Extubated!

TJ has just been extubated!

The plan so far is to keep TJ in the ICU for another 24 hours for observation and then move him to a "regular" floor, more or less for more observation.

Also great, the doctors are going to try feed him at noon; TJ was intubated a short enough period they think his gag reflex and whatnot are still fine.

Best, I was actually have to talk to my dad, kinda. It was about 15 seconds -- he does have a face mask on which makes it sound like he is in the middle of a strong wind -- but I did get to hear his voice.

That is all I have right now.

High Hopes & "Bad Feelings"

As was noted yesterday (Thailand time) hopes are that TJ is able to get extubated today.

I spent most of my afternoon scanning in all of TJ's medical records from his MRSA battle in case they are need quickly. I also spent time putting blog entries from the same time into some three ring binders.

As I started reading through this blog from the beginning (I didn't make it too far, it is kinda long...) there were a couple of entries that stood out to me in particular.

The first was from early on, December 6th, two days into TJ's hospital stay (about 3 days before we found out it was getting bad, longer before we would find out just how bad) where we wrote:

"As a family we believe in medicine (MA is a nurse and [TJ's father was the chief surgegeon at United Hospital in Saint Paul, MN), but we believe more strongly on the power of God and intercessory prayer...

We believe in a God with a father's heart who has always been faithful, and so believe in God's healing hand."

The second was was titled, A More Specific Prayer Request, which contains the mantra we carry now:

A consensus has been reached among the family and our most trusted friends and prayer partners. We are *not* praying for doctoral wisdom regarding the heart, we are praying for a miraculous healing. Plain and simple.

We also asked for, "passages that support (and some demand) such prayers." Out of 274 posts not one generated as many comments.

We are again asking you to pray for such healing over TJ. I (Jon) have been having a "bad feeling" since I came across that second entry and I can't tell you why. But at the advice of my mother (who may put something up herself soon, I don't know) I am putting it out there anyway; "if we feel nudged we have a responsbility to share."

So that is what I have, a feeling (nudge?) that today, at the very least, there is the possibility for stuff to turn as ugly as it did last year. And so, as a family we ask for renewed prayer, especially on a day with such high hopes.

-Jon

Hopeful for extubation tomorrow

The intensivist was just in and said they are hoping to extubate tomorrow. YAY! The vent settings are being turned down and TJ is doing well with it. It will be a few more days in the hospital, either ICU or a regular floor, then discharge. If the treatment plan is to discharge him to home we may have the option of staying in Bangkok for a few days to rest. If the treatment plan is to go to another hospital we would fly home immediatly and go directly to a hospital in MN. Either way we will be flying with a medical escort.

Tubes and IV lines are being pulled one by one. It is very encouraging as each one is gone- it also makes it alot easier to move around when you are not connected to so many tethers.

Chip is supposed to take the day off today (once he wakes up). He has places he wants to explore in Bangkok, including checking out a kayak that seemed relativley cheap. He would love to kayak the canals around here. He found a chat room of American expats in BKK and was asking about kayaks. The reaction ranged from "awesome idea" to "Are you crazy?? Do you know what is in that water??" I think a lot of the fun for him will be just to check it out and sort of ignore the hospital for a while. As a 21 year old he had to sign consents for all the treatments, including intubating his dad in a foreign country. He is due for a break. BTW for all you Bethel classmates, your facebooking, etc. has been a huge encouragement to him.

We are grateful for all your prayer and encouragement and cannot thank you enough. We feel amazingly surrounded by friends!

MA

Sunday Morning Medical Update

It has been one week since TJ was pulled off the plane. Chip reviewed some of the story for DaveR and me last evening. The plane was taxiing for take off and Chip, who was sitting a few rows behind TJ, noticed some passengers pointing at TJ and calling for the flight attendant. Chip went up to check on things. TJ was sort of jerking, not conscious, then puked and came around. Chip checked his blood sugar (OK) and then things started moving fast to get him off the plane. Chip did an amazing job in those first critical moments and hours.

In talking to the Infectious Disease Doc today I was pressing him for why he was ruling out MRSA based on negative cultures and not every other bacteria. He said that if it were MRSA it would have caused some inflammation of the heart and been circulating throughout TJs blood stream. The cultures have shown "normal throat flora"- or the normal critters that live in all of our throats, which would be consistant with aspiration pneumonia- or choking on puke which would pick up the normal flora on it's way down the wrong pipe. The ID doc is satisfied with his progress.

I did a little reading today on ARDS and found an article from NIH (National Institute of Health) in the US and they are following all the recommended protocols as well as being on the top of the curve for recent recommendations. For you medical types this includes ventilator settings of peep and tidal volume, acid base balance in blood, albumin for pulling fluid off the lung and back into the blood vessels, and enteral nutrition support (formula via NG tube).

TJ observed today that once you get on a ventilator it seems hard to get off. Indeed. Please pray for patience and stamina for him- it is a very taxing position to be in.

Last evening DaveR (a good friend from a creative access country) took Chip and I to an Outback Steakhouse for dinner. It was good to get out of the hospital for a bit and have a change from the cafeteria selections.

That is all the news from Lake Wobegon for now.

MA

Ponderings..

I have not been over to TJ's room as yet- moving kinda slow this morning-so I do not have any medical updates. I wanted to put some things out there that have been stirring in my mind since Chip's first phone call, but between jet lag and the challenges of the situation it has been hard to articulate these thoughts.

This is a spiritual battle. Please continue to keep up praying in that mode. I think that I have sort of a warped view of things because it has not been as terrifying as last year and TJ is awake- so he just seems a lot better. However, he is still on a vent and not out of danger by a long stretch. During the conference that TJ and Chip were a part of here there were prayer teams and they felt like they did " a lot of damage". The enemy is fighting back. The following is from an email I received today:

" I went over to get more stuff from my old house a few days ago and was talking to my old landlord who is a Christ follower. I told her about my dream. She said, "I had a dream too. There was a man in a hospital in a foreign place. There was evil and people going throughout the hospital releasing flies (infection/illness) everywhere and draining blood of patients." I told her about TJ and asked her to pray."

Bangkok is one of the darkest cities one earth with the highest concentration of the sweetest and kindest people on earth. A word that has come to several peoples minds is illumination. Please pray that God's light emanates from TJ's room and our lives to the staff here. It would be quite a coup if the enemy was trying to take TJ out of commission and we gained some family members instead!

Finally, it has been impressed upon me that God will not share His glory with anyone else. Last time we said that if TJ had not been at United Hospital, if Dr. Corbett had not been around, if I had not been around, if TJ's dad had not been around things easily could have turned out differently. I think God is proving that He can do miracles in our lives without our help.

Now I am going to finish the way too strong coffee i made in a press mug I bought at Starbucks in the Tokyo airport, shower, and head over to his room.

May God bless you and keep you, make his face shine upon you and give you peace.

MA

on a side note (main post below)

k so i have adopted a unofficial theme song (kinda) for this whole little skirmish check it out its "between the cherubim" by misty edwards. it seems to speak to what where dealing with extremely well)

download it its an awesome song (if you really want ill spot you the buck later for your itunes purchase) (ok that was a lie... to many people check this blog for me to say that)

We will awaken the dawn with a song in the night
For a new day will come just as sure as the sun will rise
Though deep darkness prevail for the night weeping endures
Yet the light will not fail He won't rest until His righteousness shines

You who dwell between the cherubim to You we cry
O Shepherd of Israel restore and cause Your face to shine
Don't remember our former sin Let Your mercy speedily come
O Shepherd of Israel restore and cause Your face to shine

Though we're feasting on the bread of affliction
And the water of tears is our wine
We won't draw back but we'll run to
You for we know it's just a matter of time
You will answer the cry of Your people and
Your ear is attentive to their sighs
So we lift up our voice to You and we sing in the dawning light

For the glory of Your name for Your glory and your fame
Though the earth be removed we lift our hands to only You
For the glory of Your name for Your glory and Your fame
Though the nations rage toward You let our love remain true

immmmmmmmprooooving (slowly)

Ok so we just talked to the infectious disease doc, and looked at today's chest xray. the news is good the xray is considerably more clear, but still shows some infiltrate.This is an improvement. In addition TJ has not been running a fever, so everything continues to improve.

they attempted to begin to ween him of the vent yesterday, but staff observed this caused a drop in his blood oxygen level, which isn't serious but dose mean that they have to take it more slowly. the doc said he thought it would be "a few more days." This means a longer time with an extremely uncomfortable tube down pop's trachea, and more days of torturous suctioning.

so the prayer request for this week is that the tube would come out ASAP, and that he would be discharged on Jan 14th. (this is the day he was discharged last year and has been dubbed his second birthday.) this is highly unlikely, medically speaking. However we have all seen and been part of miracles that have been highly unlikely medically speaking, so we pray in faith. this would also be an excellent display of Gods power to the Thai staff here. for the glory of His name.

