So far Ava is doing really well on this chemo! At least, she seems otherwise fine and is playing a lot and cheerfully. We continue to pray for no side effects but rejoice in the fact that she is able to play during this time.
Ava will stay in the hospital one more night tonight, only because her chemo will finish around 10pm. Tomorrow her chemo will finish at 8pm so they will go home for the night and then return the following day. The timing/cycle is such that each day Ava will finish her chemo 2 hours earlier than the previous day, so she should be done around 4pm on Friday. Woohoo!
Thank you so much for your prayers!
Tuesday, September 30, 2014
Monday, September 29, 2014
Last Round of Chemo?
Ava started her 5-day treatment of chemo today. This may be her last round of chemo before heading out to Seattle. She's getting nelarabine, etoposide and cyclophosphamide this week. You may remember that nelarabine has the potential to cause some serious nervous system side effects. Please pray that Ava would display none of them!
Their original plan was to keep Ava at Lurie's the whole week during chemo. However, if she does well through tomorrow, they will consider letting her get chemo on an outpatient basis for the remainder of the week! That would be great - even though she would need to be at Lurie's for a full 8 hrs, the prospect of going home to sleep in her own bed at night is definitely appealing!
Thank you for your continued prayers!
Their original plan was to keep Ava at Lurie's the whole week during chemo. However, if she does well through tomorrow, they will consider letting her get chemo on an outpatient basis for the remainder of the week! That would be great - even though she would need to be at Lurie's for a full 8 hrs, the prospect of going home to sleep in her own bed at night is definitely appealing!
Thank you for your continued prayers!
Feeling Better
Thank you for your prayers, the Lee family is all doing much better post-virus, and it looks like Mike didn't get the full brunt of it in the end. Thanks again for your prayers!
Lots of logistical things and questions to ask/decisions to make in the next weeks. Ava goes in for chemo tomorrow. We'll keep you updated.
Lots of logistical things and questions to ask/decisions to make in the next weeks. Ava goes in for chemo tomorrow. We'll keep you updated.
Friday, September 26, 2014
Enterovirus and Next Steps
Ava was at the ER earlier this evening to get nebulizer treatments for a couple of hours. Both girls have enterovirus (the ED68 that's hitting asthmatic kids pretty hard). Ava & Gwen are on steroids and nebulizers to manage their symptoms. Please pray for them, and also for Mike & Esther: Esther is pretty sick and Mike is just starting to have symptoms. Thanks in advance for your prayers.
Looking ahead, Seattle is eager to have Ava out as soon as possible for transplant (e.g., as soon as yesterday). Obviously, this is challenging on a practical level and they recognize that. And as Mike mentioned in his most recent post, the doctors feel there is benefit for Ava to have another round of chemo before transplant. This is because:
1) Ava hasn't had chemo in a little while. It may be another couple of weeks before she can even get out to Seattle, so they don't want to leave her cancer "unchecked" for too long.
2) Ava's residual disease shows mainly T-cell leukemia, and there is a drug she hasn't had yet that specifically targets T-cells. (The drug in discussion is nelarabine).
3) If this new chemo regimen can drive down Ava's MRD any further (to MRD negative even!), that would put her in a much better position going into transplant.
The downside? Nelarabine has some pretty serious side effects (like all chemo). But nelarabine can cause problems in the nervous system such as seizures, tingling/numbness, paralysis, even brain damage (though these are "less common"). Still, the small percentage makes little difference to anyone who actually experiences any of these side effects. On the other hand, the potential to attack the cancer with greater efficacy outweighs the risks here if it means Ava's life.
At this point, we don't know for sure if this is the drug (among others) that they will try on Ava this next round. Ava is scheduled to go in on Monday to begin a 5-day course of chemo, but the actual drug regimen is unknown to us right now. I guess we will find that out on Monday.
It is possible that the Lee family will be out in Seattle in a couple of weeks. We'll have to see what the doctors say about Ava's next chemo regimen (and how she responds), and when they feel Ava would really need to be in Seattle. Please pray that the enterovirus will not hinder her on this trajectory, or anyone else in the Lee family. Of course, we rest in God's sovereignty and great wisdom. His ways are higher than our ways. Please pray for the Lee family to remain in that place of "rest" even amidst very practical busyness. So many things happening and all rather quickly.
They are thankful for each one of you and covet your prayers!
