Only be careful, and watch yourselves closely so that you do not forget the things your eyes have seen or let them slip from your heart as long as you live. Teach them to your children and to their children after them.
Deuteronomy 4:9

Karen and I were extremely happy with ourselves Thursday afternoon. We worked very hard to get to our 3:00PM appointment with the radiation oncologist on time. In fact we got to the appointment early! This was quite a feat considering that on the way there we had to drop Hannah off at ballet, deliver paperwork to one of my customers, drop my Mom off at her house, and then brave the traffic into San Francisco.

We were quickly humbled in our short lived triumph, however, when the gentleman who checked us in informed us that we were actually late to our appointment. By 2 hours! Our appointment was apparently at 1:00PM … oops ... my bad. Fortunately they were willing and able to see us.

As anyone who has gone to a doctor’s office will be intimately aware, even the most efficient and well oiled doctors offices still make you wait for inordinately long periods for the doctor to arrive. Maybe making us wait for their imminent arrival is a scheme developed generations ago by some of the first physicians to generate a sense of suspense and to make the doctor feel important. Or, maybe they’re all just bad at staying on schedule. Or, maybe there’s a lot of inconsiderate patients who arrive two hours late to their appointments and throw the doctor’s immaculately conceived schedules off for the whole day. In any case, we knew that at least in this one case we deserved the long wait and so we passed the time dutifully and without one word of complaint until the doctor arrived.

Actually, because UCSF is a teaching hospital it is usually the lowly neophyte med student who sees you first. They ask preliminary questions and do standard neurological tests the result of which will then be delivered by the student to the doctor in an academic version of the “telephone game”. It’s during this preliminary examination that the med students practice their textbook bed side manner that always seems a bit awkward when applied in real life. I must say I wonder sometimes if the sympathetic nods, grunts and other gesticulations that these med students make are truly genuine and if the almost eager interest in our case stems from a deep seeded concern for our well being or from an eagerness to finally be working on a real person. In spite of my natural suspicion I do believe that our med student that day was one of the genuine ones and so I was entertained as I always am as he went through his regimen of neurological tests that they use to asses general gross motor function.

The reason I always get a kick out of watching these tests performed on Karen is because she is in a word, competetive. I hold my breath in anticipation just waiting for the look of surprise and maybe even stifled fear each time a new doctor performs this test for the first time and says “push against my hand as hard as you can with your leg.” As soon as that simple command is issued the doctor and his chair (regardless of size, weight, or position) are promptly catepulted a foot or so back from his or her starting position. It is also immediately followed by a subtle look of satisfaction on Karen’s face.

After the med student was done with his tests and questions he left the room to consult with the doctor who eventually came to talk to us. I must say that I really liked her. She was very clear and descriptive about what Karen should expect from the radiation. In fact, she was extremely generous with her time considering that we arrived at 3:00 and she is usually gone by then. When all was said and done she stayed with us until 6:00PM.

She even scavenged the halls for a laptop on which to show us on the MRI scans where the tumor is located on Karen’s spine. If you look at the picture below you can see the yellow arrow pointing to the spinal cord (a black cord running up and down the MRI). The green arrow is pointing to the white cerebral/spinal fluid just to the right of the spinal cord. This bright area should run up and down the whole spinal cord and should appear to be consistently white. As you can see in the scan, however, there is a significant presence of a grey discoloration (I have two red arrows pointing to some of the grey areas to give you some perspective. The grey areas are the cancer and as such should not be there. Given the significant presence of cancer, you can now see why the doctors agree that it is really important that they radiate this stuff right away.

The good news continues to be that ependymomas typically respond very well to radiation. According to the radiation oncologist treatment is considered successful when the tumor stops growing. Their expectation is that radiation will probably prevent Karen’s tumor from growing anymore and may even shrink what is already there. This, as always, is not a guarantee or a certainty, but it is what they expect to see given how ependymomas typically respond.

