At the Cliff's Edge

 

It's spring in Kentucky. The trees are putting on an early show with short bursts of color. The bright purples, pinks, and whites are a shock to the senses after the dull browns and grays of the long winter. The grass is starting to grow rapidly and has transformed from a dull, dark green into a vibrant, living, movement filled carpet that is so beautiful and bright it hurts the eyes. We are surrounded by new life. The birds are singing bright notes, the earth is teeming with living things. It's a low hum of life that will become louder each day until it reaches a shrill frenzy in the hot summer and regresses into sleep with the autumn days. 

We celebrated Easter and Christ's resurrection with a perfect blue sky day. I watched the bees happily making their way through the warm air. I listened carefully for the frogs singing in the evening, but I couldn't hear them from the hill on which my parents' house is perched. And while my eyes delighted in the colors and my skin relished the warm breezes, I also had to fight, claw my way out of the darkness, coldness that tries to control me. 

We've cruised past the one-year anniversary of Covid, one year of lock downs, isolation--one that was very different from all the years before. One year since I walked into a store, sat near a friend, hugged a friend, sat in our church, and heard voices lifted to Heaven. I could have made different choices early on in the pandemic, but God, in His wonderful grace and mercy, gave me peace regarding COVID, and also an odd desire to be careful that I couldn't always explain. I was fearful at first, like many others, but later it wasn't fear but some urging that kept me cautious. I thank God for that direction and how He kept Kurt safe. This time last year, Kurt first starting feeling faint at times, oddly out of breath. We chalked it up to getting older, being out of shape, and later I suspected Lyme disease, poor diet, anything, anything except Leukemia. 

Eight months ago, after months of isolation, church on the lawn, drive by birthdays, lots of Amazon orders and grocery pick ups, life was again thrown off in kilter an even greater way when Leukemia seemed to blindside us. I'm a researcher by nature and thankfully my degree has helped me to be able to find good sources of knowledge. What is at times a gift can also be a curse. I remember wishing during that time of waiting that I wish I didn't have the knowledge--just enough--to know that something was very, very wrong. They day we got the blood work back that sent us racing to a hematologist/oncologist, I saw the results first on the medical portal while in the van. We were somewhere in Indiana driving home from Missouri. I scrolled up and down frantically, reading the numbers again and again. I knew. My stomach sank through the floor of the car. My breath grew short. I felt bile in the back of my throat. "Whatever it is, it isn't good." I knew that. 

I think I have been reflecting on that day more recently, as we get closer to transplant day. A lot of those initial emotions have been washing over me again and again. There is fear of the unknown. No matter how much we read regarding transplant, no matter how much we feel prepared, we are stepping off another cliff and diving into a mysterious and unpredictable future. I, for one, am terribly afraid of heights. I can only climb onto the second or third rung of a ladder before I start become dizzy. I didn't expect the kind of cliff diving we would be called to do during the last thirteen months, but apparently metaphorical cliff diving also triggers the same dizzy, out of control feelings as I imagine the real thing does. 

The truth, however, is that we are always standing at the edge of a cliff, the edge of the mysterious and unknowable future. In the long run, as believers, we know the end of the story--the magnificent and glory-filled end. As finite humans, we don't know what's coming day to day, hour to hour, minute to minute, heartbeat to heartbeat. Leukemia, and I imagine any other life changing diagnosis, just brings the cliff edge into sharper view. What we once viewed through the hazy fog of our own weak willpower and human ability to think we are in control, is given over to a sharp, clear, binocular-like focus of the cliff's edge. We don't know if we will fall in the abyss or sprout wings and soar. Perhaps we will fall a little way and land on a surprisingly soft bed of grass or snow. We might be beaten, bruised, or impaled on the sharp rocks at the bottom. 

Approaching transplant is a bit like this. It's not a task that is undertaken lightly. It is a treatment reserved for when the "big guns" are needed. It's something to be avoided until it becomes absolutely necessary. It is a hope for a cure, but a road sometimes paved with hellish suffering. We won't know if Kurt will be among those who sail through or if he will be one who has a rocky road before him, until our feet leave the cliff's edge and and we jump headlong into the wind. 

I find myself rocking on the ocean of a thousand emotions. Some moments are so normal that they slip by unnoticed as they did before--the daily grind of dishes, laundry, school, bedtime routines, crafts, and family walks. Other moments are filled with such a grief-filled sorrow that I can only clasp the edges of my little boat, white-knuckled until they pass--folding his shirts, his wedding band on the dresser, the soft rustle of the bed as he climbs in--what if it all passes away? And I'm off, sailing through a private storm until my little boat catches, and the anchor pulls me back to calm waters. 

We are watching the sunrises and the sunsets from the cliff edge these days. They are frighteningly beautiful, so clear. Soon we will rise, dust off our feet, join hands and when he jumps into that darkness, I'll jump with him. We'll hold on tightly to the sides of the boat and trust God's hands will gently guide us through to the other side of the valley. 

"But those who wait for the Lord shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary; they shall walk and not faint." 