Not to mention thanking the Lord for how well this has gone, and that there hasn't been any serious complications.

Chip for all

Evening Update

As you can tell updates are starting to get a little fewer and farther between. This is definately a good thing. Updates I got from MA:

The pulmonologist said the most recent X-ray showed the lungs looking a little bit better. The vent settings are being tweaked, mostly in a good way. The pressure is down but the O2 level up. What this does mean is that it is easier to take TJ off the vent but keep the O2 up via a C-PAP or BiPAP. At any rate, TJ is mostly breathing on his own despite still being on the vent.

The doctors are also trying regulate TJ's blood gases. As my mom didn't get any details this means pretty much nothing beyond what it says, e.g., what eactly they want to regulate and why, etc.

I'll update when I know more, there may not be anything to add anytime soon.

Friday Afternoon in Bangkok

TJ was not extubated today. The pulmonologist explained that he does not want to be in a situation where he has to re-intubate. He is satisfied with TJ's progress and explained that TJ's lungs are becoming more pliable. Part of ARDS is that lungs get stiff so they don't work well. His chest x-ray in unchanged which is fine. Once again the pulmonologist explained that this is lagging indicator, behind improving symptoms. I asked the pulm. to order morphine to help with the pain of suctioning and the drowning feeling that TJ has had. That has been successful today. He has been able to sleep a short time after receiving the morphine. He told me (via his legal pad) a couple of minutes ago that he cannot believe he rested even for a bit. I will go back to the room in just a minute and he is planning to get up in the chair. TJ's temperature remains normal.

The endocrinologist came by and explained the insulin regime- it is basically what would be done in the states. She said that she will consult with the endocrinologist in the US about not using the insulin pump speculating that it could have been the source for MRSA. That leaves some questions-how could such a small port of entry that only goes into subcutaneous tissue cause the infection, and is it MRSA???

Staffing was better this afternoon, sadly because of a crash cart for the room across the hall and grieving family.

Chip has a migraine after basically being up all night in TJ's room. The RG family with the baby who was ill are planning on flying "home" this evening.

Much appreciation to all!

MA

Evening Requests (P.S. 15 Minutes Later)

Just spoke with MA again and she has two concerns and prayer requests.

First, TJ says that he can't take being intubated much longer, so he/we again ask for prayer that he is successfully extubated today. For better or for worse my mom has noticed that the Thai medical staff are more "stingy" with pain meds than the U.S. tends to be.

Again, imagine having a garden hose going down your airway for a week. Every time you move you feel a gag reflex starting to kick in and have to hold it back as best you can. And it is constantly up against your throat.

While this is MA's analogy I've seen what it looks like and have no doubt this is accurate. It was obvious that TJ was having trouble taking it a year ago when he was so far out of it it took over a week for him to completely recover from his coma. It really is bad.

Second, the hospital staffing appears to be under some duress. We don't know why, MA is just noticing that for the first time the attentiveness to TJ is dropping, dropping to an uncomfortable point (if not life-threatening etc., less than we would expect in the U.S.). So you can pray that whatever is causing this (perhaps something as simple as the hospital gaining more patients than they expected in a 24 hour period) that this is resolved.

And, honestly, the staffing thing applies to everyone in the hospital. If TJ (in serious, if not critical condition) does not have adequate nursing staffing, then it is a good bet that very few -- if anybody -- else in the hospital does.

Again, thank you all for your prayers! We are seeing God listen to them in a more tangible way than the vast majority of people do in a lifetime. Please, keep it up!

P.S. To clarify a previous post, it is not clear whether TJ has MRSA or not. This is another major area of concern; we need an answer to prayer as to finding out what the underlying infection is. A sky-high WBC of 28k means there was a bacterial infection (viruses won't shoot up the WBC). And we need to know what it was/is.

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Renewed Request

TJ again is personally asking for prayer that he is extubated today. Being extuated, he wrote down, "is challenge." Which is quite the understatement.

Specific Prayer Request from TJ

It is Thursday evening Bangkok time. It has been a very decent day. TJ was up in a chair for a total of 5 hours. They have started to wean off the vent- PEEP 14 and O2 at 40%. The Infectious Disease specialist stopped by and said that he does not think we are dealing with MRSA since nothing has shown up on cultures. I could not really get an answer on what he thinks caused all this, but he said that they will discontinue one antibiotic but keep the ones that were used last year going.

Tonight I was having some trouble communicating with the nurse about his blood sugars- they have been running higher than we would like, but she was not really understanding what I was trying to say so TJ and I said not to do anything and asked to talk with the endocrinologist tomorrow. What we do NOT want to happen is that she over compensates and he goes too low overnight. Please pray that communication does not become a problem with this issue.

TJ's specific request is that he can be extubated tomorrow. Suctioning is really an ordeal- his whole body is wracked with coughing when they put the suction catheter down. It also is very uncomfortable to have the tube in at all. It is tied on with twill tape, rather than a more stable adhesive pad that is used in the states so the tube gets pulled and wiggled with every move.

TJ also wanted me to thank all of you for your persistent prayer and support. Amen to that!

Chip had some stomach issues today-seems to be better now. At the conference TJ and Chip were at last week there were several viral things going around. A family from a country north of here has a baby hospitalized in the room right above us and their 3 year old is sick, too. They are exhausted and if everyone is better will be flying "home" at midnight tomorrow so please keep them before the throne as well.

Sodexo runs the food service at Bethel University and the nutrition department and cafeteria here. I told Chip I will never accuse him of exaggerating about the food choices and tastes again. There is an Au Bon Pain and a Smoothie Bar for back up. What it lacks in taste is made up for by the sweet lady who dishes up the food.

I started a list today of all the ways God has shown His faithfulness and goodness in this situation. It is difficult to be so far away from home while TJ is so ill, and some times the communication can be frustrating-especially for those of us with "time zone challenge." (TJ says he does not get jet lag- he is just time zone challenged). It is amazing to see all the ways God works even in tough situations. GIGATT!

Mary Ann

Late Evening Update (1/7/09)

K, just got off the phone with MA again, all good news today. TJ's WBC is down to 6,000, an actual normal place to be. His platelets are also down 150k, which is also good.

The intensivist told TJ that if he is up and moving around the pulmonolgist is more likely to extubate sooner rather than later. TJ wrote back, "Never underestimate the power of my resolve." He has been sitting up and looking relatively comfortable, e.g., as comfortable as one can be in the situation.

They also put a "cough" around his ET (vent) tube so he doesn't have to be suctioned as often, which is more comfortable than suctioning, not sure how good it feels to be coughing while intubated though.

TJ is currently sleeping and wanting his computer as soon as he wakes up. For all I know the next post will be by TJ, we'll see.

MA continues to be impressed by the nursing staff, which are ever so attentive to TJ. Also, TJ's orgranization has been great in keeping someone around -- again, very nice.

So keep up your prayers! And thank you, as always!

Early Afternoon Post

I am kinda on Bangkok time, so I just listened to a couple of voicemail messages left for me from MA and Chip.

They are planning on keeping TJ on the vent for the net 24-48 hours, but they will still be weening him tomorrow (in the next few hours). They are keeping the pressure on the vent high to continue to push fluid of TJ's lungs while preventing a pulmonary edema.

The intensivist expected a 7-10 days stay in ICU -- again it wasn't clear whether this is from now or altogether.

Finally, a quick note on the comments. Feel free to use mine or Chip's name, please use MA or TJ on the blog. If you work with TJ or a similar organization it is best for you to not to actually use the name of the organization. This is especially true if you or your coworkers live or work in a CAC country. A couple of comments have been rewritten for the sake of security.

I am sorry to come down hard on this but the internet is a good place to be paranoid.

Early Morning Update

Latest update: very little.

The cultures came back with no growth. Meaning that they aren't negative -- which take up to a week before they are called such (or show growth) -- but didn't tell anybody anything either.

TJ is running a low grade temp, but nothing huge and is very tired.

