Monday, July 28, 2014

An Interesting Sunday Call
So a couple of Sunday’s ago, I (John) had a fairly eventful day on call. I saw 6 patients throughout the day/evening/morning and here are their stories – the most interesting one is the last:

Patient #1: She was riding in the back of a dump truck, like many people here do including us at times, and across the top in the middle is a large log that had been tied on in order to keep your balance or tie a tarp onto. Many people were holding onto this log and when it suddenly broke, coming down and hitting her forcefully on the head. She said that after about 20 minutes of being unconscious, she woke up and after five hours of continued headache came to our hospital for evaluation. Thankfully, our CT scanner just arrived and has been operational for about 2 weeks. After a negative CT scan of her head with no signs of bleeding, I sent her home with meds for her headache.

Patient #2: He was an 8 year-old who came in with his parents with pain in his arm. He apparently fell with his hand behind his back. An x-ray showed that he had fractured both his ulna and radius and would likely need surgery to have it repaired. We don’t have an orthopedic surgeon, so he was referred onto Abancay after a splint was placed. My primary concern was that the story didn’t seem consistent with the fracture. I’m not an expert of fractures, but I didn’t ask the father anymore in hope that in Abancay they will find out the whole truth about how the fracture really happened (a beating?). Any thoughts based on this x-ray and the story of falling with his hand behind his back?  photo IMG_1993_zps9c0e637b.jpg

Patient #3: A 28 year-old woman who came in with 3 days of cough and pain in her lungs. The chest x-ray showed a pneumonia. She followed up in 3 days and was greatly improved with antibiotics!

On the x-ray you can see a faint line in the patient's right lung between the middle and lower lobes.
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Patient #4: A ~75 year-old woman came with history of liver masses from a recent ultrasound in Cusco as well as labs and ascitic fluid being taken out of her abdomen and sent for analysis. When she arrived, her oxygen saturation was 75% (normal is 90% or higher). She was very dehydrated and looked terrible. I admitted her and in the morning ordered an ultrasound and labs. They showed that she had an 8-cm mass in her pancreas, cirrhosis of the liver and was in the beginnings of renal failure. Her chest x-ray showed what looked to be possible metastasis in her lungs. I talked with the family and told them of the poor prognosis and said that the only place to treat her cancer would be in Lima. I recommended that due to the severity of her disease and the extremely poor prognosis that she not get chemotherapy, radiation or surgery that would severely decrease her quality of life. Instead I recommended that she go home with pain medications. I then prayed with them that the Lord would be with her in these final days and that He would give her peace in Him. After a couple of days she was sent home feeling better, but also knowing that these would be her last days on earth.

On the x-ray there are some questionable nodule behind the heart concerning for metastases.

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Patient #5: This was a 50 year old woman who came with three days of pain her belly. An ultrasound showed that she had an infected gallbladder and she was admitted with antibiotics and will have surgery to take out her gallbladder.

Patient #6: This is likely the most interesting case of the day. He was an ~80 year-old man who lives high in the Andes mountains with his wife. Over the last 3-4 months he’s had more and more troubles with swallowing and eventually it got so bad that he could hardly get anything down for the last 3 weeks. His daughter came to visit him and his wife 3 weeks ago (with her 1 year-old son) and realized how sick he was and immediately took him to the health post in Cusco. They checked a couple of labs and gave him some medicine for pain and sent him home. He wasn’t improving so she took him back and they checked his urine and gave him some medicine for a urinary tract infection (UTI) and sent him home. He still wasn’t better and so upon the recommendation of a friend, brought him to see me at Diospi Suyana. Looking at him, he looked like one of those people you see in Africa that is starving to death or dying from AIDS. Just looking at him, I knew it was more than a UTI. His mouth was so dry that there was some dried mucous attaching his tongue and palate that he couldn’t remove because it had dried that way. He also had spots of blood under his mucosa throughout his mouth and throat. I gave him some fluids and unlocked the lab and ran a lab test finding that his platelets were only 29,000 (Normal 150,000-450,000). He also had signs of infection. I admitted him and did some tests in the morning finding that his kidneys were quite stressed from the dehydration and that his lungs looked terrible! See the picture below. The following day, Dr. Klaus John did an endoscopy and found that he had thrush from his mouth to the bottom of his esophagus and found tuberculosis in aspirates of his gastric fluid like we expected based on the x-ray. Even after just one day of fluids, he already looked SO much better and he and his family were extremely thankful for the treatment that he’d received. After a few days of care by Dr. Martina John (She saw all of my patients for a few days while I was stuck in bed sick) he was sent to the local health post now with a diagnosis of tuberculosis which they typically treat very well. We pray that he will not only find physically healing through this process, but also spiritual healing as well!  photo IMG_1994_zps530234b1.jpg

