Dear Family, we received this post today and would greatly appreciate your prayers. Our student who underwent the intestinal transplant is fighting for her life. Please, please storm the gates of heaven and stand in her behalf. Many thanks and much love, Terri

Friday, 05-nov-2004

Karis has taken a major turn for the worse. She may not make it. She is fighting two life-threatening situations:
1. her intestine, which is doing very badly;
2. pneumonia in both her lungs, which has even made it difficult for her to breathe even with the respirator. She is coughing up blood and they are going to remove the intestine. The goal is to remove the intestine today or tomorrow before the situation gets worse. It is a fungal infection in the lungs, and they are going to treat it as powerfully as they can. To do that they need to stop suppressing Karis' immune system, which is why they need to take out Karis' intestine.

Karis' brother, Dan, has joined Debbie at the hospital. Karis' sister, Rachel, is on her way. Dave is flying out of Brazil tonight and will arrive in Pittsburgh Saturday.

Karis is in my prayers for a miracle.

Praise be to the Lord God Almighty!!! He preserves the lives of His servants. He hears and answers our prayers! He is faithful and just! He looks upon His children with compassion and mercy! Praise be to our God!

Dear Family, the past 24 hours have been a battle with the powers of darkness. I've included all posts giving you the most recent first. Thank you for your continued prayers in behalf of this child of God! Terri

Saturday, 06-nov-2004

5:00 AM EST: Karis has survived the night! This is an answer to prayer. Though she is still a long way from being 'out of the woods', we rejoice in the following bits of good news: 1. her fever is down; 2. her oxigenation is up from mid-70% to 96%; 3. her blood pressure is stable. Thank you for your continued prayers!!

Friday, 05-nov-2004

3:00 PM EST: The pathologist working on Karis's biopsies did his Ph. D. in Legionaires Disease which is caused by a bacteria named Legionela. There has never been a case of this at Pittsburgh Children's hospital, and the infectious disease specialist at the hospital has seen one case in his entire life. Because of his Ph. D., the pathologist recognized the patterns in the stomach biopsy and was able to diagnose that this is the infection. So they are making up the antibiotic now, three different medicines and will administer it as soon as it's ready. The docs says this gives her a little bit of a fighting chance. If they hadn't found this out, they would never have administered the right antibiotics.

2:30 PM EST: Deb just called. Good news and bad news. The good news is that in spite of the intestine looking awful, the biopsies show no signs of either infection or rejection. The bad news is that Karis may not make it through the night because both of her lungs are almost full. She is breathing through the ventilator, but even so having difficulty breathing and not maintaining the level of oxygen that she needs in spite of their pumping her with as much as they can give her.

They kept Deb out of the ICU the last three hours as they worked on Karis, but now Deb is back with Karis. They are doing everything possible to keep her breathing. She is paralyzed by virtue of a slow drip paralysis and under heavy sedation so that every ounce of energy she has can go into breathing. They've stopped all imunosuppression and are hoping that her immune system will kick in hard and fast. The fact that the intestinal biopsies show no sign of rejection or infection gives the docs hope that they may have 48 hours or if we're really fortunate, 72 hours before the intestine goes into major rejection and they need to remove it. They're not trying to save her intestine, they're trying to save her life. They're hoping that they can turn around the crises in her lungs before they have to go in and remove the intestine.

Right now, Karis is so weak she can't handle a minor surgery in her chest for them to take a biopsy of exactly what kind of infection is in her lungs. So they are hitting her with everything they've got: two anti-fungal medicines, three antibiotics and maybe something else through a new central line dedicated to these medications; her old central line is being used 24 hours with parenteral nutrition trying to get as much energy into her as possible to fight with. The infection is violent, going from practically non-existent in terms of symptoms to life-threatening in 36 hours. She may not make it through the night. And if she does, she may not make it through the next day. It's touch and go.

Dear Friends and Family, as you read the following update, I would ask you to begin to agree with David as he makes his request in the last line below. Pray that God will allow Karis to keep this intestine. That the doctors will decide not to remove it on Tuesday. That she will continue to improve and that the infection would be irradicated from her body. That God would complete the work He has started in her and so bring glory to His Name and the Name of His Mighty and Wonderful Son, our Saviour, Jesus Christ. May you be blessed for your faithfulness to stand in Karis' behalf. Much love, Terri

Sunday, 07-nov-2004

08:00 AM EST: Karis is stable without much change from last night. She continues with 65% oxygen being administered into her lungs (normal is 21%). The percentage of oxygen saturation in her blood is 98%, up from 95-96 yesterday, which is excellent. Dopamine, which increases blood pressure, was reduced from 5 to 2, which is a great move in the right direction. She's bleeding some from her lungs and they've given her platlets for that and will be giving her FFP (Fresh Frozen Plasma). This has impeded their managing to reduce her high level of fluids, inspite of increasing the diuretics they're giving her. Her central venus pressure (CVP) which measures liquids in her body is at 18, normal is 7-8. As a result she's very swollen. They're trying to bring that down to reduce the fluid in her lungs and the pressure on her lungs.

Every hour that goes by is a victory, giving more time for the antibiotics to have effect.

