Boston Review . . . .

view from Dr. Stephen Foster's waiting area

Our trip to Boston has confirmed that we are definitely "small-town girls" at heart!  We love visiting big cities, but prefer the slower pace and more open spaces of our area.  (And we love living in a valley, with mountain ranges on both sides of us.)

I hardly know where to begin with an update.  Maybe I feel a little bit of pressure, feeling that some (with limited understanding of Anna's issues) may hope for us to have received a quick fix or a brilliant answer from God above revealed through this appointment.  I've learned over the years to "manage my expectations."  In fact, I try to go into many appointments with no expectations, having learned that what I thought I might hear and what I thought might happen are usually NOT what I hear and not what happens.

Because of my continuing conversations with Jesus, I know deep in my soul that He guided us in this direction.  That is not to say that I didn't have concerns--mainly about where we would stay without paying more than our monthly mortgage to stay just two nights and then once I found a decent hotel for a reasonable price---I kept asking Him how in the world we were going to get where we needed and wanted to go, since we were outside the city and not all that close to a "T" stop! (I did NOT want to drive a rental car through Boston and pay all the parking fees which would come with that.) Now those issues were where I saw brilliant answers from God!  We met such helpful people along the way, and it turns out that the hotel we stayed at provided 24/7 shuttle service to the "T" stop and to the airport.  Our shuttle drivers were such a blessing and were so kind and nice.  They also gave us a chance to rub shoulders with the local people---I LOVE to do that whenever we go anywhere---I prefer doing that than to visit tourist attractions.  (AND, God "sang" to me via Casting Crowns songs playing in my head continually, each and every day in Boston---some of the songs I've quoted in previous blog posts--we KNEW He was walking with us with every step.)

So . . . . why did we make the trip to see Dr. Foster?  When we first thought about it (and talked to Anna's pediatric ophthalmologist), it was because she had significant inflammation since January, and I felt like we were spinning our wheels, and her vision continued to get worse (just in the left eye, thankfully), even when the inflammation was finally quieting down.  As indicated in my last post, we figured out that the vision issues were being caused by Macular Edema, which is usually treated by Diamox, unless a person is allergic to sulfa drugs, like Anna.  Anna's doctors in Hershey decided to try an oral Prednisone taper (thinking that maybe this would take care of the Macular Edema.)  They were thinking that Dr. Foster might want to do an injection to the back of the eye, which is not without risks, and they wanted to see if this would help before we had to resort to that. 

Good news---because Anna has been on Prednisone, the left "anterior chamber" (correct medical term) was totally clear of inflammation---has been for the past week or so---for the first time since January 2014.  AND, the extensive testing completed at Dr. Foster's office revealed that there has been significant improvement in the swelling of the macula.  I find that doctors don't get overly excited about Prednisone, though---because staying on it long-term is not good (too many side effects), and once a person stops taking it, the problems can come back. 

The tests done at Dr. Foster's office included a "Fundoscopic examination," which was very interesting.  The technician injected a vegetable-based dye into Anna's vein, and then took photos.  The dye enhanced Anna's blood vessels in the pictures.  The "fellow" we had with us on Friday was very nice, and she showed the photos to Anna and me, and explained them to us.  They do show that Anna's blood vessels in that left macular are still "leaking" a little bit---that's what causes inflammation, she explained (and it's fascinating to see the difference between the right eye and the left eye).

Dr. Foster listed four options to treat the macular edema.  He gave us a sample and a prescription for Prolensa--an eye drop--but he told Anna she would need to take it twice a day "without fail," for probably at least 2 1/2 years.  The other options include "sandostatin," which is an injection, I believe, into the buttocks (long-term, and I think he said maybe daily? for several years); "Retisert," which would be an implant to the back of the eye (that would be more long-term than short-term, as well), or "intravitreal avastin" (the injection to the back of the eye).  Both Dr. Foster and the fellow, Dr. Li, cautioned that the Prolensa is very expensive.  I haven't taken that to the pharmacy yet (since we have a sample), but I'm really hoping that the supplemental insurance through the state will cover what our primary health insurance does not. 

Since it's unrealistic for us to take regular trips to Boston for follow-up care, we will continue to see the pediatric ophthalmologist we always see, as well as a retina specialist at the Penn State Hershey Medical Center (so that she can monitor the macular edema with OCTs, etc.).  And of course, we continue with the Remicade treatments every four weeks.

 

"Something Is Just Not Right!" -- on the road to some answers

For some reason, I've always loved the book, "Madeline"  (by Ludwig Bemelman). Remember when Miss Clavel woke with a fright and said "Something is just not right!"?  Some people have intuition like that.  I sometimes do!  (My husband recently said he needs to learn to trust that intuition, because in many instances, my intuition is right!")

For weeks (maybe months) now, Anna has been saying, "Something is not right!" with her vision in her left eye.  She has mentioned this to the ophthalmologist on several occasions (we've been seeing him at least every two weeks since January) and has explained to him in detail how her vision is different out of her left eye.  He has listened well, and tried a few things (thinking that maybe she had some near-sightedness going on there---but that didn't pan out).  I remember that in the spring, he also dilated her eyes again to make sure he wasn't missing anything.  But all along, her inflammation had been hovering around a 1+, and she had clumps of white cells sticking to her cornea.  So he attributed her issues to those factors.

