Monthly Archives: December 2011

Dec12

My first night in our new home…

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It’s a little after 4 in the morning and I can’t sleep.  Allistaire just had her vitals checked again.  What a strange new world we’ve entered.  So many new sounds (beeps and ventilation), new ways of doing things.  Each diaper is put in a bucket to be weighed to help determine how she’s doing with her fluid intake.  When I asked about some diaper cream, the nurse Megan, joyously exclaimed that they have, “a whole algorithm” for that.  Thoughts of calculus came flooding my mind as I tried to see the connection between butt paste and math.  Apparently it’s just a fancy way of saying they are quite thoughtful about what type of cream to use in differing circumstances.  We have a wee little bin – and I do mean wee – in which we can put food in a refrigerator.  You must label each item with the patients name and the date .  Food that is over 48 hours old will be tossed.  Can you imagine coming home from Trader Joes and piling your food into a container about 8 inches by 14 inches, labeling everything and knowing someone will come by and throw it away within hours?  This would just never do for mom – of course I’m guilty too.  Only a few weeks ago I threw away a bottle of lemon juice that expired in 2008.  I hope to figure out how to add some pictures soon so you can get an idea of our new homeland.

As for little Allistaire, she is doing okay though agitated by the confinement of her new life.  Until she gets her central line on Tuesday, she will continue to have an IV in her foot.  She has been drinking well so they have been able to disconnect her from fluids at night.  During the day she is usually attached to her IV pole.  Because her hematocrit was down to 20 yesterday morning, she received 2 transfusions of blood yesterday evening.  I think this perked her up because she was lively, even playful, to past 10pm last night.  Her goofy, toothy smile brings us great delight.  Even her insistent, plaintive, “All Done” during blood pressure checks is adorable.  She is a joy to everyone who encounters her.

I’m going to attempt to include some very specific things for which to pray each day for those who are interested.  At the moment, sleep would be lovely.  There are constant interruptions here at night.  For myself I struggle with sleeping so lightly and lots of neck and shoulder pain which isn’t helped by our sweet “bed in a chair” contraption.  Also, every time I wake up, my mind starts going immediately so that it takes a while to fall back asleep. For Allistaire, she is woken up at least several times each night for vitals, diaper changes, etc.  And for now she has a silly sleeping outfit consisting of her footy jammies that we call, because she does, “Jammie Shoes.”  Because the IV is in left foot, we can only get her arms and right foot into the jammies – zipping the front up is not an option so she sports a little hospital gown over the top to at least semi cover up her tummers.  I imagine this isn’t the most comfortable or warm.  So sleep – pray that the Lord would provide us with as much sleep as we can get and the ability to thrive on less.

Speaking of sleep, I think I should try to re-enter that land before 6 am rolls around and Allistaire has to be poked again for her morning blood test.

Dec12

Finally We Know update from Sunday, December 11th…

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Here is the last back story email written Sunday, December 11th:

It is a gray beautiful morning here in Kent with the clouds rising up among the jagged points of the dark evergreen trees on the hill…

I’ll keep this brief for now as Solveig and I are about to head out for church.  About 5pm yesterday Sten and I were told that Allistaire has Acute Myelogenous Leukemia.  I just now had to google AML to see what the “M” stands for – so this should tell you how much I know about her diagnosis.  There will be time for that.  What we do know is that we have 5 months of hard chemotherapy ahead and the real possibility of a bone marrow transplant as well.  The treatment for AML versus the more common ALL form of leukemia, is much harder but much shorter.  There will be four rounds of chemotherapy, each consisting of 5-7 days.  Some days Allistaire will have chemotherapy more than once that same day.  This will immensely lower all of her blood counts.  It takes about 3 weeks for them to come back up to a point where they can do the next round.  The first round and the following three weeks we will have to be in the hospital the whole time.  This means about 4-5 weeks solid at the hospital right off.  After the second round of chemo we will be able to go home with office visits every few days to check her blood.  The doctors said that we would also typically have to go back a few times to stay in the hospital during that 3 week span because of things that come up as part of your immune system being so repressed.  Before each new round of chemotherapy, Allistaire will have her bone marrow checked again in order to look for cancer cells.  If any show up after the first round we will know that she will also need a bone marrow transplant because the chemotherapy is not sufficiently effective.  The transplant would take place after the 2nd or 3rd round in order to suppress/kill the cancer cells as much as possible.  In the event that she were to have a transplant, they would, as part of the transplant process, give her a special round of chemotherapy that would actually completely wipe out her existing bone marrow prior to them giving her new donor marrow.  Depending on the genetic changes that have taken place within the cancer cells DNA, the chemotherapy will either be more effective, less effective or about in the middle at destroying the cancer cells.  This therefore, will be a big determining factor in whether or not she will end up needing a transplant.  They will be doing genetic testing which I think we will get results back from within a few weeks.  They said that getting a matching donor for a transplant is usually not hard -which amazes me.  Apparently Fred Hutchinson Cancer Research Center pioneered bone marrow transplants starting some 40 years ago.  We are told that the results of a transplant here are better than anywhere else in the country.  If at the end of the 5 months they cannot find any cancer cells, Allistaire will be considered to be in remission but will be checked often especially within the first few years.