To our surprise yesterday, inspite of stopping all the medications that repressed her immune system, Karis maintained a level of 19 on Prograf, 20 being normal. Apparently the medically induced paralysis, the heavy sedation and the stress on her liver because of all the medications, hasn't permitted that the prograf be eliminated from her system. Since she's responding well to the antibiotics, we're not very concerned about that. The up side of this is that the intestine continued to be protected yesterday from rejection, giving us a little longer before it needs to be removed. The operating room for that is scheduled for Tuesday (96 hours after stopping the prograf, an optimistic scheduling option since we were hoping for 48-72 hours). No one except me (David) is talking about the possibility that maybe we can beat the pneumonia without having to take out the intestine, but it's worth praying about!

Master hear our pleads and answer them oh rightous and holy God!

Amen

Dear Family, if you can take time to read this (from the last post first) you will see that the Doctor's have said this child has 0% chance of keeping her intestine that was transplanted about a month ago. Our God is able to overcome a 0% chance. He's done it many times before. The reason it is important that they not have to take this out is that she had only one uncollapsed vein through which to take nourishment when they started this process. She would have to recover sufficiently for surgery and then they would have to find another intestine where this whole thing would start over. PLEASE PRAY that God will miraculously intervene. We all know that He is able to prove Himself strong. He has done mightier things than this. Please pray and stand with us. Terri

Monday, 08-nov-2004

02:30 PM EST: Karis is stable. The only significant change is the pressure being administered by the breathing machine (oscilator) has been reduced from 34 (lbs per sq inch) to 28. This is a good thing. The goal is to bring it down to below 20, so that she can be placed on a normal respirator. There are no signs yet of dangerous rejection. Surgery continues to be scheduled for tomorrow (Tuesday). The respiration team predicts she'll be on the respirator for another week, and therefore sedated.

07:00 AM EST: Karis is stable, had a very peaceful night and making small significant improvements, the main one being that she is down to 50% on oxygen being sent into her lungs and that her CVP (Central Venous Pressure) is at 15-16 (normal being 7-8). That's the measure for fluids in the body and a major improvement over the 22-23 most of the day yesterday. They've completely stopped the blood pressure medicine and her blood pressure is holding steady. She's tolerating being turned, which yesterday made her stats go crazy enough that they sometimes didn't turn her toward one side or another.
The down side is that she spiked a fever last night and that she has an air pocket between her lungs and ribs that they may need to use a needle to suck out. The fever is a sign of the intestine's rejection and was expected. The air pocket is a side effect of the oscillator which is functioning on 33 pounds of pressure, whereas normal air pressure is 14 pounds.

Next steps and prayer requests:
1. That increased signs of rejection (more blood from the stoma and recurrent fevers) would be moderate today so as to allow her another day of recovery from the pneumonia before the major surgery tomorrow to remove the intestine.
2. That she would do well on 50% oxygen and they would be able to reduce the pressure slowly but surely from 33 pounds to the upper teens in order to switch her from the oscilator onto the normal respirator. This is fundamental for surgery, for a number of reasons, the principal one being that her whole torso is vibrating or oscilatting with the oscilator and it would be hard to imagine major surgery under those conditions. Secondly, she simply needs to be stronger and healthier to survive the surgery and thirdly (my conjecture) they may have difficulty administering anesthesia to her and controlling it well if she's on the oscilator.
3. That everything would work right (blood pressure stable, central venous pressure low, heart rate stable, maintain the 50% oxigenation being pumped into her, high oxygen saturation in the blood) for them to do surgery on her tomorrow morning. The goal is to find the small window when her pneumonia is under control and breathing is sufficiently stable to withstand anesthesia and surgery, before the intestine goes into sepsis (generalized infection spreading to the whole body). They want to do as quick of a surgery as possible so that she will be under anesthesia as short as possible.
4. For our emotional and spiritual resources as we walk a second time through the valley of the shadow of death. Ted Limpic, our team leader from Brazil, is arriving today which is a real encouragement. We have also been surrounded by support and love from Church of the Ascension, especially the pastoral staff. An additional blessing has been that the hospital has given us our own private waiting room to camp out in: about ten chairs and a table where we can sleep, eat, talk or whatever. This is especially helpful as a place to go to outside of ICU and still be family. What a blessing to have the whole family together!

God has brought Karis through thus far; may He be merciful and gracious to us all in bringing her through the next major hurdle. Thanks again for the tidal waves of prayer!

Sunday, 07-nov-2004

17:30 PM EST : I am becoming aware that some of our communication has been confusing. That's not surprising, given our state of mind and the complexity of the situation. I'll try to clarify some of the questions that are being asked.

First, a correction and a prayer request: We have learned that there have in fact been three other cases of Legionnaire's Disease at this hospital. The last one was 12 years ago. We are praying that the source of the infection be located and that no other children in the hospital will be hit. The vulnerable ones are the transplant patients and cancer patients who are immunosuppressed.