So many people (including many of you!) have been praying for Anna.  THANK YOU!  Our pastor has been recently praying for her doctors---for creativity to help them figure out how to help Anna.   I've been so thankful for her doctors and the care they give Anna and their wisdom and intelligence that I believe God has blessed them with.  Today we had another appointment with the ophthalmologist.  I was expecting another routine appointment---check the level of inflammation, chat a little about the upcoming trip to the specialist in Boston so that we're all on the same page and so that I have all the background information I need (summary of care) to hand to Dr. Foster in October, etc.  Anna's visual test on that left eye was not the best (not too much different from other appointments).  So the doctor went ahead with the slit lamp examination and found that the right eye is totally clear (as it has been), and the left eye inflammation is down to "trace cells."  With no clumps of white cells sticking to the cornea.  That was the good news.  The bad news was that her vision STILL was not right (and he was thinking that it should be with the "trace cells.")  It should have improved, anyway.  So now the doctor is thinking, "Something is JUST not right."  

He dilated Anna's eyes and examined them more thoroughly.  He was beginning to suspect that she has Macular Edema (swelling of the back part of the eye).  He sent us over to the medical center to get an OCT to confirm his diagnosis.  The photographer explained the images to Anna and me (we were asking a lot of questions---the differences between the right eye and the left eye were blatant---I could see it as soon as he moved the camera from one eye to the next.  He did give us a disclaimer about him being only a photographer and not a doctor---but he's been doing this for 20 years and has a good understanding of the images on the screen). 

right eye (what the doctor sees when he
looks at the back of Anna's eye, and a
cross section.  (This is the normal eye.)

This is the left eye---this is what swelling
in the back of the eye looks like.

Our reactions to the images have been interesting.  For Anna and I, I think we were feeling validated that yes, something is different.  For Scott (my husband), his reaction to the images tonight was one of compassionate dismay.  Both responses are appropriate, I think.  I'm so sorry that this is happening, but so relieved that we finally know what's going on.  Sometimes I have fleeting thoughts of "Why didn't we figure this out sooner?"  But I'm reminded that God's timing has been perfect in the past, and it continues to be perfect in the present.

It was such a long day (so much more time spent in Hershey today than we anticipated), and we just wanted to get home (and in time for Anna's bassoon lessons, and for her to touch base with a few teachers about what she had missed in school today).  I don't exactly know where we go from here (except another appointment with the ophthalmologist on October 1st, and the appointment in Boston on October 10th).  But I am relieved that finally it's more than Anna and me that is saying, "Something is not right!"  (Something besides the inflammation.)

Taking More Steps . . . . .

If you read my blog regularly, you know I usually have songs running through my head all the time!  I figure it's the soundtrack of my life.  The songs for this part of Anna's JA Journey are the same as some in the past.  Focusing on Steven Curtis Chapman; specifically his "Take Another Step" song that I've quoted before:  "Take another step, and another step, when the road ahead is long, and you don't know what to do---take another step . . ."

My conversations with the Lord are constant, but last week, my conversations with Jesus were more frequent and fervent.  Anna was seeing both of her doctors within two days of each other, and we had already resolved with the ophthalmologist that if there was no significant change in Anna's left eye by this week, we should make plans to see a uveitis specialist.  Anna had shared with me (at length as we drove home from an appointment two weeks ago) her concerns about the vision issues in her left eye.  The ophthalmologist had already explained his conclusions for why she's having the vision issues (she described them in detail to him at one appointment).  His thinking is that once the inflammation goes away and she no longer needs the dilating drop, her vision should clear up again.  I think Anna is getting tired of waiting for that to happen, and two weeks ago, the inflammation had decreased (at the appointment on Friday, it went back up to 1+), but her vision had not improved.  More frequent and fervent talks with Jesus (on my part, and I think on Anna's part, as well.)

So this week has been a turning point week---when we decide which steps to take in our journey.  Over the past few weeks, we were presented with two different options for a specialist to see.  My talks with Jesus involved entreaties for wisdom!  I once heard that to intentionally follow God's will often means doing the next wise thing (when He doesn't send down an e-mail from heaven, as I often long for Him to do!).  So while Anna was receiving her Remicade infusion on Friday afternoon, I began to make phone calls.  The wisest choice seemed to be the specialist in Philadelphia.  (The trip would be shorter, and cheaper, and the specialist is nationally known, and recommended by the pediatric rheumatologist.  We're familiar with the Wills Eye Institute, since my mom was treated there for ocular melanoma years ago.)

What seemed to be the wisest choice ended up being a closed door.  (I like closed doors sometimes---then it's easier to turn away and go to the other open door, instead of agonizing over the choice between the two.)  To get an appointment with the doctor in Philly meant a six-month wait (unless the doctor deemed otherwise, but he's away for two weeks).   Six months?!?!  Anna has had chronic uveitis (usually at 1+ inflammation or more) for the past 8+ months.  I don't want to wait another six months for some answers.  So I called Dr. Foster's office in Boston.  They could have made an appointment for September, but we decided on October instead, since Anna has a few days off school in the middle of the month.