I am going to bed (finally) but first, prayer points for the day:

• Pray that the cultures would start growing, e.g., come back with something. We really want to know what TJ has. If it is not MRSA again, "it is like getting struck by lightening twice in a year." (MA)
• Still, and always, pray for complete healing of TJ and his body and mind. That he would be fully restored by the time he flies home again.
  

Thursday afternoon (I think)

TJ is improving. His white count is 7,000, fever low grade, and they are making plans to wean the vent. His blood is a little low and they are ready to transfuse if needed (sepsis really beats up on blood cells). His chest x-ray is about the same, but that is a lagging indicator. The ARDS is the biggest issue as his lungs are still quite inflamed and producing a lot of thick mucous causing a need for frequent suctioning. They did add a pain medication today which has helped. Cultures have not come back yet, but the treatment would not be changed as it seems to be working.

I am super impressed with the nursing and medical care. The nurses are competent, kind, and gentle and the docs seem really sharp. The nurses shaved TJ today (with a straight edge). When they were done I showed them a picture from Thanksgiving and they laughed and apologized to him so he gave them "the look."

This is discouraging for him and it makes for VERY long days laying in bed in an ICU breathing through a tube. Yet, we continue to be confident in God's goodness and faithfulness to us!

GIGATT!!

With much appreciation,

MA

Late Evening Update

Alright, I spoke with MA a few minutes ago, here is that latest.

Overnight they had to suction TJ every hour. While it is good that they are doing this, as I think was posted, TJ says (or rather writes on a pad) that it feels like he is having a heart attack every time.

TJ's white blood cell count (WBC) is down another 1,000 or so to 7,000, just above the target of 5k-6k. On a similar note, as the WBC suggests, the intensivist still thinks that the infection is under control.

TJ's hemoglobin and another word I can't type (MA said it was basically the same thing) is running low, and so TJ may end up with a blood infusion to take care of that.

TJ's lungs are still inflamed but the doctors are still planning on trying to start weening him tomorrow.

This morning (Thailand morning) TJ seemed pretty discouraged, according to MA, but was looking better after the doctors made their rounds, who are obviously optimistic.

MA continues to be impressed by the medical staff and the attentive care TJ is recieving. It is certainly up to par with Western hospitals.

You can continue to pray for:

• The pain TJ is in, particularly when they suction
• For compelete healing of TJ's body, so he returns as healthy as he was before his first round with MRSA.
• Energy for the rest of us, most specifically for MA (who is feeling better after getting some rest) and Chip, who got to run ground ops initially mostly by himself, and is obviously still there on the ground.

Again, thank you to all of you!

Friends in odd places and God in all places

D 'Roff-garr'* (read it phonetically and it should ring a bell, (security, creative access so on and so-forth) just showed up, to meet any needs that we as a family may run into. The nurses had to post a sign on pop's door that says "do not enter without talking to the nursing staff," and as I was walking out of the room with 'D' it struck me that even on the other side of the world from home we have had so many visitors and so much support that they had to post a sign in an attempt to control traffic. God is good, all the time, and in all places.
Chip

*Edited for Jon to make it look less like the last name.

Morning Update

Today TJ has been feeling pretty well (again, given the circumstances). Just a few minutes ago he was sitting up working briefly on one of his books. All of his symptoms being watched are trending in the right direction. Let's pray that this continues. Every day, several times a day, the staff has to "suction" his lungs; essentially using a vacuum to pull fluids out of his lungs via his breathing tube. This is vital and has helped his lung function considerably, however it is extremely painful and uncomfortable. He said he feels like he is going to have a heart attack when they are suctioning. TJ wrote today that its during that time that a coma of heaven sounds appealing. They will start a low dose of IV sedation for the night (in addition to the light sedation he is already on) so he can sleep.

He was up in a chair a couple of times today and did quite well with that.

Prayer requests....

continuation of the upward trends.

comfort during suctioning, and that it would no longer be necessary, ASAP.

energy and strength for the family - we're all a bit on the worn out side.

Evening Update

I was able to speak with MA about 30 minutes ago (took me a bit to write this), here is her preliminary take on the situation:

• She is very impressed with how proactive and cautious the doctors have been at the same time. That proactiveness probably is saving us from a lot of pain, waiting, and close calls that we had last year. She also said she was impressed with the nursing staff.
  (On a side note, I called the hospital to get ahold of her; every person I spoke with knew two phrases: first, they understood, "Do you speak English?" and second, "Just a moment," as I was transferred to someone who did if they did not)
• The intensivist said that they had a really hard time getting the central line into his left side (basically a big IV-like line that all the IV's go into) which was the same deal last time. They were able to get it in, just not where they were hoping to.
• TJ's white blood cell count has been dropping rapidly; 28k when he was admitted, 18k yesterday and ~8k today. 5-6k is normal. This indicates that the infection is under control.
• In the event that he does not have MRSA (not all the cultures are back) they started TJ on another broad-spectrum antibiotic. With the antibiotics he is on, he should not come home with so much as a flu!
• His kidney functions are back to where they were early December 2008, not great but not bad either. Very good in our current situation.
• The doctors said he came in with bacteria in his bloodstream which they believe spread to his lungs, the cause of the sepsis.
• TJ has endured quite a bit of suctioning today and a lot of bad stuff is coming out. This is, of course, a double-edged sword: it is great that so much is coming out, but it is difficult to imagine something more uncomfortable (other than perhaps being intubated).
• TJ's "peep" (vent pressure setting) is at 16 (max, I believe, is 20) in order to keep forcing stuff out of his lungs. In contrast, last time around the vent was set as high as it would go (including oxygen) when he was doing much worse than he is now. This is part of the proactiveness
• The medical staff is going to try to get TJ into a chair today, while being on a vent.
• Tomorrow, depending on what happens today ICT (ICT meaning Thailand time), they are going to try to ween him off the vent. Given that he was intubated 18 days last time round this is pretty amazing.
• TJ is hypercoagulating, meaning that he is clotting faster than normal and is on a Heparin drip for that. They will cut that down after the central line is pulled and essentially treating him for DVT (deep-vein-thrombosis: clotting in major veins, usually in the legs or arms, hence "deep.")
• The cardiologist who has been watching him thinks everything looks good so far (anyone remember a mitral valve problem last time around? Yeah, apparently not there as far as the cardiologist as seen.)
• Finally, the rest of us (MA, Chip and myself) get to have nasal swabs done! Basically, checking to see if we are carriers of MRSA and if so, what strand. MA most likely is, Chip & I are also a high liklihood.
  
  Some 25-30% of people in the US carry a similar form of Staph, about 1% of the overall population carries MRSA specifically. Both numbers vary depending on the geography and population, health care workers are especially high, which is why MA probably has it. While MRSA isn't airborne spread, Chip & I have had enough close contact with both our parents that between TJ (a known carrier) and MA (a lifetime RN) we get up there in terms of probability.

And that is it! What you can take away from this is that almost everything is going well (great, compared to last year!)

You can:

• Give praise for the continued progress. I don't think anyone expected things to be going so well ~48 hours after being admitted to the ICU.
• Pray for comfort for TJ -- again, the suctioning process is pretty painful (a vaccum being shoved down your throat into your lungs).
• Pray for rest, most specifically for MA & Chip.
• Pray for complete healing. That TJ would be fully restored to his younger self (at least by a 14 months, before this started for the first time!)

Thank you all! Your prayers mean the world to our family.

MA Arrived

MA just arrived at the hospital ten minutes ago. No new news, just an FYI that she made it.

There should be some updates either this afternoon or later this evening (as morning greets Bangkok) after my mom has a chance to talk to doctors and the doctors make their rounds.

Brief Update

Spoke to Chip briefly who is at the airport waiting for my mom, NWA.com says the flight has arrived but there is customs and luggage to deal with. I'll post when I hear from her.

Yesterday (last night for those of us in the US) they were suctioning fluid of TJ's lungs most of the day. This is a good thing, but again, incredibly painful. Last time round it was obvious that TJ was in pain even though he was in a coma. I cannot imagine what it would be like to be awake as they shove whatever it is into your lungs.

More good news, the intensivist (sp?) there thinks that they have the infection under control. So that is a huge spot for praise.

Please pray for the pain, and continue to pray for complete healing of TJ.

It's the Bug that Never Ends

Sorry all, I took some time to sleep in this morning. I'll have two morning updates, this first one is from the same guardian of TJ that I quoted yesterday:

We're here in the room with [TJ].