Karis has not yet had her intestine removed. She has been too sick to survive any type of surgery--you may remember that they did not do even a simple lung biopsy last Friday because it was too dangerous. Despite the desire David expressed earlier today that perhaps the intestine might be saved, Dr. Mazariegos says there is zero chance of that. It was not in good shape even before she went into this massive pneumonia, and is bleeding a little more today than yesterday. Dr. M says that will increase, and will be one of the indicators for when they will need to take her to surgery. We want to wait as long as possible to give her devastated lungs more chance to heal, but can't wait so long that she goes into sepsis (generalized infection throughout her body) from her intestine. Dr. M has reserved OR time for Tuesday, hoping the intestine will hold out until then. In order to go to surgery, she must be able to wean off the oscillator and switch over to the regular ventilator. She's not ready to do that yet, although she has come down a little bit more on her oxygen percentage today. Dr. M says that this surgery to remove her damaged intestine will be more difficult than the original transplant surgery, because of inflammation and friable (easily bleeding) tissue, but they will have to do it as fast as possible to limit her time under anesthesia.

If any of you have undergone surgery, you know that even a common cold is usually enough for a surgery to be postponed. Imagine, then, the stress and danger of Karis going through major surgery with both her lungs almost completely compromised. As my father would say, "It's too soon to stop praying!"

Some have asked how Karis will live without an intestine. She will be nourished through TPN until she is well enough to go back on the transplant list for another intestine. The big concern in regard to this is that her mediport hold out through another long waiting period and then the recovery from a second transplant, since she has no other options for central lines in her upper body.

Karis went under anesthesia Thursday morning for what was supposed to be a one hour simple endoscopy from above and below. The doctores chose to maintain her sedated, so she never regained consciousness and won't do so, as far as we can tell, until after the major surgery Tuesday, and for as long after that as she's still on a ventilator. When she wakes up, Lord-willing, she'll catch up on everything that has happened, including the fact that she's lost her intestine. I wept today, imagining the day when Karis will be able to wake up from her sedation, and talk with us, and we with her. What an incredible moment that will be. I think the most difficult part of this is seeing her lying in that bed totally out of our reach, although we talk to her anyway, and pray for her, and play music for her. On the other hand, she doesn't know, I don't think, that her life is in danger. We have prayed for complete peace within her mind (wherever it is) and her soul.

A friend has given me this very appropriate Scripture:

"Have I not commanded you? Be strong and courageous. Do not be terrified; do not be discouraged, for the Lord your God will be with you wherever you go" (Joshua 1:9).

Thank you.

Dear Family, while it will seem from this post that perhaps Karis' condition is not as good as it was, you will see they have determined to put off taking out the Intestine. My prayer is that God will cause the body to accept this new organ as her own; that He will irradicate the infection and restore her whole to her parents and family. Please stand for her during this time. I know it seems this has been an enduring battle; and, I know it takes time to read these updates and to pray. But, we would hope someone would stand in the gap for us should we or our loved ones ever face these circumstances; and, we must continue to intercede in her behalf. Thank you for your faithfulness! Trustworthy is our God! Terri

Tuesday, 09-nov-2004

6:30 AM EST:Karis had a stable night until they suctioned out her lungs at 5 a.m. They do that roughly every two hours and each time it makes all her stats drop. This time was worse than normal, with fresh blood coming up from the lungs (often they don't get bring anything up). Her numbers dropped more dramatically than usual, but, they're coming back up as they normally do. The percentage of oxygen in the oscillator is at 57, with the intent to get it back to 50; they had to increase the pressure from 26 to 28 pounds (the goal is to get it below 20). The over-all percentage of oxygen in the veins is 91, and they won't bring the oscillator levels down until that gets up to 95 or 96. The amount of oxygen saturation in her blood (arterial gas) is down at 68 which is quite low (normal is 90-95). So in general her lungs are fairly stable, with some signs of distress, and not progressing in the direction of being able to do the surgery, but no one is feeling pressure since the surgery has been put off until tomorrow morning.

Her CVP which measures the level of fluid in her body was down at around 12-13 yesterday, went up quite high during the night, but is back at 12-13 again (normal is 7-8). Karis is much less swollen and has been losing excess fluids well. PTL! She's back to pretty much normal size in her arms and legs, tho still swollen in her neck and chest and her tummy is very distended.

Her intestine is holding its own. No spiked fevers through the night, no new blood coming out of the stoma, so the surgery will definitely not be today (Tuesday). We're now aiming at Wednesday and one doctor even said it could be Thursday.

The situation is critical, Family. The doctors have said there are signs of kidney and liver distress indicating rejection. The have scheduled Karis for surgery to remove the transplanted intestine tomorrow morning. Please stand in prayer that God will arise and grant mercy and heal her body. Much love and gratitude, Terri

Update Tuesday, 09-nov-2004

6:30 PM EST: Karis took a major step forward today. Since last Thursday Karis has been on a special breathing machine (called an 'oscillator'). But, in order to proceed with the needed surgery, she had to be transferred to a regular breathing machine (called a 'ventilator'). Today the doctors sucessfully made that transfer to the ventilator. Karis did handle the transfer very well in the beginning, but with the latest suctioning of her lungs her numbers went way down. Thankfully they are slowly coming back up.

Surgery was originally scheduled for Wednesday afternoon, but recent kidney and liver tests are showing signs of distress. The doctors decided she couldn't handle waiting that long, so the surgery has now been moved up to 7:45 am tomorrow (Wednesday) morning.

Thank you for praying!