Since we have to be on this journey, at least we can have
some adventures along the way.  I like Boston!  Anna doesn't remember our visit there in the summer of 2001---she was too young.  So she is eager to go again (and pinning some tips and places on Pinterest!)  I like to fly---and we're choosing to fly up and use public transportation (which we like to do in big cities.)

There's an older song that often flits through my head at various times.  I can't remember the artist, but it says, "For such a time as this, I am placed upon the earth, to hear the voice of God and do His will . . . "  I have no idea why we are on this journey or why we now need to go to Boston to see a specialist.  But I DO know that Jesus loves us beyond measure, and that He makes all things work together for good (maybe not right this minute, but eventually---God's time is not our time.  His ways are not our ways, His thoughts are not our thoughts---but He LOVES us).  So whatever the purpose--whatever the plan, we continue to take another step, and another step . . .

We Keep Singing . . . . even though it's been a little dark

A favorite author, Cindy Woodsmall, posted a quote today:  "Faith feels that dawn will break, and sings while it is still dark."  We are a singing family, and sometimes the on-going health issues seem to have a darkness about them.  So this quote seems so appropriate to describe the year of 2014 so far.

I'm not feeling particularly eloquent tonight, but this blog needs updating.  I know many of the blog followers want to know what's going on with Anna in her JA journey.  Other JA parents like to know about life with Juvenile Arthritis and Uveitis.  It truly helps to know that none of us are on this journey alone.  We have each other, and for those of us who put our faith and hope in Jesus, we know that He is with us on this journey---no matter whether we are feeling Him or not.  For me, and for Anna, He is the source of our strength---our "strong tower," our hope, our anchor.  Despite everything that has happened these past several months, one of the true highlights of 2014 for Anna was attending the Creation Festival (Northeast)---celebrating our Creator!, and especially seeing and hearing her favorite group, "For King and Country."  She was excited to see the above photo on the Creation website, and she found herself in the picture!

The summer has been busy with trips to and from Hershey at least every two weeks, sometimes even more frequently.  (Plus a few visits to the oral surgeon, and a trip the Lancaster Cleft Palate Clinic as we begin to get her teeth into place for eventual jaw reconstruction.)  Add to that daily Pred Forte eye drops, a dilating drop at night, Remicade infusions (every four weeks), and weekly Methotrexate.  Except that Anna has not had her last two Methotrexate injections, because she developed what would seem to be a small infection from the extraction of her four wisdom teeth and four front molars (that was in mid-June).  Her ophthalmologist sighed a little when we told him that (about missing the Methotrexate recently)---her left eye has maintained inflammation at a 1+ level for the past month at least, with no improvement.  While we are so thankful that the eye is not worse, we're getting a little uncomfortable with the duration of this level of inflammation, and the negative effects it's causing for her left-eye's vision.

I've talked to God a lot about all of this!  He has answered.  I've heard Him---with loving whispers from Him, songs and peace and assurances that we can trust Him for the entire, big, beautiful picture, despite the fact that He's not planning a sudden, healing miracle in the near future (I got that message from Him, too).  So we continue to sing, praise Him in the storm, thank Him for protecting Anna in many ways (her brother ended up with a bacterial infection at Creation, but Anna didn't!, and she hasn't experienced a whole lot of really negative side effects from her various medications so far).  I also pray for her doctors a lot (and thank God for them and the wisdom and intelligence He has given them).

And when the worrying seems to get a little heavy at times, I remember the lines of a Newsboys song from their "Adoration" CD:

Lord, I don't know where all this is going, or how it all works out.
Lead me to peace that is past understanding; peace beyond all doubt.

Wrestling with God (and He continues to offer songs, people, direction, and peace)

Lay your head down tonight
Take a rest from the fight
Don’t try to figure it out
Just listen to what I’m whispering to your heart
‘Cause I know this is not
Anything like you thought
The story of your life was gonna be
And it feels like the end has started closing in on you
But it’s just not true
There’s so much of the story that’s still yet to unfold

And this is going to be a glorious unfolding
Just you wait and see and you will be amazed
You’ve just got to believe the story is so far from over
So hold on to every promise God has made to us
And watch this glorious unfolding

(Artist: Steven Curtis Chapman  Album: The Glorious Unfolding)

Oh, these song lyrics!  This "Glorious Unfolding" song must have been recently released for radio broadcast, because I've been hearing it on my favorite station, WJTL.com (90.3) for the past two weeks.  God has used it to speak over our life and to my heart in various ways lately.  (I own the album, so I've had an opportunity to listen to it previously and get to know the words and upbeat melody.)

In this journey/race of life, the road has been rather busy and rough lately.  We've had two infusions of Remicade so far (the latest one just last Wednesday), but Anna's vision in her left eye is worse than it has been.  The inflammation is at a 2+.  The level of inflammation has held steady since last Wednesday (at least we can be grateful it's not worse), although her vision today was slightly worse in that eye --- she couldn't read the (sight test) line she was able to read last week.  Clusters of cells have clumped on the cornea, and that's why her vision in that eye is slightly impaired.