Thanks for your continued prayer for our family as well as all of the people that we are coming into contact with! God is working in their hearts and lives and every day we have more and more people coming saying that they know that they will get healing here because this is where God is working! We know that we may not be able to find physically healing for everyone that comes, but we do know that God is offering spiritual healing to everyone of them through Jesus Christ if they are willing to accept it. This is the most important healing that anyone can receive!

Saturday, July 26, 2014

Pictures and Cakes

I am a little behind on pictures and cakes. Here is a little shot from Hannah's birthday session with me that was in April. I still have not gotten around to making Huddy's first birthday cake or taking his or Caleb's birthday pictures?!!? So terrible but my excuse was that I had pneumonia. That is a pretty good excuse after all. I cannot believe how fast they are all growing up. photo CoffeeShop10Picblogheader_zpsa362764e.jpg

Friday, June 27, 2014

Another Update on Hannah
It is hard to figure out where to start with this update but I suppose I should start by thanking everyone for their prayers and support. So many people helped make our quick stay back home go much smoother than anticipated. I am sorry for the huge delay in getting this information out to everyone but life seems to be going in one great blur right now.
Our trip flight back was pretty uneventful considering how young our children are and the flight length/layovers. We actually had a layover in Fort Lauderdale for 14 hours so my mom drove 5 hours and got a hotel just to see us. I am sure it was a five hour drive well worth it for her because I KNOW it was for us. It was great getting to see her even if for a short time. She picked us up at the airport and took us out to breakfast at the closest IHOP. The kids were super excited about eating but I think Caleb was more impressed with the bathrooms as he came out saying, “ MOM! That bathroom had toilet paper and toilet seats!” – He then looked at the waitress and told her she had a really nice bathroom and he liked it a lot – WHICH IS HILARIOUS since it was a rundown IHOP at that. Oh, I could go on and on about the ridiculously funny stories we have about the kids experiencing the U.S. for the first time in a year…which feels like forever to a three (or now four) year old.  
We spent the day eating food we had not had in a while – I think we hit up several fast food places. My mom did come prepared though with a fridge FULL of goodies. The kids were in heaven and so was I with my ice cold Dr. Pepper. I am not even a pop drinker but after a year I was grateful to see some DP. We had a fabulous time at the beach and the kids did not want to leave. My Mom is AMAZING and I am so glad we had the layovers on both ends of our trip. Our time in Florida made for the perfect beginning and perfect ending to our trip. Love you Mom – you are an amazing woman.
We got into Denver late Sunday night, having left Friday morning we were happy to be at our final destination. Just was we were getting into the elevator to meet our family Caleb got sick all over the place – you know just the “perfect” ending to our trip. Really, though it was no big deal seeing as everything else went so well – prayers appreciated here because it could have been much worse.  
We got in on Sunday and had our appointment on Tuesday to meet with the GI doctor for Hannah. From Tuesday on most of our time was spent driving to Denver, which was about one and a half hours from our home base, going to appointments and waiting for results. To make a long and emotional story severely short we are still not exactly sure what is going on with Hannah. We had wonderful doctors who expedited us through the system getting us all types of appointments and running all kinds of tests. Hannah did have a colonoscopy and endoscopy where they did find some swelling in her colon. This coupled with other tests is leading the docs to think we are dealing with some sort of inflammatory bowel