Isaiah 40:31

Early 2021 Re-Cap

     

(Kurt working on the Lego Disney Castle we got for Valentine's Day)

It has been a couple of months since I have done an update, so this will be a quick post to catch up on recent events in Kurt's battle against ALL.  

We really enjoyed the Christmas season and Kurt was able to rest a lot and recover from his last round of Hyper-CVAD B. Kurt's hemoglobin was really low for a few days around December 28th and he developed petechiae (small red bruises) all over his arms and legs. Thankfully, he was able to get two units of blood! Because the clinic didn't have an available chair, he had to have the transfusion down the street at Good Samaritan Hospital. It took several hours and I ended up picking him up around 11:00 PM, as no visitor were allowed. It was a long day, but the new red blood cells really helped him to feel better! 

 On January 8th, Kurt's bone marrow biopsy unfortunately showed that he still had 0.03% MRD. While it wasn't what we had hoped for, we took encouragement from the fact that his numbers continued to fall. Kurt's oncologist decided that it was time to switch things up and move from more traditional chemo to immunotherapy. She decided that Kurt would do 1-2 cycles of a drug called Blincyto (Blinatumomab). This drug specifically targets the B-Cells in Kurt's body with the CD19 marker. We had been able to hear about other patients' experience with this drug and were encouraged. It has had great success at getting people MRD negative and keeping them there! We felt that God was using this situation to make sure Kurt was able to reap the benefits of this drug. 

On January 19th, Kurt was admitted to start Blincyto. The plan was that Kurt would spend the first four days in the hospital, so that doctors could monitor any reactions. If all went well, he would be discharged to finish the 28 day cycle at home with an infusion pump. Blincyto has a short half-life in the body, so it would need to be given 24-hours a day without pause. During the first 36 hours of treatment, Kurt experienced an immune response to the drug. This is expected but carefully monitored to make sure it doesn't get out of control. He ran a fever and felt like he had the flu. At one point, his blood pressure was a little low. Kurt was put on continuous monitoring and labs were also ran to make sure it wasn't an infection instead. After the 36 hour mark, the fever left and he started feeling great. 

On the first day we were at UK, the nurses noticed that Kurt's PICC line seemed pulled out too far. They did an x-ray to confirm. We were soon surprised to learn he would be getting a new PICC line that night. Because of the nature of Blincyto, it is only paused once a day for a couple of minutes for the bag to be changed. Since Kurt got his new PICC line a few hours after the medication was started, he had the joy of having two PICC lines in for a little under 24 hours. He told me he was a "you pick two!" The removal the next day was quick and easy. I think the thought of it coming out was worse than the actual process! 

Our insurance was slow in getting things approved for us to go home with the infusion pump. After many phone calls and time spent on hold, we were finally given the all clear to come home on January 28th. It ended up being a much longer stay than we thought! We were thankful that Kurt felt really well for the remainder of that stay. He was able to do some work in the hospital. We caught up on some movies and were able to go for walks each night after 8pm on his floor. 

Nothing is better than being at home! We have been able to enjoy time at home since the end of January. What a blessing to be home and to have Kurt feeling well. Because Blincyto doesn't destroy all the cells as chemo does, Kurt's hair and beard quickly began to grow back. His hemoglobin has continued to recover and was a whooping 14.5 this week! He has been able to work every day and has had some busy days working from home. The children have enjoyed these more "normal" days too. Homeschooling is going really well for us and I feel so pleased with all the ground we have been able to cover during such a crazy time. This week, we will start our 24th week of school! 

(Look at that beard!) 

(Finished Castle)

Kurt finished his round of Blincyto on February 16th. He claims the hardest part was carrying his fanny pack and trying not to get snagged on things! Blincyto is technically a 6-week treatment, even though the infusion is only 28 days. So, on March 1st Kurt had an other biopsy preformed. We received those results this week on March 10th. When Kurt's oncologist walked into the room, her first words were: "I have GREAT news!" Kurt is finally MRD Negative! We were both thrilled to hear that right now Kurt is Leukemia free. It was wonderful to hear those words but also sobering because we know that the biggest mountain is now right in front of us: transplant. Because Kurt's ALL took longer to reach MRD negative and because of the MYC 8 rearrangement that showed up in his initial diagnosis, we know his ALL is somewhat resistant and more prone to relapse. His best chance at a cure is through transplant. We know God can cure him and pray He is using transplant as the means to do it. 

Kurt's oncologist told us that they have activated his donor and sent him some dates to choose from for donation. We are currently waiting to hear back if one of those dates works or if there will be a little delay. We were told if we didn't get a phone call on Thursday that things would be progressing. No phone call came, but we are still holding our breath a little until we hear from his transplant coordinator on Monday. If transplant is on schedule, it will happen as early as 2-3 weeks. If there is a delay, Kurt will need to do an interim dose of chemo or Blincyto to prevent him from going too long without treatment. This would push transplant back. We are trusting God to work everything out for Kurt's good. 

Right now, Kurt will be repeating some of the testing that he already did to clear him for transplant. We don't expect any hiccups, but continue to pray he stays healthy. Before transplant, Kurt will also have an outpatient procedure to place a tri-fusion line in his chest to be used instead of the PICC line in his arm. Before receiving his stem cells, he will have 6 days of total body radiation and chemo to ablate his own bone marrow. Radiation will be 2x a day. It is a lot to take in. but we know God will help us and protect Kurt. After the 6 days of conditioning, on day 0, Kurt will receive new stem cells and a new journey will begin! 

