausea another 12-18 hours. Obviously, we are not looking forward to the trip for those reasons.

The other reality that has struck me lately has been more sobering, at least to me. It is the realization that every single time we ever go for follow-up, the basic question being asked is, "Does Dee Dee get to live, or is she now dying from this cancer?" We have chosen not to do the surgery. We are very comfortable with that decision. We know that the likelihood of her cancer leaving the stomach are between <1% (Mayo's estimate), 1-2% (MD Anderson's), 1-5% (Johns Hopkins), and 15% (Duke's and Mt. Sinai's). We also recognize that if it ever leaves her stomach, it is too late to do the surgery, and at that moment we will realize that her clock is officially ticking. If it goes to small intestine, the clock shows ~15 years. If it goes to her liver, lungs or pancreas, the clock shows 3-4 years. No treatment. No surgery. No options.

When the cancer was first diagnosed, we had a two week window where we knew that all the tests being done were to determine if she were going to live or die from the cancer. What I did not realize is that we will go through that same ordeal, that same emotional battle, every six months. Because we know the crux of the question, the window this time is just longer. For the first time, I find that I am a bit concerned about her emotional/mental state as we go through years and years of that question being asked over and over. Not second-guessing the decision, but just a new wrinkle to pray about.

So, we begin again. I ask that you all begin to pray again, and I realize that many of you have never stopped. Thank you! Pray that we would have health, and peace, and patience with each other and our kids. This is tough enough on them, they sure don't need a crabby version of their folks making it harder. Pray that either the cancer would be gone, or at least reduced. Pray, certainly, that it has not spread. Pray that she would not get so sick this time. Pray that travel goes well.

By the way, Bruce Willis saves Earth by becoming a martyr and destroying the asteroid (which was the size of Texas!) What we need here is for God to bless science and medicine with medical devices to blow up the carcinoid, removing the threat and restoring peace and health (grin). I know, as far as analogies go, this is not one of my best. But, my brother Randy and I love the movie, so I knew at least he'd enjoy the reference.

It is amazing how many secular productions are based on a Christ-typology, isn't it? In Armageddon, sin=asteroid, earth=well, it equals earth and all it's inhabitants; and the only way to save it is through the sacrifice of a man. Please, now, don't yell at me for equating Bruce Willis with Jesus! I'm just pointing out that even screenwriters are influenced by Scripture, though they would probably deny it. Check out Armageddon if you haven't seen it, and you'll see what I mean. Same is true of Green Mile (innocent man takes on the sickness of others to resotre them to health), written originally by Stephen King. Same in Shawshank Redemption, also by Stephen King: innocent man, saves another after personal abuse and shame.
One caveat with these, by the way; they are rated R for language and violence, so be forewarned.

When did this become Ebert and Clark at the movies????? Am I supposed to ask you to save me an aisle seat or something like that??

Bless y'all!

Tony
Psalm 4:8

By the way, given the less frequent nature of the blog for the past few months, I'd love it if you could maybe email or talk to a few of your fellow readers to let them know the situation, and that I am cranking up the blog-o-matic again. Thanks!

Hello Again!

2007-03-19T07:06:00.000-07:00

Well, Hello again! I know, I know, I've been a bad blogger. No updates in 6 weeks! Several of you folks have gently reminded me that I need to be a bit more regular in the updates; thank you for your graciousness, and for reminding me that a lot of folks care very much for us.

One of these friends (thank you Jill!) made the comment that hopefully "No news is good news?" In a real way that is true. I'm not sure what it says about my own character that I write like crazy when everything is difficult or scary, and not too much when it is smooth and comfortable, but that's the way I seem to function. Basically, we are learning a new life-pattern, a new calendar cycle.

Every six months or so, we will go to Mayo for about 4 days. Between trips, not too much will happen. Right now, we are in the calm in the cycle. We return to the storm in late May. What I expect is that we will coast along pretty well for about 4 - 4 1/2 months, half-forgetting all the great lessons we learned the last time we were in the storm. Lessons like dependency and weakness before God; humility; the willingness to receive aid and comfort from the body of Christ at work; our complete need of the Holy Spirit to guide and direct; things like that. Then, about 6 weeks before the next trip, we'll start to be re-broken before Him.

That is when the emotional aspect will kick back into the game. I suspect that Dee Dee is already beginning to think about the cancer more, to anticipate the tests and procedures, etc. As we get even closer, as we coordinate child care, time off from work, the details of the trip, I will not be surprised to see us have some emotional "bottoming out." My prayer is that it will not be accompanied by spiritual bottoming. Then, we'll go to Mayo, and the physical aspect smacks us around again. Last time, many of the tests made her quite ill, so we are already praying that she will get through them this time without such nausea and discomfort.

One of the reasons that I have not written sooner is that 4 weeks ago I had surgery on my right shoulder. I had big bone spurs, which were cutting the bursa and rotator cuff. The orthopedic surgeon (who said that I was simply getting old and wearing out!) sawed off ~ 3/4 of an inch of two bones, stripped the bursa, and repaired the rotator cuff. I go to PT (physical therapy, or pain and torture, depending on your perspective) twice a week, and they tell me the full recovery is 6-8 months. Getting old is not for the faint of heart!

We are quite busy right now, as I am sure you all are as well. Caleb made the Wake County Home School all-star varsity high school baseball team. He is a freshman, and he and his best friend Whit, also a freshman, are on this team of juniors and seniors. They play all over the place, all the time, so the Clark Suburban has been rolling up the miles! Their first tourney was in Atlanta, and they have games all over central and eastern NC, as well as another tourney in Marietta, GA and in Pensacola, FL. This has been a terrific experience for him, and we have appreciated the godly men who are coaching the team. This team finished 6th and 3rd in the last two home school World Series, so we'll see what happens this year.

My friend Reid, whose wife died suddenly, seems to be doing well. I think that he is somewhat consumed with the simple details of life, with working, parenting during a time like this, visiting with all the out-of-town family that comes to visit, etc. I appreciate your continued prayers for him and his kids.

I will try to write at least once a month for now, and obviously more as we get into the Mayo deal again in May. Thank you all for your faithful prayers, for the emails and cards, for the surprise visits. One church, which we do not attend, has faithfully sent her at least one card a week since the first diagnosis (Yay Salem!). Thank you all for this tangible expression of love. If there are ways we could pray for you, please let us know. We pray in general for you when we see the notes/etc., but would love to pray more specifically.

Blessings!

Tony

Prayer for a friend

2007-02-03T21:36:00.000-08:00

Dear friends,

Tonight, I have several things to thank God about. I thank Him for choosing me, apart from any merit or worth, to be His adopted child forever. I thank Christ for giving up His own rights, to secure my rights as a joint-heir. I thank Him that He blessed me with His Spirit to teach and to guide me, to comfort me when I hurt.

I thank God that despite the confusion of medical opinions, Dee Dee and I are still like-minded about going with the Mayo Clinic treatment plan of observation. I thank Him for equipping us for this time in life. I thank Him that there are mountain-tops as well as valleys.

I thank Him that Dee Dee had the opportunity to speak at a women's retreat for our church this weekend, and that I am told she was amazing. (No surprise there for me, by the way!) I know her heart's desire was to glorify God, and to edify her sisters; I thank Him that He used her for His purpose. I thank Him that "we glory in tribulations, knowing that tribulation produces perseverance; and perseverance, character; and character, hope. Now hope does not disappoint, because the love of God has been poured out in our hearts by the Holy Spirit who was given to us. Romans 5:3-5) I thank Him that our trials have been with divine purpose. What comfort there is to know that our trials are intentional, and that they have purpose for good; that they are not random or outside the reach of our God. I got into a dispute with a pastor once, in front of a group of folks, because he was telling them that Gabe's illness was not from God, but from Satan. What comfort is there in a God who is not in control of the events of our life? How would that logic have been comforting to Paul, while in jail, or shipwrecked? How would it have comforted us during this illness? No, God ordained this disease, and he knows why. That is enough. This weekend, He used it as part of preparing Dee Dee to speak. Later, He will use it in other ways. I thank Him for that.

Now, I'd like to ask you all to pray for friends of ours. They have been in our small group, and tribulations are more real to them than I can truly fathom. Reid and Stephanie have 3 children, ages 6, 4, and 2. For the past couple of months, Stephanie has had chest pain, but the cardiologist said everything was fine. While driving home from the grocery store last Friday night, 4 days after her 35th birthday, Stephanie had a heart attack and died while talking to Reid on her cell phone. Now, I've had too much occasion to consider my own wife's death this past year (seizure in January, cancer this Fall), and still I really cannot comprehend all the ways to pray for my brother. He is a very solid believer, and I believe that he will persevere, develop character, and have hope. I asked him if I could recruit other prayers through the blog, to which he agreed. Please pray for the comfort of the Spirit, the love of the Father, the fellowship of Christ and His suffering to begin to heal all the hurts. Pray for those sweet little kids. Pray for our little church, and our small group, as we provide care and love. Pray for all the things that I can't even think of right now. Just pray!

Thanks everyone. I'll write again later, and give updates on Reid, as well as our next medical trips to Mayo, etc.

By the way, I'm also thankful to Him for all of you. Ya'll are a blessing.

Tony

I guess it's not supposed to be easy, huh?

2007-01-11T21:39:00.001-08:00

Well, I waited a long time to post again, because I felt that once we got past the business of the holidays, we would make a final decision and I could post that. Sure enough, I had opportunity to talk to the doc at MD Anderson in Houston, Dr. Yao, and he felt that observation would be perfectly acceptable. He is a leading expert on carcinoid, and he likes to use the "What makes you sleep well at night" test. In other words, if you are going to have this everyday sense of anxiety and foreboding, then do the surgery and be done with the cancer. Accept that you will have some (either a lot or a little) consequences, but rest easy because the cancer is gone. On the other hand, if you can live life without that sense of dread, then don't do the surgery.

As we finished up our conversation, he mentioned that he would like me to talk to a doc in NY named Richard Warner, who has treated as many of these as anyone in America. He said that Warner has reported anecdotal success with slowing the progression via an elaborate diet. Yao's point was that if we are going to do observation, we could easily add the diet thing to that.

As you hopefully know, Dee Dee and I are not really fearful folks, and we can sleep quite well at night (well, she can; I never sleep much anyhow) regardless of things like this. We slept well when we thought this might have already spread, and would not have been treatable. So, we decided not to do the surgery, and began making plans for our next trip to Mayo.

However, to satisfy Yao's recommendation, and my wife's love of healthy diet, I called Warner. He listened to her case data, then said, "If she were my patient, I would not try the diet. She has too many tumors, and at least one that is too big for the diet to work. I would remove the biggest tumor with wedge resection, and then do the antrectomy surgery to remove the lower 40% of her stomach. I am concerned that the one larger tumor may be self-feeding already, and not dependant upon the gastrin (hormone) that caused the tumors to form initially." While he agreed that metastasis was unlikely with gastric carcinoid, he said that in his clinic (Sinai Medical Hospital and University) he has seen it spread in 5% of cases. Honest to goodness, I nearly hung up on him as soon as he started talking, 'cause I did not want to hear what he was saying. And I didn't want to report it to Dee Dee either! Sure enough, as I walked in the door that night, she asked if I had gotten to speak with "the NY doctor."

So, the buoyancy that I had seen in Dee Dee for about a week, after we made the (we thought) final decision, has lessened. It has not vanished, but I could physically see her countenance falling as we discussed Warner's thoughts. At the least, it introduces doubt; doubt that will, I am afraid, make her less able to rest confidently in an observation approach. I still suspect that we will opt for no surgery, but we will have a period now where we wrestle with it all again. Maybe we would have had that every time we went for follow-up evaluation? I don't know. We will definitely ask our Mayo doc about these issues.

Please pray for peace. Pray for confidence. I know that God has ordained and decreed how this will turn out; I know that He loves us, and is showing that love by refining us. Pray that he would enable us to boldly live in light of that love. Pray that we/she would not get discouraged. Amazing - 5 hospitals, and at least three opinions.

Thank you all for praying so much, and so long. You all encourage us so much! If a few of you could email Dee Dee, or send a card, it would help put some wind in her sails. With me blogging less, fewer notes come in. That was actually great when we thought we were done working through things; it helped with a feeling that this chapter was closed. Now that it is at least partially re-opened, I know she'd appreciate hearing from you.

By the way, she and I had the opportunity to see the Monet in Normandy exhibit at the NC Museum of Art this afternoon. Amazing! I thank God that He gifted some, that they could put onto canvas a sense of the splendor of His creation. I felt like saying, "Amen" as I looked in wonder at the original works of Monet. I don't know if he felt like he was honoring God as he painted, but I felt like I had worshipped as I enjoyed his work. That is what art should do - reflect God's majesty and glory in creation. That's what we should do in our daily lives, because in some ways, we are the canvas that God paints upon!

God bless ya'll!

Tony

Early Christmas present

2006-12-17T22:03:00.000-08:00

Hello All! Merry Christmas about a week early from the Clarks. I know that the posts are a bit more irregular in frequency lately, but that is simply because of two things. One, and I am sure you can all relate, it is BUSY right about now! And two, there's just not much happening medically for Dee Dee. She has mostly fully recovered from the surgery, with the exception being lingering soreness if direct pressure is applied to her left side. We cancelled one follow-up at Duke, just because there seemed no point in it until we decide what to do from a long-term, big decision standpoint.