The doctors want the radiation to begin no later than two weeks from this past Thursday. Once it begins the sessions will go for six weeks, Monday through Friday, and will last between 15 and 20 minutes. This will be a more aggressive radiation than what they originally intended because the ependymoma has demonstrated that it is more aggressive than initially believed. The first 2/3 of each session will be a mild dose of radiation spread consistently over the whole brain and spine. The last 1/3 of each session will be a more powerful dose focused on the areas of Karen’s brain and spine where there is significant tumor presence.

The potential side effects that Karen may experience during treatment are:

Fatigue. This will progressively increase through the end of the therapy. It should not be to the point of incapacitation, and she can be as active as her body will allow her, but the doctor did say that help around the house will be important.

Hair loss. The radiation oncolgist assures us that she WILL lose all of her hair. This is because her whole head will now be irradiated. It will start to grow back about two months after radiation is over.

Decreased blood count. A decrease in red blood cells, white blood cells or possibly platelettes could occur. If this does occur it will not be to the point of immuno-suppression, but because a decrease is a serious possibility her blood will be monitored weekly to make sure that her counts don’t dip to low.

Skin dryness. Her skin will not be burned and there will be no pain involved, but her skin may become dry. This can be addressed by a simple skin lotion.

Nausea. Because her spine will be getting radiation some of that radiation will go through her stomach which could cause nausea. In order to prevent the discomforts of nausea the doctor will provide anti-nausea medicine from the start to avoid any potential discomfort.

The potential long term radiation side effects are:

Short term memory difficulties. This would manifest itself years down the road. Examples of this could be not remembering all the numbers in a new phone number, or needing to write down a grocery list rather than committing it to memory.

Hormonal regulation problems. This would be caused by potential damage to the pituitary gland which regulates hormones like estrogen, and cortosal. There is about a 40% chance that sometime in the future (between 2 and 40 years from now) her pituitary gland could have trouble producing hormones in the proper amounts. This could be easily treated if it becomes an issue and with yearly level checks they should be able to monitor the levels and respond accordingly.

Fertility problems. Because of potential long term damage to the pituitary gland the hormones that control fertility could be impacted. This could make it difficult to conceive if the needed hormones are not provided in sufficient amounts.

Vision, motor function, balance and language should all be unaffected by the radiation.

There are good days. There are bad days. And then there are days like today, somewhere in between, when you are forced to recognize that each new day may take you round a corner that changes your perspective yet once again. We are blessed that the bulk of the past few weeks have been filled with really good days. In terms of Karen's healing things continue to get better each day. Today, however, wasn't terrible but it wasn't good either.

Dr. Prados called this afternoon because he'd had a chance to review the MRIs. When I took his call I actually didn't think that there'd be much to tell. Dr. Prados first asked how Karen's back was feeling. I thought he was just being nice, but it turns out that he was asking because after reviewing the MRIs he found a number of cancer spots on Karen's spinal cord. He thought the pain she had been experiencing in her back and thighs may have been caused by the cancer he'd just discovered there.

I don't know if this is the actual cause of her pain since the pain has totally disappeared, but regardless, I had to inform Karen of this new and disappointing news. I took her outside while the children occupied themselves with "bear and the big blue house". I wanted to speak freely without fear of little ears picking up on words and emotions that so often get misunderstood and mixed up in their young minds. I also wanted to give Karen a context in which she could respond in whatever way came naturally to her. In the end she received the news like one would expect who knows her well.

She didn't cry for herself. Tears came to her eyes when she thought about having to tell her beloved parents the bad news. No one likes to deliver news that you know will disappoint or cause fear especially when you are delivering this news to people who you desperately want to please and whose joy is so closely tied to your own. So as she asked me questions about my conversation with the doctor and heard my answers in response, tears gently rolled down her face.

The tears came not because of the additional discomfort she'd have to undergo with a more aggressive course of radiation or the additional thoughts of uncertainty that seem to attach themselves to this kind of news. The tears welled up because of the mental picture that formed in her mind of delivering this news to her parents. At that moment the first images that filled her thoughts were the sadness in her mother's face and the concern in her father's voice that would inevitably greet us on the other end of the telephone line as the news was delivered.