There are so many thoughts and emotions right now which I don’t have time at the moment to convey.  I am hoping to start a blog in the next few days to make updates easier to access and easier for me to provide and of course to give a more colorful view of our new world.  Your overwhelming outpouring of love, prayers and willingness to help is what – what can I say, it is staggering, it is a comfort.  The Word of God says that we are the body of Christ.  This is a mystery and it is ordinary and mundane.  This is part of the way in which the weight that we bare is dispersed, is spread out.  As we are yoked to Christ – we are yoked to His body which many of your are.  You are one of the beautiful tangible means of hands, feet, voice, and ears.  In the coming days I think we’ll probably start taking you up on your offers of help.

On Tuesday Allistaire will have a central have central line put into her chest.  This is near her heart so that as soon as medicine and chemotherapy is put in, it can quickly disperse into all parts of her body.  This also means she won’t have to have an annoying IV that is so cumbersome right now.  While she is sedated she may also have another bone marrow draw if they need to get more sample.  They will either begin chemotherapy this Tuesday or Wednesday.

As you can imagine, this is not what I thought my life would be like on December 11, 2011.  Of my own accord, I would never choose this road.  I woke up in the night and saw the glowing green light of Allistaire’s monitor – there’s no one in her room.  I didn’t have to step lightly when I got out of bed so as to not have the creaking floor wake her up.   She is not here.  When I went to get the clothes out of her closet I saw the dresses she’s only worn a few times, there is no need for them now.  What can I say?  If I let me mind go down the innumerable roads of how life is not what it was, what I want it to be, what it feels it should be…well the pain is like having the flesh ripped from your bones.  But at some point this morning the Lord lifted my heart and encouraged me not to look at what is not but look at the possibility of what will be – to keep my eyes alert for how He is at work, for what He will do.  Again, here is the Rest He keeps extending to me – it’s like when you’ve been hiking with a ridiculously overloaded heavy pack and someone offers to take it off your shoulders and carry it for you.  There is a strange awareness of feeling light and able to charge ahead.

Much love to you all,

Jai

Dec12

Update from Friday, December 9th…

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Here is the email sent out Friday afternoon December 9th:

I just got a call from our doctor who said the preliminary results from Allistaires bone marrow test show tumor cells in the biopsy.  There were no tumor/cancer cells in the blood portion of the bone marrow which is atypical of leukemia.  It looks like this is more likely some sort of cancer where there is a tumor.  We will be heading to the hospital in the next few hours for them to do more blood tests.  Tomorrow they will sedate her and do some cat scans to look for the tumor(s) and potentially do another bone marrow test.  They will do their best to diagnosis what she has so that we can move forward with a treatment plan.  Please keep praying for us.  We have very much felt your love.
Jai

Dec12

Update from Thursday, December 8th…

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Here’s the email I sent out Thursday, December 8th:

Well, it has been a hard day today.  I brought Allistaire in this morning for labs at 7:40, met with the doctor at 8:30 and the scheduled bone marrow test at 9:30.  Allistaire had her finger poked and blood taken and then we met with the doctor.  The labs were not back yet at the beginning of our time with the doctor.  She examined Allistaire, asked about how she’s been doing the last few days and I signed some consent forms for samples of Allistaires marrow and blood to be used in needed studies.  Then the lab results came in and they were quite disappointing.  Everything has gone down closer to the levels of last Saturday, with the exception of the Reticulocyte Production Index which remains at .3.  I was so hoping today the numbers would be up.  We had to wait nearly 40 minutes past the scheduled time of the procedure.  Forty minutes in that little room – it was hard to keep the tears from overwhelming me.  The doctor didn’t say much about the numbers other than clearly we need to do the bone marrow test to know what’s going on.
Allistaire sat in my lap on the bed in the procedure room and had a mask held to her face until she fell asleep.  I then sat in the adjacent room and waited for them to complete the bone marrow draw.  After they were done they simply opened the sliding frosted glass door and wheeled the bed into the room I was in so that I could be with her when she awoke.  About 15 minutes later she awoke and was quite upset for the next half hour or so until she fell asleep in the car.
So now we wait until this coming Tuesday, 12/13, to meet with the doctor and get the results.
We wait. We wait and try to figure out how to live life in this realm of the utterly unknown.  I think I said it before but it really feels like life is suspended – strangely eerily still.  We sit at the crossroads, hoping and praying desperately that we are to turn down the path of health and healing.  But it may be that the Lord will take us down the other direction.
When I was young I memorized 2 Corinthians 4:16 – 18, “Therefore we do not lose heart.  Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.”  At that time in my life I applied this verse to the awful acne that was a horror for a teenage girl.  Today, December 8th, 2011, my troubles don’t feel momentary, they don’t feel light.  In my heart and mind I link this verse to another verse dear to me, Matthew 11:28 – 30, “Come to me, all you who are weary and heavy laden, and I will give you rest.  Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy and my burden is light.”  I never cease to be awed and mystified by this verse.  Just at the moment when one feels overwhelmed and exhausted by the weight they’re lugging around, Christ offers you and I to put a yoke on our necks.  A yoke is a tool of hard labor.  What sort of offer is this?  How can such an offer provide me with rest?  Is not rest the opposite of labor and work?  But twice Christ says that He is offering rest.  Here is the resplendent beauty – I am being extended the offer, the invitation to be yoked to the God of the Universe!  I think about how I offer to let Allistaire or Solveig help me do something challenging, their hand might be touching the box “we” are carrying but it is really my strength that is carrying the box.  This is the only way I can say my troubles are “light” and “momentary.”  Because I am bound to Christ, the source of my weariness, the heavy burden is in truth being carried by Him.  Rest is something the Lord has been teaching me about bit by bit over the past 9 months beginning with our study of Isaiah in Bible Study Fellowship and then in a sermon series on the 10 Commandments in our church and now again in BSF as we study Hebrews.  I feel the Lord giving me glimpses of His rest here and there.  I don’t truly understand much of it yet, but He has shown me that somehow, the Rest He offers me is a rest that frees me up, unburdens me to be able to work, to act, to walk forward – it is not a static rest.  It is a pressing forward against the reins sort of rest that can rest ultimately because Christ completed His “work” on the cross by resting in submission to the Father’s will in the Garden of Gethsemane that night.  At the moment of Christ’s greatest work He rested, He constrained Himself to the Father’s will, trusting in His ultimate wisdom, goodness and power.  This is the rest I am offered day after day, blood test after blood test.
I’ve attached two pictures of Allistaire while she was waiting to wake up from the bone marrow draw.
PS – Lowell, Sten’s dad looked at these numbers and felt that were just natural fluctuations rather than a downward trend that one might see from day to day.  I pray he is right!
                                                Normal           12/1     12/2    12/3    12/6     12/8
Hematocrit                              30-40             9.6       17.8     25      24.4     23.5
Platelet Count                        200 – 450         137       106      99       104     97
White Blood Cell                      5 – 15             2.9        1.9      2.3       2.1     1.9
Neutrophil                            Over 1000         186       158      77       204     91
Reticulocyte Production Index      .5                 0           ?         ?         .3       .3
Dec12

Update from December 6th…

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Here is the email update sent out on December 6th:

Here is the most recent update on Allistaire.  We went to Seattle Children’s Hospital this morning to get another CBC (Complete Blood Count) done and to meet with the Hematology/Oncology Specialist.  Below you will see Allistaire’s most current numbers and a correction to the white blood cell count which I recorded incorrectly last time.  Overall she is doing a bit better.  This weekend she has been joyful, eating better and much closer to her old self, though certainly still sleeping a lot.  Her hematocrit (red blood cell count) has remained essentially stable.  Her platelets have gone up a little bit, though her total white blood cell count has gone down slightly.  Most encouraging is that her neurtrophil count is up from 71 to 204; granted normal levels are over 1000 but we’ll rejoice over every gain!  Also the doctor was encouraged to see that her Reticulocyte Production Index has raised from 0 when we first brought her in up to .3 (.5 being normal).  This is a measure of the new red blood cells being produced in the marrow.  Allistaire’s RPI shows that her marrow is doing at least a little on its own and isn’t totally suppressed.  Overall, we are so thankful to see some upward progress!  Our doctor consulted with the other specialist in today and they agreed that we should still go ahead and have the bone marrow test done because her counts are so low.  Sten and I are thankful we’ll have more helpful information sooner than later.  Our next blood draw, appointment, and bone marrow test will be scheduled for some time this Thursday.  At this point they have pretty much ruled out Leukemia, they are also steering away from Transient Erythroblastopenia of Childhood (TEC) given that it primarily suppresses red blood cells rather than all the blood cells as in Allistaire’s case.  They are narrowing in on Aplastic Anemia (Aplastic means empty – as in the marrow is empty or not producing blood cells).  Aplastic Anemia is an overarching category of diseases which have quite varied causes and thus some variation in treatment.  Some of the main categories of Aplastic Anemia are congenital which means that it is genetic and also is often accompanied by physical deformities, environmental as in the case of those who are exposed to chemotherapy or radiation, autoimmune or viral.  In all these cases the bone marrows production of blood cells is suppressed.  The bone marrow test will significantly help to make a more conclusive determination of what type of Aplastic Anemia Allistaire has.  Of course we are hopeful that hers is due to a viral suppression which can rectify itself, but there is always the possibility that it will be a type that could require something as significant as a bone marrow transplant.
 As I stayed up late last night pouring over one google search after another, trying to understand big words and the web of how one thing leads to another, I was at times overwhelmed with all that can go wrong and all the scary possibilities.  It was about the time that I was reading through Wikipedia’s simple explanation of lymphocytes that I realized that within the very same overwhelming complexity which allows for untold numbers of things to go ary, in that same complexity is the screaming evidence of an absolutely brilliant able God.  It is too amazing – it is simply too much that our body does all that it does even within the limited realm of blood.  As I looked at the electron microscope picture of various blood cells sitting there so innocently as though they are merely little round balls, not the incredibly complex, sophisticated protectors and providers that they really are…in this place I felt peace, the rest that God has promised me.  Whatever comes with Allistaire, He is able.  He has not stopped being God, He has not stopped being all knowing, He has not stopped being all powerful, He has not stopped being the creator of all things, He has not stopped being good.  I don’t know what the road ahead looks like, but I cling to Christ and I know He holds me to Himself with the very same power that the Father exerted when He raised His Son – overcoming sin and death.  To quote my friends mom who was bed ridden nearly her entire life, “God wastes no pain.”  So I look expectantly for what the Lord will do, knowing that His ways are not our ways, but His ways are good – a good that doesn’t not always fit with my finite understanding of good.  I fix my eyes on Christ, the author and perfecter of my faith.
                                                   Normal    12/1     12/2     12/3    12/6
Hematocrit                                 30-40      9.6      17.8       25      24.4
Platelet Count                           200 – 450   137     106       99      104
White Blood Cell                         5 – 15      2.9       1.9       2.3      2.1
Neutrophil                              Over 1000  186       158        77     204
Reticulocyte Production Index         .5          0           ?          ?       .3
I attached a few pics of Allistaire normal happy self.  Much love to you all!
Love,
Jai
Here is a link to the Wikipedia site:
  A scanning electron microscope image of normal circulating human blood showing red blood cells, several types of white blood cells including lymphocytes, a monocyte, a neutrophil and many small disc-shaped platelets.
Dec12

Here’s the Back Story…

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I’m going to add in the previous email updates so that everyone can have the whole picture.