I have spoken to the folks at Johns-Hopkins, and they affirm that both Duke and Mayo are logically, medically reasonable in their advice. Duke's surgical answer guarantees no cancer but lingering "yuckiness" (a highly sophisticated medical term, by the way); Mayo's means some long-term risk from leaving over twenty tumors in your stomach on purpose, but is reasonably safe with no yuckiness. Johns-Hopkins says that both make sense, and that neither clinic is giving strange advice. I have had one conversation with the doc at MD Anderson in Houston, Dr. James Yao, who is recognized as one of the nation's leading researchers for carcinoid cancer. He also says that sometimes they do the surgery, and sometimes not. He, too, says that both answers are valid. He is debating the need to see Dee Dee, versus just looking at her info and talking to me on the phone. We are leaning more and more toward the Mayo approach of life-long surveillance, probably twice a year for now, once a year down the road. We would do this at Mayo, simply because they are the ones who most earnestly believe it to be appropriate (my decision on that part of the plan).

Now on to the really important stuff. Today was one of the best days in our young church's life. We are less than nine years old, less than 150 people, and just a great community of members. We have this one family, fantastic couple with two girls. The dad, at age 40, became a Christian yesterday! Lots of cheers and tears in Ambassador Presbyterian today, and I am sure for a long time to come. He has loved his wife by attending faithfully with her all these years, as a show of support and respect. She has personified 1 Peter 3, by being a steadfast and godly wife, making the gospel attractive to her husband. PRAISE OUR GOD for His sovereign plan, for His choosing this man to reign in glory, for electing to save another who, like me, did not deserve it. PRAISE OUR GOD that none of us get what we deserve, that none of us can do anything worthy of His approval, but that we can be adopted by the King of all glory to be sons and daughters, full of His grace and receiving His mercy. Let us join with the angels, who are rejoicing for my friend tonight.

Well, there is nothing else that I can write about that warrants inclusion with a sinner being saved, so I'm gonna go to bed now. Take a moment to pray for that friend or family member who you used to pray for regularly, but time has dulled your sense of urgency. You know, that person who seems like a lost cause, that if you really could be honest with yourself, you're not even sure God can save, or wants to save. Time is nothing to our God; and His grace is irresistible. (And all my reformed brothers said, "Amen!")

Love, thanks, and prayers,

Tony

Now that we've calmed down....

2006-12-02T16:51:00.000-08:00

Okay, yesterday was no fun. The results were good (the scan showed no new tumors, and the areas of concern were deemed "okay."). For that, we are very thankful. Now to the frustration.

It took a great deal of effort and aggravation to even get yesterday's test scheduled, because Duke insisted that once you have had a doctor do any type of "scope" procedure, no one but that doctor could ever do another scope. So, we had to coordinate her test yesterday with the doc who did her first scan at Duke, and that was tough. Finally, we got that scheduled, nearly three weeks after the initial order for the test (lots of other openings were available sooner, just not with her assigned doc). Then, we had to get the consultation with Dr. Bendell scheduled for after the scan; this was finally set up for Monday, 12/04.

We get to the pre-op area for prepping Dee Dee for the scan, and sure enough, her doc is NOT even in town. Instead, the doc is someone we could have had do the procedure two weeks ago. We maintained a sense of humor, and let it go. The procedure lasted about 50 minutes. Normally, the patient is sedated at the beginning, and wakes up after it is all over. They have a scope down the throat, into the stomach, and this scope is pretty large in diameter. Well, they did not give Dee Dee enough sedation, and she kept waking up during the procedure. She would try to tell them she needed more meds, and they just told her to be still, or to be patient, they were almost done, yada yada yada.

This started shortly after they started the procedure, and it hurt basically the whole time. When they got me to her after it was over, I thought I was going to have to restrain her she was so upset. The doc came and apologized, but that did not erase a pretty bad afternoon. Her throat was very sore the rest of the day yesterday, but today has just been "not normal."

Okay, the venting is over. We are very pleased at the results of the test, even if the test itself was tough. I already emailed the doc at Mayo, and he responded that this is further proof to him that we should not do the stomach surgery. At the very least, we are sure that we will not have any further procedures at Duke. The last 2-3 experiences have been....well, bad. From a scheduling standpoint, from a compassion standpoint, from a pain standpoint, they've just been bad. It seems as if in their desire to practice great medicine, they forgot to practice preat patient care. There's more involved than just the stomach; there is a whole person attached to that stomach! In their zeal to do surgery on her stomach, it feels to us as if they have forgotton to care for the woman. Oops, I think I vented some more!

Thank you all for praying about yesterday. The results were good, and we are grateful for that. Pray that we don't smack anyone at the last appointment on Monday. Also, we are going to at least talk to the folks at MD Anderson (a great cancer clinic in Houston); not sure yet if we are going to go for official consult, but may just talk to them about their philosophical approach to this condition. Pray that we would be wise about that as well, and that the path to doing either of those courses of action would be smooth.

This is Saturday night, so I pray that you have a blessed Lord's Day tomorrow.

Immortal, Invisible, God Only Wise

1. Immortal, invisible, God only wise,

In light inaccessible hid from our eyes,

Most blessed, most glorious, the Ancient of Days,

Almighty, victorious, Thy great name we praise.

2. Unresting, unhasting, and silent as light,

Nor wanting, nor wasting, Thou rulest in might;

Thy justice, like mountains, high soaring above

Thy clouds, which are fountains of goodness and love.

3. To all, life Thou givest, to both great and small;

In all life Thou livest, the true life of all;

We blossom and flourish as leaves on the tree,

And wither and perish - but naught changeth Thee.

4. Great Father of glory, pure Father of light,

Thine angels adore Thee, all veiling their sight;

All praise we would render; O help us to see

’Tis only the splendor of light hideth Thee!

Thanks-giving

2006-11-24T06:39:00.000-08:00

Gobble Gobble! I finally remembered where our blog was, so I'm here to "post" again. Actually, I've just been slack/busy/waiting for new developments. There is still not much news to report, but I wanted to share a few things we are thankful for, as well as a brief medical update (which is at the end). I hope you all had a great Thanksgiving. How about you folks overseas? Did you do the whole Thanksgiving occasion?

Dee Dee and I have been married for almost twenty years. I am thankful for a godly wife, who loves our Lord, trusts His word, and lives it daily. I am thankful that she is still so good-looking, and that she somehow still thinks I'm okay as well. We are thankful for six great kids. Caleb turns 15 in a couple of days! They are all healthy and well, and we usually want to keep them (grin). We are thankful for a church where God's word is faithfully taught, where the people truly care for one another, and where our gifts are given opportunity to be used. We are thankful for extended family, that despite the normal peaks and valleys of lifelong relationships, are still strong, and in many ways more enjoyable than ever. We are thankful for many friends, who care enough to read stuff like this, to write, to pray, to cook, to love us after the manner of Christ, with grace and mercy. We are thankful for a great practice, with an understanding partner and his wife who care for us as we go through this; and with amazing patients who not only understand when I have to cancel, but many of whom are reading this blog and praying for us as well. We are above all, thankful for a God who is alive and well, active and strong; who is trustworthy; who is faithful to forgive; who never forsakes us even when we turn from him to chase our own idols.

We can just look back and see His providence and protection in so many ways! For example, God used Julius Erving (the basketball player) and J.I. Packer (the theologian) to bring Dee Dee and I together. Amazing! The list of health care issues that we have been through, and delivered from, is surprisingly long. It would take far too long to record them all, and to be honest I started to write some of them, but it just felt wrong. Suffice it to say, we have often been on the receiving end of the medical field!

On to the medicine. Dee Dee has the endoscopic ultrasound scheduled at Duke for this coming Friday, 12/01. Just getting this thing scheduled has been a royal pain, but it is finally almost here. She then has follow-up with Dr. Bendell on Monday the 4th. At that point, there will be no more medical testing or investigating to do; we will have all the information. It will only remain for us to decide. Neither of us wants her to have the stomach surgery, but we will if she needs it. The medical and scientific arguments espoused by both camps (Duke - do surgery; Mayo - no surgery) make remarkable sense.

Mayo says the cancer will never leave her stomach, and will never shorten her life. It will significantly inconvenience her life, but that is all. Duke says that may be true, and the science makes sense, but no one can guarantee that it will not spread. If Dee Dee is that ultra-rare patient (that Mayo says does not exist), then we will regret the decision not to do surgery. Once it has spread to another organ, it is treatable, but not curable. If we do the stomach surgery, then all agree it will be permanently cured. As Dee Dee puts it, Duke is "selling" life insurance.

However, the premium for this insurance is awfully high. Her weight would immediately drop to 90 pounds or less. She may need to be tube-fed for a period of weeks. It could take as much as a year for her weight to recover. It would take about the same length of time for her energy and strength to recover. She would run the risk of significant bone-density problems as a senior citizen because of the extended time of weight loss. It would make the normal living of life for her difficult for a season (homeschooling, teaching, mentoring, etc.). This is all separate from the other issue, the potential for the lifelong digestive problems. So again, we'll do it if she needs it, but man she really needs to need it! I don't think we will do it just out of fear, or from a sense of "What if...."

Certainly, we will not do surgery without another institution concurring with Duke. I have already talked a fair bit with Johns-Hopkins, and they approach this condition from a team format. One doc gathers all the info, then presents the case to an oncology board. They discuss it for an hour or two, then vote. Majority wins. Bottom line, they go about 60% of patients with surgery, and about 40% surveillance; a poor tie-breaker. Sloan-Kettering is very difficult, and will not talk with me on the phone. So, if we decide to go for another opinion, it will be to M.D. Anderson in Houston, TX. This is a great cancer clinic, and is the one our Aunt Jackie received care from during her battle with terminal cancer. We have not decided yet whether to go for another opinion or not. On many of the issues we have faced, I have decided for her/us. This issue is really one that gets to Dee Dee's peace of mind, so I am following her on this one.

Thank you all for persevering in prayer on our behalf. I'll try to write more regularly. Ya'll are great, and I thank God for each of you!

Tony

Oh, also I thank God for turkey and for oyster dressing. And for pecan pie. And naps. He didn't have to let us have any of those, ya know?

Wisdom

2006-11-09T20:10:00.000-08:00

Psalm 111:10 - "The fear of the LORD is the beginning of wisdom; all those who
practice it have a good understanding. His praise endures forever!"

It seemed appropriate to start tonight's post with the topic of wisdom, because we sorely need it. Our appointment today with Dr. Bendell went fine, and we liked her well enough. She was very encouraging about the lymph node results, which actually weren't really even lymph in origin. She was encouraging that the long-term prognosis is very good. She was emphatic that the correct course of therapy is to do the stomach surgery to remove the antrum of the stomach.

Ugh.

(Heavy sigh)

So now we come to it, to the deciding point. Mayo says do not, under any circumstances, take out her antrum. In fact, I got an email from the doctor at Mayo last night reiterating that point (Dr. Thompson). The science behind this approach makes wonderful sense to the medical side of both of us. The desire to avoid major surgery, with a 6-9 month recovery, is obviously attractive. The avoidance of the risk of permanent side effects in her digestive system would be great.

At Duke, every doctor, physician's assistant, and nurse practitioner have all said to do the surgery. No exceptions. They have stopped just short of calling Mayo's "Surveillance Therapy" approach ridiculous and irresponsible, but they've come close. (Mayo, on the other hand, essentially called Duke's surgery approach barbaric and uneducated.) The reasoning behind Duke's approach is a bit more philosophical, and unfortunately for us, the folks who ultimately have to make this decision, it also makes absolutely perfect sense. Their reasoning is that she has cancer; it is confined to one location. If we do this surgery, the risk of further complications or spread are permanently eliminated. It is gone, won't come back, completely finished. She never worries about it again.

Also, and this is a part of medicine today, I am sure that everyone at Duke knows that if they recommend the surgery, there is no risk of me coming back 5-10 years from now with a team of lawyers because they failed to act and prevent the early death of my wife. If they go with surveillance, they are convinced that there is some risk of shortened life; why would we chance it, and why would they risk it legally? I just know that is part of their thinking.

Duke agrees that the risk of metastasis is very low, but refuses to say impossible. Mayo says they "think" it is impossible. Dr. Bendell said that if Dee Dee were 72, she would say not to do the surgery. But as young as Dee Dee is, it just doesn't make sense to leave the cancer inside her body when you have a guaranteed way to get it out forever, according to Dr. Bendell. By the way, Bendell is probably in her mid-thirties, female, and fairly thin (not as thin as Dee Dee, but slim). So, she fits the profile for higher risk of post-operative complications that Dee Dee would be at risk for. When asked today what she would do, Dr. Bendell did not hesitate: "I would have the surgery as soon as possible, and be done with it."

We told Dr. Bendell that we would take everything under advisement, but there was no way we were deciding this thing today. We got (more!) bloodwork done today - seven vials worth. They are scheduling the last study they want to do (Mayo agrees), an endoscopy with ultasound of the possible sub-surface tumors in the stomach. Then, we will talk a lot, pray even more, and decide what to do. Obviously, we don't get to simply refuse to decide; that then would be the decision to simply observe. We discussed, briefly, getting yet another opinion (from either Johns Hopkins or from MD Anderson in Houston); but to be honest, starting over at another center made us both feel a bit nauseous. We may revisit that idea later.

By the way, if we go with Mayo's approach, basically for the next several years Dee Dee would get endoscopy 3-4 times a year, CAT scan once a year, PET scan once a year, and octreatide once a year. After that, they would try to spread things out, assuming everything was holding stable. If the lesions grow in size or number, there is increased risk of internal bleeding. If they metastasize, there is risk of shortened life span. Obviously we can come back and do the surgery later, but with any cancer there is a "too late," although evidently that is a low (Duke) to no (Mayo) risk here. If we do the surgery, the cancer risk is gone, but there is between a 5% risk of the permanent digestive problems (per the surgeon, Dr. Pappas), to a 15% risk (per Bendell), to a 50% or greater risk (everyone at Mayo).