Please continue to pray for Kurt: 

-for protection against illness or anything that would delay transplant 

-for strength, for him to pack on the pounds, and stamina to endure transplant 

-for protection against mucositis (mouth sores) during the first phase of transplant. We are told this is one of the most common and worst side-effects. Many patients have pain pumps and even feeding tubes for a period of time. This usually resolves once engraftment happens around day +10. 

-protection against GVHD (graft vs host disease) post transplant 

-protection against weight loss (he's always been a skinny guy--I'm trying to fatten him up!)

Please pray for his donor: 

-for protection against illness 

-for a smooth donation process and no side-effects 

-pray that God will use this process to reveal himself to the donor, if he isn't a believer 

Thank you for praying for our family and for journeying along side us! We are so blessed. Kurt has done so incredibly well with everything and I know that this just shows how God is taking care of Kurt and being so merciful to him. There's no other way to explain it! 

We look forward to sharing more concrete days regarding transplant soon. 

-Priscilla 

As we close out 2020...

     2020. I can imagine years from now the mention of this date will bring with it a sigh and a heart ache for most of us. As I was reflecting on this year and trying my best to do some sort of planning for what the next couple of months could bring, I thought about some of the odd milestones we are about to reach. March 2021 will be one year since I physically went into a store! January and February mark the last months of our "normal life." March 2021 also will bring the last time we were physically inside our church building as a family--how saddened my heart is over that thought. July was the last time we saw our BFG (small group) at church outdoors. July was the last time we saw most of our Johnson family, and even that was socially distanced and outdoors. 

    Birthdays in 2020 were celebrated at home with drive through visits and zoom gatherings. We spent the 4th of July visiting cousins but staying 6ft apart and outside to watch Kurt's annual fireworks display. And just when we thought maybe, just maybe, it might be safe to do a little bit more, Leukemia sent us down a new path to an even deeper isolation. Shortly after, COVID began to surge again as well. 

For me, 2020 has been a year filled with both grief and joy. From talking with other families who have faced a cancer diagnosis and from our own experience, we know there is a lot of grief to process with the initial diagnosis. We grieve our "old" way of life. We grieve the sweet innocence we never really knew we enjoyed--time without direct and specific concerns for the future that seem to mar even the most joyful of days. 

Having had my own battles with chronic illness, I know a smidge of what it is like to grieve the loss of a "healthy" body, a body that hasn't betrayed you or limited what you can do. I know of the trauma that can result from suffering and how it sticks with you. While I believe this knowledge is a good gift in that it will help me understand more of Kurt's battle with Leukemia and be more empathetic, it also brings me much sadness in knowing how terrible and lasting some war wounds from illness can be. 

One of the most difficult things this year has been watching the impact of COVID, isolation, and Kurt's illness on our children. Anxiety, loneliness, frustration, behavioral changes have had to be met and dealt with. Sometimes we didn't deal with them well either, as we were nursing our own heartaches. 

One day at a time...365 days...and we have kept marching forward with hope and through the grace of our Savior. And here we stand on the precipice of 2021, looking back and we can find blessings too numerous to list or count. I want to list some of the major ones here, so that I do not forget the goodness God has shown us. In the hardest of years, He has surrounded us with love and encouragement. He has shown Himself ever faithful. 

2020 is really all about perspective, so I choose to shift mine: 

-Back in January and February, Kurt had to travel to California and New Orleans for business. We are so thankful that he remained healthy. He was in California right before the March shut down for COVID! 

-In the early part of the year, I was dealing with a flare up of health issues. While I am still dealing with some of them, I saw great improvement throughout the year. 

-I am thankful for a wonderful doctor who always responds to emails, checks on me, and has the capability to do virtual and phone visits. I'm thankful we could see her in July and that she re-checked Kurt's blood work, sending us on a whirlwind trip to a diagnosis with Leukemia before he was very symptomatic. 

-When COVID first hit, I will admit I was anxious and fearful. I had a slew of health issues that made me more vulnerable and I wondered what would happen if I caught it. We were very strict about isolating, mask wearing, and social distancing. I prayed for wisdom and discernment. I didn't want to be too lax, but I didn't want to live in fear either. God granted me such peace. I firmly believe He gave me the push to keep practicing wisdom through proper precautions because He knew Leukemia was coming and that Kurt was so much more at risk than we knew (during the summer). 

-I am thankful our children celebrated their birthdays. We now have a 5, 9, and 12 year old! Each birthday showed our children just how much they are loved. Cards, phone calls, safe visits, gifts from teachers and friends all meant so much to them. Mabelle keeps a poster signed by her teacher and classmates in her room and still talks about it often. 

-Because my parents have a lot of property, we were able to enjoy and explore outside a great deal. We loved hiking to the waterfall and spending time with Mamaw and Papaw in ways we normally don't get to do with hectic schedules. They let us put up a pool at their house and we enjoyed many hours swimming. 

