August 5, 1946 - May 5, 2010

At 3:05 p.m. this afternoon, dad left this world. The past few days, he has been surrounded by his family, friends, and pastor. It was as it should be. He had been unresponsive for more than 24 hours, but just minutes before passing, he squeezed mom's hand. I am overcome with peace by the knowledge that he is no longer fighting and his spirit is at rest.

Warmest gratitude to all who have walked through the last 21 months with our family. We are deeply grateful.

"For what is it to die but to stand in the wind and to melt into the sun?
And what is it to cease breathing, but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered?

Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance."
Kahil Gibran, The Prophet

Onward....

The last few weeks have been tough to say the least. Mom and dad traveled to St. Louis where dad had a new stint placed in a bile duct and underwent a nerve block to help with the pain management. While there, it was discovered that he had double pneumonia. A recent scan revealed the cancer has metastasized significantly and vastly. Mom and Aunt Joan have to empty the chest tube that was placed in his right lung every other day. Fluid has now started building in his left lung. He is home now. Nurses come into the home a few times a week, though mom does the majority of his care. Dad is determined to continue to fight the disease with everything he has. It is a remarkable fight.

Thank you for your continued support and prayers.

Angie

Good day

Better day today--fish fry with lots of grease, fun, and sunshine. Was enjoyable for dad to have his family and friends surrounding him.

I am leaving you with a gift-peace of mind and heart! And the peace I give
is not fragile like the peace the world gives. So don't be troubled or afraid.
John 14:27

Quick Update

Dad is in significant pain with is only partially managed with the medications he is currently on. He is eating very little when at all. Saw the oncologist yesterday--his chest x-ray revealed no change in his lung status, which is good. Lots of family around--dad has had a nice visit with Uncle Don and Aunt Marge. Uncle Craw and Tim returned last night. Thank you for the continued thoughts, prayers, and calls.

Angie

Monday

Dad is hanging in---he is in a great deal of pain. He has a chest tube that mom has to manage daily. He is still trying to keep his spirits up, though reality is taking its toll on him. Craw is staying in Sikeston, for which we are deeply grateful. His physical and emotional support have been invaluable.

The extended Bixler family came to Sikeston over the weekend and did a tremendous amount of work around the house for mom and dad. We are so grateful for their acts of love and labor.

We continued to be so touched by the outpouring of love and support, but at this point we need to ask that anyone outside the family limit their visits to 10 minutes. Dad loves the visits, but he needs to conserve his energy. He would not want me to say this...but it's better to ask for forgiveness than permission ;-) Thank you for understanding.

Warmest,
Angie

Sunday morning

Yesterday, the goal of the procedure dad underwent was to explore the lungs with a small camera, to identify the source of the bleeding, to cauterize the tumor thought to be producing the blood, and seal the lining of the lungs with a powder to prevent pooling. After only having dad back in surgery for a short time, the surgeon called us back for a talk. He explained that the exploratory procedure with the camera revealed that there is Stage IV cancer "everywhere" in the lungs. There are multiple tumors in the lungs, all of which are producing blood. I'll spare you the other details. So, dad will have a permanent tube coming from his lungs that will allow him to manage the fluid and prevent the lungs from filling.

He was kept in ICU overnight to be monitored and will remain there until late this afternoon. The goal now is for dad's pain be managed and for him to enjoy the time he has with his family and friends. We will know more after we see the oncologist tomorrow, who will determine if dad can come home.

You have heard us say repeatedly how inspired we have been at dad's will and attitude throughout his fight. Yesterday, the surgeon (I am calling him "the surgeon" instead of his name because I have no idea how to spell it, and can barely say it-but he was wonderful) anyway, the surgeon said that before he met dad, the longest living patient with Stage IV pancreatic cancer he had ever seen had lived 13 months. Dad was diagnosed 19 months ago in March. Truly amazing.

On a lighter note, in the spirit of the Olympics, there was an intense crossword puzzle competition in the waiting room. Girls, I'm glad to report that the only female in the running dominated!! (Sorry, Tim).

All of us, especially dad, have been truly touched by the outpouring of love demonstrated by so many. Please continue to hold up mom and dad in your prayers. Each day holds abundant challenges, but our faces are turned upwards and our hearts are linked.

Love,
Angie

Friday

Dad says to thank everybody for your visits, phone calls, prayers, and messages. He also says to thank everyone for how you have supported mom, Tim, and me.

We're still waiting--dad had a blood transfusion this morning-his second. He has a chest tube in the right side of his body which is continuing to drain blood. The doctors are not sure of the source of the blood. His blood pressure is low, and the doctors are not sure why it is remaining so low. His nurse, Dillard (who's great) just told us that the BP should have come up following the transfusions and following a meal. So, that's a concern. Dad is in a moderate amount of pain, but they are managing it fairly well with medications. He's very lethargic, but still talking and eating a little bit. If the blood continues to drain from the lungs tomorrow, they will try to perform an exploratory procedure to identify the source. So...that's where we are and what we know.