The Docs here in Bangkok are saying [TJ] should plan for a two week stay before they would certify him as 'fit to fly'. [Name withheld] came to the hospital this morning and went over ALL medical files with the Thai Doc. She was very impressed with the quality of the care.

A couple of things came out this morning. First, [TJ] would never have made it to the states. He would have died enroute and all the Docs agree on that. Second, while he is now stable, the MRSA is back and they are throwing antibiotic cocktails into him hoping that something gets it. The first of the dozen or so blood cultures comes back this afternoon. These are hoping to identify the specific culprit in order to try to design something to kill it. It just goes latent in the body until a trigger sets it in motion like yesterday.

This email mostly speaks for itself. I cannot believe TJ came down with MRSA again. If you recall from last year, many people carry it rarely actually develops into an infection. You would be surprised at all the gross and nasty things your mouth carries in it. The odds of it developing twice in TJ are extremely slim, almost nil, as the antibodies should have been built up.

I'll update again when I know more. MA should be arriving in about 15 minutes according to NWA.com

Evening Update II

I just got off the phone with Chip who had just finished speaking with the doctors. This is what he had to say:

The overall prognosis is good, TJ is alert -- even smiling and "chuckling!" Although, for obvious reasons he isn't in a great mood.

This morning's chest X-Ray show improvement over yesterday. The doctors think that may have come from the pressure of intubation. However, they also had him on 100% oxygen yesterday, which is now turned down to 60%. As a side note, they are really staying on top of things. Normally you wouldn't start someone on 100% O2 right off the bat, but staying ahead of the curve is great and could significantly speed up the recovery process (in the hospital and out).

His white blood cell count is down from yesterday (I don't know by how much) which is another good thing. His kidneys are also functioing better than yesterday although Chip says they were never bad (amazing, given that they have been an issue even in the last few months).

I'll probably head off to bed again soon, so expect this to be the last update for the evening. Feel free to leave questions if you have any as always.

Prayer Points:

• Pain: TJ was feeling pretty crappy before he "left," and is feeling worse now. It's great that he is not sedated past what is necessary but everything else aside, being intubated is not a fun thing. In my mom's words, "it's like having a garden hose shoved down your throat." Ouch. So pray that he is as comfortable as can be.
  
• Wisdom/Safety: The doctors may increase the pressure on the ventilator to try to continue to "push" the pneumonia out. With ARDS this does carry a risk of rupturing the lungs, no good. Pray that the doctors make the best deciscion, and that if the pressure is increased there are no negative side effects.
• Complete Healing: We continue to ask God to completely heal TJ, and to bring him back to his level of health he had before MRSA (which he never fully regained).
• Praise: I can't say this now with confidence, but we may already be at the turning point (although last time around we had a few of those, or thought we did). I can't say it with confidence because if we are there we are in the middle of it and can't see it yet. Still, we thank the Lord for all He has done so far.
• Patience for the family: All of us had the same reaction as the news came in: you've got to be kidding me! Again??? Patience is not coming quickly. We thought we were "over this." There is a sense of bewildermant. How does this happen twice? So please pray that we are patient through this process and that we wait upon the Lord while praying boldy at the same time.

A Couple of Notes on the Evening Update (Update 8:10 CST)

There are a couple of things I feel like I should have fleshed out a little bit more.

First, as pneumonia, ARDS and Sepsis are both collections of symptoms there is going to be some overlap between the three. My guess is that the doctors could have said TJ has ARDS yesterday. The fact that they are only calling it that now isn't as big of a deal as it may seem. Of course, I'll be able to speak with at least a little more confidence on the matter when I hear from Bangkok.

Second, even if the recess of fluid in TJ's lungs was slight it is a very good sign. It suggests that the antibiotics are kicking and working, even if all they have done is stall the pneumonia that is great. This post from yesterday explains why even small steps can be big wins. We don't need the antibiotics to "heal" TJ so much as help his immune system step up to the plate and swing harder.

Third, MA and I were discussing whether TJ was actually in septic shock or not. Without having all the facts, being there, etc., one can't say for sure, but our conclusion was that TJ probably had sepsis which got translated into, "the first stage of septic shock." It is the precursor to septic shock, but again, there is a world of difference between the two.

Sepsis is bad, don't get me wrong, but it means that while TJ's body is under incredible stress it is dealing with it still. Septic shock, as I said yesterday, is when the dominos start falling. Thus I mostly see encouraging signs at this point.

Finally, if you do Skype you can find me at madjon84. A screen name that I was starting to let drop until I realized how handy anonymity can be (my last name is not on my profile). Calls are accepted by default and will go to a Skype voice mailbox if I am not around. I may end up getting an online number through Skype so anyone without it can call and leave a message. (The advantage is basically giving myself an emergency number [the one currently posted] and a non-emergency number.)

This just came in from one of TJ's guardians who took the night shift (I think he meant "AM" below):

I left [TJ] last night around 4pm Bangkok time. He had just been bathed and the nurses had given him some sleeping pills, so they said they would wake Chip in the apartment (there are apartments for family only right on the same floor as the ICU) if they needed to. However, the BP has been in the ‘low normal’ range (105/65) and the sats are in the mid 90s, but again he is intubated. I took a taxi back to the hotel where the conference was and just woke up (8:20am here in Bangkok).

[TJ] is aware of the events surrounding him. I talked, he nodded or shook his head to communicate. A couple of times he wanted a pad to write on.

Evenening Update (Updated 7:36pm CST)

I got to Chip once since I've been up, I think I caught up right as he was getting up. The good and the bad:

TJ is stable and alert. "He knows what's happening." Another member said that he could communicate with winks and nods, write a note from time to time. This is drastically different than last year.

The same person said that his blood pressure was stable and pretty good overnight, and that TJ's O2 sats were in the mid 90's throughout the night as well. Granted, TJ is vented, but last time round we had a hard time keeping them in the upper 80's. For at a least a couple of days the vent was set at "full blast."

The pneumonia has made a small recession since the last chest X-Ray (done yesterday afternoon Thai time, early yesterday morning U.S. time).

He has been diagnosed with ARDS -- Acute Repository Distress Syndrome. We've been down this road as well (December 15th, 2007):

He has also developed acute respiratory distress syndrome (ARDS) from the MRSA. The most important part about this is that it can lead to increase pulmonary edema, , e.g., more fluid [and/or inflamation] in the lungs... ARDS can lead to complete respiratory failure, so it is very dangerous...

In essence, his lungs are being pounded once again and developing an inflammation which in turn impairs the breathing process and again in turn impairs the rest of the body as oxygen levels drop. Fortunately, last I heard his O2 Sats were still good.

This time we don't know from the ARDS -- or the pneumonia or anything -- is from yet. Chip heard that blood cultures were coming back today, however they normally take 72 hours. Thus my ever so thorough medical knowledge (look it up as we go along) makes me think that what is coming back today must be a pretty narrow sample, that is, only testing for some specific things. I imagine there are more culturals being done that will take 72 hours.

I'll probably have one more update this evening, but it may be a couple of hours. Thank you all for reading. As I know longer have an Rn of 20+ years besides me anymore, anyone with medical expertise is more than welcome to contact me if anything I post is innaccurate or needs to be clarified.

P.S. My travel plans are to probably stick it out another day here.

P.P.S.: UT sent in this link on ARDS. It is more readable than anything else I've come across so far.

Brief Update (Updated at 12:45 CST -- See P.S.)

I don't have much in terms of real news but thought I'd update a couple of small changes.

Earlier this morning TJ's blood pressure was back into a normal range. As I assume many of you remember this was a major problem last time around and the only good news to emerge out of the last 24 hours.

TJ is also not in a coma; apparently they completely sedated him for the intubation but is only partially sedated at the moment.

Chip managed to convince the doctors that TJ could have MRSA again (not likely, but possible, especially given that the type he had before appeared to be a new strand of MRSA.) All in all, the Thai doctors have been listening closely to whatever MA or Chip have said, which is good.

Chip also managed to get some rest, or at least so I hear. Hopefully he is sleeping now.

MA is at the airport and the flight is schedule to leave at 1:oopm CST. She is completely exhausted. While she tried to get some rest last night all she managed was to lay down for a couple of hours.

Finally, I am going to get some sleep myself. Feel free to email me or leave a message over IM (GoogleTalk, madjon@gmail.com) or, as always, leave a comment. I am reading them all.