In the end, however, it is important for us to remember that the prognosis is basically the same as it has been since the beginning. So any sadness we feel isn't fear or dread for the future. It's just a mixture of the disappointment that anyone would feel after getting this kind of bad news mixed with some apprehension about what the radiation treatments will really be like now. The answer to the last question will be a lot clearer after our meeting with the radiation oncologist on Thursday.

What we know at this point is that Dr. Prados found between 7 and 8 cancerous "nodes" on her spine in both the thoracic and lumbar regions of her spine. He also found what he called a "sheet" of cancer on the backside of the same part of her spinal cord. All of these areas appear to be on the surface of the cord rather than in the center, which is a good thing.

This new finding changes the recommended treatment. Initially the recommendation was a focused treatment at the precise site of the tumor and we could do it now or wait. Now that the cancer is in both regions they are not recommending any kind of wait, in fact they are seriously recommending that we do the radiation treatment right away. In addition, the radiation treatment will not be a localized treatment, rather, radiation will be applied to the entire brain and spinal cord. The reason for this more aggressive approach is that now that we know that the cancer has spread the chances of microscopic cancer cells existing in other parts of the neurological system is pretty high. By radiating the entire brain and spine they will be taking any of these unseen little buggers out of commission.

Additionally, because this cancer has manifested so uniquely they are going to take some additional precautions. The first is that Dr. Prados is going to have the pathologists re-diagnose the tumor. Because it spread, which is unusual, he wants to confirm again that we are really dealing with an ependymoma. He said that the pathologists will not like this but that it is important that this get done.

Also, though he's never heard of it happening before, he wants Karen to get a CaT scan to rule out any masses other places in her body. He said that this kind of tumor is not known to spread into other areas of the body but he wants to make sure that this general understanding is verified in Karen's case.

Also, Dr Prados said that if the tumors in her spine were to start growing the first kind of symptoms would most likely be numbness in her limbs. If the tumor were allowed to progress she might experience weakness in her limbs. If the tumor were to progress to a significant degree then she might experience some motor control difficulties.

The good news is that ependymoma of the spinal cord responds just as well to radiation as ependymoma in the brain and the prognosis at this point is not much different than it was before. It just means that the radiation process will be quite a bit more exhausting and that we have some additional areas of her body to which we must now be attentive moving forward.

Thank you all for your continued prayers. Days like today are made so much easier knowing that so many people are continuing to lift Karen up in prayer.

"The Lord God said, "It is not good for the man to be alone. I will make a helper suitable for him." ... Then the Lord God made a woman from the rib he had taken out of the man, and he brought her to the man. The man said, "This is now bone of my bones and flesh of my flesh."
Genesis2:18, 22-23

Today Karen had her follow-up MRI. Our Neuro Oncologist sent us to an MRI center in San Francisco because there were no openings for another month at UCSF. She had 4 scans done, one brain scan and then one each for the three sections of her spine (Cervical, Thoracic and Lumbar). For those of you who don't know what an MRI is like here's a little taste. The MRI machine is a huge electromagnet that has electricity running through it at all times and is extremely loud. So loud, in fact, that you have to wear ear plugs when you are in the machine.

Imagine the sound of a fax machine hooked up to the sound system at an AC/DC concert, mixed with a jack hammer being used 6 inches from your head, punctuated by R2D2 screaming and the obnoxious banging of woody woodpecker hopped up on steroids.

Here’s a picture of an MRI machine for those of you who has never seen one.The patient lays down on the bed which then moves the patient into the right position in the big donut shaped electromagnet. At that point the concert begins.

In addition to the obnoxious loudness, one of the main discomforts of the traditional MRI machine is that it is extremely claustrophobic. Each scan takes between 40 minutes and an hour, and while you are being scanned you can't move at all. If you move while the scan is taking place you don't get a gold star and a smiley face from the MRI technician. In fact, he has to do the scan over again.

Laying in bed may sound like an easy task considering we spend about eight hours each night slumbering away, however, there are a few important differences. The biggest difference is that while we may not be aware of it we are constantly moving throughout the night, sometimes violently (very violently as many wives can attest who have been accidentally socked in the nose in the middle of the night by her husband’s wayward elbow).