-We lost both of our dogs this year. I still miss them so much. Their presence was such a comfort in hard times. I am thankful that they both were able to pass peacefully at home with the help of a a wonderful vet from Lap of Love. When Mattie passed, God worked to allow me to be able to leave the hospital and come home for several hours. I was able to return with no issues. 

-I am thankful that we have the resources of two wonderful therapists. They have helped our family process this year and have given us support in special ways. 

-In July, we traveled to St. Louis to visit Kurt's family. We didn't know it then, but Leukemia cells were crowding out his healthy cells at a rapid rate. It was on the way home from this trip that we got the call to find a Hematologist/Oncologist asap. I am so thankful God protected us from illness during that trip and we got home safely. 

-The week of Kurt's diagnosis is a bit of a blur for us, but one thing that stands out is how our family and friends immediately jumped into action to help us. Our parents cared for our children during that long 35 day hospital stay. Our BFG quickly organized meals, GoFundMe, and other resources to support our family. We could not have survived that time without our community. 

-We got the phone call about Kurt's "terrible" blood work while we were driving home from STL. I think we were somewhere in Indiana. I had pulled the labs up on my phone. I didn't know what was wrong, but I knew enough to know it wasn't good. Our doctor called us shortly after I saw them. She told us to pull over. Kurt got out to talk with her. He was as steady as could be and took it all in stride. 15 minutes later I found myself leaping out of the van while we got gas to walk and have a panic attack alone. We messaged a few medical friends from church and within an hour had an appointment with a wonderful doctor on Monday. Again, God showed us He would make a way! 

-I am thankful God allowed Kurt a quick diagnosis with mild symptoms. He was very stable and strong physically when he was admitted the first time. I know that gave him a great starting point for a hard journey. 

-Kurt's parents have been able to help us so much these past five months. We are so thankful that God used such a horrible thing to give us so much time with his parents. The kids love all the grandma and grandpa time and it has been nice to have them here for longer and more frequent stays! They are so helpful with everything from household chores to installing new lights! 

-We are thankful for Kurt's team at UK. How amazing that we live in a city with such a wonderful research hospital downtown?! Kurt's doctors have proven to be extremely knowledgable and also extremely kind. We are thankful that they choose to serve others by doing what we know is such a demanding and hard job--physically and emotionally. 

-My BSF study this year is on Genesis. I have marveled again over God's creation and the last few weeks have focused on his mercy and love for Abraham. We feel as though we have set out on a journey far from the life we knew. Like Abraham, we don't know what is to come, but we know WHO to trust! 

-Our church hung the verse Hebrews 13:8 over the year. "Jesus Christ is the same yesterday, today, and forever." What a verse for 2020! Reminding ourselves of God's steadfastness has brought such comfort on dark days. 

I could go on and on (if you made it this far, wow!). 2020 has been a hard, ugly year in many ways. There's no way to sweep that under the rug and pretend everything is just great. However, I am thankful for a merciful God who does bring good out of the bad. I am thankful that He is forever steadfast, forever merciful, and forever loving. With hope in Him, I can face 2021 with a deep joy and an abiding peace. 

As one of my favorite songs by Sarah Groves says, "From this one place I can't see very far. In this one moment I am square in the dark. These are the things I will trust in my heart: You can see something else." Even though I have felt completely blind a lot of times this year, I find comfort in the fact that He can see something bigger, something beautiful, something else that I cannot. 

Do as the old song says, and count your blessing...

Wishing you peace and joy this New Year. 

-P

From This One Place--Sarah Groves

I was about to give up and that's no lie

Cardinal landed outside my window, threw his head back
Sang a song so beautiful, it made me cry
Took me back to a childhood tree, full of birds and dreams

From this one place I can't see very far
In this one moment I'm square in the dark
These are the things I will trust in my heart
You can see something else, something else

I don't know what's making me so afraid
Tiny cloud over my head, heavy and gray with a hint of dread
And I don't like to feel this way
Take me back to a window seat with clouds beneath my feet

From this one place I can't see very far
In this one moment I'm square in the dark
These are the things I will trust in my heart
You can see something else, something else

From this one place I can't see very far
In this one moment I'm square in the dark
These are the things I will trust in my heart
You can see something else

You can see, you can see
Something else, something else
You can see, you can see something else
You can see something else

He just threw back his head
(Take me back, take me back, take me back)
And sang a song, it was beautiful

(Take me back, take me back, take me back) 

Hyper CVAD B #2

 

We continue trucking along on this crazy journey. Kurt had his second Hyper CVAD A treatment in mid-November and is now inpatient at UK for his second Hyper CVAD B cycle. The A cycle went well with some nausea following it and a bit more fatigue than Kurt's experienced before. In true Kurt fashion, I was soon talking him out of climbing on ladders to hang lights and into taking more breaks from work or other activities he wanted to do. You can't keep a good man down! I am so thankful that he continues to rebound well from chemo. We watched as he grew some facial hair and laughed as it all fell out again in a 24 hour period! His hair is really keeping up the good fight and trying to gain some ground. 