I believe that is it. Thank you all for your prayers, I speak on behalf of the entire family: we firmly believe in the power of prayer, we saw it a year ago like few people ever do. And we ask that you continue to pray for complete, miraculous healing once again. We know in a very personal, tangible way that God can and does bring people back from the dead. And we really want to see it again.

-jon

P.S. One year ago today, around 6:00pm CST, TJ was discharged from the United ICU (not the hospital, that would come ten days later). There is an irony here -- I think. In another way, it is like December of 2007 picked up just in time, as if it is not over. I am too tired to grasp whether that is profound, stupid, just a random thought, or a combination of all of the above, but it does come to mind. At the very least the story is not yet over.

P.P.S. My plans for travel are still up in the air. I'll decide whether I fly out 24 hours from now or not later this evening, depending on changes, if there are any.

Intubating and Going Under

To clarify, after a question, this does mean TJ is going into another induced coma.

Intubating

They are currently intubating TJ.

Please continue to pray for Chip (Steven) who has been handling just about everything over. He has been the go-between for the doctors and my mom, and all the information that we have. He also get to sign all the consent forms. While he is a tough young man, I don't know anyone who would want to be signing consent forms for their parent.

Probably Intubated

TJ is probably going to be intubated. Probably meaning, "the odds are greater than not." Another specialist is apparently being consulted first.

Getting Worse

I just got a text from Chip, TJ appears to have pneumonia in both his lungs now, the left one bad.

The pneumonia is spreading now -- very bad. His lungs looked better this morning than they do now. As always, there will be updates as soon as I have them.

Please pray that the antibiotics kick in and the pneumonia starts retreating. If it does not, than we have hit 2007's level of seriousness.

Update 5 minutes later: TJ is also being switched from his C-PAP to a BiPAP. This post from our last major health battle explains the difference.

Message from the Field

Message from the field so to speak. I was just talking with the doctor and as of right now things are looking up. TJ's stats are good, and his BP is closer to normal and he is coherent. The doctor is optimistic, which as many of you may know is a pleasant break from the norm. (And yes find it a little odd that we have 'norms' for this kinda thing) thanks, keep praying. (specifically that...)

• The antibiotics would take hold and eliminate the infection
  

• His lungs would clear quickly so they do not have to ventilate him
  

• Protection in the spiritual side of things, bangkok can be a pretty dark place

-Chip

Another Answer/Important Update

TJ was just put on another drug, Rifampin, a strong anti-biotic. MA says, "Basically he is on the same drugs that worked last year. But that could change when they get cultures back [in order to determine what the infection is] which can take up to 72 hours." Depending on what the cultures show that drugs he is on may change.

In good news, his SATS are at 97 (remember that a glossary was setup last time round) with his C-PAP (a machine for sleep apnea that keeps a continuous pressure on the lungs, as opposed to actually being put on a ventilator which forces the lungs to stay at a certain pressure).

Someone I was chatting with asked:

Are we in the same stage we were last year but this is attacking more rapidly?

I am just going to give you the transcript of the chat for the answer:

(1:24:29 AM) jon-lappy: No
(1:24:34 AM) jon-lappy: There are a couple of differences
(1:24:51 AM) jon-lappy: Odds are he doesn't have one of the worst viruses in the world at this point [aka MRSA, pretty much a once in a lifetime thing]
(1:25:11 AM) jon-lappy: We are still about half a step away from the blog entry I assume you are referring to. [The last blog entry] [He also is not in a coma, dealing with a failing mitral valve, among other things.]
(1:25:30 AM) jon-lappy: In a few hours (probably under 24) we'll know whether things are getting really bad or not.
(1:25:54 AM) jon-lappy: Septic shock does not move slowly. It comes in fast and goes out fast when you get out of it.
(1:26:23 AM) jon-lappy: In essence, it is all of your vital organs shutting down as the body hits the point where it cannot deal with the infection anymore.
(1:26:35 AM) jon-lappy: So the infection either gets cleared up or it doesn't.
(1:27:08 AM) jon-lappy: When any organ starts going haywire the rest start to follow in general, so going the bad way it is like dominos.
(1:27:26 AM) jon-lappy: Going the good way everything just starts working again as the immune system kicks in again.

To give some analogies:

• If you have a heart attack everything else shuts down rapidly due to lack of oxygen.
• If you get pneumonia everything else becomes less effective as your body fights the pneumonia while not getting as much oxygen as it needs in the first place, which can lead to more problems.
• If you have liver or kidney problems, the rest of the body starts getting poisoned as the toxins that are normally filtered out start to recirculate.

Like these examples it can be a vicious circle. When any vital organ fails to operate normally it puts more stress on the rest of the system -- including the immune system -- which causes greater stress and so on. However, when the antibiotics start to work the body has extra help fighting the infection, hopefully giving it enough power to restore normal, if minimal, function to everything else.

Answers/Up All Night

Given the pace at which events are changing I'll probably be up all night and probably on a plane Monday.

To answer Abby's question:

Do the docs still think he has pneumonia as well as septic shock??

Yes, both of those things are symptoms, which leads to Arthur's question:

Jon, how can it be septic shock without serious infection? Can you explain?

Odds are that there is an infection. We just don't know what it is yet.

We've been here before, and going back helps outline what we are looking at. On December 12th, 2007 we wrote:

The main issue so far is controlling the infection. So far TJ may not be responding to the antibiotics that he has been given, and, as noted, the pneumonia has started moving into the right lung.

[...]

Basically, the sepsis dilates the blood vessels and makes the lungs "leaky." This leads to [congestive heart failure], which means that the heart isn't pumping enough blood and can lead to a drop in blood pressure. An analogy, the blood vessels are pipes which have expanded, but have the same amount of fluid is flowing through them so they no longer have the pressure that they should.

The sepsis can also evolve into septic shock, which is mostly simply defined as sepsis that is severe enough that fluid starts leaking into the lungs, the person becomes confused, and eventually myocardial dysfunction will occur (heart attack). If septic shock occurs it can clear in as little as 24 hours, or stay for days. Depends.

The next day we wrote:

Tj is in septic shock and a primary concern here is the loss of blood pressure. During the night his blood pressure dropped below 80 several times. The doctors are very concerned with the pulmonary edema (fluid in the lungs) because it can lead to respiratory failure.

We will be looking at the same things here, hence why he was so rapidly put on Vancomycin, to control whatever infection is there. TJ's blood pressure has not dropped below 80 so far (at least so far as I know) but it wasn't far from it last time I had a number (around 6:00pm).

A moving pneumonia would be quite scary here (all we have is the baseline right now, so whether it is moving or not is undetermined) possibly indicating a move further into septic shock, which has a mortality rate of about 50%.

So, yeah, we are officially into the "very concerned/scary" stage of things. Past this we are getting to the "scared of death" stage. I made such a remark a year ago and was later chastised for it, it made a lot of people upset. But it was the truth. We aren't there yet today, but only moving in that direction and rapidly.

Possible Intubation

K, just got this text from Chip in Thailand:

If he doesn't respond well and quickly to the antibiotics they will have to intubate him.

This is not going well... Please pray that they do not have to intubate him. We really don't want that. Again.

Little More on Bad Things

TJ has been put on Vancomycin again and the hospital's infectious disease doctor there has been brought in. He does have pneumonia in his left lung. The doctors in Bangkok were able to call TJ's doctor here (the one that pretty much walks on water). MA has a flight booked for tomorrow and is getting concerned because, "they are pulling in the big guns fast." It takes a bit for MA to get concerned.

We are also working on getting her an international cell phone within 11 hours (from now). Don't know if that is going to happen.

The link to hospital's website is http://www.samitivejhospitals.com/srinakarin/aboutus_en.aspx they probably are the best hospital in Bangkok.

This post may be updated in the next 10 minutes as I get MA to look it over (she just got off the phone with Chip, there may be updates that I didn't hear).

And for everyone asking, no, I (Jon) am not getting a flight at this point. I am planning on waiting another 24 hours or so, or at least waiting for more concrete information to fall into place.

K, Things Are Now Getting Bad

I've been asked by more than one person how I am doing, compared to last year this has largely been an annoyance, until now.

The doctors think that TJ is in the first stage of septic shock. Very bad. His urine output is low, probably due to that. He is running a fever of 37.9'C, which equates to 100.2'F, and is feeling cold. His blood pressure remains low.