disease such as crohns. Since it is really abnormal to have this at such a young age (age of normal diagnosis is between 15-30 years of age) the docs wanted us to see an immunologist just to make sure there were no other autoimmune things going on. As we were waiting to see the immunologist Hannah’s stool cultures returned positive for campylobacter bacteria. This bacterium can also give the same results on a colonoscopy as inflammatory bowel disease. So at this point we do not know whether her results were tainted by the bacteria or there is something else going on. This was incredibly frustrating. It is technically in the realm of possibility that Hannah has had campylobacter since before we left to come to Peru last year but it is not probable as campylobacter usually resolves itself after a short period of time. Hannah has had a few rounds of antibiotics since being in Peru as well and we think this should have taken care of this type of infection, but this would be a good reason as to why she is not growing. Results from the immunologist suggest that Hannah does not have any underlying autoimmune problems and we are thankful for this.
 In the middle of all this we wanted to get Hudson some shots to keep him up to date and we decided to go ahead and do stool samples for the all the kids since campylobacter is highly contagious. Hudson came back positive and Caleb came back negative. This made total sense because Huddy was having such a tough time while we were home. I won’t go into details but campylobacter means I changed A LOT of diapers – enough said. So Hannah and Huddy were on antibiotics for a while and then we stool checked them again and they had Clostridium Discophiles (or C-diff). This is kinda common to have after exposure to antibiotics, but totally not something you want to have while you are traveling with small children.
Up until the day we left we were chatting with docs about whether or not it was safe for us to come back to Peru and even though both the kiddos were really sick they said it was okay to return. At this point they cannot do much more for us as there is no straight up test for inflammatory bowel or crohns. So here is what our future looks like right now. Hannah has to gain weight. She does not have to be in the 90 percentile but she has to have an upward curve. The docs want us to really get Hannah eating well for the next two months. We do weight checks every week and stool cultures every two weeks to make sure she is not getting re-infected with ANYTHING. This sounds well and dandy but it is much harder than it sounds. Hannah has no appetite – which I consider strange for a two year old. You can put candy or whatever you want in front of that girl and she will not eat it. Even at the IHOP, after not eating on the plane, when pancakes with strawberries and ice-cream were put in front of her she never even touch it. Gratefully, her appetite appears to be slightly better this week but still I have to sit with her and feed her EVERY bite – yes, every single one- just so she will eat.  Our meals take hours because I am also doing this for Huddy too since he is still a baby. In addition to this, while we were in the States we found out that Hudson has started to take a dive off of the growth curve as well (this could be due to travel, teething or a variety of things) at just the same age Hannah did and he also appears to be iron deficient.  He is iron deficient but not iron deficient anemic which is worse and often at his age means cancer. So we are grateful, at least at this point no cancer for any of our kids.
