Saturday

If we thought there was any schedule to be had it's that this past Monday Marty would have begun his next round (third) of chemotherapy. But that was not meant to be. Many things have to be just right for the chemo to function effectively and with minimal predictable risk to the patient. The cause for the delay at this time is that Marty's liver enzymes are higher than they should be and need to drop somewhat before he begins round three. 

The trach tube is still in, but it's corked. This means that all of Marty's breathing is now done through his nose and mouth, the way it was created to be. The fact that the tube is still in is just a safeguard -- just in case.

Marty is now eating, three times a day, a diet of soft solids (ice cream, pureed fruits, yogurt, cream of wheat, etc.). Though he can now eat orally, he is still receiving 95 mgs/hour of food which goes via his PEG tube directly into his stomach. Swallowing continues to be a challenge for Marty. Sometimes it's easy for him and sometimes it isn't and it's hard to know when it will or won't be an issue for him.

Last night Marty was running a slight fever - he continues to be on antibiotics. 

With this beautiful Autumn weather, Marty's been able to spend some time outside basking in the sun -- he even has a bit of a tan line! The reclining wheelchair's sure been a blessing in this regard.

"Our God is in heaven; he does whatever pleases him." 

-- Psalm 115:3

Mike

Wednesday

Since the good news of the MRI results last Friday, we have continued to see small improvements from Marty everyday.  On Monday some were able to witness Marty walk from his room to the nurses station, right outside of his room with a walker and two physiotherapists on either side of him.  Tuesday was a beautiful day here and Marty was able to get into his wheelchair and sit outside in the "wellness garden" and enjoy the sun for about 20 minutes in the afternoon.  He also had an ultrasound of his liver done on Tuesday.  His liver enzymes were elevated over the weekend and the oncologist wanted to be sure that this was a result of the chemotherapy and not because he had any blockages or gallstones.  The results came in later that day and everything looks normal.  Since then the liver enzymes have come down slowly every time the blood work results have come back.  Your liver functions to filter all your toxins out of your blood so it is very important that it is working properly.  The chemotherapy drugs that Marty is on are very hard on the liver and so the oncologist was just being extra thorough in ordering this liver ultrasound.  The liver enzymes need to come down a little more yet before they will start a third round of chemo.  The oncologist, in consultation with the neurologist  have also decided to wean Marty off one of the two of the anti-seizure medications (Tegretol) he is on.   They will keep a close eye on Marty during this process to make sure he's not having any seizures. Tegretol is also very hard on your liver so the doctors are thinking to remove any medication that might be causing unnecessary stress on the liver.  

The Speech Language Pathologist has also come by again to see Marty eat.  She is happy with his progress and he is now allowed 3 different items per meal time.  He still has to be very careful when eating and sometimes is unable to swallow his food but then he just spits it out and tries to swallow the next bite.  

Tomorrow morning it is expected that Marty will have his trach corked.  This means that all airflow will come in and out through his nose and mouth.  This should be more comfortable for Marty as the air will be humidified, as the natural process, through his nose and mouth as he breaths in.  It should also decrease his cough.  Though the doctors have not talked about taking the trach out completely this is one more step for Marty in the right direction.  We are thankful to our heavenly Father for allowing us to witness these positive improvements in Marty's health and continue to acknowledge that He is in complete control.  

"Praise the LORD. Give thanks to the LORD, for he is good; his love endures forever." -- Psalm 106:1

Amanda

Friday

This past Tuesday Mel and Aileen (Erica's sister and cousin respectively) came from Winnipeg and have spent the week with her. Wednesday was Erica's birthday. We are thankful she could celebrate with Marty, her children and also Mel and Aileen.  In the evening some friends from Guelph organized a party for her.  It's great to witness this care and communion of saints surrounding Erica.

Marty sat in a reclining wheelchair on Wednesday for approximately 30 minutes. This gave him opportunity to get out of his room and see some of the hospital floor that he's on. -- A nice change of pace for him, for sure and something to break up the day.  Today, he was in the same wheelchair for over an hour and a half and he was sitting up quite straight, which was great.  Because he has been lying in a hospital bed for so long it is very hard for him to hold his head up and he sometimes talks about a sore neck.

Marty has been struggling with fevers again after this round of chemo.  After doing some blood cultures the doctors realized he had an infection in the blood that was drawn from the PICC line.  After intravenous access was established in the other arm the doctors took out the PICC line to give a chance for this infection to clear up.  It should be noted that they also drew blood from the other arm and no bacteria was grown in the blood drawn from that arm so the doctors are confident that the infection was only in the PICC line.  He is currently being treated with 3 different antibiotics.  Because of this infection in the PICC line the doctors did a echo-cardiogram to make sure there is no bacteria in the heart.  This echo-cardiogram was done on Wednesday and has come back negative.   