There are placing a central line in now (more or less like the pic line he had in last year).

MA is working on travel arrangements as I write.

Feel free to comment with questions, I'll answer as soon as I can.

Update on Previous Post

First, if you didn't read the post below, do so.

Second, MA just got off the phone with the Thai pulmnologyst who said that TJ either has pneumonia or a scar from his last plural effusion. It is most likely pneumonia. It is also worth noting that pneumonia is a symptom, not a disease. So why TJ has pneumonia is up in the air.

TJ does not have a fever, but his blood pressure is low and his on five liters of oxygen. He and MA were able to talk over the phone a few minutes ago.

Finally, the CT scan has been put off for the time being. Which means almost nothing other than that they are not doing it now.

Possible scenarios...

I was just able to speak to the doctor in Thailand. Tim was not feeling well on the plane, got very sweaty, and then does not remember exactly what happened, although another passenger reported that he was shaking. The CAT scan of his brain was fine, his pulse and heart rhythm are good. The doctor thinks that it may have been a syncopal episode (low blood pressure leading to passing out and sometimes shaking) vs. a first time seizure. They may do an EEG tomorrow. He is getting a cardiology consult and an endocrine consult for the diabetes. He does not want to add a medication for possible seizures since TJ is pretty complicated medically and the doctor does not want to add unnecessary medication. The doctor is concerned that his blood pressure is remaining low and on a chest x-ray it looks like he may have pneumonia. That part makes me nervous!

Chip has a room down the hall-like a hotel room that is part of the hospital and a couple men who work with Tim are also with them.

MA

Admitted

So TJ has now been admitted to a hospital three times in his life, and has managed to be in the ICU every time!

The doctor that checked him over didn't like something he heard in TJ's heart (not really a surprise) and checked him into the ICU for 24 hours and ordered a CT scan as well. It would be a surprise if the staff there found anything new. His neuro checks (strength equal on both sides, oriented, etc.) were good. The doctor was wondering if it could be a clot (hence the CT scan), but he seemed to be throwing possibilities out for consideration.

There have been some Thai people from a similar organization that have been helping to translate, but the doctor speaks English well enough for Chip to understand him. Also fortunately, there is a hotel at the hospital where Chip is getting a room.

Two other people from TJ's organization -- one who lives in Hong Kong currently, previously in China -- will be on hand as soon as TJ actually gets his room. The staff did not want them in the ER (again, not surprisingly).

We'll update as things come back to us. You can pray for Chip as well, who apparently is going on a mere three hours of sleep and no food as yet. Guess he wasn't expecting a crisis at the airport.

On the Way to the Hospital

Chip just called and they are on the way to a hospital in downtown Bangkok (they were told this is the "best"). He has an IV and on o2- pretty standard. The medical staff wanted Chip to take care of passports before leaving for the hospital and they did get their luggage. Chip thought that they were not in too great a hurry. TJ will need a signed certificate from a doctor to fly.

Without seeing him and just guessing, I am speculating that he was exhausted, dehydrated, and perhaps getting sick..He seems to get food poisoning every other time he is in Bangkok.

He is stable right now and this does not appear to be anything life-threatening. Everything we know has been posted so far and there is no a diagnosis from Thailand yet or how sick he is or whether there was an actual seizure or not is unknown.

Please pray that everything is cleared for them to get a flight home tomorrow and all the details of getting sick in a foreign county get worked out.
MA

A Major Concern in Thailand

TJ and Chip (his younger son) are at the Bangkok airport right now where TJ may have had a seizure on the plane, and the were subsequently deplaned.

The details are scarce for me at the moment, but TJ did black out on the plane, possibly due to low blood pressure (which can look like a seizure without actually being one). The airport medical staff are checking him out right now and giving him a IV flush in order to make sure he is hydrated.

I'll update as soon as I know more. Thankfully Thailand is one of the better places in Asia to have something like this happen. With travel health insurance it is common to have a plan in place to medivac someone out of another country, such as China, to Thailand.

P.S. (6:08CST) TJ is conscious and does not appear to be in a serious condition at this moment. But, again, the info is coming through slowly. Thank God for international cell phones!

Wonderful Christmas to All!

From T.J.’s heart to yours

I have done a lot of thinking this Christmas season knowing that one year ago I was in a long struggle between life and death. This year I have read and re-read the blog entries that my family posted and which so many responded to. I cannot read it without tears streaming down my cheeks and those of you who know me know that is not the normal TJ.

It is a gift to be at the end of oneself when only God has the power to heal. It is a gift to be the recipient of the thousands of those who prayed. It is a gift to know that a spiritual battle was waged and that God defeated the enemy. It is a gift to know that every day I have post January 14, 2008 is an undeserved gift from God. It is a gift to be a walking testimony to His goodness, mercy and grace. It is a gift to be able to look outside and see the beautiful snow that I missed last December. It is a gift to look forward to Christmas day with my family – no gifts are needed this year – being here together is the greatest gift I could have.

The past year has been a gift. To know my heart has been healed, to continue to recover my strength, to spend more time with Mary Ann. In addition God has graciously allowed me to publish my second book, Leading from The Sandbox and to complete a third, The Intentional Life, which will be published by NavPress in October 2009. One of the dedications for my third book is to each of you who so faithfully prayed for us.

Suffering is not something we ask for but it is an amazing gift. It focuses the heart and life like nothing else can. It clarifies what is important. It allows us to share in the fellowship of His sufferings and to understand our savior better. It sensitizes to the sufferings and hardships of others. I count the past year with all of its challenges as the greatest gift of my life along with Mary Ann, Jon, Steven and my relationship with God. I would not trade it for anything!

I do not understand why the physical and spiritual battle was waged but I do not need to know. What I know is that God is good all the time – and that would have been true had I not survived, that His mercy is amazing and that He is utterly sovereign. I can trust Him with each situation, every challenge, all disappointments and all the turns in the road of life. If I have just one more day to live, I will be forever thankful. He is the alpha and omega of our lives, the beginning and the end.

If you come to this blog from time to time it is most likely because you were one of the thousands who upheld my family and prayed for my healing when I could do neither. I thank you from the bottom of my heart. God used your petitions to strengthen my family over 42 long days, to heal my body and bring me back from the brink. I am forever grateful to you and one day will be able to thank and rejoice with each one on the other side of eternity. It will be a big reunion as we celebrate God’s goodness.

I start to travel internationally again on December 26. I am not as strong as I used to be – perhaps it will come back in time, I don’t know. But even if there is a new normal it will daily remind me of God’s grace and goodness. There remain some health challenges but given what God has already done, I can and do trust him for the future.

As I celebrate Christmas this year I do so with thanksgiving for you and your prayers. May He give you great joy as He has given us.

T.J.

Boma

When TJ was in the hospital last year I would get a picture in my head when I prayed for him. It was a man (I assumed to be TJ) sitting on the ground by a large bright fire. He was sitting with his right leg out straight and his left knee bent sort of leaning back on his left arm. His right arm was stretched out toward the fire with a stick in his hand. He was in an oval shaped shelter that I described as a hedgerow because it was the only thing I had seen that could describe it. It was a thick fence made of thorny sticks and seemed impenetrable so TJ was sitting there relaxed, yet alert and waiting.

A couple weeks ago my brother Will got back from a trip to Tanzania where he had the opportunity to visit a community in a very remote area accessible only by small plane. As he described the enclosure around the village, I realized that what I had seen when I prayed for TJ was really a Boma- as I understand it, a word used to describe the fence around a village and the homes in the village.
Here is an article that describes a boma: http://en.wikipedia.org/wiki/Boma_(enclosure)

I was really excited when I found the articles on bomas because it really fits the sense of safety I felt the picture I was seeing portrayed (albeit TJ was in a very small boma). We are supposed to go to Tanzania in March and I really hope we get to see a boma!

A year later we are still learning through the experience. It's not always comfortable -- there are many days when if would be nice to finally leave it behind -- but makes me hopefully eager at the same time for what else is in store for us due to that one, long, painful month.

Love and appreciate you all!
MA

Brief Update on TJ

TJ is feeling a little bit better. Early last week he drove down to Rockford, IL and came back up yesterday. Frankly, it's a good sign if he can site that long.

That said he is still quite sore which makes all-day meetings (such as today) more difficult.

As always we appreciate your prayers.