Dear Sweet Family, Faithful Friends,

My heart is heavy today as Karis has had to have the intestine removed. She came through surgery well; and, is in recovery now. I have to admit I was asking God where He was today. Why did He not choose to heal her and to stop the doctors from having to start all over? Then, I received the following daily devotional from Steve. I have edited it slightly to point out the things that really ministered to me. God went ahead of us and prepared our encouragement, knowing we would be weary and question this sequence of events. God is faithful and will finish the work He has started in Karis. Habakkuk 2:3 says: "These things I plan won't happen right away. Slowly, steadily, surely, the time approaches when the vision will be fulfilled. If it seems slow, do not despair, for these things will surely come to pass. Just be patient! They will not be overdue a single day!" Thank you for your faithful prayers. Much love, Terri

Devotional for November 10th, 2004

When the enemy attacks, we may be called to fight with all the strength and ability God provides. During the time of King David, a battle was about to occur between Israel and two neighboring kingdoms: "The Ammonites came out and drew up in battle formation at the entrance to their city gate, while the Arameans were by themselves in the open country" (2 Samuel 10:8). Joab, the commander of David's military, saw enemy troops in front and behind him so he divided his army - one group remained with him and the other group went with his brother. 2 Samuel 10:11-12

"Joab said, 'If the Arameans are too strong for me, then you are to come to my rescue; but if the Ammonites are too strong for you, then I will come to rescue you. Be strong and let us fight bravely for our people and the cities of our God. The Lord will do what is good in His sight.'"

Joab knew God was in complete control, but he never allowed his faith to be a reason for becoming complacent in preparation or passive in battle. Joab used all his intellect and past experience - all the tools God had provided - to devise a plan. He then encouraged those with him to fight bravely with all their ability. Joab knew he was accountable to use everything God had given, but he also knew the real battle belonged to God.

Notice Joab never said God would guarantee a victory in this particular battle. Trusting God with all our heart means knowing with certainty the final result will be good in the eyes of God - regardless of whether the immediate battle is won or lost.

Many times our Christian walk turns into a battle zone. We face spiritual battles of doubt, fear, and anxiety - many of us also face very painful physical and emotional battles. God has gifted us all in many ways; and, when He directs, we must not hesitate to bravely put His gifts to use. We must "fight" with all the perseverance we can muster - but we must also completely surrender the outcome to God.

True victory comes as we look past the success or failure as seen with our own eyes and trust God for the working of the good in all our battles. Let's stand against the enemy and trust God will do "what is good in His sight." As we enter the battle today, let's fight bravely and trust God.

Dear Family and friends, this is the post from Karis' parents this morning, after the surgery. Please pray as she is struggling this morning (as you can see in the last paragraph below). We can praise God for her life, and for how He has brought her through thus far; but, please do not become complacent or weary in standing. There are many concerns looming before this family; and, they will need prayer warriors standing guard round about them. May God bless you all richly today for your faithfulness and for your love for Him and His children. Terri

Thursday, 11-nov-2004

6:00 AM EST: I (Debbie) have just woken up after sleeping for ten hours! Unfortunately, the telephones are all in rooms where other people are sleeping, so I can't call the hospital to see how Karis passed the night, without waking someone up. The nurse promised to call if there were any adverse events, so I believe Karis must have done well. Their immediate concern when we left last night was once again diuresing extra fluid from her body and lungs, so that they could begin weaning her back down from 100% oxygen. She received a unit of platelets before going to surgery, and another unit of platelets plus 5 units of blood and a liter and a half of fluids during the surgery.

Our reaction yesterday to the success of the surgery was great joy and relief. It occurred to me that had we not been through the experience of the last few days not knowing whether she would survive the next hour, or the night, or the next day, we would have had a very different reaction to this surgery. There have been significant losses over the last week, that Karis doesn't know about yet. YES--we are profoundly grateful that we have been spared the biggest loss--her life. And where there is life, there is time to deal with the rest.

Karis herself, however, does not have the benefit of experiencing how close she came to leaving us. When she regains consciousness 4-7 days from now, she will have to come to terms with:
* the loss of her intestine, taking her back to square one in terms of transplant, delaying for many months yet her return to "normal" life, to her studies at Notre Dame, to living out her dreams and plans
* complete dependence on TPN, with accompanying concern over longevity of her mediport
* a whole new level of anxiety regarding transplant, knowing that the first one "didn't work" (The docs say they don't know whether Karis so seriously rejected the first one because of characteristics of the graft, characteristics of her own body, or a combination of the two--so there's no way to predict how she'll react to another one. And she's already had the limit of OKT3, the main drug that seemed to help with her rejections. Should she need more OKT3 in the future, she runs serious risk of developing a lymphoma as well as other complications.)
* a prolonged recovery from very serious illness that has impacted every part of her body. (For exemple, she'll need physicaly therapy to recover the use of her muscles that were intentionally paralyzed by drugs and not used for 10-15 days of being unconscious).
* not being able to eat at all for 6-12 months, until she can have another transplant; she can have liquids because of a drain in her stomach.
* the consequent likelihood that she may begin to have liver problems (docs say that the ability to eat a little bit over all these years has protected her liver; she'll no longer have that protection), The next transplant may need to include a new liver.
* scarring on her lungs, that the docs say will give her some degree of respiratory difficulty in the future, similar to asthma

Will you pray with us that over the next few days God will begin to prepare her for waking up and learning what has happened to her since last Thursday? Thank you so much!