On the 8th, Kurt saw his hematologist/oncologist for an appointment. Since there wasn't a biopsy after the last cycle, there wasn't much news to relay. We did get a chance to ask and have some more questions about transplant answered. Transplant is such a BIG thing--we always have new questions pop up and want to try to be as prepared for what it will be like as possible. Our plans are still the same regarding a timeline:

-If Kurt's next biopsy (probably around January 1st is MRD Negative (0 Leukemia cells)), he will proceed to the prep for transplant. This will include organ function testing and the placement of a Trifusion catheter to replace his PICC line. The Trifusion will provide three lumens for more access points than the two on his PICC and is a bit safer and less cumbersome than the PICC line. Placement does require mild sedation. He will most likely have the Trifusion in his chest until at least 100 days post transplant. 

-We were told that if he is cleared after the biopsy, it will probably be 2-3 weeks until transplant begins. Some of the timing depends on the donor. The donor's stem cells will need to be harvested and transported to UK before Kurt begins "conditioning." 

-"Conditioning" for transplant will be 5-7 days of intense chemo in the hospital counting down to "Day 0" when Kurt will receive his new stem cells. The purpose of this part of the regiment is to obliterate Kurt's own bone marrow to make room for the new stem cells. He will have intense chemo and radiation. Current chemo simply is enough to kill the Leukemia but allows the bone marrow to continue functioning. "Conditioning Chemo" will be so strong it will permanently damage Kurt's bone marrow to the point it can no longer work properly, allowing the new stem cells to engraft and take over. 

-During transplant, we expected to be in the hospital for 4-6 weeks. Engraftment generally starts to take place around day 10. Kurt will probably experience some degree of of Graft vs. Host Disease (where his new stem cells attack his body). This usually manifests in skin, mouth, and gut issues. Some degree of GVHD post transplant is a good thing as it creates a "Graft vs. Leukemia" effect where the new cells fight any remaining Leukemia cells! However, we don't want GVHD to get out of control and actually cause harm to Kurt's body either. It's something that is carefully watched, especially during the first tenuous weeks. 

-For the first 100 days after transplant, Kurt will be on immunosuppressant drugs. If all goes well, on day 100, he can begin weaning off of those drugs, giving his new immune system a chance to really start to work and defend against germs! We will have to continue to be extremely careful during that first 100 day period of his recovery. For the first year after transplant, Kurt's immune system will still be like that of a newborn baby. We will have to be careful, especially with the COVID situation but we look forward to this healing process and getting closer to see those we love in person! 

-If Kurt is not at 0 after this next biopsy, the plan is to do a round of the drug Blincyto for 28 days. Blincyto is not a chemo drug. It is a pre-programmed antibody that binds to certain markers on the Leukemia cells and destroys them. It is a revolutionary drug that we have heard great things about, getting many patients to 0 for transplant. For this medication, Kurt would do 7 days inpatient to make sure there are no reactions or side effects and then come home with a pump that would administer the drug 24-7 for the reminder of the 28 day period. We would then do another biopsy and proceed with transplant at that time. 

-The great news is that there have been many donors identified for Kurt. Praise God! His doctor will choose the best fit for Kurt based on HLA typing. Male donors are preferable because many women who have given birth have additional antigens from their children. They also like to match blood type when possible. The more ways Kurt and his donor can be compatible reduces his risk for severe or chronic GVHD. 

During this whole process Kurt has also been receiving spinal chemo through lumbar punctures (similar to an epidural). To administer the spinal chemo, a small amount of CSF is taken out to "make room" for the chemo (because the CSF system is a closed system, some must come out before more can go in). This allows the doctors to test the CSF for Leukemia cells. ALL is a tricky cancer and is prone to relapse in the CSF. We are so thankful that Kurt's CSF has remained clear of any Leukemia cells. His doctors had a goal for him to have at least have 8 spinal chemo treatments and Kurt completed his 9th Lumbar Puncture on Thursday. He will have one more, for a total of 10, on Monday. This should be the last one! He had some pain from scar tissue with the previous two LPs, but God showed mercy and answered our prays on Thursday. There was no pain! 

If all goes well and Kurt clears the Methotrexate from his body, we should head home on Monday. I am so thankful that I am able to be with Kurt during this round of chemo. COVID restrictions at the hospital are tight, but we are so grateful that they are still allowing one visitor per patient on the Markey floor. We have also been able to walk the halls from 8-11PM. I think Kurt really enjoys getting out (I can go down for food, so I usually get one walk in a day to pick up dinner). We wear our eye shields and masks and get a little exercise. Tonight, we counted 8 doors labeled "BMT." 8 people going through the incredibly scary and taxing process of a transplant. Please pray for those 8 patients, especially as we know this is a lonely season for many of them. 

Thank you for continuing to support us in prayer and through your generous gifts and service to our family. We can never express how grateful we are: meals dropped off, cleaning supplies, toilet paper, treats, gift cards, even help for Grandma and Grandpa when van battery died! We are so loved and so thankful for our families and our friends. We will continue to update you as we draw closer to transplant and we are praying that God will provide full healing and a cure for Kurt through this miraculous process. 

With much love, 

K and P

Trees

Trees

(a work in progress..) 