We've read dad your messages. He was very touched to hear from you all.

Gotta run, the pastor just brought us in a basket of chocolate!

Warmest,
Angie

Walking through the unknown

If you are reading this now, please stop and say a prayer for my dad. James, Ben, Sam, and I are leaving to go to Missouri in a few minutes. Emotionally, dad is doing well. He is up talking with Craw, Harley, Mom and Tim and is feeling pretty good. Physically, there are some serious complications and the source of these complications seems to be eluding the doctors right now. We are going hour to hour now...dad could pull right through this as he has done before. However, the situation does not appear good at the present time. Leave a message of hope and cheer here for dad if you'd like, and we will read it to him.

Angie

Procedure went well

Dad has just returned to his room from recovery following his procedure. He has a tube in his right side placed between two ribs. They drained 2 liters of fluid already and the surgeon is optimistic that he will be able to perform the second procedure to seal the lining around the lungs in the next couple of days to prevent fluid from gathering in that space. Talked to dad a few minutes ago. He is a bit out of it from the anesthesia, but is in good spirits, as usual. This procedure is supposed to be very painful, but we are hopeful the pain can be managed with meds. The next few days will be critical for monitoring the development of infection. Infection is a risk since a foreign body has been introduced and since dad's WBC remains low.

Tim, mom , Uncle Harley and Aunt Joan are with him now. The pastor spent the morning with them as well. Thank you all for your continued support and prayers.

On the road

Mom and dad are on their way back to Missouri. Dad was released from the hospital yesterday afternoon. There was still some fluid in his right lung and fluid has started building in his left. The doctor said there is a procedure they can do to seal the perforation in the lung, so mom and dad will follow up with the oncologist Monday to discuss options. We are still waiting for the analysis of the fluid that was completed two weeks ago in Cape.

Update

Just left the hospital. Dad is definitely much better than he was this time last night. Still in pain from the procedure they completed to drain the fluid. He's in good spirits, though tired. He will get an x-ray in the morning to assess the right lung and to be sure the fluid is not returning. We are praying that the lung is clear with the exception of the fluid they could not drain today. As I was leaving, I told him that I was so sorry he was having to endure all of this. He said some people have it much worse and that, "It really ain't nothing but a thing."

Angie

Sam's baptism - Tuscaloosa, AL

What a surprise!!

Isaiah 58:8-11:


"Then your light will break forth like the dawn,
and your healing will quickly appear;
then your righteousness will go before you,
and the glory of the LORD will be your rear guard.

Then you will call, and the LORD will answer;
you will cry for help, and he will say: Here am I.
If you do away with the yoke of oppression,
with the pointing finger and malicious talk,

and if you spend yourselves in behalf of the hungry
and satisfy the needs of the oppressed,
then your light will rise in the darkness,
and your night will become like the noonday.

The LORD will guide you always;
he will satisfy your needs in a sun-scorched land
and will strengthen your frame.
You will be like a well-watered garden,
like a spring whose waters never fail."

When the phone rang this morning, and I looked at the caller id, I was prepared for the worst. As Tim reported, mom and dad were given difficult news by the oncologist two weeks ago and this morning was the appointment with the oncologist to get results of the CT scan. Even Monday, his labs revealed that his tumor markers were elevated, evidently confirming the news the doctor had shared two weeks ago--that the chemo was no longer working. He had recommended mom call Hospice. Well...the CT scan revealed the seemingly impossible...the pancreatic tumor has shrunk!!! The lung nodules have also shrunk. The doctor was a bit baffled, to say the least.

So...now, dad will start chemo again. The chemo regimen may change, as the more toxic of the two drugs creates debilitating side effects including neuropathy in his limbs and fingers and vision problems. A new Phase 3 clinical research trial is beginning in St. Louis. Dad may be a candidate for the study--his M.D. is looking into that as a potential option.

While this is wonderful news, and we're all thrilled, the disease continues to take its toll in numerous ways in mom and dad's lives. They show amazing strength, though the challenges are vast.

As always, we are deeply grateful for the continued prayers and support. We are confident that this progress is due to the power of prayer, the wonderful care dad receives from mom, and the positive outlook he has maintained throughout this experience.

With love and gratitude,
Angie

Our dear cousins, Bill and Connie Reid, are participating in a walk funded by the Pancreatic Cancer Action Network in St. Louis October 18. They are walking in honor of Connie's friend and in honor of dad. Please don't feel pressured to contribute. I just wanted to take a moment to thank Bill and Connie for this kind gesture and to provide additional information to anyone who may want to offer a donation, or to participate in another way. The link to Bill and Connie's team page is below, followed by information about PanCan and the event in St. Louis.

http://pancan.kintera.org/faf/donorReg/donorPledge.asp?ievent=316311&lis=1&kntae316311=40D8C9C3C02647559E9B8E9538D3C80C&supId=265099601

The Pancreatic Cancer Action Network is a non-profit organization working to advance research, support patients and create hope for those affected by pancreatic cancer. The organization funds research grants, provides information and resources to patients and their families at no cost, pushes for increased federal research funding and educates the public about this disease.