Additionally, it is very unusual for someone to get four scans in a row. "Very unusual" means they’ve never let anyone do it before. In fact, the radiologist almost didn’t let Karen do it. He actually sounded annoid that Karen even wanted to atempt the feat and skeptical that she'd be able to finish. That is a really long time to lay motionless in a loud enclosed space. In the end all the scans took more than four hours. I don’t think many people could have done so well in this unusual MRI marathon. To lay motionless for that long is more like something you’d have to do to become a Samurai warrior or Army Ranger sniper, not when you are a 5 foot 4 inch mother of three.

After the MRI was over I took Karen to Kincaid’s. This is the restaurant where I first told Karen I loved her, and we’ve shared a number of other great moment’s there since then. It’s located in Jack London Square (Oakland) and sits right on the water over looking the Marina.

As I sat across from Karen sharing a quiet moment and a glass of a refreshing California Riesling, I was trying to synthesize all the thoughts and feelings that kept popping in and out of my mind. For a while all I could really focus on was her striking blue eyes. That, by the way, was one of her features that I remember thinking a lot about the first few years we were getting to know each other.

Finally it dawned on me what the idea was around the edge of which my thoughts had been flirting. It wasn’t a totally new thought to me. In fact it was an idea that I’ve considered a number of times before. But the truth of the idea stood out more starkly and clearly than when the thought had come to me in the past (this often seems to be the case when the same idea is seen in the light of a new experience).

I realized afresh how different I am after being married to Karen for 8 years and how different my life is today because I chose to marry her and not someone else. To a significant extent I am the man that I am today because Karen is my wife. God has used her as the biggest and most important instrument in my life to sharpen and mold me. I am very thankful for the life that I have been given and Karen is responsible for much of the life I am now enjoy. I shudder to think what my life would be like were she not a part of it.

In Genesis we are told that God made Eve to be a helper suitable for Adam. She was to fit him perfectly in his calling to subdue the earth to the Glory of God. It is not enough to realize that women are suitable for men in a general sense. It is also central that we realize that each particular wife, given to a particular man, has been given because she is specially suited for him, to be a helper in his God given calling. Not only has Karen been a great help to me in terms of my secular vocation, God has used her in my life to mold and shape me as a person, so that I am more effective in all of the callings God has placed before me. I look different, talk different, listen differently, think about things differently, have different priorities and in so many other ways am different than I would have been had I married another woman. She fits me perfectly, better than a hand and glove, because unlike a glove she makes my hand so much stronger, more efficient, more tender ...

Because of Karen I have learned how to be decisive, I’ve come to appreciate that the small things are actually big things, she’s shown me what it looks like to passionately desire God to remold us into the image of Christ, I’ve been privileged to observe first hand what it looks like to live a lifestyle characterized by endurance, I’ve seen and received by association the blessing that accompanies a good reputation and I know what it feels like to walk into a room and feel honored to be seen with someone truly special.

It also says something about Karen that for the most part the changes God has wrought in me through her occurred not because she’s talked a lot about them, but because I have seen these attributes modeled in her life. I could write for quite some time listing the many things that I have learned from Karen and I know that there are many more ways she has effected me that I am not even aware of yet.

One of the reasons I look forward to growing old with her is that I am confident God will show me many of the other numerous other ways that God has already shaped me through her. Though a residue of vanity in me groans when I imagine the wrinkles, back problems and various invasive and undignified probing that accompanies growing old, I am in the last analysis really looking forward to getting old and saggy with her. I know that each day that I am blessed to fall asleep beside her, that is a day that I am made a better man because of my time with her.

"I thank my God every time I remember you. In all my prayers for all of you, I always pray with joy because of your partnership in the gospel from the first day until now, being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus. "

Philippians 1:3-6

Here's a picture that Chris and Wanda Kersey graciously took two days ago. You can see how great she looks!

Karen and I continue to be overwhelmed by the unending cascade of generosity that you continue to shower on us. It is truly hard to articulate how utterly thankful we are for everything that each of you has done for us. Thus we are left on the horns of a dilemma.