Dave adding update: Karis rested well, tho has high blood pressure that has required extra sedation to control and even then hasn't been responding very well. Her respirator settings have been reduced from 100% oxygen to 70%. No fever. Her oxygen in the blood (arterial) is at 67 (normal is 90-95) and the oxygen saturation in her veins is 89%. They may have tried to come down a little too fast on the oxygen ), but things are generally stable.

Karis has been in an induced coma and state of paralysis since the surgery. They found legionella in her abdomen and have been giving her antibiotics to fight it. Her lungs are clearing up from the pneumonia; and, they are trying to get her onto a regular ventilator by the end of the week. God has been merciful and has spared her life. She will have to be told that the intestine was removed when she wakes up. They hope to be able to wake her by the week's end as well. Please continue to bear her up in prayer. I am believing for a new digestive tract...not a transplant; but, a newly created one. Our God is able. And, until He says "no", I feel we must ask. If you are able, please go to Him with me, asking that His Name be glorified. Much love and many thanks for your faithfulness. Trustworhty is our God! Ter

Dear Family, this is the most recent update on Karis. Please pray after you read this as the next week could be difficult for Karis and her family as they begin to try to wean her off the narcotics and ventilator. Thank you for your love and prayers! Terri

Tuesday, 16-Nov-2004

10:30 PM EST:
This has been an exciting day. For the first time in almost two weeks we saw Karis move a little bit. Not much--just a little bending of a finger, a little raising of an eyebrow--but enough to encourage us that Karis is finally beginning to come out of her paralysis. She's still heavily sedated, but once she's free to move again, she should start breathing some on her own--the ventilator is now set to accomodate and support any initiative on her part. The speed of the weaning process on the ventilator will depend now in large part on how ready she is to start breathing on her own. Karis' body is very weak, so she'll need to strengthen the muscles she needs to use for breathing as well as continue the slow but steady healing in her lungs.

Some people have asked questions about the weaning process. We're trying to understand it ourselves, since we haven't been through anything like this before. From what we understand (though I won't be surprised if we have to correct ourselves as we go along), they will not be using the paralysis drug any more unless Karis becomes to agitated and tries to pull the tube out. If that happens, they will evaluate whether to paralyze her again or just restrain her arms. Weaning her off the sedative will be a careful, slow process because it's a narcotic 50 times stronger than morphine, that she's been on for almost two weeks. If they stop it quickly, she'll go into withdrawal. She also still needs to be relaxed and quiet, freeing her energy for healing of her lungs and fighting all the bugs in her body (at last count, there are four positive cultures from the abscess in her abdomen that was found during the surgery, in addition to legionella). She's also still having some trouble with her liver and kidneys--as we've been saying, she's making progress, but there's still a long way to go.

Anyway, back to the ventilator process, as we understand it now: As the paralysis wears off and she starts being able to move her body again, and as her muscles get strong enough, she'll start breathing some on her own, with support and help from the ventilator. When the docs feel that she's capable of breathing on her own, they'll start weaning her off the sedative, which will be a slow process. They'll want her to be awake and breathing well on her own with the tube still in but off the ventilator for at least 24 hours before they take the tube out. The goal is to judge all of this correctly so that once extubated, she'll be free. If they do it too fast and she has to go back on the ventilator, re-intubating her will be traumatic.

I hope that helps. Now, a few other bits of news:
1. Dr. Green has determined that the Legionella was NOT contracted in the hospital. All of the tests that have been made of the hospital's water system (starting with Karis' room) have been negative. This is a great
relief to everyone, since there are so many immunosuppressed and therefore vulnerable children in the hospital. Karis apparently breathed in the bacteria on one of her passes out of the hospital, in a place where normal healthy people also breathe it but do not become sick because their immune systems simply kill it. The situation has been turned over to the county health department for evaluation of the places Karis went during the two weeks before she got sick. No other cases of Legionnaire's Disease have been reported in any area hospitals.

2. Dr. Sindhi told me yesterday that their discovery of infection within the abdominal cavity when they did the surgery was indication that Karis would not have been able to keep this intestine even if she had not had the pneumonia crisis. You may remember that the CT scan that was done of her abdomen because of all the abdominal pain she was having showed fluid in her abdomen, but did not reveal the source or the nature of the fluid. It was a small enough amount that the doctors were not too worried about it, but since she kept having severe pain, they had started talking about aspirating some of that fluid to find out what it was. This never happened because the pneumonia hit. Had they done it, however, they would have discovered it was a collection of pus from active infection (four different bacteria have been identified so far), which explains the pain she was having. That situation, Dr. Sindhi said, would have been incompatible with keeping the intestine, which was in bad shape after six weeks of every effort to redeem it from severe rejection. It would probably have taken them just a few days longer to arrive at the same conclusion, that they would have to remove the graft. (Of course, that would have been much simpler without life-threatening pneumona thrown in!)