On Wednesday Marty also had an MRI. The last one he had was prior to his chemo treatments. It makes no real sense to do an MRI after just one round of chemo, so the doctors have indicated that they will do it every two rounds. We were anticipating this MRI and today we could get the results -- favourable results. To quote the results of the MRI, "There is marked improvement with almost complete resolution of abnormal enhancement within [the areas of Marty's brain that have cancer]. ... There is a significant disease improvement." A way to interpret this is that the chemo is doing its job on the cancer in Marty's brain. We also see the LORD's hand at work here. This is good news and we are thankful for this news. We hope and pray that the LORD will continue to allow Marty's health to improve. 

First thing this morning Marty had a video x-ray to assess his swallowing ability.  We are very thankful that Marty passed this and will now be able to receive oral nourishment.  Some examples of the food he will be able to sample are yogurt, applesauce, cream of wheat, and cream of ______ soups. There are various guidelines to follow: Marty has to be completely awake when eating; he must use a teaspoon as an amount indicator; only one type of food per meal at first; if he shows any difficulty eating, he must stop; the intake of food must be very minimal for the first while and increase as time goes on; etc.

Today a neurologist saw Marty and was happy with his progress. He indicated that Marty has along way to go but, at this time, things are encouraging.

So, while today's blog indicates many positive things in regards to Marty's health, we are mindful of the fact that he remains a cancer patient and that he's far from the health he could enjoy earlier on this year. But when we consider how far he's come since his diagnosis, we can only give thanks to God for the healing that has taken place and continue to place Marty and his family in the LORD's care.

"The Lord is good, a refuge in times of trouble. He cares for those who trust in him," -- Nahum 1:7

Mike and Amanda

Sunday

In many ways, Marty is still the same as he was when we last blogged. Some of the treatments he has received in the last couple of days are two units of blood, platelets and physiotherapy sessions. The last couple of evenings Marty has been developing fevers.  The doctors are treating this with a broad spectrum antibiotic. We have noticed that Marty's voice is slowly getting stronger; he can now be heard above a whisper.  We can hear him, though he is soft, by sitting close to his bed.  We no longer have to have our ear right to his mouth. During the day the speaking valve is attached to Marty's trach tube.  He does seem to cough a lot during the day.  The coughing seems to be minimized at night because the speaking valve is removed and he receives humidified oxygen. 

The boys enjoyed a visited with Marty on Friday afternoon and hope that this will continue to happen on a weekly basis.

If you want to visit Marty, be sure to ask for Leonard Toet at the front desk and you'll be directed to where he is.

While there have been some large day-to-day changes, and recently minimal day-to-day changes, we know that the LORD is steadfast and unchanging. He has a plan Marty -- he has a plan for all of us!

"God is not a man, that he should lie,

    nor a son of man, that he should change his mind.

Does he speak and then not act?

    Does he promise and not fulfill?"

-- Numbers 23:19

Mike

Wednesday

Since we started this blog in August, we've posted every day, with the exception of one day (and then we posted twice the next day). Our goal was to provide updates on a regular basis regarding Marty's health. Recently, the updates have been less content-heavy and today, there's really nothing new to report. So, we are going to stop posting on a daily basis. 

We will continue to post to this blog any significant updates as pertains to Marty's health. One could say that at this time, Marty is doing quite well. As was mentioned in a recent blog posting, "well" is a relative term. The reality is that Marty is a brain cancer patient at the Juravinski Cancer Centre. Brain cancer. Several weeks ago, he was lying in a bed with multiple pipes, needles, lines, etc. inserted into him -- and day to day, there were many uncertainties. The doctors, for instance, had no protocols to follow regarding Marty's treatment and they and we were taking things one day at a time.

We are still taking things one day at a time but now, medically speaking, there is a longer-term plan of action. For instance, 

Marty's received two rounds of chemotherapy and is scheduled to receive two more. Tentatively, the third round is scheduled for about a week-and-a-half from now. The chemotherapy is the only medical treatment that Marty is receiving for his brain cancer.