***Sigh of relief*** We had lots of appointments at Children’s and after seeing the little kids with chest tubes and no hair I am feeling really grateful and blessed. Yup, I shed lots of tears this trip…
Back to eating for Hannah – so she must eat LOTS of food and if after two months if there is minimal to no weight gain we will be starting her on meds for inflammatory bowel disease. We really did not want to jump into these meds as this is not always easy on small children and basically she will take them for the rest of her life. We will try these meds for two months – that is, if we get this far in the plan- and if she is not responding well we may have to come home on a more permanent basis.  Good news is - we did have a positive weight gain this week !!– which I am so grateful for since this is really my whole life right now. The trick will be seeing weight gain over the next few weeks as she has just gone off of the antibiotics. Hannah seems to have a pattern of eating well while she is on antibiotics and then taking a dive in weight after she finishes.  This pattern is consistent with inflammatory bowel disease. We will be doing a stool sample over the next couple of weeks to make sure she is not getting re-infected with anything and then we will also get an MRI done in Cusco, if she has a clean stool sample. We are now washing/rinsing every dish in clean water, and bathing the kids in clean water too. Other families do not have to do this, but we will do what needs to be done. That being said my kids do not get bathed that often because it is quite the chore to heat up water and fill a tub. We also have to be extra careful with ALWAYS washing our hands and at this point- Hannah is having minimal contact with the outside world. We need to make sure she stays healthy to get accurate results – living in a 2nd world country makes this incredibly difficult. I mean how many families can say they have a favorite antibiotic? – We can because we are constantly sick here. I never imagined how sick we would be and how often we would be sick – just thinking of it makes me SICK J - NO, but seriously I am sick right now – but with a chest cold – which for us is actually abnormal here.
What does inflammatory bowel disease mean for Hannah? Well, if she indeed has this it will be hard to tell whether she has ulcerative colitis or crohn’s disease for a while. We will have to see as things develop but one of the most common risks for someone with these diagnosis’ at such a young age is that she will lose her colon/ and or have a much higher risk for cancer. Not exactly the news you want to hear about your two year old. It is hard to imagine my playful little girl with a colostomy bag. I pray this is not what our future looks like, but we are taking things day by day. We are still not sure what is going on. We are frustrated we do not have answers but we also know that no one can give us those answers right now. Even the doctors told us it just takes time and that at this point it is fine to continue to work on things from Peru.
We had really hoped to come back with answers, but we do not have them unfortunately. This month has been exhausting physically and emotionally. We are so humbled by all of the help from everyone during this difficult time for us. We are so sorry we had to come home right in the middle of everyone’s super busy schedule and we appreciate everyone’s flexibility while we were home. I also just want to say a special thanks to my Dad for making our hospital stays much more comfy – we are so grateful.
We feel so blessed to have had such a wonderful team of doctors working with us over this last month. I am overcome with gratefulness that we could return to the States and get such excellent care for Hannah. The medical system in the States is incredible. Truly it is. I cannot help but thinking of so many little kids John sees in his office who have a terrible prognosis and nothing can be done for them because the medical systems here. The world we live in here is so different from our world back home.
Please pray for us as we embark on our two months of trying to get Hannah to eat. Pray that God gives me patience for this difficult task and pray that God gives us wisdom to figure out what is going on. If she only had a bacterium all this time we are so grateful but if this is not the case we would like to figure out what is truly going on.
I think your prayers are what kept us going the last month – so please, do not stop. We feel so blessed to have such a wonderful team of supporters always lifting our family up in prayer.  We love you guys!