Looking ahead, Seattle is eager to have Ava out as soon as possible for transplant (e.g., as soon as yesterday). Obviously, this is challenging on a practical level and they recognize that. And as Mike mentioned in his most recent post, the doctors feel there is benefit for Ava to have another round of chemo before transplant. This is because:
1) Ava hasn't had chemo in a little while. It may be another couple of weeks before she can even get out to Seattle, so they don't want to leave her cancer "unchecked" for too long.
2) Ava's residual disease shows mainly T-cell leukemia, and there is a drug she hasn't had yet that specifically targets T-cells. (The drug in discussion is nelarabine).
3) If this new chemo regimen can drive down Ava's MRD any further (to MRD negative even!), that would put her in a much better position going into transplant.
The downside? Nelarabine has some pretty serious side effects (like all chemo). But nelarabine can cause problems in the nervous system such as seizures, tingling/numbness, paralysis, even brain damage (though these are "less common"). Still, the small percentage makes little difference to anyone who actually experiences any of these side effects. On the other hand, the potential to attack the cancer with greater efficacy outweighs the risks here if it means Ava's life.
At this point, we don't know for sure if this is the drug (among others) that they will try on Ava this next round. Ava is scheduled to go in on Monday to begin a 5-day course of chemo, but the actual drug regimen is unknown to us right now. I guess we will find that out on Monday.
It is possible that the Lee family will be out in Seattle in a couple of weeks. We'll have to see what the doctors say about Ava's next chemo regimen (and how she responds), and when they feel Ava would really need to be in Seattle. Please pray that the enterovirus will not hinder her on this trajectory, or anyone else in the Lee family. Of course, we rest in God's sovereignty and great wisdom. His ways are higher than our ways. Please pray for the Lee family to remain in that place of "rest" even amidst very practical busyness. So many things happening and all rather quickly.
They are thankful for each one of you and covet your prayers!
Wednesday, September 24, 2014
A very real post about nothing really
It's been non-stop action since we were told Ava needed a transplant and we headed out to visit the best transplant centers we could find. After Ava's bone marrow biopsy last Wednesday, we piled into the car and drove to Ohio. Then a few days later, we found our way to Minnesota. Each consult was balanced with grim realities and hopeful outcomes as we were laden with more info than a first year med student. :)
It's sobering to hear statistics about my child's case. Especially, you know, because my girl is special to me, a one-of-a-kind gem. She's not a number, an interesting case, or, God forbid, a statistic. But the reality is that Ava is in very real danger of a relapse if we do not move quickly. Yet, how can we get our whole lives in Chicago neatly packed up in a few short days? How do we tell Ava to say goodbye to her room, her house, her friends, her school, her church, her dog, her aunts and uncles and cousins, knowing that she is flying full fledged into the most precarious situation she has ever known?
This requires supernatural strength like we've never had to showcase before. Our hearts are made of steel as we give Pippin away for a year. Our smiles defy logic as we cheer Ava along as if our trip to Seattle is a fantastic adventure. The longing for our past lives is hidden behind calm and collected posts and conversations about what the future holds.
Yet, the truth is, our hands tremble and betray us as we type out list after list of "things to do", our hearts waver between the choices we have made so far, and our smiles are traded in for heart-stopping sobs as we ponder the unfathomable.
We want our girl happy; we want our girl healed; we want our family complete.
But life is not about what we want. It's about something bigger than us. And so we lay down our frantic fears and put up our shaky hands and expect greater things, more beautiful things. Because, after all, it's not about this life anyway.
It's sobering to hear statistics about my child's case. Especially, you know, because my girl is special to me, a one-of-a-kind gem. She's not a number, an interesting case, or, God forbid, a statistic. But the reality is that Ava is in very real danger of a relapse if we do not move quickly. Yet, how can we get our whole lives in Chicago neatly packed up in a few short days? How do we tell Ava to say goodbye to her room, her house, her friends, her school, her church, her dog, her aunts and uncles and cousins, knowing that she is flying full fledged into the most precarious situation she has ever known?
This requires supernatural strength like we've never had to showcase before. Our hearts are made of steel as we give Pippin away for a year. Our smiles defy logic as we cheer Ava along as if our trip to Seattle is a fantastic adventure. The longing for our past lives is hidden behind calm and collected posts and conversations about what the future holds.
Yet, the truth is, our hands tremble and betray us as we type out list after list of "things to do", our hearts waver between the choices we have made so far, and our smiles are traded in for heart-stopping sobs as we ponder the unfathomable.