So we pray for wisdom. I pray for the courage to be a godly husband and lead my wife even in the scary times and the scary decisions. The Bible says that fear of the Lord is the beginning of wisdom. Proverbs 8:13 - "The fear of the LORD is hatred of evil. Pride and arrogance and the way of evil and perverted speech I hate." So, I pray that we would fear God more, in the correct and proper way. I pray that our reverence and awe and humility before His perfection and holiness would grow. I pray that we would be more convicted of our sinful nature, and of our specific sins, in light of His holiness. This is proper fear of God. And this will lead to greater wisdom. It is a mathematical certainty. Fear of the Lord is the beginning of wisdom.

People ask me if we want to flee, to just get away from this. No! I didn't ask for it, but I have asked God to take it from us. And He has repeatedly said, "NO." His answer, given that He has promised to only do good for us, is good enough. I will not deliberately try to avoid His plan. And by the way, I am not nearly brave enough, or good enough, on my own to stand up to this. It is Christ in me, it is the Holy Spirit comforting me, that enables me to talk about this candidly, to face it daily with sanity and some humor. Our younger kids sing, "My God is so big, so strong and so mighty, there's nothing my God cannot do." And while that does mean that He could take the cancer away, it seems in our case to mean that He can empower us to live as if Scripture is true, even when life circumstances turn scary and sad and hard.

That's really all I/we are doing: living daily as if the Bible is actually true. After all, we're Christians; shouldn't we live this way?

Tony

Proverbs 2:6-7 - "For the LORD gives wisdom; from His mouth come knowledge and understanding; He stores up sound wisdom for the upright; He is a shield to those who walk in integrity"

Proverbs 8:14 - "I have counsel and sound wisdom; I have insight; I have strength."

Final report on the "Lymph"

2006-11-08T12:23:00.000-08:00

We had our appointment today with the thoracic folks at Duke. Basically, all GOOD NEWS! They said that she is healing as expected, and that her incisions are great. The pain, and more recent addition of significant burning, are normal and will pass over the next two-three weeks. The doctor said that you can tell a great deal about a person's overall health by how they do while under general anesthesia, and that Dee Dee is "the very picture of excellent cardiovascular health." One of the anesthesia docs commented that he needed to get on "whatever workout program this lady is on." That's my bride!

And best of all, the lymph was actually more of a blood vessel problem, totally benign, unrelated to the stomach in any sense of the word. It was large enough that they are glad to have it out, but suspect that it had been there for years. Amazing! The thymus gland was partially involved, and they removed part of it, but that, too, is no big deal. The thymus is hugely critical in developing immunities during the first decade of life, but by age twenty it begins to atrophy, and by now is mostly inert tissue. It has done its job, so it basically goes away over time. Again, we are fearfully and wonderfully made. If Darwin himself could see the human body with the level of medical and scientific knowledge that we have today, he would scoff at his own theory.

Thanks for continued praying, and meals, and notes and cards. She has never been a big fan of spending time on the phone, but she's even up for more calls and visits now. Thanks for your continued efforts to encourage her, and me, and all us Clarks!

Tony

One week post-op

2006-11-06T13:56:00.000-08:00

Greetings! I know it has been a while since my last post, but that's simply because not much has changed. Basically, this has been a much more painful and slow surgery to recover from than we had anticipated, but she is getting better. Yesterday, for example, she had to leave church early because it just hurt too much to stay.

However, she is clearly better now than she was 2-3 days ago. That is how we have realized that we must think of this process: looking at several days for progress, not daily progress. This is not easy for two sinfully self-sufficient, strong "type A's" to readily accept. We are sort of wired to look at the new morning and compare it to last night. Or, for me to get home from work and want to know how much better she is than that morning. So, it seems, God intends to teach us patience through this process, among other things.

When Gabe was sick, exactly ten years ago, I remember saying that there are times that God shapes his children gently, with very fine sandpaper. There are other times that he is a sculptor, using chisels to knock off great pieces of sin. This is a new time of sculpting for us, and self-sufficiency and patience are two of the chunks getting leveled! Maybe if we'd learned those lessons well enough last time....

Now, I'm not saying that God has sent Dee Dee's cancer purely as discipline. He may very well have sent it simply to refine us, to strengthen our faith. However, His word is clear that he will also correct His children when they are in sinful patterns that they seem unaware of, or unwilling to repent of. Therefore, we would be remiss not to do some introspective soul-searching any time difficulties are sent our way. All opportunities to learn more of our sin, of our need for a savior, should be welcomed and vigorously pursued. This is one of those times, when we are driven back to Christ. We should be thankful when God, in His love and grace, works to get us back to the cross! This is the concept we see in so many Psalms, where He searches our hearts (Psalms 4:4, 7:9, 139:1, 139:23).

Some good news: the preliminary pathology results for the mass removed last week are that it is benign, and unrelated to the stomach cancer. We should get final results tomorrow at her appointment at Duke. So, the surgery was able to be done locally (not at Mayo); in the least invasive manner possible (no broken ribs or sternum sawed in half); with what appears to be the best pathology result possible. Praise God! The pain can wear your body down, but our hearts rejoice in the goodness of God.

Our upcoming schedule looks like surgery follow-up on Wednesday; and first official appointment with the medical GI oncologist at Duke on Thursday. She, we assume, will then schedule the remaining test to look at the sub-surface lesions in the stomach that were seen at Mayo, and then we will decide on further treatment.

I was thinking, how things that you would not really expect to minister to you during troubling times, actually end up being part of the key ways you are blessed. Now, I know you all will laugh at this, and say to yourselves that every Clark male would say the same thing, but food really has been that for us. Many have brought food, both for lunches and dinners. Thank you all! We know some very good cooks! It has been a blessing not to need to figure out menus, try to get them prepared, or just constantly go for take out. Thank you.

Another unexpected blessing: When Gabe was ill, one of our dear friends really ministered to our hearts regularly. Doug and Susie then moved to Oklahoma (proving the depravity of man and that all sin and fall short!), and we have missed them ever since. As we have gone through this, I have missed Doug. I have missed his laugh, his genuine affection, and his ability to quickly connect to my own emotional state. Sunday afternoon, I got a call from this dear man telling me that he would be in my house in about 2 hours. What a treat! He was just in for a brief trip, knew of our situation, and came to spend a few minutes with us. It reminded me of .... the last time I approached this level of hurt/pain/ fear/helplessness, and how God used this brother to minister comfort and peace. In Is. 61, He promises to bring beauty from ashes; isn't it great when He let's us be a part of that process?

Tony

Praising Him for another day done

2006-11-01T20:15:00.000-08:00

Don't you find, when you are sick or hurting, that you almost count the days? You know, for example, that the flu doesn't last forever. So, you count the hours, knowing that relief comes with time. In school they taught us that one of the most effective treatments in all of medicine is "tincture of time." Time alone will cure a lot of ills!

So today, no big events, unless you count a short walk down the street. Unless you count her fever breaking so that she did not have to be readmitted (this was a strong possibility last night at about 9-10 p.m. The magic number for re-admittance was 101.5; she got to 101.2). Unless you count no real nausea for the first time in 48 hours. Well, I'm counting all those things!!!

Yes, time is starting to mend Dee Dee's body from the insult of surgery. She is beginning to feel less sharp pain, and now has this more steady pain, less severe than yesterday. Yesterday the oxycodone narcotic pain meds didn't do a lot of good; today they are helping. These are great things!

She told me yesterday that if the full thoracotomy surgery, as originally proposed as likely to be necessary, actually did hurt a lot worse than this VATS surgery, then she would have opted to leave the tumor in there. My wife is pretty stoic, so I knew she was in a deep hole. Today she can see out of the hole. Thanks for praying.

Tony

Home now

2006-10-31T14:16:00.000-08:00

Just a quick prayer request. I'm guessing that my dear bride came home too soon, because of concern for me and her children. Typical action of my servant-hearted wife, but she's in a lot more pain now that she cannot have the Toradol. Pray that this stage passes soon.

Thanks,

Tony

Going Home

2006-10-31T11:21:00.000-08:00

We are waiting on the wheelchair folks to come and then we are headed home! Dee Dee had a tough time with pain and nausea from yesterday afternoon through the wee hours of the morning, but the nausea has greatly abated. She does have a fair bit of pain, but decided a couple of hours ago that she could rest in her own bed and deal with pain better than she could in the hospital bed. She will be on oxycodone for about a week, and can't drive until she finishes with that.

Thank you all for praying us through this. The doctors continue to be positive and encouraging, and we have a follow-up appointment with Dr. D'Amico's PA on 11/10/2006. We will probably hear about the pathology report sooner than that, at least we hope to!

In terms of visiting her at home, she is still weak and tired, so please hold off today (Tuesday). After that, maybe just call first, but I am sure she will enjoy (brief) visits. Thanks!

We are completely humbled and full of gratitude for the prayers and love of our family and friends during this. You are all loved and prayed for as well. Truly, we are of one body, and that has been evident to all during the past weeks. Thank you for your living testimony of God's grace and love.

Tony

Late night Monday

2006-10-30T20:12:00.000-08:00

After today's earlier posting, things got ...interesting here. The anesthesia finished wearing off, and the pain came hard. There was a delay in getting the Toradol on board, so she had a solid hour or so of real pain. Then, as the pain began to lessen, she began to develop pretty significant nausea. It seems that my super-healthy wife is too fit!

The PA said that she is so thin that her body cannot tolerate much in the way of anesthesia; and since she is not prone to drunkenness or recreational drugs, she is not as able to handle narcotics. So, the morphine, which is necessary to handle the pain, causes the nausea. We have decided that we evidently need to go out drinking and clubbing every couple of weeks, just for preventive health care!

This has slowed things a fair bit. She has not been able to eat anything except jello, and that didn't, er, stay. They warned us that she is going to wake up tomorrow convinced that something is very wrong, because the pain is going to be huge. However, in 50% of patients, they rapidly improve and by lunch time or so feel up to going home. That is certainly our prayer!

Other adventures? How about a nurse giving a heparin injection in her stomach to prevent clots, only to realize as she finished that the needle had separated from the syringe, so an unknown amount of medicine spilled onto her bed. Should we give more? How much? Unreal.

This was an important day, and a very good day overall. We are thankful for all God's mercy today, and pray that it soon fades into the rear-view mirror of our lives.... Thanks.

Tony

Chest tubes suck....

2006-10-30T12:00:00.000-08:00

....the fluid out of your chest, but they sure do hurt! What that obviously means is that Dee Dee is out of surgery, and is now in her room (3303).

Lots of praises today! The surgeon was able to remove the entire node, which he felt might actually have been more of the thymus gland than node, so he also removed a portion of the thymus (Not sure yet if there are any implications long-term from this). He was able to do the surgery with the least invasive type of surgery, just two incisions and no rib spreading. There were no "roots" or attachments from the tumor to surrounding tissue. He said that it did not look like carcinoid at all, and in fact looked like it would prove to be benign and unrelated to the stomach cancer. ALL GREAT ANSWERS TO MANY PRAYERS - THANK YOU ALL!

They did leave in a chest tube, to drain any blood or other fluids from her chest. It will stay in at least until tomorrow morning. It does cause a fair amount of pain, because as the PA said, "You have nice pink healthy lungs, with no room in your chest for things like a tube." A combination of the tube and the surgery are currently causing a fair amount of pain. She felt much better during the 1-2 hours after the surgery, until all the anesthesia wore off. She bottomed out from the pain at about 1:00 p.m. They have her on high doses of Toradol (non-steroidal anti-inflammatory) and morphine, whaich have started to help. They continue to hope that she will be discharged tomorrow, but Wednesday is a possibility.

Last night was a great time to pray together as a family, then individually with each child. Micah, who has not shown tremendous emotions with this thing up until now, could not stop crying; when the dam broke for that little 6-year-old heart, it broke hard. Josiah was the only one who seemed to have no fear, and acted like this was just a big adventure. Even though we left at 5:00 a.m., all the others got up with us this morning to kiss Mom good-bye. A sweet time for us! Thank you all for lifting my kids up as well.

It will take about a week to get the pathology report from the tumor today. After that, we will have an appointment with the digestive oncologist at Duke to decide on how to treat the stomach. If the pathology report is negative, which again is what the surgeon today thinks it will be, then we can probably go with the surveillance approach for the stomach. Our God is amazing! As the coach of the football team in the current movie "Facing the Giants" asks his team near the end of the movie, "What can't our God do?!"

Folks, what can't our God do?

Tony

"Twas the night before....

2006-10-29T14:27:00.000-08:00

Hey everybody! Tomorrow is the big day, and it is with mixed emotions that it approaches. We are eager to have the surgery behind us, eager to have the lymph node out, eager to finally know the opponent we face... we are not looking forward to pain, to the hospital stay, to the finally knowing our opponent.

The surgery is scheduled for 7:00 a.m., and we have to be at the hospital at 5:30. It is a blessing to have the first surgical procedure of the day, for several reasons. It means less waiting time, where our minds drift "to the dark side," as my friend Dave put it. It means less likelihood of getting delayed, or even postponed. It increases the probability that Dee Dee will go home on Tuesday, just because it gives her a few more hours of recovery that day. The doctors say this surgery has a hospital stay of 1-3 days, but they believe that her excellent health and fitness will help her leave quickly. She cannot leave until the chest tube stops draining fluid, and until her pain is manageable by oral meds instead of IV meds.