Tuesday, May 6, 2014

Tuesday, April 8, 2014

A Few Photos of the Boys
Hudson, or Elias as he is called here because no one can pronounce his first name, is quite the go getter. I think that is just natural since he has to catch up to his older siblings. He is wasting no time though. We went from army crawling to crawling up on top of things. He has definitely already had his share of faceplants to our tile floors, and for this reason I hope he starts walking soon. Enjoy a few picks of our little Huds.
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Oh, and check out Caleb on his first day of school a few weeks ago. What a HANDSOME guy in his little uniform - minus the slacks. We are so grateful to have this new Christian school here in Curahuasi. It has been such a blessing for us and Caleb.
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Monday, March 24, 2014

An Update on our Little Princess
We have been sparse with sharing our information on what is going on with Hannah mainly because we just do not know exactly what is going on with Hannah. We started running a myriad of tests on her in October but we still do not have any concrete answers. We ran a bunch of tests here at Diospi last week and we are currently consulting with a German Pediatrician here to plan our next move. We have done blood tests, urine tests, stool tests, and ultrasounds. At this point I cannot tell you much but it looks like we are not dealing with Leukemia types of cancer, celiac, heart problems, or kidney problems. We will continue stool sampling this week and will go in for an x-ray and abdominal ultrasound as well.  Her stool samples both here and in Arequipa show she has white blood cells in her stool but no blood. Unfortunately, her blood tests are also consistently showing elevated platelets at 750 with normal being under 400 I believe. Hannah is ranking in at less than the 3rd percentile for weight and actually they cannot measure below the 3rd percentile so we really do not know where she fits on the charts. Charts are not all that important since John and I are small people but we noticed a huge dive in her weight after she started on solid foods. Her height has also started to drop off and her head circumference remains okay right now which we are grateful for as developmentally she seems fine. That girl is super smart, and quite frankly she has a hilarious little personality. More concerning than the lack of being on the “charts” is her night sweats. She consistently wakes up from naps and nights with her pillow soaked within a 10-15 inch radius. Having cancer on my side of the family, this symptom kinda makes my skin crawl. It’s also really hard to look at Hannah and then look at Hudson because right now they could be wearing the same clothes – that is if I really wanted to dress Hudson in pink. I am sure Hudson is passing her in weight but in all honesty I have not checked lately because I really do not want to know. She is still wearing the same clothes that we came to Peru in almost a year ago next month.
This is hard on the heart especially being so far away from home.  I think we both feel a little helpless. Especially John is he is the doctor – who can heal everything, right? – WRONG. This is a constant reminder to us that God is our healer and ultimately he is in charge. I have started asking myself questions that make me a little sick. What if this time next year Hannah is not with us (and I might be being incredibly rash here) but what if that is true? Would I be okay with it? Would I be bitter about being here in Peru and not being able to find the answers? Would I be angry with God that we have come all the way to Peru only to have God not show up in some miraculous way? Really, when I think about these things my heart aches, but my answer is no. No, I would not be bitter or angry because I know that my children were given to me. They are a gift, and they are not really mine. I am grateful for all three of my gifts, and I would miss them terribly if they were taken away from me. I also know that God’s heart would break to watch me go through such a terrible ordeal, but I know that in this world there is sin and therefore our bodies do not always work as they should. I am not bitter about it; it just is what it is. My eyes tear up even now writing this as I watch her dancing around the house knowing that things are so unpredictable in life be it disease, car accidents, whatever it may be we only have so much time here in this world – and in life, disease and death our God will be exalted.  In all honesty, I am at peace with everything, whatever it is. I do not even worry about it anymore, as I know ultimately my worrying will not change anything (except how many gray hairs I have J ).
Currently, we think the tests we need to run are not available here and we are trying to get an appointment at Children’s Hospital in Denver which has proven quite difficult. We were planning on returning in August to visit family for the annual fantasy football draft, but with things being the way they are we are hoping to return earlier sometime in May if we can get an appointment at Children’s. We will see what the results from this week are, try to get an appointment at Children’s and then we will make the decision on whether John goes back with just Hannah for a while or whether we all go back for a short time to try and figure out what is going on with our little Hannita.
All this being said we would really appreciate your prayers this week. We really need to get an appointment at Children’s Hospital ASAP, and we would love to find some economical tickets so that we can all go back together. Right now the prices are not bad but the longer we wait to figure things out the tougher the details get. Pray also that Hannah continues to eat well. We have had a terrible time getting her to eat, and she really cannot afford to lose any weight.  As always thank you so much for your prayers and support!