We want our girl happy; we want our girl healed; we want our family complete.
But life is not about what we want. It's about something bigger than us. And so we lay down our frantic fears and put up our shaky hands and expect greater things, more beautiful things. Because, after all, it's not about this life anyway.
Consultation in Minnesota
Esther and I spent a good amount of time after yesterday's consultation discussing which doctor and hospital to move forward with. We ended up sticking with our original plan, which is to bring Ava to Seattle for the cord blood transplant.
We got home from Minneapolis today just in time to get the kids settled and our plan was to head out to our small group Bible study. But then Gwen started showing some very alarming symptoms: respiratory distress, vomiting, fever. We've been keeping the girls separate, and if Gwen gets any worse, we'll take her to Lutheran General.
The consultation at the University of Minnesota was incredibly helpful. To be able to consult with the high risk leukemia specialist ten days earlier than planned was a big encouragement. We were so eager to hear about their unique protocol for doing transplants for those who are MRD positive, ever since we heard last Saturday that Ava's leukemia levels remained the same inside her bone marrow.
We ended up concluding that this special protocol being offered was not for Ava. But the doctor actually did not recommend his protocol for Ava. Instead, he recommended one more cycle of a different chemo drug before heading for transplant. This was very eye-opening for us, because we had been thoroughly convinced that any further delay in transplant would be too risky. But to summarize his insight: do we put the risk on the front end (by delaying transplant in order to lower the MRD levels even further with chemo), or risk it at the back end (by having a higher chance for relapse due to doing the transplant with positive MRD)?
He thinks that there's a drug that Ava hasn't tried before, which might lower the amount of leukemia in her body. Lowering the level from .03 to .001 is critical to having a successful transplant that does not end in relapse. (A second transplant due to relapse is often unsuccessful.) So we have benefited greatly from this visit, and are currently working out a way to get to Seattle for the transplant as soon as possible, but try to fit in a 5-day course of this chemotherapy drug before heading out.
For Esther and I, the decision to stick with Seattle comes down to one key factor which we believe gives Ava the best opportunity to have long term disease free survival. Ava is eligible for the stem cell expansion program in Seattle, which is not being offered anywhere else. It was designed to make cord blood transplants safer. But it's still in the early phases of development, and can only be offered through a randomized selection process. The doctor herself actually does not know what the percentages are for being selected.
Although the dice is rolled and it seems we are leaving the results to chance, Esther and I believe that God is not in the least limited by what may seem random to us. We have been asking that God be involved in this computerized algorithm the same way He is in all things: more purposeful and prepared than we could ever fathom. So we regard Seattle's stem cell expansion program as one way that plays favorably into Ava's upcoming transplant procedure. It's a chance that we don't want to take for granted, and what we believe is part of God's plan for Ava.
If she doesn't get selected for it, going to Seattle involves FAR MORE than just that added treatment. We are already beginning to be hit (in a very good way) with the world of provision and care that we know will change our lives in deeply beneficial ways. We are so blessed by those who have already reached out to us from Washington, and for friends and family who have been connecting us to such great people there.
As we prepare to go, we have so many people to thank. Our church (NSCCC), family (the Lee's), relatives (from all over), friends (old and new), Ava and Gwen's school (Pritchett Elementary) - we have been sent off with absolutely nothing to worry about other than being by Ava's side the whole way through. We are SO thankful for each of you.
Please keep praying for us:
- for Gwen's health
- for Ava to be selected for the stem cell expansion
- for wisdom regarding one last cycle of a new chemotherapy
If we choose to go with it, that 1) it would drive down the MRD even further BEFORE the transplant, and 2) all common and unlikely effects would be avoided, most notably any neurological (brain) damage.
We got home from Minneapolis today just in time to get the kids settled and our plan was to head out to our small group Bible study. But then Gwen started showing some very alarming symptoms: respiratory distress, vomiting, fever. We've been keeping the girls separate, and if Gwen gets any worse, we'll take her to Lutheran General.
The consultation at the University of Minnesota was incredibly helpful. To be able to consult with the high risk leukemia specialist ten days earlier than planned was a big encouragement. We were so eager to hear about their unique protocol for doing transplants for those who are MRD positive, ever since we heard last Saturday that Ava's leukemia levels remained the same inside her bone marrow.