I was SO hoping and thinking that these Remicade infusions would "fix" the problems with Anna's eyes.  I often shake my head at the society in which we live being such an "instant" society---and we've come to expect "instant" fixes to everything.  I find myself having those exact expectations, even though I really do know better.  

I've been wrestling with God---working through all of this, longing for some sort of peace in the turmoil and worry over the Anna's vision.  He's provided calm doctors with knowledge and solutions to propose.  (Calm doctors who sound confident in their knowledge and wisdom really help me to maintain a level of calmness.) He's provided friends and family who constantly keep in us their thoughts and prayers and encourage us when we need it most.  He's opened up the lines of communication with just the right people at just the right time at Anna's school, to help her work through the pressures which she puts on herself to be the best student that she can be and to accomplish all the work which needs to be done in the next few weeks as school winds down (taking into consideration a LOT of missed classes for appointments, Remicade infusions, and then another day off last week for the funeral of her grandmother).

So where do we go from here?  The dose of Remicade will be increased for the next infusion (early June).  We had the option of going back on Cyclosporine until the next Remicade infusion, but in conference with the two doctors, we decided to go with adding Methotrexate injections instead.  I am actually happy with that, and the doctors seem to think it's a good decision.  (I know so many parents balk at Methotrexate, but I'm actually more comfortable with it than with other medications, including Cyclosporine---I've come to dislike Cyclosporine for Anna.)  For the past ten days, Anna has been using the Pred Forte drops six times per day.  I am very, very grateful that she has not had problems with those drops.  In her younger years, her pressures would rise fairly quickly after just a few weeks of Pred Forte drops.  But she's been on them since January, and her pressures have remained lower than the right eye (which is perfectly fine).

I sometimes wrestle with how much to share here.  Anna would prefer to err on the side of privacy.  But we also want to provide a realistic picture for other parents and families, and hopefully at least a little bit of hope for those who are traveling this journey behind us or beside us.  Although life currently is not as "normal" as it used to be (for this season, at least), we are not in despair.   God doesn't mind that we wrestle with Him---we work out our faith and grow in our relationship with Him as we continue on this journey and work through the hard parts.  On my hardest days, my meditation often is, "May the God of hope will you with all joy and peace as you trust in Him."  I'm hanging onto hope, and enjoying the little bits of peace I'm feeling as I continue to trust in Him and hold on to every promise He has made to us --- as we continue to see how the rest of this story is still to unfold --- we know that ultimately, it WILL be a glorious unfolding---and we will be amazed!   

"In the Arms of God, Who Won't Let Go"

God continues to speak to me through so many various songs lately as we travel this journey.  On Easter Sunday morning, we were singing a song I've sung countless times in my lifetime.  I had even prepared the PowerPoint slides for Sunday's worship service, but the relevance of the words didn't truly sink in until I was staring at the words on the wall as we sang, "How sweet to hold a newborn baby . . . but greater still the calm assurance, this child can face uncertain days because He [God] lives."  ("He Lives," Gloria Gaither | William J. Gaither; © 1971 William J. Gaither, Inc.)  Such a perfect reminder for me, especially when my heart's desire is to live what I truly believe.  Since I believe that I serve a living, loving God whom I can trust with all of my heart, then I can trust my children's "uncertain days" to Him.

And then there's a Casting Crowns song I first heard at a concert I recently attended.  Just purchased the album two weeks ago and had a chance to really listen to it yesterday as I was cleaning my kitchen.  "Just Be Held" has such beautiful words and a beautiful message:

So we continue on this JA Journey, knowing that God is painting beauty with the ashes and our lives are in His hands.  We ARE finding Him in the storm, and where we are, He holds our hearts.  We can come to Him, find our rest, in the arms of God who won't let go. (from "Just Be Held," by Mark Hall, Bernie Herms, and Matthew West)

Since I last updated this blog, we've had a flurry of activity, putting plans into place, and Anna has had her first Remicade infusion.  No problems, really, so far.  Anna doesn't always like to broadcast what's going on with her life (she wants to be known for who she is as a person--her character qualities--, and not for her diseases), but last week it was time to explain exactly what's going on to the staff at her high school.  She's been missing quite a bit of school for appointments, and will now be missing more because of infusions.  She had just been telling them, "I have health issues, so my absences are necessary."  There comes a time when the people you deal with on a daily basis need a few more details, and it was time.  (I'm SO thankful for the school district we live in---couldn't ask for more understanding staff there.)  She does have a lot to catch up on (not much gets studied or worked on during an infusion day---just mostly sleep).

I feel like some of the pieces of our life's puzzle are fitting together lately (at least as far as scheduling).  The first few Remicade infusions are now on the calendar, and some insurance details have been worked out for Anna's wisdom teeth extraction (they need to use a surgical room for that, because of the structure of her jaw and the way her tongue sits---the oral surgeon feels it's medically necessary, and insurance didn't want to cover that cost at first).  We also decided that we needed to wait until school is out to have that done.  So we now have that scheduled for the week after school lets out (two weeks after the June infusion).  That's helped to know when to schedule her next visit to the orthodontist in Lancaster.  As of right now, I don't have any short-term medical appointments that are up-in-the-air, waiting for another detail to be in place before I can nail down a specific date.   