    The day you were diagnosed with Leukemia, the weather was full into one of those humid August days in Kentucky. While the doctor spoke to us, I remember watching the trees outside the large windows of the exam room. Our room overlooked a little stone courtyard, empty except for one woman who walked in circles talking on her cell phone for ten minutes and then disappeared. The trees were tall, spindly things with curling bark. A few yellowed leaves had dropped from the branches and scuttled along the grey cement riding the hot breeze. The trees were tall enough and full enough to create a little canopy above the courtyard. The sunlight cut through the leaves making a dappled pattern on the ground. The room in which we sat was icy cold, and I shivered, goosebumps creeping up my arms, each hair standing on alert for some sudden attack. I checked my heart rate on my Apple watch. I saw it climb, sit steady, and then slowly fall. I watched the trees and tried to breathe. Every particle of my body longed to fling myself out the window and into their arms. 

    It was to the trees I often ran as a child when the world was weighty, my heart claustrophobic in my chest. Our yard, a country yard where the yard only stopped at the edge of as far as my dad was willing to mow, contained so many trees I loved: the large dogwood with the perfect branches for sitting and climbing and the huge stately pine where I got my fingers sticky from the sap and made beds of pine needles or woodland “soup.” There was a dip in our yard surrounded on either side by much smaller trees that created a ceiling above--my own Lover’s Lane, and the exotic Mimosa, whose wild perfume and pink blossoms transported me farway during the summer. There was the dark trunk of the cherry tree and the tart cherries I had to race the birds for and the apple trees that produced the most sour green apples as the seasons hastened toward Fall. 

    I loved each of them like a little dryad. It was to the trees I would run to play, having no brothers and sisters of my own. I would lose myself in the world of fairies, King Arthur and Anne. On foggy, rainy days, the rolling land became Dartmoor and I, a female Sherlock Holmes. It was to my dogwood tree that I ran to sit, cradled in its branches to write stories of my own. 

    At Christmastime, my dad created magic in the trees with large, brightly colored bulbs. He would string them through the branches of my dogwood tree until it looked like the glittering top of a carousel. I loved to sit inside our room with the bay window that overlooked the dogwood tree and watch the lights and snow at dusk. When allowed, I would bundle up and sit in the dogwood tree surrounded by the glow of the lights, December air stinging my cheeks. I remember the feel of the warm bulbs in my mittened hands--the primary colors with chipped paint, how their minuscule warmth competed with the whipping breeze. 

    As I grew, my trees grew with me and I found new friends: the tall trees standing like centuries over the picnic tables at the camp I loved. The tree outside Cherry Hall at Western Kentucky University that turned the most brilliant shade of yellow I had ever seen each Fall, such a brilliant yellow that it made my heart ache in the strangest way, the Bradford Pear trees at the first house we owned together and their white blooms covered in a late spring snow--how I cried the day the electric company cut them down without warning. 

    There is a tree that stands alone on a hill on our family farm. It overlooks the pond my dad built many years ago, where his cattle now drink. Everyone in my family knows that as my tree. I don’t know why I love it, for I haven’t spent hours sheltered under its branches as I did the trees of my childhood, but something about it’s strength and beauty draws me to it. It leans slightly to one side but stands resolute. I photograph it, trying to catch each angle but none of the pictures I take conveys the smallness I feel as I stand at a distance and admire it. There in that smallness I find a kind of comfort that cools the burning in my heart for a few moments. It is here and yet not here and makes me now think of the tree Niggle worked to paint in Tolkien’s short story that I want to read over and over as I struggle with my own words and thoughts and the difficulty of the craft of capturing them. 

    I remember the trees that lined the winter walk to our wedding reception--the forest was so quiet that only the sound of a stream could be heard running under our feet. I was not cold on that January day, as your hand warmed mine. I remember the trees in our yard that calmed our babies as they cried from colic and how they would blink their dark eyes open at the trees above, suddenly silenced by the change of the air and feel of the breeze. My heart again pained by a queer ache of knowing and understanding the souce of their comfort. 

    I love the trees that line the edge of the farm near my parents home, the sudden transition from mown grass to woodland mystery. The trees that shelter two small graves of my best companions. I think about the wind ruffling white fur, the dart of a squirrel up a tree, and the tumult of barking and paws. I think of the day the orange earth swallowed the tiny white body curled so perfectly at peace, and the mad urge I had to run, scream, rescue him from the cold ground--how I just stood against that urge and watched, wept, and crept silently back to the house. 

    And so, the day the world tilted on its axis in such a sharp way, the day I had to work to coax each breath in and out of my body, the trees helped me again. Stand in the wind, bend with the breeze, they whispered. You will bend, you will not break, though your leaves yellow and fall. There is magic in the death of winter. Look for it. Be on the lookout for it. It will find you in the safety of the branches and in spring time, you will be reborn. 

Hyper CVAD B: Day +1

(Kurt getting spinal chemo 10/21-Kurt has not had any leukemia cells in his CNS. These treatments are preventative, as the leukemia can migrate into those areas.)