The surgery is called a VATS procedure; a good web site is http://www.health.harvard.edu/fhg/diagnostics/thoracic/thoracic.shtml

Pray for the surgeons and anesthetists and nurses and PAs. Pray that the surgeon (D'Amico) is able to visualize the node, that it has no roots growing into surrounding tissue, and that it is small enough to remove without spreading ribs. Pray that her left lung re-inflates properly and quickly; and that her chest stops draining fluid quickly as well. Pray that her pain is minimal, and that they can do this with two incisions instead of three. Pray that the incisions heal well, with minimal scars.

Pray for us relationally as well. As the hour approaches, our tension has built, and neither of us is real friendly right now. There are short fuses in the Clark home, including the kiddos!

Many have offered help with logistics for home and children. Thank you! We are blown away by the outpouring of love and encouragement. One of the nice perks of living where you grew up is that we have family staying in the house while we are in the hospital, and after, so the child care is covered. Thanks to all who are helping taxi children to their classes and events. For meals, a great young lady at church has volunteered to coordinate this aspect. Her name is Christy Neal, and her phone # is 363-5441; email is nealcw@hotmail.com.

We cannot express our thankfulness and gratitude to you all. More, we cannot adequately express our thanks to God. We thank Him for being perfectly good, perfectly just, perfectly powerful, perfectly faithful. We thank Him for being a perfect Father. We thank Him for perfect mercy and grace. We thank Him for being Savior and God and King and Daddy!

One of our favorite worship groups to listen to is Indelible Grace. They take old hymns and make them new, and my favorite is "Whate'er My God Ordains Is Right" and some of its lyrics are:
1. Whate’er my God ordains is right
Holy His will abideth.
I will be still whate’er He does,
And follow where He guideth.
He is my God,
Though dark my road.
He holds me that I shall not fall
Wherefore to Him I leave it all.

4. What'er my God ordains is right,
Here shall my stand be taken.
Though sorrow, need, or death be mine,
Yet I am not forsaken.
My Father's care
Is round me there
He holds me that I shall not fall
And so to Him I leave it all.

And then, from one that our worship team chose to sing this morning, I suspect because someone wanted to see me cry and blubber so much that Micah was worried about his Daddy, "I Need Thee Every Hour":
2. I need Thee every hour,
in joy or pain;
Come quickly and abide,
or life is vain
I need Thee every hour,
teach me Thy will;
And Thy rich promises in me fulfill

(chorus) I need Thee, O I need Thee;
I need Thee every hour;
I need you Lord, O bless me now,
My Savior, I come to Thee.

We pray that He will teach us His will, and that we would truly leave it all to Him.

Thank you everyone, and I'll update tomorrow as I am able.

Tony

A very long, very good day

2006-10-26T18:49:00.000-07:00

Usually in a good story, the author doesn't give the ending until, well, the end. (Except in Pulp Fiction, or Reservoir Dogs, but that reference is probably just for a few, like Randy! I actually thought about naming each of the people we met with today Mr. White, Mr. Pink etc....) Well tonight, I'm giving the ending first. Today was a very good day! It was long, but there was nothing terribly painful or miserable about it, and the outcomes were better even than we had hoped.

We started at 10:30 a.m., and finished at 6:00 p.m. We actually spent 5 hours sitting in one exam room! We joked that for us lately, that might qualify as a date. (I then observed that the exam room door had a lock, but Dee Dee didn't think that was terribly funny.) Every 60-90 minutes someone else would come in and ask a bunch of questions, marvel that this young, fit woman had any serious health issues, and assure us that everything was going to be fine. We met with three docs before the end of the day. Dr. Garst was great; she just sat up on the exam table while we sat in the chairs, and talked. She was friendly, warm, and encouraging. She also said pretty quickly that she was the least important "doctor-piece" to the puzzle, because her specialty is lung cancer. She saw herself more as the facilitator/coordinator.

Dr. Garst then went and personally found a doc we had no appointment with whatsoever, but this was the doc that Garst felt would be the best one at Duke to help decide about the stomach, after the node has been dealt with. This was Dr. Johanna Bendell, a medical oncologist specializing in digestive cancer. She just stopped by to meet us, and couldn't really get into the medicine yet, but was also very engaging. Then (well, 60 minutes later) Dr. D'Amico's personal physician's assistant came in. He stayed for at least 45 minutes, and was fantastic. He connected with both of us, and you just felt a trust with him right away. Further in the conversation, he talked about his faith, and asked about ours! Every doc eventually picks up on the fact that we are in a medical profession; every Christian picks up on the fact that we are believers.

Here's where it starts to get medically great. Dr. D'Amico has invented a surgical technique that he is extremely confidant will allow him to get the entire node out with a much less invasive procedure. He will use a video-microscope and two small incisions (1-2 inches each) to get to the tumor. They will deflate her left lung for the surgery, re-inflating afterward. They will leave a drainage tube in her chest until it stops draining any fluid, about a day or so. She will be in the hospital for 1-3 days instead of 4-5 days with thoracotomy (the one we actually thought was the best option) or 2 weeks with the most serious approach. She will be on prescription pain meds for about a week, as opposed to a month the other way. He has done about 2500 of these surgeries, and feels almost certain this will work. Praise God! Finally, he is going to do this surgery at Duke on Monday, 10/30, which is much sooner than we had thought Duke's wheels would spin.

We still have some hurdles to clear. This whole thing is too big to finish all at once. That's the old metaphor, you can't eat an elephant at once, you have to eat a bite at a time. Today was a really good day for progress, for encouragement, and for basic good news. We still have to find out what the node actually is. We have to decide what to do about the stomach. Also, that was a second lesion lower in the chest, and we have to investigate that at some point. Today, they were not terribly worried about this smaller spot. We'll get to all those things, but for tonight we will sleep a bit better, and enjoy the good from today.

Thanks for praying today. "The prayers of a righteous man availeth much." We are grateful that the are hundreds of righteous men and women praying much, availing much, on our behalf. We are aware of people in Peru and Sweden, South Africa, Slovakia, and Germany, and all over the good ol' USA praying for us. Our prayer is that God would richly bless you as you walk this path with us. Thank you! Thank God!

Tony

For His Own Glory

2006-10-25T20:05:00.000-07:00

I'm sorry that it has been a few days since the last post. Nothing has happened medically, and normal life has been pretty busy. However, with the time lapse, there's a lot on my mind, so this could spin into a long one (sorry Kim)!

Let's go medical first. If you remember, Dee Dee suffered a seizure in January this year. She awakened me at 4:30 in the morning with the seizure, and we spent the next two weeks getting her head scanned and tested in every imagineable way. Bottom line: no cause found, "pretend like it didn't happen." Well, I got to thinking that maybe this lymph node, because it presses against her phrenic nerve (the one that operates her left diaphragm, the muscle that makes your lungs work correctly), could it have initiated the seizure? I talked to her neurologist today, and he said that the lymph is almost certainly the cause of the seizure. However, my logic was off a bit; he thinks that because it is on the heart, it started an arrythmia that triggered the seizure. Either way, it is more evidence that the thing must be removed! Now, more than ever, we are opposed to the biopsy approach.

More medicine: we start tomorrow at 10:30 at Duke for (yet more) bloodwork. Then we meet with Dr. Jennifer Garst, the pulmonary oncologist. Here is where there is a huge praise! We have a friend at church who works at Duke Med. She knows Garst personally, and affirmed to us that she is a terrific doc, and a very nice person. Unfortunately, she is not a surgeon. She is a cancer doc, and maybe a biopsy doc. We were quite bummed, because that basically would have meant at least another week of waiting. Well, our friend told Garst our story, including Mayo's recommendation to skip the biopsy and just go straight to surgery. Garst responded with a recommendation on her favorite thoracic surgeon at Duke, and took it upon herself to get him to meet with us tomorrow as well. His name is Dr. Thomas D'Amico, and we meet with him whenever we finish with her. It may not seem like a huge deal, but I gotta tell you, for the Clarks right now there's not much that could have been better news. Our heartfelt thanks to Julia P. for helping us here! More, though, is our sincere thankfulness to God for orchestrating the daily events of our lives to accomplish his good purposes.

Last medical update for the day (hopefully many more tomorrow): I'd like to explain the surgery that was proposed at Mayo. If you take your left hand and make a fist, with the thumb pointing up, hold it in front of the middle of your chest. The fist is the heart, and the thumb is the aorta. Her node sits on top of the fist, leaned against the thumb. In front of the node is the phrenic nerve, that controls the diaphragm. To the right of the node (I think I'm correct here) is the nerve that controls her voice box. The danger of trying to biopsy is that one of those nerves could be accidentally damaged. So, the head thoracic surgeon at Mayo proposed to do a sugical procedure in which he makes a ~5 inch incision in her left side, probably breaks 2 ribs to gain access, and goes to the tumor that way. If he can adequately visualize the tumor/heart/aorta/nerves, he would remove the tumor in this fashion. This also would be dependant upon the tumor being "encapsulated" as opposed to a tumor that is "growing roots." If he cannot see well enough, or if it is rooted into the heart and aorta (like ivy growing on a wall), then he would change and make an ~8 inch incision in the center of her chest, saw through her sternum, and split open the ribcage to almost do open-heart surgery. The first surgery would hurt really badly for ~ 3 days, with hospitalization for 4-5 days. If he has to change gears, we are dramatically increasing the length of recovery.

Obviously we are praying for the least-invasive, lowest-risk surgery that will succeed. We pray that that docs at Duke agree with this approach, and that for a change the two sets of medical experts agree on the correct treatment. We pray that the lesser surgery will succeed. We already pray that her surgery would be without complication, that her life would be protected, her heart and aorta safe, and her nerves undamaged. We pray for a fast recovery, and that the pain would be less severe than they anticipate. We pray that we can do it at Duke, but if things just aren't "right" at Duke, we have decided that we would return to Mayo for the surgery. We pray that we leave Duke tomorrow with firm answers and dates.

Now on to non-medical. People have been graciously, wonderfully supportive in prayer, words, notes, and deeds since this started. We are blown away by the goodness and love of the body of Christ! One of the things that folks keep asking is, "I know how her health is, but how are you both doing otherwise?" I can honestly say that we are doing better than anything that makes good sense. I have yet to detect any anger or despair in either of us. There is no lack of faith; we are perfectly content to be in the center of His will and plan for our lives, and for our kids' lives. We are encouraged daily by His word, your prayers, and our love for one another. We are actually excited by the opportunity to parent our children through this time, because we know that it can be a time where God does amazing things in and for them, too. I told Caleb and Samara the other night that while Dee Dee and I don't want to "Waste her cancer" as Piper put it, our kids shouldn't waste their mom's cancer, either. This will be the seminal time in their adolescence that they will remember their parents actually living out their faith. For them, it may be the most visible time in which our faith was not just theoretical, but real. How great is it to be able to recognize that opportunity, not just have it lazily drift by? The heat of this moment forces us to recognize it, and for that we are thankful.

Don't get me wrong! There is certainly fear (of the surgery, of the pain, of the outcome, of all sorts of things); this is scary stuff. There are many sleepless nights; I haven't slept more than about 4 hours in a night since we found out she had cancer 6 weeks ago. There are more stress-related headaches than we usually have in a year. We wrestle with patience with our kids more, and I wrestle with patience with work issues more than usual. It is just that these things exist inside an over-arching awareness of the sovereignty of almighty God.

So why are we doing well? Why aren't we falling apart at the seams? How are we getting out of bed each day, instead of simply lying there holding each other? This is a living definition of faith. As Dee Dee told our small group Sunday night, faith is choosing to live as if the God of the Bible is real and His word is actually true, even when our emotions don't feel like it. When we do this, our hearts will follow our heads. What do our heads know to be true here? It is just this. God planned from before time that Dee Dee would have cancer in 2006 A.D. This has always been in His design for us, it is under His control, and it is not surprising Him nor stretching His ability to govern it. And because our Lord is also our Father, He loves us too much to let us get to this place unprepared! He not only planned the cancer, but He planned every event, every encounter, every relationship and conversation, even our childhood enjoyment of science which led to medical training, so that when we got here we would not drown. Not only will we get through it, we will triumph, because this is the God we serve.

Why is this so? FOR HIS OWN GLORY. Not for our own praise, but for His. Several have mentioned how amazed they are at our attitudes, or how proud they are of our strength. This is kind, and I thank you. I know the intent of the words, which is to encourage; it does! But remember, I will not boast in anything, save Christ at work in me. Trust me, Tony Clark is not man enough nor Christian warrior enough to handle Dee Dee having cancer and be anything but a babbling idiot. BUT, through Christ we are victorious; through Him we don't just get by, we excel. In Him we live, and move, and have our being. Not for our own glory, but for His.

This cancer was ordained by our Father for our good and His glory. And that is true, no matter the medical outcome from this whole thing. We pray that He will allow this cup to pass, that her health will be restored quickly, and that we soon we are looking back on this time as a closed chapter. But no matter what cup He has for us, we will drink deeply. To do otherwise would be to deny that He is good, to deny that His promises to perfectly love and to always do the best thing for His children are false, to call Him a liar. Our God is true, and trustworthy, and gracious to His chosen people. Never let us doubt the goodness of God!