I HAVE found some definite positives lately:  Anna's eye inflammation is down to a 1+ (while still concerning and not good, it sounds a whole lot better than a 4+!).  I was able to take all of her unused, leftover medications (Cyclosporine, Methotrexate, Leucovrin, Lidocaine for mixing with the Humria, etc.) out of the "Anna's Medication Box" on the counter and put them up in the cupboard for now.  Anna says it's a little strange not to have to remember to take medications at home (besides the eye drops she currently uses).  We are VERY thankful to stop the Cyclosporine.  Anna had a list of side effects that she was experiencing, even after just a few days of taking it.  It's good to find little things to celebrate and be thankful for.  We have NO appointments this week!  That's definitely cause for celebration!!!  

I was reminded this morning of our purpose and goal.  In all of life, in the good and the bad, our prayer is that we remain "a witness to the resurrected Jesus."  (Thank you, Pastor Dean, for those words.)  Because Jesus lives, we can face tomorrow.  We don't need to fear.  We know He holds the future.  Life is worth the living (even when troubles come) because He lives.  (Happy Easter one week late!)

We Have a Plan . . . .

As of today, we have a plan.  And we have a little breathing room.  At Anna's appointment with the ophthalmologist this past Thursday, the inflammation was better.  A 2+ instead of the 4+ inflammation a week prior.  (ANY inflammation is not good, but a 2+ actually sounds good after a 4+!)  Anna's pediatric rheumatologist has researched the latest information available to decide between Remicade and Orencia.  The plan is to start Anna on Remicade.  Then, once her eyes are quiet, he will switch her to Orencia.  This will happen soon, but we still have some things to do, like wait for the insurance company to approve the Remicade, get a TB test for Anna (that will happen this week), and settle on a time frame for the infusion.  Anna didn't realize until tonight that this means she will no longer be taking Humira.  She seemed pleased with that.  She's glad that she can give herself injections, but it's not her favorite thing to do.

I choose to share Anna's story here, because for so many years, I have wanted other parents to know that Juvenile Arthritis does not HAVE to overtake your life.  (Things I wanted to read when Anna was first diagnosed and I wanted to have a glimpse of what life might be like in the future.)  I do have to concede that for the past few months, this disease (more the uveitis than the arthritis in the joints) has interfered with our lives a little more than we would like, although not nearly as much as some families experience.  I do believe, though, that this is just a season of life.  Although we cannot choose our circumstances, we can choose our response.  So we continue to choose to pray for those who make decisions for Anna's care, for wisdom and clear direction.  We choose to find all the things we can be thankful for, and we've seen and felt so many answers to little and big prayers.  We choose to laugh and set goals for the future.  This may be a sizeable bump in the journey, but the journey is not done yet!  Stay tuned . . . . 

Circumstances We Would Not Prefer

I LOVE the "undo" features that come with most computer software.  It is such a relief when I am creating letters and and flyers and newsletters, changing things which sometimes become a mess.  And I can just hit "undo".  The mess goes away, and I can try a better fix.

This week, I wish there was a way to "undo" the switch to Cellcept.  But no going backward in life.  We have to pick up from where we are and move forward.


If you've read my blog posts before, you know that God has a way of playing songs in my head at times.  About two weeks ago, I remember waking up early hearing the words to "Even If" by Kutlass:

Sometimes all we have to hold on to 
Is what we know is true of who You are 
So when the heartache hits like a hurricane 
That could never change who You are 
And we trust in who You are 

Even if the healing doesn't come 
And life falls apart 
And dreams are still undone 
You are God You are good 
Forever faithful One 
Even if the healing 
Even if the healing doesn't come 

Lord we know your ways are not our ways 
So we set our faith in who You are 
Even though You reign high above us 
You tenderly love us 
We know Your heart 
And we rest in who You are 

You're still the Great and Mighty One 
We trust You always 
You're working all things for our good 
We'll sing your praise 

You are God and we will bless You 
As the Good and Faithful One 
You are God and we will bless You 
Even if the healing doesn't come 
Even if the healing doesn't come

Songwriters: WOOD, TONY / KRIPPAYNE, SCOTT

Even If lyrics © Sony/ATV Music Publishing LLC

Since the phrase "even if the healing doesn't come" kept repeating more than the rest of the song, it felt like a forewarning in some ways.  And rightly so.  Scott took Anna to see the ophthalmologist this past Thursday.  I was home with a stomach bug.  He stopped by the house before going back to work, to tell me that  in the span of ten days (since the last appointment), Anna's left eye had gone from an inflammation level of 1+ to a 4.  (On a scale of 1 to 4 for those of you who are unfamiliar.)  Scott's assessment of Cellcept for Anna is summed up in one word:  "worthless."  Her inflammation has never been this bad.  The two doctors conferred via phone while Scott and Anna were there, but Scott asked them to call me about any final decisions.