MA Doing Better

And I am up watching her eat breakfast, a real rarity indeed (I am up at 7:18 am). Yesterday she spend most of the day in the bed but was able to keep some food down.

IMHO it does look like food poisoning which is generally a 24-72 hour deal.

Thank all of you again for your prayers. If I have time later today -- and am awake for it -- I'll do a short post on T.J.

M.A. "Better"

At any rate she feals better after being on a drip to hydrate her.

She just got home (as of right now) . She doesn't really look better but I (JA) thinks she is just tired after over 6 hours at the hospital.

She says she is not over this yet. The doctors sent her home with some meds to help, but nonetheless...

I'll update when she feels (or actually is) better; or if she is worse. In the meantime just pray that she feel/is better than when she left for the ER.

Thank you all again,

-jon

M.A. Now Admitted

[Updated 10:15pm CST; just spell check]

M.A. Had a very sick night Saturday/Sunday. After waiting 3 or so hours in the waiting room she was admitted and got a drip for dehydration.

They think it is food poisoning but given the problems the TJ/MA have had recently I (Jon) would not be surprised if it more than that, although I hope that food poisoning is the extent of it.

At any rate prayers are greatly appreciated. TJ is with her at the hospital currently. Updates will be posted if there are any.

He's Home!

TJ was discharged today. While he still has significant discomfort, for some funny reason he is finding it much easier to find a comfortable position in his lazy boy in his study than in the hospital. Now time to start climbing to wellness once again.

Gratefully,

Mary Ann

Post Op Day 2

TJ is still in the ICU as there were no beds available on the neuro floor. The staff is incredibly friendly and they are really enjoying seeing some positive outcome from their work. I have been introducing him to some people of whom he has no recollection. A nurse walked in this evening and looked at me and said, “You look really familiar.” She had taken care of TJ a couple of times but did not recognize him without a tube in his face.

TJ is doing well although his neck and back still are very painful. The nurse practitioner from the neurosurgeon's office was in and put him on a new pain medication regime. She changed his dressing and the incision looks really good. He took a good walk and hopefully will be able to get some sleep tonight. The nurse who is on tonight had him several times in December and is a wonderful nurse. The plan is discharge some time tomorrow, but no one will make any promises.

Prayer requests are for good pain relief, some sleep, and once again an uneventful recovery.

Many thanks again for all your support!

Surgery Day went well

The neck surgery today went very well. The surgeon was pleased and felt that he was able to fully decompress the nerve roots on the right side. He got the MRI scans to review them and did not see anything on the left so he did not do anything on that side. It took a long time to get a room because TJ is on an insulin drip again. He has a little insulin pump he usually uses at home but the nurses in the hospital don't do the home pumps (about as large as a pager) so he was put on a drip. The post op neuro nurses don't do insulin drips and the nurses on the units that do drips don't do post op neuro patients so he ended up in the same ICU as he was in in December! One of our favorite nurses was in charge and it was great to see him again.

Now TJ is not in the ICU because he is so sick, instead it is a staffing issue for the hospital. TJ is doing well. He has no pain in his arms although the numbness on top of his right arm is still there. The surgeon said that the he expected the pain to go pretty quickly but numbness and strength in his right hand would take longer to improve. It is a huge praise that the pain in his arms is gone. He does have pain at the incision site but his very sweet evening nurse was on top of that. I expect that his night will not be comfortable and the ICU is noisy but he said that he can sleep when he gets home. It should be a one or two night stay. The insulin drip will be discontinued tonight so he will probably go to a regular post op neuro unit if there is a bed available.

Prayer requests would be for full recovery of feeling and function of his right arm and an uncomplicated recovery. We are really ready for uncomplicated right about now!

Grateful again for all your support.

Mary Ann

Brief Update

Via MA, TJ is out of surgery, everything looks good at this point.

Hopefully we'll have something more to say tonight or tomorrow, but really, if things go well there won't be much to say.

Neck Surgery Scheduled

TJ has neck surgery scheduled for October 8th at around 10:45 am and we are very happy to have this scheduled. To bring you up to date on what has happened since the last update to get ready for the surgery. TJ had an EMG where they stick needles in your arm into the nerves that are inflamed, wiggle them, then send an electric current through them to see how the nerves respond. It was lots of fun. (NOT). A neurologist who was new to walked in and said, “It’s worse” and walked out. He also two advanced MRI’s that indicated that he has a narrowing of disks in his neck at two vertebrae leading to the severe pain and weakness in his right and now left hands. Specifically he has a small herniation at C7-T1 and interbody spurring and annular bulging at C5-6. It has made daily life challenging as he has been in significant pain making it hard to sleep and almost any activity that involve his arms hurts. He also has difficulty buttoning small buttons or lifting anything as heavy as a half gallon of milk. The actually surgery is a bilateral C5-6 foraminotomy and Right C7-T1 foraminotomy. The surgery should last about 2 ½ hours and is considered minimally invasive. Here is a link that explains the procedure: http://www.spineuniverse.com/displayarticle.php/article554.html . After the surgery he will need to take it easy for a month and can expect as full recovery as he will get in three months. He should be feeling pretty good by the first anniversary of his discharge from the hospital in January!

TJ had an echocardiogram a couple of weeks ago to determine why his pulse has been so high. The results looked great so he will not need the holter monitor. The doctor made a copy of the results for us and I felt like I was holding a miracle in my hands looking at it last evening. The reason listed for the echo was a “ruptured papillary muscle” and the results indicated normal heart function with mild mitral and trace tricuspid insufficiency. While we knew about all this in March, the wonder of it still makes me catch my breath. The doctor feels the reason for the rapid pulse is deconditioning from the hit in December. After his neck is fixed we will feel more freedom to push past the elevated pulse knowing that everything in his heart is looking good.

Last weekend Jon removed the remaining base cabinets in the laundry room and removed the remaining sheet rock to check behind it for mold. We are confident that any possible mold issues are taken care of (since there is nothing left to take out down there!). I am still feeling a lot of fatigue which according to the allergist may last a few months after the repeated exposures I have had. Jon and Steven have been incredible in helping with this big project.

This weekend, TJ’s brother Jon with some others are hoping to finish the siding and painting outside our house. It is going to look great! Jon is a saint- he and others have been here several Saturdays and evenings to paint and work on siding. We are so grateful for their help!

While life continues so have some challenges, God is always good and has showered us with blessings! In his leadership blog TJ recently wrote, “It is a gift to fully understand what it means to live by faith. When we have reached the end of ourselves and have nowhere else to turn but to confidence in a good, all powerful, loving and holy Father, we have received a great gift. It is at that point that what we believe in our head becomes truth in our bones! The gift is wonderful because "without faith it is impossible to please God."

Prayer requests:

Successful surgery with full recovery of function, strength, and pain relief in his arms and neck.

An uneventful recovery

A rapid return to full energy for me.

Praise for all the amazing things:

Resolution of clolt

Normal heart

Incredible support from our personal family and spiritual family!

Waiting for results

On Friday TJ woke up with swelling in his right arm pit an increased arm pain. His doctor wanted him to come in right away because of the holiday weekend and with the RNC in town next week access to the medical center will be limited. Dr. Corbett ordered a doppler (ultrasound) of his arm and shoulder since that is the side that was affected by the clot back in December. The good news is that the ultrasound showed that the clot has totally resolved and all the vessels looked good. The cardiologist had expected that the large clot would rubberize and become a permanent fixture in TJ's arm so it was great news that it is gone! He then had two MRI's of his neck and shoulder, but it will take several days for those results.

After things settle down in St. Paul TJ will be scheduled for a Holter Monitor to figure out why his pulse is running so high. He saw the cardiologist in March when they discontinued the Amioderone, started when he was in atrial fib in the hosptial, and has not had a cardiac follow up since.

The moisture issues in our laundry room are not fully dried up. I have been reacting pretty strongly to it so we have been staying with friends in Prescott and being wonderfully cared for. We may need to have a professional company come in for remediation. It is discouraging as I had just cleared the symptoms from being exposed to mold at school when we started having a problem at home! Here is a link to what the pulmonologist thinks I have; Until Jon gets on a creates a hyper link you will need to copy and paste it into your browser.

http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/hypersensitivity_pneumonitis.jsp

This weekend Tim's brother and a crew he has assembled are painting the outside of our house. What a wonderful gift!

Prayer requests are:

Quick results from TJs MRI's and an issue that can be treated.

Reduced pain for TJ

A good solution to our laundry room and rapid resolution of my symptoms.