On the one hand, all the words we come up with aside from “Thank you” risk sounding trite or insincere. And yet on the other hand a simple “Thank you” seems to run the risk of sounding weak and obligatory.

As we approach the one month mark since we first rushed Karen to the ER, please know how much we continue to covet your prayers and appreciate your generosity.

Here are some current updates on Karen:

We have our next two appointments scheduled and approaching fast. Karen will be going to get her post operative MRI next Friday the 20th. She'll actually be getting 4 MRIs. One of her head, and three of her spine. She’ll be in that machine for about four hours with a couple of “stretch breaks” in between each scan as they change the "coil" (whatever that is). These people talk to you like everyone speaks the same techno-babble that falls from their lips.

The following Thursday we'll be going back to UCSF to have an interview with the radiation oncologist. They'll use the MRI results from the week before to determine their suggested course of radiation treatment. Our nuero oncologist will also look at Karen's spine to determine if the ependymoma has traveled to her spine through the cerebral fluid. This is rare but happens occasionally. During this meeting we'll be able to ask the radiation oncologist all the specific questions we'd like about the radiation therapy itself.

Also, Karen’s been experiencing pain in her thigh and back muscles. We were wondering what the cause of this might be but our oncologist and pharmacologist were stumped. After about 2 minutes on Google, however, my sister in law found a great article on the side effects of the steroid that Karen is taking. Apparently this medication (among its many side effects) causes a depletion of potassium which in turn can cause cramping and muscle pain, ergo … she’s eating bananas. Anyone know what the side effects of bananas are? On second thought I’d rather be ignorant on that subject.

We’re thankful that Karen’s last day taking the steroids will be on Saturday.

As I glance over at Karen throughout the day I can't help but smile as I consider all that God has been doing over the past few weeks.

• Karen could have died that Thursday afternoon that I found her unconscious on the floor ... but God preserved her
• The tumor could have been inoperative ... but we were blessed to have been provided with a skilled surgeon
• She could have had a stroke after the surgery ... but she came through perfectly
• The tumor was supposed to be terminal ... but it turns out they were wrong
• She wasn't supposed to be able to talk after the surgery ... but she sang and played the piano at a wedding last night

One of the Psalms that she sang last night was Psalm 128A. The words to the last stanza of that song are:

"And may you see Jerusalem's good all days on earth you dwell. May you your
children's children see, and peace on Israel."

Because the prospect of Karen actually seeing her children’s children had been so poor only a few days before, the great news we received on Tuesday made the blessing that accompanies seeing your grandchildren a truly sweet picture. Coming out of the meeting, however, it wasn’t this picture that was on Karen’s mind.

As I’ve said before Karen is currently at a real disadvantage. It often feels to her like everyone around her has a better understanding of what’s happening than she does. Trying to wrap her mind around this whole situation has been like trying to envision what you look like without the benefit of a mirror to help. You have to rely on everyone else’s description of reality and thus the details in your mental picture remain fuzzy.

So, I’ve been trying my best to help nudge her along as we all endeavor to come to terms with what this all means. In part this has taken the form of summarizing what the doctors are saying and what each bit of information means for her future.

Karen didn’t need my nudging on Tuesday, though. As we sat in the car and began preparing to drive home she told me that she was finally beginning to understand that this cancer was something that she’d have to live with the rest of her life. Silly as it might sound, until this last appointment she had imagined that after the radiation she could simply put this chapter of her life behind her and move on … cancer free. She never even considered that she’d have to get periodic scans, or the possibility of recurrence.

I was glad that she was coming to terms with the long term consequences of her cancer but I also wanted to make sure that after such a positive meeting her focus was in the proper place. I didn’t want her focus to be on radiation or MRIs or recurrence etc. Instead I wanted her to focus on what Dr. Prados kept repeating in our meeting, that Karen should plan on a long and happy life.

I struggled to summarize this message in a way that would create a clear mental picture on which she could set her mind’s eye. After a few moments it finally struck me and I told her gently, “Karen . . . You can plan on seeing your grandchildren.”