Anna's pediatric rheumatologist called me to discuss options.  We're going to go with infusion therapy.  (Something to be thankful for---there is no agonizing over all of the pros and cons of this decision for me---it HAS to be done---I AM constantly praying for clear direction.)  The question is just the choice between Orencia and Remicade.  He's doing a bit more research and will let me know and start the necessary steps for insurance approval.  That could take awhile, evidently.  So since we need to do something before we can make infusion therapy happen (could take weeks, and most likely, more than a month), we have stopped the Cellcept and started on Cyclosporine.  Anna had responded favorably to Cyclosporine in the past, until she began to experience noticeable side effects.  But since she'll be on it for weeks instead of months, the hope is that she'll be stopping the Cyclosporine before the side effects begin to appear (more hair growth, and darker hair---like eyebrows and upper lip--, gum growth, etc.)  Anna continues to take the Pred Forte eye drops four times daily, and a dilating drop at night (to keeps those cells from sticking together when they begin to cluster).

I want my friends, family, and blog-readers to know that I believe in my loving, Creator God, and I know that He is faithful, and I know that He walks with us and loves us more than we can ever imagine.  I've said that before---many times over.  Sometimes I talk about feeling calm and feeling peace.  To be totally honest, right now I'm not FEELING much of anything (but feelings are fickle---I know---we cannot rely on feelings!).  I am human, so there are aspects of this disease and this development that strike some fear in me at times, if I allow myself to dwell on that.  There are times when I receive news such as this when I know I need to absorb and process the information (and allow a few tears to escape at times), before I'm really ready to talk about this with anyone.  There are so many things going on right now (BUSY, busy schedules around this time of year, still a lot of appointments to get to, schedules to rearrange because of appointments, unexpected stomach bugs, etc.)  When life seems overwhelming and we face even more "circumstances we would not prefer" (phrase borrowed from Priscilla Shearer from the Session 5 DVD of the Gideon Bible Study), we go with what we know, not what we feel.  We hold fast to our Anchor for the Soul, because how else could we handle storms such as these?

His Grace Is Enough . . . . (Update on Anna, family, and questions for God)

So many ways I could begin this post:  The bottom line is the update on Anna:  the injection to the elbow worked wonders!  Within days of receiving that shot of cortisone, she is back to having full range of motion and can easily do all the normal tasks of life without having to compensate for an elbow that would not extend or bend normally.  The eyes are another story.  Despite a flurry of changes in dosages and then medication, her left eye is not responding.  It's not getting worse, but it's not getting any better.  Something different though, from previous flares--despite having Pred Forte drops four times daily, her pressures remain in normal range!  And this is after six weeks of those daily drops.  SO thankful for this, since Anna's pressures usually rise quickly even when she has been on two weeks of two drops daily.  (That was several years ago.)  

The photograph above is my view of the ophthalmologist's exam room, and I've seen it many times since January, usually every 7-10 days.  Something else to be thankful for:  the location is about 20 miles away from home.  The doctor was mentioning that he has a family who comes every other week from over 100 miles away.  And I thought Anna's appointments have been really eating into our schedule--especially her school schedule!

For those readers who, like me, want to know what happens next if the inflammation continues, the ophthalmologist says he'll give it one more month.  If it's not any better, then we need to consider a different medication.  The rheumatologist had already mentioned "infusion therapy" if the Cellcept doesn't get the inflammation to subside.  We've talked in the past about pros and cons of Remicade and Orencia.  My guess is that the infusion therapy would be one of those two. 

In the midst of all of this, I have just finished up two surgical procedures (3 weeks apart) to fix two significant issues which have been plaguing me since the end of October. Thank the Lord, I've been released from the acute care of two different doctors, and all I really need to do now is get over the "anesthesia haze" which always takes me several weeks to do. 

So a lot has been going on with the family!  I have been happy, though, to get back into a Ladies' Bible Study, and we are doing Priscilla Shirer's "Gideon" study.  This has "homework" which really has us digging deeper into God's Word and seeing what God has called us to do and be, and how He uses our circumstances to accomplish His purposes, and equips us with His strength when the tasks seem hard and dangerous.    I've also been reminded that God welcomes our questions, but there are many, many times when we ask questions which He has already answered in His written Word---great incentive to get into and really learn to KNOW His Word.

There are so many times when the Lord has spoken to me, and very frequently through songs which are playing in my head when I wake up in the morning, or one passage of Scripture which constantly pops up in various places and ways during the course of a week or two.  But this past week, He was definitely speaking through a clear but soft voice in my head.  In my Bible Study homework, we were encouraged to write into one side of a chart the questions we ask God.   And then there were a sets of Scripture verses to look up---ones that would answer many of the "usual" questions that people often take issue with Him about.  None of them really answered the two questions I put down, but we were encouraged to go back to the questions on our chart, and pray about those questions, and write down what God was saying to us (encouraging us to see if we had answers from Scripture).  So my one question was, "Why isn't the inflammation in Anna's eye responding to treatment??!!"  Every time that question even hovered in the back of my brain, I would instantly hear, "My grace is sufficient."  So instead of the question just hovering, I intentionally talked to the Lord about Anna's eye inflammation.  And the answer I knew I needed to put on the other side of that chart was again speaking more loudly in my head, "My grace is sufficient."   (That verse was no where in the homework---but definitely in my head.)