3. We have finally received the promised pictures of Karis' original intestine, and have posted a couple of them on the website under "Pics." If you prefer not to see them, just don't look! I found it interesting to reread the description from Sept. 24th, which I'll stick in again here for your convenience, if you're interested. The conclusion we came to that day, as we saw the differences between Karis' own intestine and a healthy one, was that God had clearly led Karis to have the transplant, and had preserved her until she could. A timely reminder at this stage of things, when we have to face the idea of starting the whole transplant process all over again and it's tempting to ask a lot of useless "why" questions.

Here's the quote:
If you're squeamish, you don't have to read this part: Yesterday before we left the hospital, we were invited to the pathology lab to see Karis' old intestine. The pathologist showed us Karis' intestine and a normal
intestine, and gave us gloves so that we could touch them. Bev (our trainer) took pictures, so if one turns out well, we'll post it for you. Both intestines had been cut open lengthwise. The normal intestine was maybe two inches wide, felt soft and velvety, kind of the thickness and texture of a balloon (a little thicker). Karis' intestine was about 3-4 inches wide (from distention) and was about as thick and flexible as a piece of old tire. It was 103 centimeters long, about 3 1/2 feet (her new transplanted intestine is 14 feet). We were truly amazed that Karis has done so well for so long with that intestine, and were filled with gratitude to God for His grace in her life. The pathologist told us that the difference between Karis' intestine and a normal intestine is even more remarkable under a microscope. The nerves are so few and scattered and malformed that it's amazing her old intestine ever functioned.


10:00 AM EST: Karis continues on the slow road to recovery with very gradual weaning off the ventilator; they're now saying it will be at least another week before they take her off. They stopped the paralysis medicine at 5 p.m. on Sunday, but Karis hasn't yet moved anything except her tongue, perhaps trying to talk, and licking her lips.

Pray for her and us in these challenging days as she needs to be freed from the ventilator, become conscious, yet not fight the tube going down her throat for breathing. From previous experience, we know that she hates that tube. One doctor explained that it's like having your finger or someone's finger in your throat and not being able to get it out. When she's conscious, Karis panics with the feeling that she can't breathe and fights the ventilator. They don't want to pull the ventilator until she's shown she can breathe through it on her own. So it seems like a no-win situation.

As she gets a little more aware, her blood pressure shoots up, so they sedate her heavily again. But eventually we'll need to cut back on the sedation and let her regain consciousness. Pray that when they do that (a week from now?), she'll be able to breathe without panicing and that they can pull the tube more quickly than the 24 hours they'd like her to keep it, while showing that she's breathing well through the tube (without the ventilator functioning).

A friend just sent us Is 49:15, 16, precious verses. "Can a mother forget the baby at her breast and have no compassion on the child she has borne? Though she may forget, I will not forget you! See, I have engraved you on the palms of my hands."

Terri -
Karis and her parents are definitely in my prayers. I truly trust in the Lord regarding Karis health. Thank you for being such a faithful servant unto him.

Nicole (NB)

Dear Friends and Family, it has been awhile since I've updated you. Karis has had some ups and downs as they began to wean her off of the respirator and the drugs used to keep her sedated and still. She has been awake for a few days and has had to deal with the news that the intestine was removed. It's amazing how beautiful her spirit is despite this most difficult turn of events. The family has asked for prayer; and, I have included an update below of today's post. While not listed, I want to tell you that the insurance company has informed them that she has almost reached her lifetime benfits limit. The ramifications of this are not fully known at this point; but, it certainly can complicate things further from a financial stand-point.

As we near the birth of our Lord Jesus, I hope you will remember that His Name, Yeshua (Jehovah Saves), is the Name that is above every Name. Every knee must bow to this beautiful Name. Every knee. Our Lord Jesus showed His power through the many miracles and healings that He performed in His ministry on this very same earth we call home. As you pray for Karis, please remember and bring the evidence before God of the things He has done for others. Just as in a courtroom of law, the past acts as precedence and is considered a valid argument for today's requests and petitions. Our God is not a respecter of persons. He is a God Who acts in behalf of ALL those who wait for Him. Waiting with you, Terri

Latest Update:

Monday, Dec. 6, 2004, 6 p.m. EST

(Debbie) Big news today: After two trial runs sitting on the side of the bed (yesterday and this morning), with support of one person in back and one in front, Karis sat in a wheelchair this afternoon for an hour! The biggest challenge (once she overcomes dizziness) is holding her head up--it seems so heavy. She can't actually lift it herself yet, but when someone lifts it for her, she can hold it for a while. She was exhausted by the time she was lifted back into bed, and we were proud of her effort. Our friend Débora manicured her right hand while she was sitting in the wheelchair--very pretty! She'll do the other hand tomorrow.

Prayer requests:
1. Karis seems to be getting reactive to the Fentanyl wean again. Please pray that she doesn't go into fullscale withdrawal again, and that the doctors will have wisdom in how to help her through this final phase of weaning. She's down to 0.6 ml/hr (started at 4); they're reducing it by 0.1 every 12 hours (5 mcg).
2. Planning for what happens next, when Karis is ready to leave ICU. She's scheduled for an evaluation tomorrow by someone from a rehab hospital.
3. Neurologists have determined that the pain and extreme weakness in Karis' right foot and lower leg (below the knee) is neuropathy (damage to the nerves) which will just take time to heal and, they say, may not heal completely. We do want to see it heal completely, even if it takes time!