Saturday, March 15, 2014

A Few Months In Curahuasi
No I have not died – although from the lack of communication you might have thought that I had. My lack of sleep and our lack of internet have put our blog on hold for a while. We are doing okay here in Curahuasi. We have been here for an entire month now. The kids and I have “settled” into the house and John started working at the hospital last week. His days are filled with interesting stories and many sad ones. Unfortunately a handful of people have passed away at the hospital over the last couple of weeks, including a newborn. John’s job is tough intellectually always having to translate in his mind from Spanish to English what is going on, learning the new meds that are available in the hospital (which are often not the same meds we use in the States), and just learning how to work with new people but none of these things are as tough as losing a patient. Medicine is tough on the heart. If only we had done this – If only they had come in sooner – If only we had had this type of equipment – horrible questions that plague the mind. The most terrifying question of all really is “Do they know their maker”? The only person in this entire world who can cure the most deadliest disease – sin. The hospital has a great system going and all the patients get to see the Jesus film while they are waiting for their appointment. Speaking of waiting- can you imagine waiting in line for days just to see a doctor? We would flip if we had to wait outside IN THE RAIN just to get an appointment the next day, and this is common practice here. Every day there is a line of about 150 people just waiting to be seen. I remember waiting for 3 hours once to see my OB in the States. I was a “little bit” frustrated,  but seeing the line everyday kinda puts that in perspective now.
John and I have moved  A LOT in our lives. My dad was in the military and John’s med school took him all over the place. Every time you move you find your “new normal” – your new normal food, your new normal routine – everything just settles into the new normal. John is working again – and is finding his new normal in his job. Which I think can be kind of dangerous. It is easy to develop a new routine, and really it becomes just like living in the States (minus lots of stuff). I cook, clean and watch the kids, and John works. It is so easy to just work a job and forget why we have really come. John has not come to just “see” patients but to show them Jesus. Not always as easy as it seems. John usually goes to work at 7:30 and returns between 6:00 and 6:30pm unless he is on call. He is usually exhausted from his day/night on shift, and then he walks 20 minutes each way home (and the hill up to the hospital is KILLER). John then watches the kids so I can finish up dinner.  We get the kids ready for bed. I spend the night making food for the next day/week, cleaning the dishes, and doing the laundry or just unpacking. The day is pretty much consumed for John and I. So what does ministry look like for John, or for me? Well we are trying to figure that out. Pray for us as we try to determine what things outside of the hospital/house that God wants us to be involved in.
Yesterday was the first day I made it out of the house with all three kids alone –quite the challenging task. I will not be doing that often, at the ages the kids are at now 3, 1, and 7 months. For me this means I pretty much stay in the house all day, every day. Thank goodness we have a small yard for the kids to play in, even so my life looks so different than it did in the States. It is tough not being able to get out of the house. By the time John gets of work and the kids are in bed nothing is even open here! I am finding that at least at this moment, my ministry will be my children and making sure that John can serve his best at the hospital. You would think that coming over to Peru would give me more time to spend with my family but sadly I spend most of my time in the kitchen cooking and cleaning. EVERYTHING is from scratch. You cannot even find a loaf of sliced bread here! I actually really enjoy cooking but all day, every day is tough.  For the first time in a month I could actually sit on my couch at least for a few hours until another load of laundry finished drying on the line and then ended up on my couch. The laundry and cleaning never end. Three kids three and under is physically/mentally exhausting – and I have not even mentioned bugs yet! Yes, bugs – they are EVERYWHERE! I found a LARGE centipede in the house the second week we were here but that was put into perspective the day Caleb found a black widow in his pale outside (and let’s not forget the scorpions we have found in the house including in Caleb’s toys). Yup, I think I was screaming- and by the time I got done with it, it was definitely dead. That prompted me to make some door snakes – long, thin bags of fabric filled with rice to put at the bottom of the door so the bugs cannot get in. This was a great idea until the rain came through the back door – soggy, rice, in a bag- not good. The ants are always in my kitchen even if I clean it every night. At this point I have given up and now I know we will never be bug free. However, after putting up the door snakes now in the middle of the night when I wake up to feed Hudson there is not a constant crackling under my feet of rollie pollies. There are still bugs in the house but less of them. You see if I am going camping I know that there are bugs but for a short time – there is an end in sight – no end in sight here. Roaches, flees, spiders, worms – you name it we probably have it (including black widows and a scorpion that I found in Caleb’s legos). Just kill ‘em.
On another note,  after two weeks of sanding, putting chemicals and varnish on all of our furniture it looks like we have not gotten rid of all the mold which is kind of a bummer since I appear to be allergic to it. Unfortunately, our dresser which is molding is still sitting in our room, because John has not had time to resand, rechemical, and revarnish it. Needless to say we are not having fun with this…
And a few weeks ago I found BEETLES in my beans!?! They were in a bag from the vendor in the market – no such thing as pre-packaged beans here. Oh America! How I miss your pre-packaged goodness! That morning I was going to pull my hair out at the sight of beetles in the beans – but I couldn’t pull my hair out because I cannot afford to lose any more of the brown ones!
** I have attached a few pics of the outside of our house. We are incredibly grateful to have this home - made of cement - not mud.**
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