This email was sent Sunday, December 4th:

Greetings All –
Because you all have varying amounts of the story with Allistaire, I’m attempting here to tell the whole story up to this point…When in Bozeman back in late September/early October, Allistaire got a nasty cold that didn’t go away on it’s own.  She was quite irritable and had poor appetite.  Soon after we returned home, on 10/14,  Allistaire saw her doctor and was given a 10 day round of antibiotics for a sinus infection and ear infection on one side.  She took the antibiotics and seemed to improve for a short bit.  However, the last few weeks she has been incredibly fussy all the time, extremely tired to the point that she has wanted to go back to sleep after an hour of being up for the day, and very resistant to eating – even the foods that in the past she has happily eaten.  In addition, I began to think that she looked strange – her eyelids have become quite puffy, when I would put her in the car I noticed in the natural light that her lips looked gray and her overall skin tone looked yellow.  This Tuesday I mentioned my concern about her color to the older ladies at Bible Study Fellowship who care for her and they affirmed they too thought she looked yellow.  On Tuesday morning I had already made a doctor’s appointment for her for Friday hoping she might be better.  I thought perhaps she was not quite over her sinus infection and might need some more antibiotics and at the same time she has been getting two new teeth that might also account for a great deal of her irritability.  On Tuesday afternoon, one of the BSF ladies called of her own accord and told me that she and the other ladies had discussed Allistaire and all agreed she should really see a doctor right away.  They had noticed she looked a bit yellow last week and thought she looked more so this week.  I called the doctor’s office to see if I could get her in sooner but they had no more appointments that day and felt she could wait until her scheduled appointment on Friday.On Thursday morning I woke up determined to try to get Allistaire in right away.  I called at 8am and was given a 9:20 appointment.  As soon as our dear Dr. Tan-Jacobson saw Allistaire she affirmed that she was severely anemic and this was to account for her coloring and lethargy.  The question was why.  She said that somehow she was losing blood but that we had not visual evidence of it.  It was possible that she was loosing it microscopically in her stool as a result of the virus she had affecting her GI track and kidneys.  She said that her greater concern was that Allistaire might have Leukemia.  We had her blood drawn and went home to await the results.  Three hours later, Dr. Tan-Jacobson called to give us the good and bad news.  Fortunately, the tests did not show any abnormalities in her blood cells in terms of their appearance.  To use her words, they were “non-leukemic” looking.  The concerning issue was however, that her blood counts were extremely low and she instructed us to go directly to the emergency room at Seattle Children’s hospital and that they would be expecting us.  We gathered our things and Sten met us there.
In the emergency room Allistaire’s was given an IV and blood was drawn for more tests.  The initial tests came back within an hour.  Again there were no abnormal looking cells – Praise the Lord!  Additionally, her numerous tummy-pushing exams showed no sign of an enlarged liver or spleen which can also be signs of Leukemia.  Her blood levels were the most concerning and pressing issue.  Allistaire’s hematocrit (the ratio of red blood cells to the whole quantity of blood) was 9.7 when it should normally be 30-40.  Additionally her white bloods cells, platelets and neutrophils were also low.  The pediatric HemOnc (Hematology/Oncology) team advised blood transfusions to get her to a stable point and the possibility of a bone marrow draw if necessary.  Due to Allistaire’s very low blood levels, her heart has been working extra hard to pump what blood she has through her body.  This has shown up in her increased heart rate of ~160 when it would normally be about 100.  It is important for Allistaire to have sufficient blood and thus sufficient oxygen to get to all her organs so that they would not be damaged.   At this point while leukemia is still a possibility the hope is that Allistaire is actually dealing with an odd phenomena where a young child’s bone marrow temporarily shuts down production, especially of red blood cells, in response to a virus.  In this case, the bone marrow spontaneously “turns on” and starts production again.  This can take anywhere from a few weeks to a few months.  There is nothing that can be done to make it start producing but one’s body needs to be supported in the mean time.  This condition is called, “Transient Erythroblastopenia of Childhood” or TEC for short.