So then I go to our weekly Bible Study session (yesterday), where we watch the DVD, and this week's session was powerful and inspirational.  As Priscilla Shirer was winding down this session, I was looking in the notes of the book for Session Three, and she had several Scripture references in the notes.  I looked at the very last reference in the notes, and it was 2 Corinthians 12:9.  Since my memory for Bible verses (at least bits of them, memorized in my childhood and teenage years) is fairly decent, but my ability to remember references is somewhat lacking, I wasn't sure which verse that was.  So I looked it up, and KNEW that it was definitely there for me in that moment (thinking about Anna's uveitis all week---or the past six weeks---and anticipating another visit to the eye doctor that afternoon).

2 Corinthians 12:9  (written in red letters in my little NLT Bible)  Each time he said, “My grace is all you need. My power works best in weakness.”

So there it is.  We continue to trust God and His purposes and calling on our lives.  (When we are afraid, we will trust in Him ---somewhere in Psalms!) The doctors are doing all that they know to do  (Dr. M. was going over that out loud with us---explaining that in January he dilated her eyes, even though it was a late appointment and he hadn't planned to do that---he wanted to make sure that there wasn't something else going on in her eye, and making sure that there wasn't something he missed, with such unexpected and significant inflammation after almost two years of quiet eyes).  We continue to pray for Anna's doctors and thank God for their wisdom and knowledge.  We are continually thankful that Anna so far has experienced very minimal (if any) side effects from the potent medications she puts into her body.  We live knowing that we are precious to God and He allows some circumstances in our lives for ultimate good and to show others who He is. He holds us in the palm of His hand.  (Now how can we be afraid when we know that?)  We continue to pray that the inflammation will go away.   Until it does, God's grace is sufficient.

Take Another Step . . . . .

We walk by faith and not by sight we know it’s true

We say it and sing it and love the way it sounds

But none of us can even begin to truly understand

What it really means ‘til all the lights go out

And there we are nothing to hold on to

But the promises God’s made to me and you

Take another step, take another step

When the road ahead is dark

And you don’t know where to go

Take another step, take another step

Trust God and take another step

If there’s an ocean in front of you

You know what you’ve gotta do

Take another step and another step

Maybe He’ll turn the water into land

And maybe He’ll take your hand and say

Let’s take a walk on the waves

Will you trust Me either way

And take another step

Take another step

Lyrics by Steven Curtis Chapman  "Take Another Step" 

(from "The Glorious Unfolding")

This week (even just these first two days) have seemed a little overwhelming---just schedule-wise.  We have so much going on, two appointments last week were cancelled because of the Thursday's snowstorm--still to be rescheduled.  No time to fit them in this week. 

Anna has several issues currently "on the table."  Her eyes at her last ophthalmologist visit were a little better but still have a ways to go before they are clear of inflammation.  She continues with Pred Forte drops (one drop to the left eye four times daily), and a dilating drop at night.  Her pediatric rheumatologist found that the measurements he takes for her TMJs were less than they have been at the last few appointments.  So he sent a disposable measuring device home with me, so that I can measure again in another week or two, to see what kind of numbers I get.  Her left elbow has continued to be a problem.  The problems have increased over the last three months.  While she doesn't complain of pain (just some morning stiffness), she has lost full range of motion in that elbow, and it's affecting her ability to do some daily tasks (like brushing her teeth and brushing her hair and getting dressed).  She can still do these things, but in a modified way, since her elbow cannot extend fully.

We'll have to wait and see on the eyes.  It may take a few weeks for the changes in medications (we changed the dose on the Humira and changed the Methotrexate from oral to injectible) to take affect.  We go back to the ophthalmologist next week.  The TMJs---I don't really know.  More injections are probably not an option.  For right now, if the measurements continue to be a concern, an MRI may be in order, even though Anna's new braces may affect the reading of an MRI.  We'll cross that bridge when we come to it.

As for the elbow, Anna's ped. rheumatologist decided that he would inject that joint today.  That went fine (as fine as injections can go!).  Anna's pretty calm and easy-going, not excitable or prone to drama, which is helpful.

So Anna went back to school today with teeth that hurt (from getting braces on yesterday at the Lancaster Cleft Palate Clinic---continue to LOVE that place and the people there!), and a sore elbow.  (She has a doctor's excuse for gym and band for a few days, until her elbow absorbs all of that medication.)

I've been thinking that life has been very full lately, with many things (mostly health-related, with both Anna and me) that are beyond our control.  I've also thought that this full, sometimes overwhelming season of life CAN have a good side---no time to sit and think about all of the ins and outs of what's going on, no time to sit and worry about what may happen if things get a little worse rather than better.  Really, just getting through these moments and days and weeks by taking another step, and another step---walking by faith and not by sight, and trusting God no matter what.

In Anna's Own Words . . . . .