Finally, I just wanted to mention one of the ways that God has sustained us. Exactly ten years ago our infant son was lying in a hospital bed, desperately ill. The medical team told us that he had about 24 hours before he would slip into a coma, and another 24-36 hours before he would die. He was the third patient in medical literature to have his specific diagnosis, and the first to recover. Today, our faith is strengthened every time we look at 10-year-old Gabe. He is healthy, and sweet, and kind, and bright. He is insightful, loves deeply, trusts God, and thinks the world of his siblings. He is funny, plays drums, is easily distracted, and hates clowns and pigs. In short, Gabe is your classic boy. Every time we look at him, we are confronted with living, breathing proof that our God is able to do whatever he chooses, whenever He chooses, however He chooses. How could I doubt this same God now? If I look at Dee Dee and begin to lose faith, all I have to do is look at Gabe and my heart rejoices.

So, thank you God for being miraculous. Thank you friends and family for being earnest and faithful in your prayers and support. We look forward to seeing the miracles that He works in this time, and to rejoicing with you as He does. I will update everyone tomorrow after we find out more.

Tony

Coming home, many questions

2006-10-19T08:13:00.000-07:00

We are in Minneapolis, just waiting until time to head for the airport now. We just had a long talk about the whole trip, trying to summarize things while they are still fresh, making sure we are together in our thoughts and feelings.

Sadly, we are coming home with more questions than we had before. The two centers are absolutely of different opinions on the stomach; Duke still wants to do the stomach surgery, and Mayo still says the stomach is safe. We don't know what the lymph node is. There is one radiology report that suggests that there is a second, smaller lesion about 6 inches lower than the big lymph, but we are not sure if that is just a poorly worded reference to the big lesion, or actually is a second lesion. It comes from the PET scan, but does not show up on the xray or CT; the big one shows on CT and octreatide, but not on PET.

The last time we talked to Duke, they still want to try to biopsy the node. The folks up here feel that would be a waste of time, and putting Dee Dee at risks that she does not need to undergo. Duke's point is that a biopsy carries less risk than surgery, less pain, and might allow her to skip the surgery altogether. Mayo's point is that the thing is too big to leave in there, no matter what it is, so skip the biopsy with its risks, and just get it out. All agree that it is most likely cancer, but until we get it under a microscope we will not know what type.

(By the way, as I write about my wife and cancer and surgery and risks, I still feel a lot like getting sick. It is a very schizophrenic feeling, letting the medical part of my brain relay facts, while all other parts of me want to scream and run around in circles!)

Emotionally, Dee Dee is very low. She is feeling some sense of failure and guilt because of not getting it done while here, allowing the questions to remain. She is flat out scared of the answers. Not in a weak, immature Christian way; more like a "I am not afraid to die, but I want to watch my children grow up, and I want them to be with me as they do; I don't want my husband to suffer through that now." I think that a big part of her hesitation at doing it here was the real possibility that she could have had a serious problem secondary to surgery here, and her children not able to come to her in time, and her husband going through it alone.

I keep assuring her that we made the right decision, and that it was not hers to make but mine. I still believe it was the right decision, and we will simply plan to get the answers to these questions back home. It will just take a bit longer. Pray for her mind and emotions as much as you do her health. Our adversary is working overtime on her mind right now. Pray that I am able to understand and empathize, to connect in the ways she needs me to connect.
Pray also that things could happen quickly at Duke, and that at least on the node they would be in agreement.

Thank you all for your encouraging words. We read them together often. Thank you for your physical aid as well. Thank you for praying; we know that we are covered in the prayers of our brothers and sisters, co-laborers in the Kingdom, joint heirs with Christ. We know that we are being prayed for by our great High Priest, who longs to intercede on our behalf. These are the things that are true, and praiseworthy, and commendable. Praise God for them, and for you.

Tony

Tuesday night

2006-10-17T15:35:00.000-07:00

Hey folks. I don't really know how to write this one, because I am not really sure how to summarize today. First, some praises. Dee Dee definitely felt better today, and was able to get the octreatide scan done today. She thought of my brother during the scan, because Randy is fairly claustrophobic and this one lasted three hours, with her in a device that was inches from her face the whole time. The results basically confirmed....everything we already knew. She has stomach things and a lymph thing.

We met with the surgeons this afternoon. The stomach surgeon adamantly insists that the stomach tumors are not that big a deal. He wants to watch them every year, essentially forever, but that is all he wants to do.

I think we started to feel a little too happy, because when the chest surgeon came in his news was more than a little deflating. He looked at everything, and said, "That node is no good, and has to come out." He feels that it is as large as an egg. He discussed the possibilities, and while he felt that it was most likely carcinoid, it could be a lot of other things. On that list are breast cancer, lung cancer, and lymphatic cancer.

He wanted to do the surgery tomorrow. This would be a major surgery, with a lot of pain and a fair bit of risk, because it is in contact with two very important nerves (one to her vocal cords, one to her diaphragm, which controls breathing), and it is adjacent to her aorta and her heart. If it is cancerous, then it may be difficult to remove because it will be "attached" to everything it touches. She will be in the hospital for 3-5 days, with a lot of pain. She will have a drainage tube in her side, and until it stops draining she can't leave.

Because of the time of day, we had about 30 minutes to decide. We prayed, cried, and talked. Medically, it made sense to do it here. It is the fastest way to find out the answer; it guarantees that the same pathologist would look at both the stomach tumor slides and the lymph slides; we really liked the stomach guy here (Thompson); lots of reasons.

We decided to come home. If everything goes well, she preferred to have it done at home, where we have friends and family. More, though, we didn't prepare emotionally for major surgery. We didn't feel that we had adequately prepared our kids for Mom having that level of surgery. Bottom line, Dee Dee needed one more very special hug with her kids before a surgery that big. She told me she would follow my decision, but I could see in her eyes and hear in her voice that the thought of doing the surgery tomorrow was hurting her deeply. In the end, that was all I needed; we are coming home. We'll meet with the Duke surgeon next week on Thursday, and have surgery sometime after that.

So all the medicine here is done now. Our flight is not until Thursday, so we will try to fill the hours until then. There is not a lot of site-seeing to do here in beautiful Rochester, MN. We will continue to praise Him for His mercy, and His goodness. We will continue to trust Him as our Father who loves us perfectly. We will count the hours until we finally know what the node is all about. We pray that it might still be something other than cancer, and that she would not need more surgery or chemo/radiation. Thank you for your prayers and love over the past month (which, by the way, has actually lasted about 6-7 years), and especially these last few days.

Tony

Pray tonight!

2006-10-16T18:57:00.000-07:00

Just a quick note, please pray for her tonight. She is really pretty sick, and has been since this morning's procedure. She hasn't been able to eat, and just hurts. Lots of nausea. Minnesota may be a perfectly wonderful place, but right now we're not big fans.

She needs to not be sick for a few hours; she needs to not hurt; she needs to be able to sleep; and tomorrow she needs to be able to keep food down.

Also, she had to drink some fairly nasty medication tonight for tomorrow's test, and was unable to keep it down. Please pray that she is able to get the test done tomorrow despite that difficulty.

Thanks,

Tony

Quick progress report

2006-10-16T12:45:00.000-07:00

It is now 2:45 local time, and I just wanted to give a brief update. The long day is close to being over.

Dee Dee was quite ill after the morning procedures. We had to stop several times as I wheeled her through the hallways. This is a HUGE place! She has just, in the last hour, started feeling okay. She has been able to keep down some dry toast and ginger ale, which is progress.

She had the octreatide radioactive dye injection at 11:30, and the scan is set for 3:30. She will be re-scanned tomorrow at 8:00 a.m., but no new injection is needed. We meet with Dr. Thompson at 2:00 tomorrow, as well as with a thoracic surgeon (same time) to discuss not only the stomach but also the lymph node.

Please pray that Dee Dee feels well enough to eat when we finish the scan today; she has to stop eating at 7:00 tonight for the scan tomorrow a.m. Thankfully, she can eat a light breakfast tomorrow before the scan, but right now she's nearing 20+ hours with lots of medical procedures and no real food. Also, I feel guilty chowing down in front of her while she's too nauseous to eat; really, it becomes a prayer for me as much as her! (Grin)

Tony

So far today (now 9:30 a.m.)

2006-10-16T07:28:00.000-07:00

We made it to the bus at 6:30 without too much trouble, found the "Alfred" building at St. Mary's Hospital by 6:50, then waited until 8:00 to go back. I guess if a one-hour wait is the longest we have, that won't be too bad!

Dr. DeViggio is her endoscopy doc. She is having the procedure right now; they allowed me to go back into the room during the procedure to observe and to begin the dialogue. I have been present for all of our kids' deliveries, seen my wife's "insides" several times during C-sections. I have dissected cadavers. This was...different. Fascinating, and scary. I tried to be intelligent, but probably asked fairly standard, not-too-bright questions. They were at 21 tumors and counting when my presence in the room was evidently no longer useful. Most were very small and soft. He clipped many of them, and cauterized the spots. Some were larger, and about 6 were, in his words, "big." He resected most of them, and cauterized the sites to stop the bleeding.

He will study the tumors under microscope, but was unwilling to offer any early indication as to the early Mayo version of a diagnosis. They will have the microscopic results before our appointment with Dr. Thompson tomorrow at 2:00. Next up today is blood work, then day one of the octreotide scan.

Thanks for your prayers. It is nice hearing from everyone, especially some of you folks we don't get to see or talk with as much as we would wish.

More later,

Tony

Here in Minnesota

2006-10-15T19:45:00.000-07:00

Well, after a day of traveling, we made it to our hotel in Rochester tonight at 7:15 local time. Tired, hungry, glad to be out of airports. It was, to say the least, a weird day.

Usually, Dee Dee and I enjoy travelling. We enjoy flying, we enjoy the anticipation of the trip, we enjoy experiencing a new place. Today, really yesterday as well, it was like we kept trying to summon up any sense of anticipation or enjoyment at the prospect of new things. We tried, but without success. The closer we got to Mayo, the less enjoyable the whole thing became. I think the reality of everything, yet again, hit as we started seeing highway signs for "Mayo Clinic."

It was sad to leave this morning as our children headed off to church with their grandmother, Memaw. We miss them, and are praying for them. Thank you for doing the same.

We have had times today when we laughed. God has continued to provide moments along the way when our love for one another has shined. He has given moments of laughter, and normalcy. We are genuinely touched by the number of people loving us and praying for us, and encouraging us.

We start tomorrow at 7:00 at St. Mary's Hospital, and adjunct hospital affiliated with Mayo. Bus leaves at 6:30, so we need to hit the sack. I'll write again soon.

Tony

PET scan results

2006-10-11T17:13:00.000-07:00

Okay, the radiologist report came in today. "Suspicious for metastatic carcinoid." We are to meet with a pulmonary oncologist, Dr. Jennifer Garst, whenever we can get it scheduled. They tried to set it up for next week, but obviously we will be in Minnesota and unable to make that work. She is the doc who Duke wants to perform the biopsy. They still haven't decided how best to get to the node, but the two leading candidates are to either make in incision in Dee Dee's neck and go down from there, or to make a larger incision between two ribs and go that route.

Even though the PET scan result is not necessarily a new thing, and there is good news (no other tumors, no other lymph nodes involved), it still brings a touch of sadness. As Dee Dee said, we know that God could take this away, and every test or scan that is done confirms that He wants it to stay, at least for now. It is tough to fight the hope, each time, that it will just be....gone. We continue to pray as Christ prayed in the garden, that if it be His will that this cup would pass. The sadness is that with each test result comes confirmation that in fact He wants us to drink from the cup.

Dee Dee went to bed early tonight, and friends stopped by to pray with us, after she was asleep. As Marty prayed, he quoted Philippians 4:8, a familiar passage to many. However, I had never thought of that passage in this light, so my thanks to Marty and Angela for their visit and their prayers; they are a representation of the real efforts being made on our behalf, by more people than we even know of, efforts of love and grace and prayer. Thank you all.

Philippians 4:7-9

"And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things. What you have learned and received and heard and seen in me--practice these things, and the God of peace will be with you."

So, tonight I pray that cancer will not prevent us from thinking on whatever things are true, and pure, and lovely; whatever things are excellent and worthy of praise. God is still the God of love, and peace, and mercy. He is still Abba Father, a loving Daddy who longs to hold His children and give comfort and grace.

We will pray that this cup passes, but more, we will pray that His will is done. We will pray that we learn great things of our God in this, and that He is poured into our kids through this. We will pray, not that He is glorified despite the cancer, but BECAUSE of cancer. We will pray!

Tony

No news, sort of

2006-10-10T19:25:00.000-07:00

Well, no news today from the radiologist or oncologist concerning yesterday's PET scan. Hopefully we will hear tomorrow. I plan to ask the surgeon when he anticipates doing the lymph node procedure as well, to try to get the wheels turning on getting that scheduled. He only does surgery on Fridays, so if he is the guy, it will not be done until 10/27, with results the following week. Yuck.

Also, my wife has officially asked that the shackles be removed, and that the phone re-enter the life of the Clarks! She has had enough time to get past the shock, the stage where you feel like you can't talk about things because you don't know how to think yet. She says that in the past ten years, our phone has never been this silent, nor our doorbell so quiet. So, over the next few days, if you would like to call, please feel encouraged to do so. Ya'll have been great at respecting her, and our, need for some quiet. The cards and emails have been a blessing. Please don't stop those! But, I think there is opportunity now to let your voice provide some nourishment as well. I have seen her blessed while a friend was praying for her on the phone; more of that cannot be bad, right?