Dear Family, it seems the worst of the financial concerns are past for the time being and we praise God for that! But, this weaning has started a fever and discomfort. There is a place with God where He meets with man and His Will and His Power is poured out upon us. We know He did this in the past through Moses, Elijah, Elisha, Jesus and the Apostles. I believe He is still the same today. I don't know where this place is. I don't know what keeps us from coming into Unity with Him to the extent that He is in a position to answer our Prayers. I know He is willing. I know He is able. Perhaps, it is that the time is not right. Perhaps it is that something is lacking on our parts as intercessors. My prayer today is that we seek Him with our whole hearts to be purified and holy vessels, so that He can use us to the fullest extent, so that our joy may be full, and His glory may fill all the earth! Thank you for your faithfulness to pray. Much love! Terri

Latest Update:

Wednesday, Dec. 8, 2004, 10:30 p.m. EST

(Kathy writing) Debbie spent the night at the hospital with Karis as she was asking for her mom to not leave her and yesterday was a rough
day. Last night Karis slept off and on...perhaps 50%. This morning
Karis' brother, Dan arrived. He is staying all night with Karis tonight, a blessing to all of us and a special treat for Karis. Karis was much more coherant than yesterday. The Dr. did put her on an antibiotic to help fight the fever she has had. Because her blood pressure was very low, she was given blood. This process also helped her with dehidration and they were able to lower the dose of pentanal again today without the serious side affects of withdrawal of yesterday.
Perhaps one of the main prayer requests would be to pray that Karis would be able to sleep at night. The Dr. said this morning that much of her reaction yesterday to withdrawal has to do with her not sleeping much 3 nights in a row, this does not let her get the energy that she needs to handle all her body is trying to handle coming off the drugs. PRAY that Karis will sleep well especially through the nights.
One highlight for Karis today was seeing Dan. Another was realizing that she can read. Pray with her as she sorts through and adjusts to what she cannot do at this time and as she daily has physical therapy and seeks to regain the functions of her body. Karis is determined to work hard and she is making daily progress and we are all thrilled with this.
It has been an honor for me to be here and visit this week (Kathy) and to see the wonderful support Debbie and Karis and their family have here
especially through their church as well as with the team of Drs., nurses and staff at the hospital. It is a very positive group of medical staff who really care for Karis in personal ways.
A highlight for Debbie today was to receive word that medicaid will cover Karis as their present insurance is reaching the limit of coverage it promised to give. This is a lot to praise God for. He has and is and will continue to meet this family on every front. Thank you for being a part of this and for your prayers.

Soteria
I continue lifting her up in prayer.

IS. 59:16AMP And He saw that there was no man and wondered that there was no intercessor [no one to intervene on behalf of truth and right]; therefore His own arm brought Him victory, and His own righteousness [having the Spirit without measure] sustained Him.

Dear Family, this is today's update on Karis. I hope you will join with me in praying for her and the family. She is still fighting a fever and they are uncertain of the cause although in the past the withdrawal from the narcotics they used to sedate her during her battle with Legionnaires (sp?) did cause fever spikes. This details what they are trying as well as the rehab facility they hope to move her to soon. These things are all meant to sustain her while she prepares physically for another transplant. Please seek God for her total and complete healing and restoration through Divine intervention. He is able. Jesus showed He was willing when he healed withered hands and restored life (much more extreme than creating new intestines). He created her in the first place and knit her together in the womb. He can certainly repair the damaged parts, replace the missing pieces...He is able. He is willing. Will we believe for her? Satan has done so much damage, the prayers of the faithful are her hope. Thank you for caring and praying. Much love, Terri


Latest Update:

Friday, Dec. 10, 2004 10:30 a.m. EST

(Debbie) I'm writing from the hospital library while Kathy stays with Karis. Dan split the night with me--he took the first half and I took the second half, after sleeping for 5 hours. Worked out well, since I was here when the doctors came by this morning. It was SO nice to be in a quiet room! Karis slept much better. She still woke up every hour and a half or so, for one reason or another, but that was much better than the 10-15 minutes she was managing out in the big room. Her main problems during the night were spiking fevers and the pain in her right foot.

The ICU doctors have decided to try taking her off the Fentanyl now, since she's so close to the end, and substituting morphine, starting off with a bolus and then putting her on a drip. They think that this will cover any remaining withdrawal from the Fentanyl and should show by the end of the day whether the fevers are related to the withdrawal rather than to infection. None of the cultures have grown anything, and yet the fevers continue. If they go away and stay away, everyone will be very relieved, and at that point Karis should be able to transfer from ICU back up to 7 North. Won't that be a celebration!

A representative of The Children's Institute, the rehab hospital that is being recommended to us, talked with us yesterday, and a doctor will be coming soon to do an evaluation. The consensus is that this is not a good time for Karis to make the transition to the very differen t environment of an adult hospital, since she has so much else to deal with right now. The Institute does have some patients who are in the 18-20 yr. old range, so it's not much of a stretch for them to accomodate Karis. They want to see her narcotic- and fever-free for three straight days before she is transferred over there, so that she'll be ready to take full advantage of their specialty, which is rehabilitation. They'll be working with overall body strengthening, gross motor skills and fine motor skills. When their doctor does his evaluation he should give us a general idea of how long it might take for her to regain basic functions. Karis is anxious to get going and to work as hard as her body will tolerate.