As posted on Anna's Facebook page on January 23, 2014:

A recent problem has emerged involving my arthritis in my left eye. Instead of listing all of my troubles and problems at this moment I choose to go with the blessings -

Thank You Lord for
-My sight, I am not going to be blind any time soon.
-for Doctors, knowledge, and medicine.
-Messages you send me through music
-my Mom and Dad 
-Your Guidance and Help and Direction 
-Reading glasses
-a Warm house
-eye lids*
-time off so I could study this past week so I don't need to strain my eyes tonight trying to see tiny print*
-and knowing what is going to happen when I don't, because I am blind to what will happen in these next very, VERY busy weeks ahead. You're going to see me to the end regardless.

[*Dr M. decided to dilate Anna's eyes to get a better view of what was happening, so although we hadn't planned on this, Anna's pupils were dilated for the rest of the afternoon and evening, making it a little difficult to see and focus---so she was extra-thankful for eyelids and reading glasses!}

2014 May Be An Adventure!

I have a feeling that this new year will be one where we gather up our courage, hold firm to our "Anchor for the soul," and continue to plod along on this JA journey.  Since we have to go through this at all, I'm praying that at least some of you will be encouraged or informed because of our journey.  At the very least, I pray that we can be an encouragement to hold on to HOPE, seek peace, and know that you are not alone. 

Anna's first appointment for the new year was last week -- with Rusty (Dr. Long--he prefers to be called Rusty) at the Lancaster Cleft Palate Clinic, where she had bands put on her molars.  Next step in this process will be to have her wisdom teeth removed, as well as her four "first molars."  We meet with a local oral surgeon in mid-February---that's the earliest I could get.  We need to wait, anyway, for those teeth to be removed, until after the County Band Festival (next weekend) and District Band Festival (the following weekend).  She'll have brackets put on in mid-February, with jaw-reconstruction surgery in sight for spring or summer of 2015.  We continue to feel an overwhelming peace about this process and this team---which is really good, since we're traveling almost an hour for orthodontic work, when we have a multitude of orthodontists who are closer (but they don't work as an on-sight team like Rusty does with the other doctors/specialists associated with the Lancaster Cleft Palate Clinic!).

In other news . . . . sometimes I "hear" God speaking in many ways, and the other day, I happened to see Psalm 112:7 on Pinterest, and it grabbed my attention.  "They do not fear bad news; they constantly trust the Lord to care for them."  While I've learned not to put too much stock in premonitions nor to worry about things that may or may not happen, I thought about this verse a lot this past week, realizing that I spent many years (maybe even decades?) being fearful of bad news.  I want to be different---I NEED to be different if I truly claim to have a relationship with my Creator and trust His love and care for me and my family.  I want to live in such a way that I live my faith, and not just speak the words.  So if I choose to do that, I need to choose to trust the Lord, even when some days seem to bring one bit of bad news after another.

How grateful I am that the Lord had given me this verse for the past week.  Yesterday was an interesting day---from trying to tie up a lot of loose ends at work before taking next week off, and getting a phone call to tell me that some pre-admission labs for me were rather worrisome to the surgeon's office and could I please come in to have more labs done to make sure I could move forward with surgery---and having a small window of time to take care of that before picking Anna up to take her to Hershey for an eye appointment.  (Thank the Lord there was so much going on that I really didn't have much time to think and worry that day---besides watching the clock and thinking about and praying that I could get my work done and then get to the outpatient lab in one town and back to the high school in our hometown in time to get Anna and get to Hershey in time for the appointment---all of that worked out perfectly!)

We arrived in Hershey in such good time that we were able to stop by the lab and take care of labs for Anna (standing order for labs every 2 months) before heading to the ophthalmologist.  Anna had mentioned some concerns about her vision in her left eye a few weeks ago.  I wasn't alarmed, because she's never had any symptoms of uveitis, so I was thinking that maybe she had some sort of reaction to the Pred Forte eye drops.  But long story short, her left eye has had an unexpected and significant flare in just the past few weeks (we saw the ophthalmologist just five weeks ago, and she had one or two cells at that time---now she has at least 200 white cells).  So now she has symptoms (that can be a good thing . . . .).  The plan (discussed via phone between the ophthalmologist and the rheumatologist with Anna and I in the room to answer any questions) is to increase Humira, switch from oral Methotrexate to injectible Methotrexate, and increase the Pred Forte drops to four times a day for a week---we go back to check on things next Thursday.

It's still possible to find some good things instead of focusing on the bad.  Since Anna was telling me (right before yesterday's appointment) about her continued symptoms, and her research on-line to figure our her symptoms, I was mentally prepared for a not-so-great appointment.  Poor Dr. M. had challenges with his last four patients (Anna made patient #5 who required an unanticipated more detailed exam and figuring out a plan of action)---so he was running behind schedule.  Which meant I had more time to skim through magazines and pray and settle my mind and remind myself to TRUST and not worry.

This also becomes a challenge (as a mom) as Anna gets older---when she was first diagnosed, it was me who had to work through all of my feelings.  But she's now a teenager and has definite feelings of her own.  So how is she handling this?  I'll post that next.  (She told me that I could copy and paste her Facebook status from yesterday on my blog).