Tony

Quick Update

2006-10-09T18:25:00.000-07:00

In honor of my dear sister, tonight's update will be brief (grin)! Thank you all for praying for today's test; Dee Dee tolerated the procedure well. She strongly dislikes drinking the radioactive contrast, but otherwise has fared pretty well today.

The test took about three hours to complete, but we did not learn anything today. The radiologist should read it tomorrow, and we should hear tomorrow or Wednesday. It has as a primary goal the establishment of the appropriate route or procedure to use in getting that doggone lymph node dealt with. It will also, as a side benefit, confirm that there are no tumors anywhere else.

So, we wait. The waiting, the not knowing with any certainty the full scope of things, is officially growing old. I think that is more draining for Dee Dee than anything else; she is ready to tackle anything, but let's please nail down exactly what it is we are tackling!

Everything for the Mayo trip is set. We have childcare arranged; a wonderful young couple, who know our kids well, is staying here at the house basically the whole time. Dee Dee's mom is staying until they get here Sunday night. Thank you all for your offers of help!

So, thanks again for praying for today. We will keep you informed as things happen, or needs arise, or I just need to vent, or whatever.

Tony

Brief Note

2006-10-05T07:43:00.000-07:00

This will be brief, or at least as brief as I am able; those who know me well know that brief is a stretch for me! One housekeeping issue: we are getting a bit of spam on the comments, so I have added the "word verification" feature for comments. Sorry about that, and thank you all for your continued written (notes, cards, emails) encouragement.

On to the medicine. I talked to Pappas at Duke yesterday. He had shown Dee Dee's CAT scan and x-rays to about 6-7 docs at Duke. They all agreed that the lymph node must be addressed, but could not reach any consensus on how to get to it. It is adjacent to her aorta, and they simply disagree as to the best physical technique to get it. So, they decided that they will not do anything until she has had the octreatide scan and a PET scan. (For more info on the PET, this is a very good web site: http://www.radiologyinfo.org/en/info.cfm?pg=pet&bhcp=1)

The PET is scheduled at Duke for Monday at 2:30, and will last about 3 hours. The octreatide is at Mayo on the following Monday, 10/16. I don't know if the biopsy will be done at Mayo, or back here at Duke when we return.

This continues to be a tough time for myself and my sweet bride. The issue of the node has weighed heavily on her heart since the day they told us about it, and the extra difficulty getting to it, the number of docs looking at it, as well as the delays in finding out the answer are all contributing to the general sense of unease. Please continue to pray that it is a medical "red herring," and not of any real importance.

More later,

Tony

No wonder it's tough to love doctors!

2006-10-03T21:20:00.000-07:00

Well, I wrote a post earlier this evening, and went to officially put it on the blog, and it totally disappeared. It was not a nice post, not upbeat, not encouraging, and I think God wanted me to meditate on Him a bit longer before I wrote anything for public consumption!

Today was, to be blunt, a bad day. The whole point of the day, medically, was to do an endoscopy and obtain a biopsy of the lymph node via the esophagus (we were wrong yesterday when we both thought it was via the trachea). We arrived at Duke at 9:15 this morning, they started at 10:30, called me back at noon. She began coming out of anesthesia at 12:15, doc came in at 12:30 or so. "We did the endoscopy, but despite all our efforts were unable to obtain a biopsy." I was shocked, did not know how to react, decided against anger (barely). They advised going home and waiting for Dr. Pappas to call sometime this week with the next, as yet undetermined, procedure time. So, my heart hurt for my wife who had undergone this procedure that while not painful, is uncomfortable and leaves her feeling pretty lousy for a day or so, to no real benefit.

I insisted that they page Pappas before we left. So, we left Dee Dee's I.V. in, etc., in the hope of doing the next thing while we were already there. He called back, and said to hustle over to try to get the octreatide scan today. We went to that area, waited 2 hours, then were told that it could not be done at all today, and that in fact it couldn't be done for a bit over 2 weeks!

Driving home, there was not a lot of conversation. We were both sort of empty, very disappointed. Dee Dee handled it best, and reminded me several times that our times are His, that the courses of our days are in His hands. I called Pappas, and he returned the call a bit after we arrived home. He said he was not shocked that the procedure did not work, and that the node was just too far from the esophagus to reach it safely via that route. He is going to have the pulmonary specialists look at the CAT scan to determine which route will work, and hopefully get that done this week. The options are an incision in her neck, or a larger incision between two ribs.

He also still wants to get the octreatide scan, and will try to get it scheduled sooner than 10/18. By the way, we found out today that this is a 2-day scan. No hospital stay, but back to Duke two days in a row for scanning.

I then called the doc at Mayo who will actually be taking care of us while in Minnesota. This was the first time I have talked with him (he called me back during Caleb's baseball game, while I was coaching and Caleb was pitching!). His name is Geoff Thompson. He wants us to go ahead with lymph biopsy here, agreeing that a 4 cm lymph is unusual, and must be evaluated. He reiterated that he doubts it is carcinoid, but that the size mandates attention. After talking, we agreed upon travel dates, and I have booked flights and hotel for Rochester, MN. Thank God for many things, including Priceline.com! Tickets were all listing for over $1000 per person, and we got them on priceline for $300 a person. Whew! I had to remind Dee Dee that just like our time is His, so is our money. If He chooses to have us spend it on plane tix and hotels in MN, that is His prerogative.

The other significant news from my conversation with Thompson is that he basically said that he was going to absolutely disagree with Pappas. He said that he NEVER takes out any part of a woman's stomach unless it is completely unavoidable. "There is no possible way that I would allow this procedure to be done on my wife. Period." He said that we would be taking a woman who is essentially without symptoms, and "sentencing her to a life of daily symptoms, where she would never again feel normal and good." He wants to look at everything himself, and repeat a few tests (octreatide scan, endoscopy, remove the larger tumors in their entirety), but if all the info we have been given so far is correct, he will simply advocate lifelong monitoring, choosing to leave the cancer in place.

This, my friends, has been the weirdest day of the whole event. We had things done that produced no knowledge, and now have two docs from the #1 cancer center in the US (Mayo) and #4 cancer center in the US (Duke) completely disagreeing. To be honest, I have no idea what to think, how to process this information. I appreciate your prayers for wisdom and discernment at this point. We will not do the octreatide scan here and at Mayo, so we will just do it at Mayo. We fly to MN on Sunday 10/15, and return on Thursday 10/19. That gives them 3 full days to test/poke/prod and talk. As I learn more about his reasons for non-surgical treatment, I will let you know. Also, when we know the time of the biopsy round #2, I will post that.

Tough day, and not a lot of medical progress. Difficult day emotionally for us both. Certainly it was a day that we were glad to see end. Actually it ends two tough days. Yesterday we had two different families that had memorial services for their sweet boys; one lost their son during pregnancy, and another lost their son one day shy of his 9th birthday. A family member/friend of ours had lumpectomy today. Lots of opportunities for God's grace! The good news? His mercies are new EVERY morning, and tomorrow morning is never more than a few hours away.

Tony

News from Duke

2006-10-02T17:13:00.000-07:00

Well, we had our first visit at Duke today, with Dr. Pappas. He did not really have any surprising news or thoughts, but we do have a clearer picture of the scenario.

First of all, he does not think the lymph node is going to be carcinoid. As he put it, "People either get respiratory carcinoid, or digestive carcinoid, but almost never both." However, that node is significantly larger than normal, so it has to be checked out. As he also said, "This cancer is rare enough that even though I see about as much of it as anyone, I average about one a year." That means you check everything out, no matter how remote the risk.

So, Tuesday we go back to Duke for a lymph node biopsy. This node is directly beside her airway in the left side of her chest, so they are going to do endoscopy with a biopsy probe attached to the scope. When they get to the level of the node, they will punch a hole through the airway wall and gather the biopsy of the node. The airway will self-seal, and that's it. It will take 2-3 days for the result.

If it is not carcinoid, then he wants to proceed with surgery in the next few weeks. If everyone is shocked, and it were to be carcinoid, then we start looking at traditional cancer issues, and chemo/radiation/surgery all come into play.

Bottom line, Pappas believes that these are gastrin-produced carcinoid tumors, and that ultimately the cure is removal of the gastrin. Why does she have so much gastrin? The cells in the stomach that allow someone to absorb B12 through the gut are the same ones that inhibit gastrin. In a patient with pernicious anemia, like Dee Dee, these cells don't work. So the gastrin is produced unchecked. Because the tumors are secondary to the gastrin, if you remove the gastrin the tumors shrivel and go away.

So, the surgery he proposes is to remove the lower third of her stomach, called the antrum. Remember, the tumors are in the upper stomach, so he is saying to simply leave them alone. Gotta tell you, it feels weird to intentionally leave the tumors inside! He also said that because this is so uncommon, there is no single definitive treatment option. He thinks there is a reasonable chance that the folks at Mayo may give different advice, just because there are so few cases of this that there are no real clinical studies for everyone to agree upon.

So please pray for several things:
* Dee Dee as she has this biopsy/endoscopy procedure today
* Healthy lymph node, and that we would learn this quickly
* Continue to pray for the trip to Mayo, and really that the docs there would be in agreement with the docs here
* For our courage and strength. There is something hard about meeting the cancer docs and surgeons that propose to remove part of your stomach. It isn't new revelation, because obviously Dee Dee has known that this was coming. It is just the hard reality of it all coming into plain view.

Thanks to you all, and we'll update later.

Tony

Piper, Powlison, on valuing cancer

2006-10-01T19:27:00.000-07:00

Friends,

Here's a quick overview of the last 3 weeks in the Clark house. This is a lead-up to the article that I am going to post at the end of my entry. A bit over three weeks ago, Samara had to be rushed to the E.R. with severe allergic reaction to an unknown airborne allergen, with her airway closing off. She now carries an epi-pen and rescue breather everywhere she goes. Then we found out about the "lumps" in Dee Dee's stomach. Then someone stole my credit card #, and began using it (thankfully a vendor became suspicious and alerted me fairly quickly). Then the biopsies came back as cancer. Then, Thursday, I was told that I needed surgery on my shoulder for several bone spurs and rotator cuff problems. Mercy!

So here's the reason for the synopsis. They are all intentional parts of God's perfect plan for the blessing of His beloved children and the good of His kingdom. There is no accident here, there is no part that falls outside His divine will and decree. So, if that is the case, why? Why us, why now? We may never know all of the answers, but that's okay, we don't need to.

Many of you may have already read John Piper's classic letter that he wrote on the eve of his surgery for prostate cancer earlier this year. For those who don't know Piper, he is a pastor of a large Reformed Baptist church in Minnesota. He is also a wonderful author, and some of his books are Clark favorites. What I had not realized (thanks to Gail O. for pointing this one out to me!) was that shortly after he wrote this letter, a fellow in PA named Dave Powlison was also diagnosed with prostate cancer, and wrote a companion article to Piper's original. Powlison was at New Life church while we were there back in optometry school. This is the approach we should have toward not just the biggees like cancer, but to all the mundane trials and difficulties of life. His letter is entitled "Don't Waste Your Cancer," and you could substitute almost any other word for cancer. Don't waste your shoulder pain; don't waste having your credit card stolen; don't waste the many aspects of raising children, or of dealing with traffic, or anything at all!

Anyhow, Piper and Powlison say it all better than I do, so here ya go. Enjoy! Piper's words are in blue, Powlison's are in red.

Tony
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Don’t Waste Your Cancer
by John Piper
February 15, 2006

I write this on the eve of prostate surgery. I believe in God’s power to heal—by miracle and by medicine. I believe it is right and good to pray for both kinds of healing. Cancer is not wasted when it is healed by God. He gets the glory and that is why cancer exists. So not to pray for healing may waste your cancer. But healing is not God’s plan for everyone. And there are many other ways to waste your cancer. I am praying for myself and for you that we will not waste this pain.

David Powlison’s reflections on John Piper’s words were added on the morning after receiving news that I also have been diagnosed with prostate cancer (March 3, 2006). In each case, the main point and first paragraph is his; the second paragraph under each point is mine.

1. You will waste your cancer if you do not believe it is designed for you by God. It will not do to say that God only uses our cancer but does not design it. What God permits, he permits for a reason. And that reason is his design. If God foresees molecular developments becoming cancer, he can stop it or not. If he does not, he has a purpose. Since he is infinitely wise, it is right to call this purpose a design. Satan is real and causes many pleasures and pains. But he is not ultimate. So when he strikes Job with boils (Job 2:7), Job attributes it ultimately to God (2:10) and the inspired writer agrees: “They . . . comforted him for all the evil that the Lord had brought upon him” (Job 42:11). If you don’t believe your cancer is designed for you by God, you will waste it.
Recognizing his designing hand does not make you stoic or dishonest or artificially buoyant. Instead, the reality of God’s design elicits and channels your honest outcry to your one true Savior. God’s design invites honest speech, rather than silencing us into resignation. Consider the honesty of the Psalms, of King Hezekiah (Isaiah 38), of Habakkuk 3. These people are bluntly, believingly honest because they know that God is God and set their hopes in him. Psalm 28 teaches you passionate, direct prayer to God. He must hear you. He will hear you. He will continue to work in you and your situation. This outcry comes from your sense of need for help (28:1-2). Then name your particular troubles to God (28:3-5). You are free to personalize with your own particulars. Often in life’s ‘various trials’ (James 1:2), what you face does not exactly map on to the particulars that David or Jesus faced – but the dynamic of faith is the same. Having cast your cares on him who cares for you, then voice your joy (28:6-7): the God-given peace that is beyond understanding. Finally, because faith always works out into love, your personal need and joy will branch out into loving concern for others (28:8-9). Illness can sharpen your awareness of how thoroughly God has already and always been at work in every detail of your life.