A smile of contentment spread across her face. The tears of peace that welled up in her eyes told me clearly that all the inconveniences that might accompany her cancer really don’t matter in comparison with the great joy she will experience when she sees on the face of our first grandchild the special smile that grandchildren reserve only for their grandmother’s.

I thought you all might be interested in seeing a before and after MRI scan:


The left image is before the surgery and the right image is after the surgery. You can think of the image as if it were taken by a camera near Karen's feet looking up through the bottom of her brain. The mass was about 5 centimeters in diameter.

The right arrow points to the white object which for the most part represents the tumor.
The left arrow is pointing to the left ventricle. The ventricles are the dark areas in the middle of the brain. There is one on each side of the brain and they should be symmetrical. As you can see from the left image the ventricle on the right side is being compressed.

After the surgery the ventricles were more symmetrical after the pressure had been released and it's pretty obvious that a lot of that tumor had been removed.

You can also see in the picture on the right the swelling that took place after the surgery on the side of her head.

Dear Family and Friends,

I do apologize that it has taken me until now to get this update out there. I tried last night but fell asleep and tried today but work got in the way. So here are some of the most important bits of info we learned during our meeting with the oncologist last night. If you all have additional questions please let me know.

Dr. Prados confirmed that Karen's tumor (funny to call it "Karen's tumor" like it's a piece of clothing or a good idea) is indeed a Tanacytic Ependymoma. As the doctor said, it's never good to have a tumor, but if you do get one this is the kind you want to get. This is considered a low grade (grade 2) cancer, slow growing and typically responds extremely well to radiation therapy.

It is also a rare kind of tumor. For some perspective Dr. Prados told us that UCSF is one of a handful of "tumor centers" in the nation so they see a lot of tumors in a year. In fact UCSF sees a total of 3 or 4 tumor patients a DAY but they will only see about 15 to 20 ependymoma cases in an entire YEAR. Only about 150-200 cases of ependymoma occur across the nation in an entire year.

Aside from this being a relatively uncommon tumor he could say that the majority of adults (85-90%) with an ependymoma have "long term success." He gave an example of an ependymoma patient that he treatedwhen he first came to UCSF in 1985 who he just saw recently and who continues to do very well. That’s 20 years later and still no problems.

Also, let me give you a sense for what he means when he says it is “slow growing.” If the tumor was left alone and they didn’t do anything to it, it might be three or more years before any growth was even detected in scans or by symptoms. In fact, the accepted practice for ependymoma patients for whom they believe they have removed all of the tumor is that they don’t even recommend radiation therapy at all.

Even in Karen’s case where they know they didn’t get all of the tumor, they said there is no urgency to starting the radiation therapy. The reason for this is that there is no known difference in outcome between those patients who do radiation right after surgery and those who wait until scans or symptoms indicate significant growth. In terms of our options, the doctor said the choice is up to us, and that the only real question for radiation has to do with the timing of when we begin.

Some of you may be asking why one would want to wait to do radiation. The reason has to do with the effects of radiation on the brain. Although they are recommending a very low level course of radiation that will be focused specifically on the area of the tumor, the radiation can still have an effect on the abilities controlled by that part of the brain.

The short term effects of radiation are typically fatigue, as well as dry skin and possible hair loss at the spot that is experiencing the radiation. But this will go away after the radiation is done. The long term effects, however, could be subtle effects on short term memory. This is due entirely to the fact that the part of her brain where the tumor still resides is the area that facilitates memory. If the radiation did effect her memory it would manifest itself in things like difficulty remembering a new name. He said it would probably not be noticeable to anyone else, and that “she might have to rely a bit more heavily on her blackberry.” All in all even the worst case scenario regarding side effects would be nothing more than an inconvenience easily overcome.

Important to note is that he also said that if she did experience some subtle deficits in memory that this would not be something that she would get back. Damage like that to the brain doesn’t heal. This is the reason to wait for radiation. In waiting you put off these potential problems a year or two more. So Karen and I will have to weigh the options and make a decision, do it now and get it over with or do it later and put off the potential inconveniences. I’ll give you one guess which way Karen is leaning …

Many of the questions that you all asked had to do with radiation. It turns out that though Doctor Prados is an expert Neuro Oncologist, we really need to address most of those questions to the Neuro Radiologist. We’ll be doing that when we meet with them.