On a day-to-day basis, Marty is getting stronger with the help of physio and a slowly increasing calorie intake per day. Thankfully his weight loss has subsided and hopefully Marty can begin to regain some of his weight -- specifically some muscle mass. Regarding strength, Marty's left side is significantly weaker than his right side and we're not sure why. This has been the case since mid-summer. At one time this summer, Marty was non- or minimally-responsive and almost comatose for about a week and a half. Today, he is stronger in the sense that he can reposition himself in bed with minimal physical assistance and a lot of verbal coaching; he can sit on the edge of his bed, being held for balance, for several minutes; he can stand, with two nurses holding him for balance, for a minute every few days; he can sit (slouch) in an upright chair for 30 minutes. So, Marty is stronger than he was this summer, but like "well", "stronger" is a relative term.

Marty shows very little to no emotion. This isn't to say that he doesn't feel/have emotions; he just doesn't really display them on his face or in his body language. That said, Marty is looking forward to Friday when his boys will visit him again.

At this time, there is no prognosis for Marty. This is because the doctors can't provide one. We don't know how he'll be or what to expect after the third round of chemo -- the fourth round of chemo.  Also, once the chemo's done, then what? The chemo drugs that Marty's been given have more risks than just short-term infection, a battered immune system, hair loss, etc. They're supposed to kill the cancer cells in Marty's brain. But what else can they/are they doing? We pray that they are just doing their intended job, and that with much success.

Our thoughts and prayers go out to Marty and Erica and their five children at this time. Hopefully by reading this post you can get a glimpse of the scope of the journey that the Marty and Erica Toet family and loved ones are on. We don't know how and where this journey will go, but we do know Who is in control and leading the way. 

So, this is the last day-to-day update. We will continue to update this blog when there are significant things to post -- for better or for worse. We are confident that the medical professionals are doing all that they can do. And even when they are looking for answers and direction, we know that they are doing their work under the watchful eye of the Great Physician. We may not understand everything that's going on or why it's going on, but we can know that all is going according to the LORD God's plan. 

"Jews demand miraculous sings and Greeks look for wisdom, but we preach Christ crucified: a stumbling block to Gentiles, but to those whom God has called, both Jews and Greeks, Christ the power of God and the wisdom of God. 

FOR THE FOOLISHNESS OF GOD IS WISER THAN MAN'S WISDOM, AND THE WEAKNESS OF GOD IS STRONGER THAN MAN'S STRENGTH." 

-- I Corinthians 1:22-25

Tuesday

The main news for today is that Marty had a speaking valve put on his trach tube. When he inhales, air is taken into his lungs via this tube. When he exhales, the speaking valve closes the exposed end of the tube thus forcing the air to leave Marty's lungs via his nose or mouth. In doing so, this air will also pass by/through his vocal chords. In this way, Marty should technically be able to speak again. However, due to the fact that he was intubated for several weeks, Marty's vocal chords were quite stressed and so will require time to return to or approach some sort of normal. 

"Shout for joy, O heavens;

    rejoice, O earth;

    burst into song, O mountains!

For the Lord comforts his people

    and will have compassion on his afflicted ones." 

-- Isaiah 49:13

Mike

Monday

Marty's been doing quite well lately. "Well" is a relative term. For Marty, doing well is sitting in a chair for 30 minutes as he did today. It takes all he can to sit straight up, and towards the end of the 30 minutes, Marty was slouched and had his head down -- tired out. We're thankful for the continual physio Marty receives and for the small improvements we can notice regarding his strength and his range of motion. 

The games of Rummikub are now a daily occurrence. Today Marty played for about one hour!

The speech pathologist cleared Marty to eat ice chips last week. Marty is looking forward to being allowed to eat other foods. He was weighed again today and has close-to maintained the weight he was at a couple of weeks ago. It should be re-noted that overall Marty has lost a lot of weight, but his relatively consistent weight over the past couple of weeks is good.

Though we know that Marty is still very sick, it's been nice to witness some positive developments lately. We continue to look to the LORD for healing.

"Heal me, O Lord, and I will be healed;

save me and I will be saved,

    for you are the one I praise." -- Jeremiah 17:14

Mike

Sunday

At times Marty has been somewhat unsettled. Today, as the day went on, he became quite settled which was nice to see. He also received two units of blood and an injection to increase his white blood cells.

Psalm 117

"Praise the Lord......For great is his love toward us, and the faithfulness of the LORD endures forever."

Saturday

Over the past few days several out-of-town and even out-of-province guests came to see how Marty is doing in person. Overall, Marty recognizes his guests and will greet them with a handshake. The visits are appreciated and have served, in part, to break up Marty's day. Recently he noted that at times he is bored. Hence today he played Rummikub with Erica, and won! (this according to Erica).