2. You will waste your cancer if you believe it is a curse and not a gift. “There is therefore now no condemnation for those who are in Christ Jesus” (Romans 8:1). “Christ redeemed us from the curse of the law by becoming a curse for us” (Galatians 3:13). “There is no enchantment against Jacob, no divination against Israel” (Numbers 23:23). “The Lord God is a sun and shield; the Lord bestows favor and honor. No good thing does he withhold from those who walk uprightly” (Psalm 84:11).
The blessing comes in what God does for us, with us, through us. He brings his great and merciful redemption onto the stage of the curse. Your cancer, in itself, is one of those 10,000 ‘shadows of death’ (Psalm 23:4) that come upon each of us: all the threats, losses, pains, incompletion, disappointment, evils. But in his beloved children, our Father works a most kind good through our most grievous losses: sometimes healing and restoring the body (temporarily, until the resurrection of the dead to eternal life), always sustaining and teaching us that we might know and love him more simply. In the testing ground of evils, your faith becomes deep and real, and your love becomes purposeful and wise: James 1:2-5, 1 Peter 1:3-9, Romans 5:1-5, Romans 8:18-39.

3. You will waste your cancer if you seek comfort from your odds rather than from your God.
The design of God in your cancer is not to train you in the rationalistic, human calculation of odds. The world gets comfort from their odds. Not Christians. Some count their chariots (percentages of survival) and some count their horses (side effects of treatment), but we trust in the name of the Lord our God (Psalm 20:7). God’s design is clear from 2 Corinthians 1:9, “We felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead.” The aim of God in your cancer (among a thousand other good things) is to knock props out from under our hearts so that we rely utterly on him.
God himself is your comfort. He gives himself. The hymn “Be Still My Soul” (by Katerina von Schlegel) reckons the odds the right way: we are 100% certain to suffer, and Christ is 100% certain to meet us, to come for us, comfort us, and restore love’s purest joys. The hymn “How Firm a Foundation” reckons the odds the same way: you are 100% certain to pass through grave distresses, and your Savior is 100% certain to “be with you, your troubles to bless, and sanctify to you your deepest distress.” With God, you aren’t playing percentages, but living within certainties.

4. You will waste your cancer if you refuse to think about death. We will all die, if Jesus postpones his return. Not to think about what it will be like to leave this life and meet God is folly. Ecclesiastes 7:2 says, “It is better to go to the house of mourning [a funeral] than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart.” How can you lay it to heart if you won’t think about it? Psalm 90:12 says, “Teach us to number our days that we may get a heart of wisdom.” Numbering your days means thinking about how few there are and that they will end. How will you get a heart of wisdom if you refuse to think about this? What a waste, if we do not think about death.
Paul describes the Holy Spirit is the unseen, inner ‘downpayment’ on the certainty of life. By faith, the Lord gives a sweet taste of the face-to-face reality of eternal life in the presence of our God and Christ. We might also say that cancer is one ‘downpayment’ on inevitable death, giving one bad taste of the reality of of our mortality. Cancer is a signpost pointing to something far bigger: the last enemy that you must face. But Christ has defeated this last enemy: 1 Corinthians 15. Death is swallowed up in victory. Cancer is merely one of the enemy’s scouting parties, out on patrol. It has no final power if you are a child of the resurrection, so you can look it in the eye.

5. You will waste your cancer if you think that “beating” cancer means staying alive rather than cherishing Christ. Satan’s and God’s designs in your cancer are not the same. Satan designs to destroy your love for Christ. God designs to deepen your love for Christ. Cancer does not win if you die. It wins if you fail to cherish Christ. God’s design is to wean you off the breast of the world and feast you on the sufficiency of Christ. It is meant to help you say and feel, “I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord.” And to know that therefore, “To live is Christ, and to die is gain” (Philippians 3:8; 1:21).
Cherishing Christ expresses the two core activities of faith: dire need and utter joy. Many psalms cry out in a ‘minor key’: we cherish our Savior by needing him to save us from real troubles, real sins, real sufferings, real anguish. Many psalms sing out in a ‘major key’: we cherish our Savior by delighting in him, loving him, thanking him for all his benefits to us, rejoicing that his salvation is the weightiest thing in the world and that he gets last say. And many psalms start out in one key and end up in the other. Cherishing Christ is not monochromatic; you live the whole spectrum of human experience with him. To ‘beat’ cancer is to live knowing how your Father has compassion on his beloved child, because he knows your frame, that you are but dust. Jesus Christ is the way, the truth, and the life. To live is to know him, whom to know is to love.

6. You will waste your cancer if you spend too much time reading about cancer and not enough time reading about God. It is not wrong to know about cancer. Ignorance is not a virtue. But the lure to know more and more and the lack of zeal to know God more and more is symptomatic of unbelief. Cancer is meant to waken us to the reality of God. It is meant to put feeling and force behind the command, “Let us know; let us press on to know the Lord” (Hosea 6:3). It is meant to waken us to the truth of Daniel 11:32, “The people who know their God shall stand firm and take action.” It is meant to make unshakable, indestructible oak trees out of us: “His delight is in the law of the Lord, and on his law he meditates day and night. He is like a tree planted by streams of water that yields its fruit in its season, and its leaf does not wither. In all that he does, he prospers” (Psalm 1:2). What a waste of cancer if we read day and night about cancer and not about God.
What is so for your reading is also true for your conversations with others. Other people will often express their care and concern by inquiring about your health. That’s good, but the conversation easily gets stuck there. So tell them openly about your sickness, seeking their prayers and counsel, but then change the direction of the conversation by telling them what your God is doing to faithfully sustain you with 10,000 mercies. Robert Murray McCheyne wisely said, “For every one look at your sins, take ten looks at Christ.” He was countering our tendency to reverse that 10:1 ratio by brooding over our failings and forgetting the Lord of mercy. What McCheyne says about our sins we can also apply to our sufferings. For every one sentence you say to others about your cancer, say ten sentences about your God, and your hope, and what he is teaching you, and the small blessings of each day. For every hour you spend researching or discussing your cancer, spend 10 hours researching and discussing and serving your Lord. Relate all that you are learning about cancer back to him and his purposes, and you won’t become obsessed.

7. You will waste your cancer if you let it drive you into solitude instead of deepen your relationships with manifest affection. When Epaphroditus brought the gifts to Paul sent by the Philippian church he became ill and almost died. Paul tells the Philippians, “He has been longing for you all and has been distressed because you heard that he was ill” (Philippians 2:26-27). What an amazing response! It does not say they were distressed that he was ill, but that he was distressed because they heard he was ill. That is the kind of heart God is aiming to create with cancer: a deeply affectionate, caring heart for people. Don’t waste your cancer by retreating into yourself.
Our culture is terrified of facing death. It is obsessed with medicine. It idolizes youth, health and energy. It tries to hide any signs of weakness or imperfection. You will bring huge blessing to others by living openly, believingly and lovingly within your weaknesses. Paradoxically, moving out into relationships when you are hurting and weak will actually strengthen others. ‘One anothering’ is a two-way street of generous giving and grateful receiving. Your need gives others an opportunity to love. And since love is always God’s highest purpose in you, too, you will learn his finest and most joyous lessons as you find small ways to express concern for others even when you are most weak. A great, life-threatening weakness can prove amazingly freeing. Nothing is left for you to do except to be loved by God and others, and to love God and others.

8. You will waste your cancer if you grieve as those who have no hope. Paul used this phrase in relation to those whose loved ones had died: “We do not want you to be uninformed, brothers, about those who are asleep, that you may not grieve as others do who have no hope” (1 Thessalonians 4:13). There is a grief at death. Even for the believer who dies, there is temporary loss—loss of body, and loss of loved ones here, and loss of earthly ministry. But the grief is different—it is permeated with hope. “We would rather be away from the body and at home with the Lord” (2 Corinthians 5:8). Don’t waste your cancer grieving as those who don’t have this hope.
Show the world this different way of grieving. Paul said that he would have had “grief upon grief” if his friend Epaphroditus had died. He had been grieving, feeling the painful weight of his friend’s illness. He would have doubly grieved if his friend had died. But this loving, honest, God-oriented grief coexisted with “rejoice always” and “the peace of God that passes understanding” and “showing a genuine concern for your welfare.” How on earth can heartache coexist with love, joy, peace, and an indestructible sense of life purpose? In the inner logic of faith, this makes perfect sense. In fact, because you have hope, you may feel the sufferings of this life more keenly: grief upon grief. In contrast, the grieving that has no hope often chooses denial or escape or busyness because it can’t face reality without becoming distraught. In Christ, you know what’s at stake, and so you keenly feel the wrong of this fallen world. You don’t take pain and death for granted. You love what is good, and hate what is evil. After all, you follow in the image of “a man of sorrows, acquainted with grief.” But this Jesus chose his cross willingly “for the joy set before him.” He lived and died in hopes that all come true. His pain was not muted by denial or medication, nor was it tainted with despair, fear, or thrashing about for any straw of hope that might change his circumstances. Jesus’ final promises overflow with the gladness of solid hope amid sorrows: “My joy will be in you, and your joy will be made full. Your grief will be turned to joy. No one will take your joy away from you. Ask, and you will receive, so that your joy will be made full. These things I speak in the world, so that they may have my joy made full in themselves” (selection from John 15-17).

9. You will waste your cancer if you treat sin as casually as before. Are your besetting sins as attractive as they were before you had cancer? If so you are wasting your cancer. Cancer is designed to destroy the appetite for sin. Pride, greed, lust, hatred, unforgiveness, impatience, laziness, procrastination—all these are the adversaries that cancer is meant to attack. Don’t just think of battling against cancer. Also think of battling with cancer. All these things are worse enemies than cancer. Don’t waste the power of cancer to crush these foes. Let the presence of eternity make the sins of time look as futile as they really are. “What does it profit a man if he gains the whole world and loses or forfeits himself?” (Luke 9:25).
Suffering really is meant to wean you from sin and strengthen your faith. If you are God-less, then suffering magnifies sin. Will you become more bitter, despairing, addictive, fearful, frenzied, avoidant, sentimental, godless in how you go about life? Will you pretend it’s business as usual? Will you come to terms with death, on your terms? But if you are God’s, then suffering in Christ’s hands will change you, always slowly, sometimes quickly. You come to terms with life and death on his terms. He will gentle you, purify you, cleanse you of vanities. He will make you need him and love him. He rearranges your priorities, so first things come first more often. He will walk with you. Of course you’ll fail at times, perhaps seized by irritability or brooding, escapism or fears. But he will always pick you up when you stumble. Your inner enemy – a moral cancer 10,000 times more deadly than your physical cancer – will be dying as you continue seeking and finding your Savior: “For your name’s sake, O Lord, pardon my iniquity, for it is very great. Who is the man who fears the Lord? He will instruct him in the way he should choose” (Psalm 25).

10. You will waste your cancer if you fail to use it as a means of witness to the truth and glory of Christ. Christians are never anywhere by divine accident. There are reasons for why we wind up where we do. Consider what Jesus said about painful, unplanned circumstances: “They will lay their hands on you and persecute you, delivering you up to the synagogues and prisons, and you will be brought before kings and governors for my name’s sake. This will be your opportunity to bear witness” (Luke 21:12 -13). So it is with cancer. This will be an opportunity to bear witness. Christ is infinitely worthy. Here is a golden opportunity to show that he is worth more than life. Don’t waste it.
Jesus is your life. He is the man before whom every knee will bow. He has defeated death once for all. He will finish what he has begun. Let your light so shine as you live in him, by him, through him, for him. One of the church’s ancient hymns puts it this way: “Christ be with me, Christ within me, Christ behind me, Christ before me, Christ beside me, Christ to win me, Christ to comfort and restore me, Christ beneath me, Christ above me, Christ in quiet, Christ in danger, Christ in hearts of all that love me, Christ in mouth of friend and stranger” (from “I bind unto myself the name”). In your cancer, you will need your brothers and sisters to witness to the truth and glory of Christ, to walk with you, to live out their faith beside you, to love you. And you can do same with them and with all others, becoming the heart that loves with the love of Christ, the mouth filled with hope to both friends and strangers.

Remember you are not left alone. You will have the help you need. “My God will supply every need of yours according to his riches in glory in Christ Jesus” (Philippians 4:19).
Pastor John
www.desiringGod.org.

Where we are tonight

2006-10-01T18:50:00.000-07:00

Hello all, and I'm sorry I haven't updated in the last few days. Part of that was that our internet was down for two days, and part was that not much was really happening. So, thank you for your prayers and cards and emails despite the lack of new information. Many of the cards and emails have been amazingly encouraging and uplifting, affirming my wife's heart. Thank you!

Our first official appointment at Duke is tomorrow at 11:30, with the surgeon (Dr. Pappas). I am assuming that he will review the test results that we have so far, order the remaining ones, and that will be about it. I don't know how much opportunity we will have to discuss the overall plan, timing, etc. I doubt we meet the oncologist in charge, Dr. Morse. We are eager to finish "defining the beast," so to speak. Will there be chemo or radiation? We don't think so, but it will be good to know for certain. When are they looking at surgery? When should we make travel plans to Minnesota for the Mayo Clinic? Those are the questions that keep circulating for both of us.