After 14 great days at home, we are back at UK for Hyper CVAD B Cycle. The best part about this cycle is that we should be back home after 5 days! We already are looking forward to being back in our own bed after the first night inpatient, but we know this time will be a little different for us at home too. Kurt has normally spent his "feel bad period" in the hospital, so he will be at home for that this time. We pray he won't feel terrible, that the meds we have to treat nausea and other symptoms will work wonderfully, that he can rest well at home, and his counts will recover quickly again. I am praying I can juggle taking care of Kurt with things at home too. Homeschool provides some really great structure to our day, but it is very hard for me to "let it go" if other needs arise. 

Since I haven't give an update in a bit, I'll back up and do that now: 

We came home from Hyper CVAD A cycle on 10/8 after a 16 day stay. We were so excited that we got to leave earlier than we originally thought! Kurt's counts were recovering really well, so we were able to be released to come home. There was some talk of going straight into Hyper CVAD B, but his platelet counts were a little low, so we got to escape home for some rest before biopsy and the next cycle. 

On 10/13, Kurt had his bone marrow biopsy at the clinic. I got to watch this one! Kurt is such a trooper through all of these procedures. He has never complained about any of them. The PA who did this biopsy was amazingly quick. Kurt said it was probably the best one yet. On Friday (10/16), we went back in to the clinic to meet with Dr. Ramlal and discuss the results. We had been told that Kurt may not be in remission after just one cycle and that proved to be the case. He has 7% of blast cells still present in the marrow. 

Timeline: 

Admission: 95% blast cells in the marrow 

Post Induction: 15-20% blast cells in the marrow 

Post Hyper CVAD A: 7% blast cells in the marrow 

The good news is that the blast count continues to decrease. The bad news is that it is resistant to chemo because of the MYC8 rearrangement. Less than 5% blasts in the marrow is usually the threshold for remission, but we are shooting for 0 blast cells as we head into transplant. Dr. Ramlal explained that the plan forward is to complete the Hyper CVAD B cycle and do another biopsy on 11/6. Hyper CVAD B contains chemo drugs that Kurt's leukemia cells have never seen before. The hope is that these drugs will do the job and clean up this remaining bit of bad cells. If the blast cells are not decreased, we will add the drug Blinatumomab to the next two cycles. We have heard great things about this drug. It targets a specific antibody on the cancer cells and has gotten many people into a very strong remission with 0% minimal residual disease (MDR). We want to go into transplant with 0 blast cells to give Kurt the best shot at a cure! Kurt also still has another Hyper CVAD A/B cycle to go, plus chemo for conditioning prior to transplant, so more chances to kill the leukemia and keep it gone.

We are still targeting December/January for transplant. All four of Kurt's siblings completed the bloodwork to see if they are a match for him. Those results started coming back while we were home and unfortunately all four siblings are only a half match. When looking for a stem cell match, doctors are looking at HLA markers on the cells. A perfect match has 10/10 of the same markers. Kurt's siblings only had 5/10 markers matching. The more perfect the match, the less chance of his body rejecting the cells and there is a slightly lower risk of Graft vs. Host Disease (GVHD). Now, we begin the search through the national registry (Be The Match). They even sent Kurt a little informational packet earlier in the week. There are around 30 million donors in the registry and Dr. Ramlal seems really confident Kurt will find a match there. We are praying we find a perfect match as quickly as possible. 

Several people have asked how they can get tested to see if they are a match. The best way to get tested is to go through Be the Match. You can go online and request a testing kit through them. If you are between 18-45, the whole process is free. The kit is a simple mouth swab that you do at home and mail back. If your DNA seems to be a match for a patient needing a transplant, you would then have some additional bloodwork for HLA typing. If you are registered with Be the Match, then you are a candidate for Kurt and many others in need! Donation is usually very similar to donating plasma--not a surgical procedure. You can read more about donating here: Be The Match  

So, we returned to UK yesterday for the start of Hyper CVAD B. Kurt had some pre-meds and fluids to prep for chemo today. He also had a spinal chemo treatment yesterday. Because of the issue with the headache he had last cycle, they did add steroids to the spinal chemo. We hope this will prevent headaches and help lessen inflammation. I snapped the picture above just to document how strong he is! Kurt has always hated needles, but he has done so well with all of the pokes. The oncologist who did the lumbar puncture yesterday is a big STL Cardinals fan, so he and Kurt had fun talking about baseball. I think that was a pleasant distraction. Kurt made sure to wear the Cardinals hat his mom made him because he knew Dr. Krem would notice! 

This morning, Kurt started receiving chemo around 9:30am. He will have methotrexate over the next 24 hours via his PICC line. The next three days, he will get doses of Cytarabine and a couple of other drugs to prevent and lessen the side effects of the chemo drugs. Kurt has had methotrexate and cytarabine in the lumbar punctures, but he has never had them via his PICC line. We pray they will do the job of destroying the remaining 7% blast cells. 

As long as Kurt's body clears the methotrexate, we will be able to return home on Sunday! So far, he has tolerated each chemo drug we have encountered really well. We pray he will do the same with these drugs. Typical side effects are fatigue, nausea, and vomiting a couple of days after chemo. Kurt does have some neuropathy that has gotten a little worse from one of the other chemo drugs (vincristine), but we have been told it will go away after treatment. One of his worst days was actually the day we were discharged from the last cycle (10/8), when he had bone pain from the Neupogen injections to help boost his WBCs. He will have this drug or a similar one post-chemo this time, so we pray the bone pain will either not show up or will be as minimal as possible. Thankfully, it went away pretty quickly after the last injection. 