That's all for now, because I promised Karis I wouldn't be gone for long. We are delighted with the idea of putting the Fentanyl behind us!

Dear Faithful to pray, Karis' family has asked for that we stand with them in prayer. She has developed pneumonia again; and, her life once again hangs in the balance. But, our God owns every breath, every heartbeat; and, He is the giver of life, not the destroyer. Please do not grow weary in well-doing; for after awhile, we will reap a harvest of blessing, if we don't get discouraged and if we don't give up! Thank you for your kindness and compassion in her behalf. Much love, Terri



Latest Update:

Sunday, Nov 12th, 2004

7:00 pm EST
X-rays indicate Karis has a second pnemonia growing in one of her lungs. The doctors have removed some fluid from that lung and have sent it out for testing in order to determine what kind of pneumonia this is. Karis has been intubated again, sedated, and is attached to a breathing machine. Oxygen levels have gotten down in the 70s a couple times (very low), and she remains febrile. Let's pray that the Lord will extend His powerful hand and touch Karis again during this new crisis.

I pray for your strength. I have faith that there will be healing.

Dear Family and fellow petitioners,

While I understand that it has been a long fight, it is not one that can be taken lightly. The battle for/against Karis is a grueling one. The enemy does not sleep. I have included the latest update below and prayer is needed. Our God says: "I am the God that healeth thee." He says: "If you abide in Me, and My Words abide in you; you can ask what you will and it will be done unto you." He says: "By His stripes we are healed." He says: "But for you who revere my name, the sun of righteousness will rise with healing in its wings. And you will go out and leap like calves released from the stall. (Malachi 4:2)"

My prayer today is this: Father God, gracious and merciful One, You are our Healer, and our Hope. You have made promises, and Your Word never fails...it never returns to You void. Grant that Your children may see Your faithfulness. Grant that Your loving power may be displayed in this child. Grant that everyone involved may be encouraged and strengthened with the knowledge that You are indeed a God Who acts in behalf of those Who wait on You. Show Yourself strong in Karis' behalf, Lord. Come quickly to her aid. Grant healing to her lungs and to her whole body. Grant rest to her parents and family members. Grant steadfastness to those Whom You have called to stand in the gap for her. We look to You expecting to see the goodness of the Lord in the land of the living, according to Your Word and Your nature. Trustworthy is our God!



Latest Update:

Wednesday, Dec 15, 2004 5:00 a.m. EST
Good news and bad. Bad news is that the X-rays have come back worse with the pneumonia continuing to spread into both lungs. As a result they have increased the peep on the respirator to 10. The good news is that her fever has been in the 37s all night, which is the lowest it's been for 36 hours and Karis rested better last night, all of her numbers being a little better, in large part because they increased the morphine from 2.0 to 3.0.

Tuesday, Dec. 14, 2004

10 p.m. EST
Sent to us by Denyse and Greg Gripentrog:
Psalm 84 has long been one of my favorites . . . "They go from strength to strength, till each appears before God in Zion" (v. 7). It would be nice if the verse read and life reflected that "they go in continuous strength," but such is not the case. I'm in a "from strength to strength" time right now. Sometimes it's strength for an hour, then a gap (and a nap), then two hours later strength returns . . . Some day I will appear before God. I wonder if He may be more interested in how I trusted Him in my weak times than in what I accomplished for Him in my strong times.
--Dale Vander Veen

(Debbie) This certainly speaks to my situation just now (I like that part about a nap!), and I'm grateful for this encouragement.

Objectively, Karis is worse: the pneumonia is quickly spreading in both lungs now. Ventilator settings and sedation have been increased to try to help her breathe more effectively. High fever is practically continuous, little daunted by Tylenol and cool compresses.

The good news is that a causative organism has been identified, a virus that can be treated with medicine: Cytomegalovirus (CMV). Ganciclovir was started immediately, but will take 2-3 days to impact Karis' symptoms. The ICU and infectious diseases docs are not convinced that this virus accounts for the whole picture, so they are continuing antibiotics and an antifungal at least until Thursday evening, when results of the bronchoscopy cultures should be in.

6:00 a.m EST
(David) Karis is having more difficulties breathing. Yesterday morning the ventilator was just helping her complete breaths, not initiating breaths for her and she was getting 40% oxygen. At the end of the day, after the bronchoscopy, the peep (volume maintained in her lungs to help her breathe) was at 5, oxygen was at 57% and the respirator was taking 8 breaths a minute for her. Now (Tuesday morning) her peep is at 8, oxygen at 65% and 18 breathes a minute on the ventilator. The X-ray shows more liquid in her lungs. The fever continues, varying between 37.7 e 40.6 (105 Fahrenheit) and between 38.4 and 39 during the night.

She's a little uncomfortable, so they gave her an extra dose of morphine and of ativan (another sedative) during the night. Yesterday afternoon and eveni