The other thing that folks have asked about is how we are doing, emotionally and relationally. It has been interesting to see the progression from the time of first diagnosis to now. It seems as if the initial shock is gone, the subsequent adrenaline rush has also gone, and our tanks are a bit on empty. We are just a little less patient with each other and the kids, a little harsher in our words, a little less on our knees than we were several days ago. At least this is true for me; I suspect that Dee Dee is not quite as impatient and that kind of thing as am I. The problem, or more accurately seen, the opportunity for God's glory here, is that all of regular life keeps going on. Homeschooling still needs to take place. Eyeballs still need to be seen. Parenting issues still come up and need to be dealt with. Our friends and families have difficulties of their own, that we hurt for. All this goes on, and yet there is this underlying current of the THING that is this tension-producing stresser. It just builds, and sometimes it bursts through. My friend Dave called it the dead rat laying on the table that no one mentions. It's always there, but dinner still must be served.

So the focus for us right now, as we are faced with the absurdity of continuing life as usual when nothing about it is really usual at all right now, is that God is glorified and exalted when He accomplishes through frail vessels His mighty works. When we parent with grace, during a time when we don't feel graceful, He is honored. If we care for others, when we don't feel any reserve ability to do so, He is praised. As two ordinarily sinfully strong, sinfully self-sufficient people accept some weakness and humility, He is glorified. For all this, we are thankful and praise Him.

One of the things that I began for Dee Dee today is to print out all the emails, and we are going to put them, with the cards and notes and everything else, into a keepsake book of some type. This will become a treasured part of our remembrance of this time, as in the years to come we can look back and re-read the love that is being poured out from all of you to us. We wish we had done this when Gabe was ill; there is value in chronicling God's goodness, and these expressions of His love, shown through you, are evidence of His grace to us.

So, as I wrap up a fairly scattered entry tonight, some specific prayer requests:
* Pray for a refilling of our physical, emotional, and at least my spiritual tanks.
* Pray for continued grace on our kids.
* Pray for our appointment tomorrow at 11:30, that we would have opportunity to talk at length with Dr. Pappas, that we would have the final tests scheduled ASAP, and that we would leave with a fairly complete understanding of the overall plan.
* Pray that we can go ahead and coordinate the Mayo trip, and that our talks with them would be excellent. Continue to pray that the medical advice from the Mayo docs matches that of the Duke docs.

We know that we are not the only ones with scary things, hurtful things right now. We have dear friends who lost their baby this weekend at about 22 weeks pregnant; another with health tests being done of her own. There's lots of stuff for us all to be praying over. As you send us your notes, please know that we are taking each one of them as an opportunity and a reminder to thank God for you and to pray for you as well. You are a blessing to us!

Tony

Next steps

2006-09-27T19:32:00.000-07:00

Hello all! Not as significant a day today, but some new info. Dee Dee's blood work came back and showed incredibly high blood levels of gastrin. The normal range is below 150; hers was over 2200. Believe it or not, that is actually a good thing. The theory here is that patients with pernicious anemia (which as I mentioned she has had for at least ten years) do not have the ability to regulate their production of gastrin, which is a hormone produced in the lower stomach (antrum). Gastrin causes the production of gastric acid, which aids in digestion. Gastrin is inhibited by acid, and pernicious anemia patients do not have the proper acid amounts, so gastrin goes without inhibition. The theory continues that the elevated gastrin actually causes the formation of the carcinoid tumors. Carcinoids, by the way, also produce hormones of their own, so it is all kind of cyclical. So, if you remove the initiator of the problem, the gastrin-producing antrum of the stomach, the risk of recurrence is almost nil.

Also, I wanted to give ya'll a link provided to me by the editor of "Oncology Today," one of the leading cancer periodicals. She has been very good about advice, who to see, etc. (So maybe say a prayer of thanks for Dr. Holly Atkinson, and also pray for her as well.) This site has more info than you can really digest (sorry about the pun), but it is written in large part for non-physicians. http://www.carcinoid.org/

The doctors at Duke are Theodore Pappas and Michael Morse; at Mayo Clinic will be Joseph Rubin and Geoff Thompson. Please pray that they would be wise, understanding, and that they would all be of like mind.

We have our first appointment at Duke, with Dr. Pappas, on Monday 10/2/2006 at 11:30. Hopefully he will quickly order the remaining scan (Octreotide scan), as well as whatever needs to be done to definitively settle the lymph node question. Then we will probably have a conference visit with he and Dr. Morse, the primary oncologist (Pappas is the surgeon). I will go ahead and schedule our time in Minnesota for the Mayo clinic as soon as we meet with Pappas next week.

We continue to be grateful, and truly blessed, by the outpouring of cards and notes. It is a blessing to be so wonderfully bathed in prayer. It was exactly ten years ago that we were in the hospital with Gabe, then 4 months old, as the physicians told us he was going to die. The body of Christ so comforted us, and so many people prayed, that for the first time in my life I actually believed in the reality of prayer. It was a humbling and in retrospect sweet time of God teaching us amazing things. A decade later, we find ourselves in a familiar health-related valley, yet we are once again beginning to sense the comforting work of the Spirit as you all pray.

What I often did not realize then, but am keenly aware of now, is that not only are God's people praying, Christ Himself is praying on our behalf (Hebrews 7:25 "Consequently, he is able to save to the uttermost those who draw near to God through him, since he always lives to make intercession for them," and thanks to Scott T. for the verse reminder). The Holy Spirit is interceding for us as well (Romans 8:26 "Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words.") So, there's a lot of praying for the Clarks, and we are thankful!

God is good, and He loves to bless His children.

Tony

Lab results

2006-09-26T15:31:00.000-07:00

Okay, just as I was walking out the door for a meeting, our primary gastro-doc called with results. Remember, the tests done so far give less than 100% proof of anything, but they are very likely correct (90%? I am not sure just how accurate, but very very good).

Basically, they are the second-best result we could have gotten. The best would have been no evidence of any carcinoid ANYWHERE else. However, there is one lymph node in the left chest that is large, and probably has carcinoid . This is evidently not surprising (according to the folks at Duke), and does not necessarily carry a big negative impact on overall prognosis. We will have to have it biopsied, and maybe it gets removed; don't know yet.

BUT, the liver is clear! Praise God! The small intestine, large intestine, lungs, and all other possible locations show no evidence of tumor growth at this time. Hallelujah! We still have one other highly specialized scan to go, and it could refute these results, but that is not likely.

This was a tough day. Every phone call was brutal, as heart rates raced, then it was just the invisible fence guy (for example). We rejoice that this stage is over, that the overall outlook just got a lot better, and we can begin to more accurately know what we are up against.

Thank you all for your prayers and emails and notes. They have been a blessing. Please, feel free to comment on the blog postings, but also email Dee Dee directly (lotofhats@nc.rr.com). She will not read the blog as often as she checks emails.

Thank you friends!

Tony

Quick thought

2006-09-26T08:16:00.000-07:00

First, we have no news as yet. We are eager to hear from yesterday's tests, but nothing yet. Pray.

I had a thought, as I have watched the amazing way in which Dee Dee has handled this whole...thing...with grace and courage and faith in a good God: I shouldn't be surprised. I should not be surprised because my wife is an amazing lady. But more to the point, I shouldn't be amazed because God has had this time in our lives in His plan for all eternity. He knew we would be here, now, and he loves us too much to let us get here unprepared. For all her life, for all my life, He has been pouring into us all the things and people and events to prepare us to meet this day. The way in which we handle it is merely a reflection of His goodness in preparing His children as only a perfect and loving Father could.

So, if you read my stuff, or talk to one of us, and think that we are brave, or admirable, don't. Take that opportunity to thank God for loving us enough to prepare us for the times.

Tony

2006-09-25T21:59:00.000-07:00

I am going to copy the original letter that we sent to our church to let them know about this. Many of you already have received this, so feel free to skip this second reading.

Late last week (9/21) we discovered that Dee Dee has a form of stomach cancer, known as carcinoids. This is a relatively rare cancer, and it is somewhere between benign and malignant. It does not spread in the traditional sense of “malignant,” where cells will seed themselves into new areas via the lymphs or blood system. However, it can spread by simple growth into adjacent tissue. The cancer was discovered during a routine procedure, while they were looking for reasons that her anemia (present for 10+ years) has recently worsened. She has no real symptoms at this time, and so we are actually thankful that God worsened her anemia; otherwise this would have gone undetected for years.

The only place we know for certain that the tumors exist are in the part of the stomach nearest the esophagus. There are 10-12 tumors total, all fairly small. At this point our next efforts are to determine if the tumors have already spread elsewhere. We started Monday 9/25 with the first battery of testing to look for metastasis. The outlook really comes down to a fairly simple equation. If the cancer is confined to the stomach, her prognosis is very good. The goal in that scenario is total cure, via surgery to remove the portion of her stomach with the tumors. If, however, it has spread, the outlook becomes bleaker. The degree to which the prognosis worsens depends on the exact location and size of the spread. The worst scenario would be spread to the liver.

We are thankful for a number of things. There are several factors in our favor (other than the fact that God is indeed good, and enjoys giving good gifts to His children). I was able to talk to the head of gastro-oncology (digestive system cancer) at the Mayo clinic for about 30 minutes Friday. He was very encouraging. He said that there are several things in her favor, from the standpoint of it probably being isolated to the stomach. These include her youth, her overall excellent health, and even the anemia. All of these things are encouraging, and I am thankful that this gentleman took time out of his amazingly busy day to talk to a scared stranger. He said that in his opinion, having never seen her or any of her tests, that he feels her prognosis is excellent, because he believes that the cancer is only in the stomach. “Now, you will have many difficult decisions to make, and dark days between now and that excellent outcome, but I will be surprised if there is anything worse for your wife,” is how he closed out our talk.

We count you all among the blessings God has placed in our lives at this difficult time. We truly cherish your friendship, your love and grace, and we covet your prayers. I know that you all will pray, and that is really all we need at this time. Our need for physical things, where you can be Christ’s hands and feet to us, is coming. For now, we are trying hard to keep life as normal as possible for the kids, so we ask that things like meals and babysitting, even visits, wait until we are in greater need of those specific things. In particular, Dee Dee is not up for a lot of calls, visits, etc., just yet. She does enjoy notes and emails, so please encourage her that way.

We are both wrestling with this thing, emotionally. Thankfully, I can honestly say that I am proud of the way my wife is wrestling spiritually. She is confident in her Father’s love and goodness, and knows that all things are for His glory. I thank God for the spiritual grace he has poured into Dee Dee. She has continued to look for ways to nurture the very people trying to bless her. We are thankful for Warren’s summer sermon series on the Lord’s Prayer, as we now pray, “Let thy will be done.” There is always a period of time where your head knowledge and your heart emotions are disconnected; where you know that He is sovereign and has decreed all things, and that there is nothing outside His plan for your good, but your heart doesn’t follow the head. Well, we are moving toward the heart believing what the head knows. There will be times that we forget, and we’d ask you to pray that we quickly remember.

The other things to pray for are our strength, our courage, and our faith. Pray for our relationship with each other. Pray that we know how to parent our children well through this time. Pray that all the learning, from all the studies and books and sermons, would yield a harvest of righteous fruit in us now. Pray that the tumors are indeed 100% confined to Dee Dee’s stomach, and further that we are able to prove this very soon. The unknown is….difficult. Pray for our doctors, and for the doctors and surgeons that we will be seeing but haven’t even met yet.

We have difficult decisions to make, so pray for our wisdom. Pray that this would take a marriage that was already sweet, and good, and be used by God to make it amazingly sweeter and better. Pray also for our kids, as they come to grips with this as well. Our youngest two know Mommy is sick, but seem fairly unaware of the possible repercussions, and that is fine with us. Their smiles and sense of “life is normal” is refreshing for us right now. Gabe and Anna Grace are concerned, but are not sure how much to be worried. I pray that they don’t internalize their concern, confusion, or fear. Caleb and Samara are hurting, but are trying to be strong in front of Dee Dee. I am quite proud of their protectiveness of her, but pray that they don’t feel like they have to be strong towers for us. That is not their calling in this; Christ is our strong tower, and theirs.

A friend reminded me of Hebrews 7:25 – Christ lives to make intercession for us. He longs for the times that he, our High Priest, can plead on our behalf. How amazing! How comforting! How like God, to plan the events of our life, and to intimately take part in that same plan. Pray for us as we experience that intimate relationship in a way that we would not have chosen, but which he has. His way is always the right and best way, and for that we are thankful.

Thank you all for your love,

Tony

We should find out the results of today's chest x-ray, blood work, and CAT scans on Tuesday or Wednesday of this week. We have an appointment with Dr. Theodore Pappas at Duke next Monday. He would be the surgeon for her case. Before that happens, we plan to go to the Mayo Clinic for second opinions and confirmation about our course of treatment. I have already spoken with the doctor up at Mayo (in Minnesota), Dr. Joseph Rubin, about Dee Dee's case, and he was very helpful and encouraging.

Our prayer for the next 48 hours is that all tests show zero spread of the cancer to any other organ or location. The prognosis is good as long as it stayed in the stomach. We especially do not want it in the liver or her lungs.

Thank you all for your prayers. Also, thanks for the emails and the cards. They really seem to pick Dee Dee up.

Tony

Getting started

2006-09-25T21:47:00.000-07:00

Well, I guess most of you know why I decided to start this blog. With the recent diagnosis of carcinoid cancer in Dee Dee's stomach, I needed a way to update all the folks who love us, and are praying for us, and who we love in return. This isn't going to be fancy, and I've been known to ramble, it is just to give a place where folks can get news, and learn of specific ways to pray for Dee Dee, for me, and for our kids. Thanks.

Tony