Thank you for reading this crazy-long update and for praying with us! If you would like more information about stem cell donation, feel free to message me. As always, information about our meal train, etc are located on the right side of this page. We could not do this without your support! We are so thankful for all the meals, the household items, goodies to keep the kids busy, cards, texts, and words of encouragement. Your prayers mean the most to us and fill us with such joy and hope! You are a blessing to us! 

-K and P

Hyper CVAD-A, Day #13

 

Hyper CVAD-A, Day #13 

We are over half-way through this next cycle of chemo. Best of all, the chemo part is finished! Because of Kurt's residual disease on the last bone marrow biopsy, this is basically "Induction #2." The goal is still to get him into remission and to keep him there. The end goal is now stem-cell transplant after three more Hyper CVAD cycles. For this first cycle, much like the last induction, patients typically remain inpatient for the entire duration of the treatment. For Hyper-CVAD cycles that cycle is usually 21 days. We remain hopeful that if Kurt's counts recover quickly, they may be generous and let him go home early, but we aren't holding our breath! 

With this cycle of chemo, the bulk of the treatment was administered the first 4 days. On day #11, he had a final treatment of vincristine and started another 4-day round of steroids. Now, it's just a waiting game for his counts to recover enough to have the next biopsy. Right now, his neutrophils (those beautiful infection fighting cells) are 0. We need them to come up to around 500 for biopsy and discharge. It's great that the cell counts drop--that means chemo is working! Now, we just need them to rebound. In order to help his counts come up, he is receiving a daily injection to help boost cell production. 

This cycle of chemo was a little bit more rough than the first (as anticipated), but Kurt has really handled things so well. Big challenges this cycle have been a headache that is more positional in nature and some mild nausea/vomiting. The mystery headache has had everyone scratching their heads. It worsens when Kurt is sitting upright, but completely disappears when he is laying flat. The most likely cause is the spinal chemo. Spinal injections are notorious for headaches and chemo in that area can cause irritation and inflammation. However, being the tricky patient that he is, Kurt's headache didn't begin until almost 48 hours after the spinal injection, so we can't be sure that is the cause. He had some fluid on his ears, which has been treated with antibiotics, and has almost felt as though it was muscular in his neck too. Thankfully, his CT scan was perfectly clear and the headache seems to be growing less prevalent each day. In the future, the oncologists will administer some steroids with the spinal chemo to see if it will prevent this from happening. Massage therapy might also be stopping by. What a treat! 

Last week, Kurt also had some nausea and vomiting one afternoon. I had gone down to try to meet a Door Dasher (our food was lost and never arrived--which Kurt said was God clearly knowing he wasn't going to be able to eat it!). I called up to the room to let him know and he told me he wasn't feeling well. By the time I got to the floor and rounded the corner, I could hear him. The nurses were talking--"Oh, that's Mr. Johnson." If you have ever been lucky enough to be around me when I have complained about Kurt's noisy vomiting, you'll know he could be heard clearly in the hall. We often have joked that he almost yells when he vomits. This loud vomiting trait seems to be hereditary, as Kurt's dad and brothers also demonstrate this wonderful quality. Shortly after we were married, Kurt got food poisoning during a trip to Seattle and I heard him vomit for the first time. Needless to say, I stood outside the bathroom door crying and asking if I should call 9-1-1. Now, I know what's up and quickly let the nurses know, "he's a loud puke-er." They agreed! Thankfully, it seems to have been brought on by an empty tummy (he napped through lunch after the spinal chemo that day) and, after a dose of meds, went on to eat a full dinner and has felt fine since. He joked about how loud he was and took it all in stride. "Welp, chemo is working" was one of his first sentiments. 

It's so hard to be stuck in the hospital, watching the cars on the street below, students walking to class, seeing the football stadium fill (only to 25%) and empty...life going on outside of these walls. We can find joy in the stillness of it all though. I am thankful for this time together. It isn't what we would choose, but we have been able to laugh until we've cried at each other's silliness, watch movies together, have long conversations, laugh at the past, and plan for the future in the face of this huge mountain before us. We have a deep hope and a joy that cannot be disturbed by the ripples on the top of the water. I am not making light of what we are going through by any means. Some days are really hard--seeing our kids over Facetime with anxious faces, worn out eyes, missing them and "normal" days. We are grieving life that was, life without the word Leukemia in it. We are missing our sweet dogs we lost this year. We are trying to process this whirlwind diagnosis that literally turned things upside down overnight. While we laughed later over Kurt's loud vomiting, I stood outside his bathroom door, fist on the wall, crying over the suffering, heartsick for him. And yet, we find God with us in the midst of all this. We hear His gentle whispers. We see Him working for us, using the hands and feet of others to hold us up. I feel like Moses in desert when Aaron and Hur held up his hands. We are thankful for those holding up our hands during this battle. We couldn't do this alone.