We ended up concluding that this special protocol being offered was not for Ava. But the doctor actually did not recommend his protocol for Ava. Instead, he recommended one more cycle of a different chemo drug before heading for transplant. This was very eye-opening for us, because we had been thoroughly convinced that any further delay in transplant would be too risky. But to summarize his insight: do we put the risk on the front end (by delaying transplant in order to lower the MRD levels even further with chemo), or risk it at the back end (by having a higher chance for relapse due to doing the transplant with positive MRD)?
He thinks that there's a drug that Ava hasn't tried before, which might lower the amount of leukemia in her body. Lowering the level from .03 to .001 is critical to having a successful transplant that does not end in relapse. (A second transplant due to relapse is often unsuccessful.) So we have benefited greatly from this visit, and are currently working out a way to get to Seattle for the transplant as soon as possible, but try to fit in a 5-day course of this chemotherapy drug before heading out.
For Esther and I, the decision to stick with Seattle comes down to one key factor which we believe gives Ava the best opportunity to have long term disease free survival. Ava is eligible for the stem cell expansion program in Seattle, which is not being offered anywhere else. It was designed to make cord blood transplants safer. But it's still in the early phases of development, and can only be offered through a randomized selection process. The doctor herself actually does not know what the percentages are for being selected.
Although the dice is rolled and it seems we are leaving the results to chance, Esther and I believe that God is not in the least limited by what may seem random to us. We have been asking that God be involved in this computerized algorithm the same way He is in all things: more purposeful and prepared than we could ever fathom. So we regard Seattle's stem cell expansion program as one way that plays favorably into Ava's upcoming transplant procedure. It's a chance that we don't want to take for granted, and what we believe is part of God's plan for Ava.
If she doesn't get selected for it, going to Seattle involves FAR MORE than just that added treatment. We are already beginning to be hit (in a very good way) with the world of provision and care that we know will change our lives in deeply beneficial ways. We are so blessed by those who have already reached out to us from Washington, and for friends and family who have been connecting us to such great people there.
As we prepare to go, we have so many people to thank. Our church (NSCCC), family (the Lee's), relatives (from all over), friends (old and new), Ava and Gwen's school (Pritchett Elementary) - we have been sent off with absolutely nothing to worry about other than being by Ava's side the whole way through. We are SO thankful for each of you.
Please keep praying for us:
- for Gwen's health
- for Ava to be selected for the stem cell expansion
- for wisdom regarding one last cycle of a new chemotherapy
If we choose to go with it, that 1) it would drive down the MRD even further BEFORE the transplant, and 2) all common and unlikely effects would be avoided, most notably any neurological (brain) damage.
Tuesday, September 23, 2014
On the Road
Thank you for all of your prayers! The Lee family is on the road back from MN after their consult yesterday. I think Mike will post about the visit sometime after they get home later tonight. Thank you for your patience, prayers, and eager concern and love for the Lee family.
Sunday, September 21, 2014
New Development
As you know, Mike & Esther are doing their best to "plan ahead" without really having much knowledge about what the future holds (or much say in outcomes along the way), while remaining as flexible as possible.
A new development has put Minnesota back on the grid as a potential place for transplant. Originally the doctor there wouldn't be available for consult for another two weeks. But after Ava's biopsy results came back yesterday, Ava's oncologist reached out to him and he got back to Mike & Esther last night! So the Lee family is on the road to MN right now and to meet with this renowned doctor sometime tomorrow (or possibly Tuesday).
You may wonder why they are still considering MN. While Seattle would still be a great place for Ava to have her transplant, this doctor in MN is very well respected in his field (even in Seattle), and MN would be in-network under their current insurance. More importantly, he has/is doing some studies on bone marrow transplants in patients who are still MRD positive (like Ava), and may have valuable input on her care. The Lee family also has some support network of family & friends in MN that will be a great blessing to them.
So, the location of Ava's transplant is back under consideration, but a final decision will need to be made in the next day or two. We praise God for opening up the doors for this consultation, and trust Him to shed light on their next steps. Thank you for praying the same. We will keep you posted.
You may wonder why they are still considering MN. While Seattle would still be a great place for Ava to have her transplant, this doctor in MN is very well respected in his field (even in Seattle), and MN would be in-network under their current insurance. More importantly, he has/is doing some studies on bone marrow transplants in patients who are still MRD positive (like Ava), and may have valuable input on her care. The Lee family also has some support network of family & friends in MN that will be a great blessing to them.