We were discharged yesterday evening from children’s hospital after Allistaire received four small transfusions of blood.  The first two transfusions she receieved through the night on Thrusday; each taking four hours.  The purpose of giving Allistaire small amounts of blood over a long period of time was to not overwhelm her heart with a sudden increase of blood volume.  They also wanted to look for any allergic reations to the blood.  Allistaire tolerated everything very well and after the first transfusion she literally came alive – at 3 in the morning!  She was up talking, standing in the crib, wanting to play and interact.  They said the blood would perk her up but we had no idea!  Four hours after the second transfusion, Allistaire had her blood tested again.  Her hematocrit (red blood cell count) was up to 17.8, however, her white blood cells, platelets and neutrophils were again a bit lower.  They then gave her two addtional transfusions.  These were much quicker (only a little over an hour each) because her body could now handle more.  Because Allistaire’s white blood cells, platelets and neutorphils are incredibly low, she is at risk for viral infection, significantly lessoned ability to clot blood and to fight deadly bacteria.  These parts of the blood are either rarely or never transfused so we must wait for her own body to increase their production.  In the mean time, we must take procautions to keep her well.
We are to return to Children’s Sunday morning and Tuesday morning for blood draws.  The purpose of this is two get two more data points to see what pattern in imerging.  Should her counts continue downward a bone marrow test will be necessary as will likely additional transfusions.  If they are increasing we will probably have to just watch her and keep checking her blood levels periodically in hopes that her body will return to normal functioning.  On Tuesday we will also meet with the doctor and get back some additional tests which are testing for various viruses she may have been exposed to which could have triggered the cessation of the bone marrow functioning.  My understanding is that should she test positive for any of these it would give as another bit of confirmation that she has TEC, however a negative result does not necessarily give us anymore reason to think that it is not TEC because of the fact that there are many children who have had TEC but tested negative for these viruses.
*Okay- rather than take the time to retype I’ll just stick this newest update in here.  Saturday morning when Allistaire finally woke up at 11am she had very puffy eyes once again (they had looked much more normal Friday night when we returned home from the hospital).  The area of puffiness was reddish and she had little red spots on the skin around and near her right eye.  We called the HemOnc Fellow on call who thought it could be pink eye but was also concerned that the red spots could be petechia which are tiny broken blood vessels and can occur when your platlets are low.  We opted to try going to our local Urgent Care first and having the HemOnc Fellow brief their doctor.  The Urgent Care doctor thought that there might be the beginnings of cellulitus (a bacterial infection of the skin) and that because Allistaire’s neutrophil count it so low (neutrophils are the part of our blood that fight bacteria), this would be much more serious than should it happen in someone with a normal functioning immune system.  Because her whole immune system is so depleted, any defense her body might mount would look much less significant than what could really be going on.  The Urgent Care doctor talked with the HemOnc Doctor on call who wanted us to come back to Children’s Emergency Room.
At Children’s a number of doctors examined Allistaire and her blood was drawn again to test her blood levels, test for presence of a protien which would indicate her immune system was fighting off an infection and a blood culture test to look for bacteria in her blood.  The good news is that no one thought the spots on her face looked like petechia, no one thought she had cellulitus especiallyy because it was not at all painful to Allistaire and her results came back negative for the protien which shows there is no indication she is fighting an infection.  Her hematocrit (red blood cell count) was 25 which is exactly where they expected it should be after the transfusion.  Her white blood cell count was up a bit but her platlets and neutrophil counts had dropped.  The HemOnc Doctor said that “orbital puffiness” – the puffiness around her eyes was typical after a tranfusion and that the numbers on her blood counts can go lots of ways after a transfusion.  So while it is clear that her immune system is even more vulnerable, the doctors did not indicate greater concern about leukemia.  On the other hand, the doctor did say that the very low neutrophil count may “have just bought her a bone marrow test.”  We were discharged in time for Allistaire to come home eat dinner and go to bed.  Throughout the day Allistaire was chipper, happy, playful and did a lot of spinning – a sign of her joy.  She is joy upon joy to us!
So for those of you who like numbers and are interested, here are Allistaire’s counts thus far:
                                 Normal         12/1          12/2          12/3
Hematocrit              30-40            9.6           17.8           25
Platlet Count           200 – 450      137           106            99
White Blood Cell       5 – 15           8.7            9.0            9.3
Neutrophil             Over 1000       186           158            77
Because we were at the hopsital yesterday and had her blood drawn we will not be going this morning.  Our next appointment will be Tuesday morning.  Thank you for all your love and prayers!  We feel very supported by you all.  At the moment we are mostly just in need of your prayers for Allistaire, the wisdom of the doctors and for our own hearts in all this.  We love you all very much and will keep you updated.