"May your unfailing love rest upon us, O LORD, even as we put our hope in you." -- Psalm 33:22

Mike

Friday

As it turns out, Marty does NOT have shingles. This is good news. He does have a rash, but not one that is identifiable. The nurses aren't too concerned at this time, and so we are not too concerned.

Today Marty got an injection which will promote the growth of white blood cells. This is a normal part of going through chemotherapy as these cells really decrease during the chemo treatment. 

Communication with Marty has been a challenge as of late -- involving a lot of lip reading and Marty writing things down for us to read. Recently, he's been able to talk in a soft whisper. One has to lean right by Marty to hear him, but this is making communication easier.

An occupational therapist coached Marty through a sponge bath which he did himself. It's nice to witness his strength and mobility increasing day by day as well as his ability to do more and more things for himself, albeit seemingly small things. We continue to walk this journey with Marty, and together we walk this journey with our LORD.

"For the Lord God is a sun and shield;

    the Lord bestows favor and honor;

no good thing does he withhold

    from those whose walk is blameless."

-- Psalm 84:11

Mike

Thursday

Just a brief update for today. Marty is off the steroids as of today. So far his white blood cell count is good; although they have been giving him injections to boost his WBCs without waiting for them to decrease.  This is not to say that they won't go down despite this injection because that is still a possibility. 

Marty had physio again today.  Physio consisted of putting on pajama pants and socks, maneuvering himself to the side of the bed, and then standing beside the bed holding onto a walker, then sitting back down. The physiotherapists really like to see Marty sit tall on the side of the bed but this does require a lot of core muscle strength and so takes a lot out of Marty.

Marty was a little uncomfortable this evening; though he did deny having any pain.  Earlier today we noticed a rash on Marty's arms and upper torso.  The rash seemed to get bigger throughout the day and developed white blisters therefore the nurses suspect he has shingles. The infection control doctor will come by tomorrow to confirm the diagnosis. We pray that our heavenly Father will surround Marty with the comfort and peace of His nearness.

"Be joyful always; pray continually; give thanks in all circumstances, for this is God's will for you in Christ Jesus."

1 Thess. 5: 16 - 18

Amanda

Wednesday

Today was all around a pretty good day for Marty. We are encouraged by the progress that we see him making on a daily basis. The physiotherapist and the occupational therapist came by today. They made Marty put on his own socks and pyjama pants while lying in bed. He also sat up in bed trying to balance himself -- this uses a lot of core muscles. Then Marty stood up beside his bed. 

The speech therapist came by to do a swallow study. Every time Marty took a sip of water he coughed so the speech therapist was not comfortable with him taking anything more than ice chips at this time. As the speech therapist cannot determine whether or not water from the ice chips is going into Marty's lungs, she has put a limit on the amount of ice chips he can have at a time. She will be by again in the next couple of days to do another swallow test, to see if there is any improvement.  

This morning Marty had his last dose of chemotherapy.  He had a good sleep last night and was not bothered by nausea or vomiting.  

The respiratory therapist came in today to replace Marty's tracheotomy (trach) tube with a different style trach tube. While at first we were wondering why the style change, we later found out that the "new" style is just the brand of trach tube that the Juravinski Cancer Centre stocks. It's also very normal that trach tubes are replaced on a fairly regular basis.

We continue to thank God for the improvements that we see in Marty's health and pray that as we approach day seven (typically a chemo patient's "low" day) that Marty will continue to do well.

"You will keep in perfect peace those whose minds are steadfast, because they trust in you. Trust in the Lord forever, for the Lord, the Lord himself, is the Rock eternal." -- Isaiah 26:3-4

Amanda

Tuesday - Round 2, Day 3

Today Marty got taken off 2 of the 3 antibiotics he was on.  The doctors will leave him on a broad spectrum antibiotic, hoping to "catch" any sort of bug in general before it starts to negatively affect him.
  
The doctors have also decided to wean him off the steroids that he is on.  We are unsure how Marty will react to this.  When Marty was in Guelph Hospital they had him on high dose steroids as well; which he reacted very well to, but as soon as they weaned him off the high dose steroids his health declined again.  Steroids are very hard on the body as they decrease muscle mass and bone density so the doctors don't want him to be on the steroids for a prolonged period of time.

Marty is on anti-nausea medication. Despite this he was nauseous and vomiting through the night last night and therefore did not have a very restful night.  The nurse did reassure Erica that they will put him on a few different kinds of medications tonight to counteract the nausea and vomiting.  The doctors have decided not to stop Marty's feeds so he continues to receive nourishment via the PEG tube.  

The physiotherapists continue to work with Marty. Today he sat on the side of the bed for a very short time without support.