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States, yet it receives less funding per patient than other leading cancer killers. Your support helps the Pancreatic Cancer Action Network fulfill its mission and provides hope to the over 37,000 Americans who will be diagnosed with pancreatic cancer this year.

Ben and I spent several days with mom and dad this week and had a great visit. One night, the Bixler brothers hosted a fish fry....pretty serious business as you can tell from this shot.



Dad is very tired and experiencing painful side effects secondary to the Neupogen injections he receives to replenish his white blood cell count. The chemo regimen he is on attacks the bone marrow, depleting red and white blood cells and platelets. However, as Tim described in the previous posts, dad never skips a beat. He is pushing and fighting and doesn't want to sit around and talk about cancer. Funny....one of Grandpa Bixler's canes was at the house. Uncle Craw told dad that he should use it to get around. Dad replied, "I don't want people to see me with it and think I'm sick."

For their birthdays, mom and dad received a veranda swing for the back yard. We couldn't get these three out of it to move it over the fence!




As always, thank you for the continued support and prayers.

Matthews reunion

Mom and dad attended the Matthews High School reunion this weekend with Uncle Craw and Aunt Jo. They had a great time.

Doctor called.....

To tell dad that the tumor markers they drew yesterday were 5,000 lower than those from the end of Feb. This most likely indicates that dad responded positively to the chemo he received two weeks ago. There is anticipated fluctuation in these numbers. Hopefully, this decrease is a good sign. They will check the markers again in two weeks to see how he responded to yesterday's treatment.

Bad news

Dad learned at his oncologist appointment today that his tumor markers had jumped from 4,000 to 15,000. A rise like this typically indicates that the cancer has metastasized. The doctor attributed this spread to the length of time dad went without treatment while he was hospitalized. There is no line of treatment beyond what he is currently receiving. He received a treatment of 5FU and oxaliplatin today, which will be infused for the next two days. They will check the markers again next week. If the markers have not decreased, the doctor recommended that dad discontinue treatment. Obviously, mom and dad are distressed today, but remain hopeful that the tumor will respond to the treatment. Mom and dad asked the oncologist if there are any clinical trials for which dad would be appropriate. We also are checking the online clinical trials databases. Given the advanced state of dad's cancer, it is doubtful that we will find a clinical trial. Please continue to pray.

March Madness

Isn't that the truth!? Dad received his first chemo treatment last Tuesday after being prevented from receiving treatments due to the blood infection and subsequent complications. He went to St. Louis to have his liver stent replaced, at which time it was discovered that the stent had been the source of the infection all along. Tim had guessed that from the beginning. Just to recap....the doctors (after days of discord on the issue) decided to allow the infectious disease physician to remove dad's port, as the doc was convinced the port was the source of the infection. Dad learned last week that all cultures taken from the port after it was removed were negative (no infection). Because the port was removed, a pic line was placed in his arm so he could receive his antibiotics. Mom has to flush the line twice daily. She is doing a fabulous job, though admits she did not miss her calling to be a nurse!

So...back to the chemo. Dad is now on to a Phase 2 chemo regimen consisting of a cocktail of 5FU and oxaliplatin. The oxaliplatin is more toxic than the tarceva was, but has shown promising results in preliminary studies completed at MD Anderson. Dad also has a new oncologist, as Dr. Sorscher is now only seeing his patients in St. Louis. This was a difficult transition, as mom and dad had developed quite a fondness and trust for Dr. Sorscher and his nurse, Sherry.

Dad is feeling quite fatigued from the chemo, but is hanging in there. He is watching lots of basketball and has been doing some yard work. Benjamin and I spent my spring break with mom and dad and had a great time. Somehow, I got through the whole week without taking a picture of dad and Ben, but here is one of "MiMi Lou" and Ben at the park that I love. Funny .....Ben started calling dad "Grandpa Lou!" Ha.



An interesting theme that has emerged is that each doctor who saw dad at the time he was diagnosed has been shocked to see how well he is still doing. His GI specialist in St. Louis said he must be a special man....he admitted he did not expect to see dad back at 7 months post dx. Everyone, even the specialists, agree that dad's attitude is the source of his strength and perseverance.

Please continue to pray for dad and mom. Each day is a blessing no matter our circumstance.

Today...

Dad was admitted to Southeast Hospital. His liver enzymes are elevated, his fever spiked to 103.8, and some new symptoms have emerged including severe chest pain. They have ruled out pneumonia, heart attack, and lung infection. They are running many tests to identify the source of these symptoms. We'll keep you posted