Jon and chip are back to college this week, both at Bethel


Deeply grateful for your encouragement and prayer!

Mary Ann

Continuing Health Issues

We are back to our "Life line!"

You may recall that last October before Tim got MRSA he ruptured a disk in his neck moving furniture. He saw a neurosurgeon earlier this summer and it was decided to hold off on any treatment at that point as it was not causing him too much trouble. In Montana after a long evening of fly fishing the pain in his neck became SEVERE with pain in his shoulder and down his arm. He also had increased weakness and decreased dexterity in his hand. He saw the neurosurgeon today hoping to schedule surgery to repair the C5-6 disk rupture. However, the surgeon felt that it is not so clear cut. He said that there is new muscle degeneration in his hand and that some of the symptoms in his arm are not consistent with simply a C5-6 issue. He scheduled an MRI of Tim’s neck and shoulder and an EMG with the neurologist. The possibilities he is checking for are a problem with his C-8 disk which would account for the weakness in his hand, a brachial-plexus mass, or a change in the C5-6, or diabetic neuropathy. Please pray that the tests can be scheduled quickly (preferably this week as activities and staff at the hospital are decreased next week due to the republican convention). Second, please pray for a clear cut and rapid solution. Third, please pray for pain relief. Vicodan is not doing much and Tim is up after about 2 am no longer able to sleep because of the pain. In addition, but not related, his pulse has also been higher that it should be and at times that it runs high he gets short of breath and fatigued. He was started on a beta blocker medication but probably will be going back to the cardiologist. This is getting discouraging.

We have several household issues going on that feel like spiritual hassle on top of Tim’s health. While we were in Montana Jon and Steven discovered that we had a wet wall, and therefore mold, in our laundry room. They took out the dry wall and insulation and bleached everything, but I am still reacting and am taking steroids again. I had cleared most of my symptoms while we were in Montana. Steven corrected a landscape issue today and we are going to add gutters to avoid future problems. Please pray that my reaction clears up quickly. When we got home from Montana our AC was caputz and we had to replace it last week (that did not help moisture issues). Then last night our main floor drain backed up into the laundry room. Fortunately, Steven was able to creatively clear it with the lawn blower. My car is making a funny noise, too. Please pray that nothing else goes wrong- we are feeling stretched.

Thanks for your faithfulness in praying!

Love, Mary Ann

Encouraging News and Update from T.J.

Thanks to each one for their prayers. We have heard back from the nephrologist and the creatinine level had declined from its significant levels back to a reading 1.3 which is very close to normal levels which are 0.6 - 1.2 mg/dL. It is possible that when I am tested again the levels will be in the normal range because of my low sodium low protein diet. This was better news than we could have expected, but God has proven himself good once again.

I am currently taking the sabbatical that I was going to start in December. Most of July, August and September will be spent working on our health, writing, reading, thinking, exercise and rest. My prayer is that when I come back to work in late September that I will have normal energy again. My take is that I came back to work too much, even though it has been a lighter schedule.

On the health front, both Mary Ann and I are doing weight watchers, exercise, and Mary Ann is doing a great job transitioning us to a low fat, low calorie and low sodium diet. We are in Montana for a month so we are enjoying the beauty of the mountains and of course the wonderful fly fishing.

Mary Ann continues to regain her stamina and strength as she recovers from her mold reaction. We are encouraged with the progress she is making.

Jon has secured a full time job working in information technology in the Twin Cities which will also serve as his business internship. Chip (Steven) is happily guiding kids in the Boundary waters of Minnesota as he uses that setting to share the Gospel and help kids grow in their faith.

My second book, Leading From the Sandbox: Develop, Empower and Release High Impact Ministry teams was published last month and is available on Amazon. I am currently working on a third manuscript which I hope will be completed in September. I would appreciate your prayers as I work on this project.

Words cannot express our appreciation for all of you who have walked through these months with us. We will keep you updated as we move forward.

Nephrologist

I [T.J.] saw the kidney specialist today. The good news is that my current lack of energy is not related to the kidneys and he thinks that the upward trend in my creatinine levels is due to some overlap in medications I was taking. He does think that I need to slow down and focus on recovery. He does also believe that there is compromise to the kidneys but, thinks that it is not at a critical stage. He will know more after he gets lab results back (hoping that the levels have gone down not up).

He will also look at a CT taken of my abdomen to see if there is a blood flow problem to either kidney. If he cannot get the information from that picture he will have an Ultrasound done to look at both kidneys. My diabetes could be a complicating factor in this although he does not know. Sepsis* in the hospital could have taken a toll due to decreased blood flow to all organs. So, all that to say, we are more optimistic than we were going in but won’t know what we need to know until the lab work is back and he has looked at some pics.

I will let you know what we hear on the lab work, hopefully yet this week. He wants to see me in about 6 weeks to talk about a game plan although he did affirm that weight loss, exercise, getting back in shape and insulin control is very important since diabetes can have a negative effect on the kidneys. I am also on a low sodium and low protein diet and that will continue. We will post results when we have them. Thanks for your prayers and concern, we are deeply grateful!

-T.J.

*madjon's [Jon's'] note: septic shock will always take a toll on one's body. I know I am not a doctor, but the septic shock must have had a negative effect on T.J., although, I, my family, my father, and many others remain confident in the complete full healing of T.J. through divine confidence and power. To me, this feels like nothing. It is something, but, to be as frank as I can, I don't have to worry about being down in the hospital within minutes. to me, this seems like nothing compared to such long December

God has proven His faithfulness -- even the ICU staff got that [in someway or another, but they did get it!] -- and I, the family, my father, the readers of this blog, expect that God will be faithful.

I have no idea what, but there is something yet in store for T.J...

Blog Subscriptions (Beta)

Jon just added a "widget" on the right side of the page. If you put in your email address you will get updated by your choice of:

• Email
• Skype
• AOL Instant Messenger (AIM)
• Twitter
• Microsoft Messenger
  
• Twitter
• Yahoo! Messenger

Note that this is kind of a test, I've never tried it before. But as the updates are more sporadic it might be helpful.

P.S. It looks like the updates are daily (if there are any)

Shortly after 1:30 AM in the time zone you selected we will send the updates for the day (if any) to your subscribers.

The timezone is probably EST, I don't see a place to change it...

Nephrology Appointment moved up

TJ will now see the kidney doc on July 1- at least it is a little earlier! No other changes to report at this point, except that I have made a couple of really good dinners with no salt at all!

His second book, Leading From the Sandbox, came out yesterday so that is very exciting.

MA

We need you again!

Last week we found out that TJ has pretty significant kidney failure. His creatinine levels were elevated while he was in the hospital, but have taken quite a jump. For you medical types, here are the numbers: Creatinine 2.68, BUN 39, and GFR 25. He can't get into see a nephrologist (kidney specialist) until July 9th, but from a bit a research I have done it looks like he is at stage 4 (out of 5) of kidney failure. stage 5 is where you start dialysis. The cause is probably from the lack of blood flow to his kidneys while he was in septic shock in December. We are taking a 2 prong approach. One is to start diet limitations of sodium, protein, and phosphorus to decrease the load on his kidneys. The other, and far more important approach is to storm heaven once again for COMPLETE healing. Hey, if the Father could repair his mitral valve miraculously, kidneys should be nothing!

1 Chronicles 5:20. "They were helped in fighting them, and God handed the Hagrites and all their allies over to them, because they cried out to him during the battle. He answered their prayers, because they trusted in him." We are crying out to God as the battle continues.

Other key factors are controlling blood sugar and blood pressure. His blood pressure is pretty well controlled and he gets an insulin pump tomorrow that will tighten his blood sugar control which has been pretty decent.

Please note, that we probably won't have much, if anything, to post here until we can see the kidney doc in July. However, if any of you have some great low sodium recipes please let me know!

On a similar, but less serious note, I have had a mold reaction from where I work that has not let up since April, and I have not been in the building since April. I am short of breath and very fatigued. I saw a lung doctor last week and had several tests but no results or plan as yet. We make quite the dynamo pair these days!

Jon is looking for work and recovering from a very strenuous school year. Steven is in the Boundary Water Canoe Area leading groups into the wilderness on canoe trips. It is through a ministry called Boundary Water Experience. Last year he had the privilege of leading a couple of kids to the Lord. It is the perfect summer for him.

We deeply love and appreciate all of you!

Mary Ann