We pray that the physical discomforts that Marty experienced last night may be diminished and that he will be granted a restful night of sleep. 

"Praise be to the Lord, to God our Saviour, who daily bears our burdens." 

Psalm 68: 19

Amanda 

(and Jolene via Skype)

Monday Round 2 - Day 2

On Monday Marty received 2 units of blood due to the fact that his hemoglobin was low. 

The physiotherapist came by and supported Marty in standing beside his bed for about 1 minute.  He also did additional physio with Erica helping him do exercises for his legs.  Marty seems eager to do the physio and asked Dad to help him do his arm exercises later in the day. At one point during the day Marty was able, with Dad's help, to boost himself in the bed by bending his legs and digging his heels into the bed and pulling up on the headboard with his arms. This is encouraging to see and he seems to be more able to move around in the bed to get to a comfortable position.  

Marty's chemotherapy got started at about 10:30 pm.  This was a little bit later than anticipated but Marty was receiving numerous drugs prior to the chemo being started.  As mentioned before Marty's pH level needs to be at a certain number prior to chemo being started.  Before they started the chemotherapy they also needed to test Marty's neurological function.  A couple of the tests he needed to do was:
- write his name,  
- touch the nurses finger and then his nose with both his left and right hands, 
- pull his right leg up to his left knee and then slide it down his right leg (done with both legs).
This provides the doctors with a baseline neurological function and will be repeated as they administer the chemo drugs during this round of therapy.  Despite the fact that Marty had to be roused from a deep sleep he performed these tests quite well; although his right side is definitely stronger.   

We are thankful for yet another day with Marty and pray that our Heavenly Father will continue to sustain him. 

"In Him I trust so completely 

as to have no doubt 

that he will provide me 

with all things necessary for body and soul, 

and will also turn to my good 

whatever adversity he sends me 

in this life of sorrow. 

He is able to do so as almighty God, 

and willing also as a faithful Father. "

Heidelberg Catechism 

Q/A 26

Amanda and Dad

Monday

Today we will not publish a formal update for the blog as Dad is not yet home from the hospital and he was the one visiting Marty for most of the day. Amanda and Mike visited Marty for about an hour this morning and Erica and her three oldest boys could spend some good time with Marty today. Anyway, you can expect another update on Marty again tomorrow.

We wish students, teachers, parents, and all other people involved with elementary and high schools the LORD's blessing as they begin another school year tomorrow. Marty is a teacher, and our hearts go out to him, his family and to his school community during this time. 

Sunday - Round Two

Today Marty started his second round of chemotherapy at around 10:00 pm. The drug is to be given intravenously over a three-hour time period.  Prior to the start of the chemo drug he was given three different kinds of antibiotics and plenty of fluids.  In order for the chemo to be most effective the pH level in Marty's body had to be at a certain level.  After the nurse came in to explain the antibiotics and how they would be given, Marty wrote on paper asking Mom if she understood everything the nurse told them.  Mom said yes she did and did Marty also understand everything that was said.  Marty then proceeded to write down everything the nurse said, the amount of millilitres per hour of the drug to be given over the number of hours.  This is comforting to know that Marty does understand what is going on at this time.

Again Marty had a good day and toward the end of the afternoon asked Dad to help him sit up.  This was on his own volition.  Dad could tell that he seemed stronger even than yesterday and we all take this as a good sign that he is wanting to sit.  

We are not sure how Marty will react to this round of chemotherapy drugs because although the drugs are the same as the first round, the doctors have told us that not every patient reacts the same way every time they get the drugs.  We pray that God will work with this treatment and help it to be effective in killing the cancer cells and also that Marty will not have a severe reaction to the drugs.  May the Great Physician grant healing and guide the hands of the doctors.

Isaiah 41:10

"So do not fear, for I am with you; do not be dismayed, for I am your God.  I will strengthen you and help you; I will uphold you with my righteous right hand."

Amanda

Saturday

As Marty awaits his second round of chemotherapy on Sunday, his physiotherapy is ongoing. Even when he is having the chemo, he is scheduled for physio treatments. Marty is demonstrating increased strength in that he sat up straighter in bed, and with more control than during previous attempts. He then stood up, free from the bed twice, with him standing there for one minute the second time. When he stands, he carries his own weight, but he has the support of two people for balance.

Today, Marty had a surprise visit from three of his uncles who are visiting from Winnipeg. As it had been around a year since Marty had seen these men, it was wonderful to witness his immediate recognition of them. 

We wish Marty the LORD's strength and blessing as he begins his second round of chemo tomorrow. 

"This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us." -- 1 John 5:14

Mike