Some of you also asked about how much of the tumor was left in Karen's brain. Well, there is no precise answer on this. The reasons for the imprecision are numerous. Some of the reasons include the inability to exactly distinguish where the tumor begins and ends. Also, the MRI, though very good, just doesn’t provide the level of detail necessary to find the edges even if they did exist. In answer to this question, Dr. Prados said that most surgeons would have gone in and only done a biopsy. Our surgeon, Dr. Parsa, was one of few nuero surgeons who could have resected anything, let alone the significant amount that he ended up removing. The take home message on this … we got the best results you could possibly hope for in this situation and the rest should be controlled by radiation.

In the next few weeks Karen will be getting an MRI of her head and spine. At that time the swelling and other effects of the surgery should have gone away so they can get a good look at her brain as well as her spine. They are checking her spine because this kind of tumor can sometimes travel through the cerebral fluids down into the spinal cord. The MRI will help to determine if this has happened, though there are no indications that we ought to really be concerned about this.

On another note, I did ask about the genetic nature of ependymomas and whether we should be concerned about our children or Karen’s brother getting this disease. Dr. Prados said that the factors that need to be present in order for this to be a realistic concern do not exist in our case and that no risk exists of transmission.

In terms of lifestyle issues here are some of the things that Karen can and cannot do:

She CAN

• Walk
• Be left alone
• Bend over
• Drink alcohol in moderation
• Do pretty much anything that she want’s to as long as it doesn’t hurt
  

She CANNOT

• Drive for the next 6 months (legally because she had what may have been a seizure)
• Jog until her head no longer hurts (about 2 weeks more)

Her our the Next Steps:

1. Karen will be getting an MRI of her head and Spine in about 2 weeks
2. We’ll meet with the UCSF radiologists regarding radiation therapy
3. We’ll determine when to start radiation
4. We’ll get recommendations from UCSF as to what radiation centers they would recommend in our area.

I hope that this satisfies some of your curiosity. Like I said in the beginning, let me know if you have any other questions at this point.

Questions ...

As we prepare for tomorrow's meeting with the oncologist I thought it might be interesting to see if any of you have questions you think we should ask the oncologist.

I won't be responding to these questions on the blog, but I thought you might have insites that could help us in our meeting tomorrow. Feel free to post the questions and we'll use the ones we find the most appropriate for the meeting.

I know it has been a few days since I have posted. I suspected this would happen. For those who may have been impatiently waiting for an update I do apologize.

The good news is that my lack of posting is a good sign. It means no major changes have occurred and that life is settling into a generally comfortable routine. Karen continues to improve everyday. We measure this by the number of pills she has to take at each meal. She’s down from 25 pills a day to 11. She did tell me tonight, though, that unlike the fast, pit-stop kind of healing that she is used to, this time the healing is "going really slowly." I don’t mind slow. If that philosophy worked for the turtle why shouldn’t it work for Karen.

Since she got her staples out on Tuesday the incision has continued to improve. The redness is basically gone, and it is starting to take on a more normal appearance. She wore her hair down today for church and you couldn't tell she had any incision except for about an inch near the beginning of the incision on the top side of her head. You wouldn’t have even noticed that unless you really looked. You can ask anyone who saw her at church today and they'll tell you that she looked great! Considering her condition 14 days ago I continue to be amazed at the healing God has provided.

In fact, today was a really wonderful Sunday. Karen was able to make it through the whole day and whereas last week she had a hard time grasping the content of the sermon, this week her comprehension was a lot better. Pastor Walker preached from Acts 12 on prayer. Given the events that spawned this blog, prayer and its importance in the life of a Christian has taken on a much more vivid reality than ever before.

It really has been a blessing to watch our God, who at the same time he’s busy upholding each molecule in the universe, take the time to bend his ear to the supplication of his saints and touch Karen’s mind and body in answer to your cries on her behalf.