So, the location of Ava's transplant is back under consideration, but a final decision will need to be made in the next day or two. We praise God for opening up the doors for this consultation, and trust Him to shed light on their next steps. Thank you for praying the same. We will keep you posted.
Saturday, September 20, 2014
MRD Results
We just found out the MRD results. They still stand at 0.03% which means this round of chemo was not effective in eliminating the cancer. We are moving quickly toward transplant. Please pray for guidance, logistics, and, most of all, peace.
Thank you for praying with us. We are so grateful to all of our friends, family, and community that have continually surrounded us with love and kindness.
The transplant process will likely be the hardest thing Ava will have to endure so far. We pray that her strong spirit will continue to fight on and make us all proud...if it's even possible to be any more proud than we already are.
Thank you for praying with us. We are so grateful to all of our friends, family, and community that have continually surrounded us with love and kindness.
The transplant process will likely be the hardest thing Ava will have to endure so far. We pray that her strong spirit will continue to fight on and make us all proud...if it's even possible to be any more proud than we already are.
Transferring to Seattle
Thank you for your prayers and messages regarding Ava's biopsy on Wednesday. We do not have the results for the biopsy, and I don't know how likely it is that we'll hear this weekend.
However, things are moving despite waiting for biopsy results. Mike & Esther have decided to transfer Ava's care to the Seattle Cancer Care Alliance.
After meeting with doctors in Seattle and Cincinnati, the message they heard was the same: time is of the essence, and Ava is in imminent need of a transplant. The fact that she did not reach remission in the first month, two months, three months of treatment is a big deal – this shows that her cancer is either resistant or aggressive (or a combination of the two). This means there is a much higher chance of relapse. Although the cancer seems somewhat suppressed by the chemo for the time being, the fact that the residual disease remains (and really hasn't changed much in the last few months) means that the cancer could come back at some point. If it does, it will likely be much more fierce and aggressive, and even more difficult to treat.
As you know, the goal is to get Ava into remission (MRD negative). Once in remission, there would normally be two possible paths of treatment: 1) continue with chemo and hope that chemo itself will be adequate to keep Ava in remission, or 2) get a bone marrow transplant. Given Ava’s unique case of having biphenotypic leukemia, plus her severe allergies/responses to various chemo agents thus far and lack of remission, the transplant docs all agree that going the route of chemo alone is not an option for Ava; she needs a transplant. It is preferable for Ava to be MRD negative before transplant, since any residual disease could render the transplant ineffective. However, the consensus is that the best option is to do transplant, with or without remission first.
Meeting with both Seattle and Cincinnati helped Mike & Esther realize the urgent need for transplant, something they didn’t realize was so critical and time-sensitive. It’s been a bit of a shock to be thrust into the imminence of it all when they thought chemo alone was a viable route. Yet God has guided their steps and helped them to make decisions quickly, but not rashly. They desire God’s plans above any of their own desires, and recognize His sovereignty even over these past 6 months of chemo. He is the source of any and all healing, so our trust lies in the Creator of all things more than any renowned physician or earthly timeline. Still, they are grateful to have the experience and knowledge of these different doctors whose input helped them come to a decision about Ava’s care. Although Minnesota was originally a place of consideration, the doctor there isn’t available for consult for another 2 weeks… too long to wait before figuring out Ava’s care. Seattle has the longest history of transplants and probably the most experience with cord blood transplants (which is what they would do for Ava, especially in the absence of a perfect match). Mike & Esther also have some support network in Seattle that will no doubt be a great blessing and help to them while they are there. Thus, they have decided on Seattle.
There is a lot to be done in the next few weeks. The first and most important is getting their insurance switched so that they could be in a network that includes Seattle. Please pray for success and covering of all such details.
There are numerous other logistics that come with this decision; picking up and moving for an unspecified amount of time is not an easy thing. Seattle docs say that Ava would need to stay for a minimum of 3 months for transplant, but any complications, infections or other setbacks could easily extend their stay to be much longer. This means they’ll also spend Thanksgiving and Christmas away from home, and Esther will probably deliver the baby in Seattle as well (she is due at the end of January). That’s not to mention the pre-transplant preparation that needs to take place for Ava: four days of total body irradiation (twice a day) in an effort to wipe out any/all residual disease. This will no doubt be extremely hard on Ava’s body, in addition to rendering her infertile. There are a whole host of other concerns and what-if’s, but as we are told in Matthew, “Therefore, do not worry about tomorrow, for each day has enough trouble of its own.” They are seeking and trusting God for each step, trying to plan ahead yet take things one at a time so as not to be overwhelmed. It is impossible for our finite minds to address and plan for so many unknowns; we trust in the wisdom of our Heavenly Father. Please pray for God's peace, grace, provision and evident presence in the coming weeks and months! Your support and prayers are invaluable.
In the meantime, Ava may get chemo next week, but the biopsy results will determine if the chemo regimen will stay the same or change. We will let you know when we hear.
However, things are moving despite waiting for biopsy results. Mike & Esther have decided to transfer Ava's care to the Seattle Cancer Care Alliance.
After meeting with doctors in Seattle and Cincinnati, the message they heard was the same: time is of the essence, and Ava is in imminent need of a transplant. The fact that she did not reach remission in the first month, two months, three months of treatment is a big deal – this shows that her cancer is either resistant or aggressive (or a combination of the two). This means there is a much higher chance of relapse. Although the cancer seems somewhat suppressed by the chemo for the time being, the fact that the residual disease remains (and really hasn't changed much in the last few months) means that the cancer could come back at some point. If it does, it will likely be much more fierce and aggressive, and even more difficult to treat.
As you know, the goal is to get Ava into remission (MRD negative). Once in remission, there would normally be two possible paths of treatment: 1) continue with chemo and hope that chemo itself will be adequate to keep Ava in remission, or 2) get a bone marrow transplant. Given Ava’s unique case of having biphenotypic leukemia, plus her severe allergies/responses to various chemo agents thus far and lack of remission, the transplant docs all agree that going the route of chemo alone is not an option for Ava; she needs a transplant. It is preferable for Ava to be MRD negative before transplant, since any residual disease could render the transplant ineffective. However, the consensus is that the best option is to do transplant, with or without remission first.
Meeting with both Seattle and Cincinnati helped Mike & Esther realize the urgent need for transplant, something they didn’t realize was so critical and time-sensitive. It’s been a bit of a shock to be thrust into the imminence of it all when they thought chemo alone was a viable route. Yet God has guided their steps and helped them to make decisions quickly, but not rashly. They desire God’s plans above any of their own desires, and recognize His sovereignty even over these past 6 months of chemo. He is the source of any and all healing, so our trust lies in the Creator of all things more than any renowned physician or earthly timeline. Still, they are grateful to have the experience and knowledge of these different doctors whose input helped them come to a decision about Ava’s care. Although Minnesota was originally a place of consideration, the doctor there isn’t available for consult for another 2 weeks… too long to wait before figuring out Ava’s care. Seattle has the longest history of transplants and probably the most experience with cord blood transplants (which is what they would do for Ava, especially in the absence of a perfect match). Mike & Esther also have some support network in Seattle that will no doubt be a great blessing and help to them while they are there. Thus, they have decided on Seattle.
There is a lot to be done in the next few weeks. The first and most important is getting their insurance switched so that they could be in a network that includes Seattle. Please pray for success and covering of all such details.
There are numerous other logistics that come with this decision; picking up and moving for an unspecified amount of time is not an easy thing. Seattle docs say that Ava would need to stay for a minimum of 3 months for transplant, but any complications, infections or other setbacks could easily extend their stay to be much longer. This means they’ll also spend Thanksgiving and Christmas away from home, and Esther will probably deliver the baby in Seattle as well (she is due at the end of January). That’s not to mention the pre-transplant preparation that needs to take place for Ava: four days of total body irradiation (twice a day) in an effort to wipe out any/all residual disease. This will no doubt be extremely hard on Ava’s body, in addition to rendering her infertile. There are a whole host of other concerns and what-if’s, but as we are told in Matthew, “Therefore, do not worry about tomorrow, for each day has enough trouble of its own.” They are seeking and trusting God for each step, trying to plan ahead yet take things one at a time so as not to be overwhelmed. It is impossible for our finite minds to address and plan for so many unknowns; we trust in the wisdom of our Heavenly Father. Please pray for God's peace, grace, provision and evident presence in the coming weeks and months! Your support and prayers are invaluable.
In the meantime, Ava may get chemo next week, but the biopsy results will determine if the chemo regimen will stay the same or change. We will let you know when we hear.
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