A Shambles of a Mandible

I draft this 800th post from Room 3355 at Florida Hospital South. The quest for solving the puzzle plaguing my right jaw stretches on toward the very end of 2015. After two hospitalizations, six weeks of heavy-duty antibiotics, a CT scan, variations on the themes of pain management, and twenty-nine hbo2 dives to increase blood supply to the affected area, more pieces now fit together to make quite clear the nature of my condition.

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I have what’s called a pathological fracture of the jaw. See the dark gap to the left below the teeth in the image above? Mine’s not that bad fortunately, but it gives you an idea of what’s going on in my mouth. This kind of thing often happens over time to head and neck cancer patients whose treatment protocol included radiation to the tumor bed and surrounding area. The advanced stage of my tongue cancer in 2005 required no less than thirty-nine such blasts. Allow me to quote one doctor who examined me after this morning’s dive. “There is so much damage down there.” To use my own words, my mandible is a shambles. No way it heals on its own, regardless of the number of dives I execute or any other healing strategy doctors might bring to bear on it. This man’s jaw, at least the right lower side, can no longer fight the good fight.

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I can’t bite down on it with any considerable pressure at all. My diet consists of liquids and mushy foods. I down a lot of smoothies, oatmeal, yogurt, and the like. Last week I hit my married weight after dropping about twenty pounds. Let’s just say Jesus sees fit in this latest version of the Heffelfinger sanctification strategy to pound away at some of my more significant idols.

What to do? All I want for Christmas is a brand new jaw! Well, a used bone that is harvested from my tibia or hip to shape and insert up there following resection of the diseased portion of the bone. Believe it or not, that’s the easier part of the whole procedure. It takes an entirely different surgical team to perform something called a free flap micro-vascular operation to the jaw for bringing ample blood supply to the area and ensuring tissue coverage of every bit of live bone remaining. Sounds lovely, eh?

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No specialist in Orlando does this free flap thing or so I’ve been told. To get this done means seeing a man in Tampa. My doctor here has referred me over that way. We have yet to connect. Why does this stuff always happen to Nancy and me around the holidays? Nobody wants to work the last two weeks of December!

So I really don’t know a whole lot yet about the details of this highly specialized solution to my particularly disabling problem. What I do know is that surgery runs about eight hours, then two days in ICU, and four more days or so in the hospital. Until I consult with the Tampa doc, I have no idea how much PT I might need and/or how long before some degree of jaw-normal returns so I can eat a complete diet once more, resume my pastoral duties, and KISS MY WIFE PROPERLY AGAIN! As those pieces of the puzzle come into play, I will be certain to log in for follow up posts. Needless to say I would like to get this over with sooner rather than later. The Lord knows.

My fellow elders at OGC have graciously granted me medical leave until the first Sunday of the New Year. At that point we will reevaluate. I am thankful for all the servants stepping up to pinch hit for me on all sorts of fronts. As we did in 2005, we have a choice opportunity for the church to be the church, relying on everyone’s gifted contribution to the body’s shalom as opposed to relying inordinately on just one person’s service. Church, reach out to your assigned elder, if you need pastoral care. New people, normally considered “my part of the flock,” please turn to any of the other elders to which you feel led. And of course, all, let’s rely on each other as we do the New Testament “one anothers” and thus build ourselves up in love (Eph. 4:12-16).

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Our thanks as well for the terrific handmade cards from last Sunday, the texts, gifts, and outpouring of offers to assist in some way. I appreciate everyone understanding my request for no visitors during my hospital stay. The more I talk, the greater the pain.

A final thought before wrapping up this entry. One evening during my previous hospital stay I watched the movie, “Unbroken.” It’s the true story of Olympic runner Louie Zamperini turned WWII prisoner of war and his heroic journey of perseverance under inconceivably difficult strains. Having thoroughly enjoyed Laura Hillenbrand’s book of the same title, I’ve desired to see the film version for some time. I prefer the book over the film for one particularly significant reason, but that’s an occasion for a separate blog post. Still the Lord used one line in the movie at this especially challenging time in my life to galvanize me in the most personal of ways. It helped prepare me for yet another daunting trial involving my physical well being. The same line turns up twice in the movie’s trailer below.

“If I can take it, I can make it.” Trust me, that’s not how I weathered the cancer storm of ’05. That sentiment did nothing for me in the loss of our son nearly two years ago. Such a notion was worthless to me with Nancy’s cancer diagnosis last December. And it won’t cut it when they open my face, dismember the dead bone, plate and screw a replacement, attach artery to vein in my mouth, close, and rehab me for who knows how long at Tampa General.

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But I tell you what grand sentiment and massive promise of God’s word will. “I can do all things through Him [Jesus] who strengthens me” (Phil. 4:13). I’ve waved that banner by God’s grace over every previous Father-filtered hard providence which has shaped my life thus far. I’m not about to resort at this point to the shaky ground of self-reliance. I know all too well that I can’t take it and won’t make it. No thank you very much, I’ll stick with the Lord who puts us in these dilemmas precisely so we won’t rely on ourselves but on Him who raises the dead (2 Cor. 1:9).

Mandible Misery My Mentor

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I know. I don’t look very miserable in this picture. That was a good day coming forth from hyperbaric O2 therapy number whatever for deep wound treatment to my radiation-decimated jaw. I managed to prevail on the nurses’ good graces that day to get some pics from the bowels of the compression chamber so others could have some idea of what my new normal looks like these days.

Here’s another.

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I’m not hooked up here, of course. There is no O2 flowing. But this gives an idea of the rig I have to wear as a delivery system of 100% O2 for three thirty-minute periods, five times a day at Florida Hospital South. All sorts of fun.

So far I’ve navigated twenty-one of these. Nineteen to go. The adjustment hasn’t gone all that rough. I read a good bit of the time now. Apart from the occasional nausea bout, things go pretty smoothly.

Unfortunately I don’t have much progress to report. Hence my word “misery.” This past weekend my pain spiked. I cut church. If you know me, I never want to give up a preaching opportunity and chance to worship with God’s people (Heb. 10:24-25). Oops. I probably should have put them in the opposite order. Oh well. Sunday is the best day of the week, by far. I am thankful for an extraordinary pastoral intern who stepped in for me at the last minute. You can listen to his message here.

With the pain spike came a fever on Sunday night. OK, now I’m getting nervous. Long story short, after consulting my dentist, infectious disease doctor, and oral surgeon since then, we have a unanimous verdict. Off to the hospital I go. It’s time to circle the wagons and call in some big gun consultants to play what-do-we-do-with-what’s-left-of-this-preacher’s jaw. The idea is to get my pain under control. I’m all for that. Then to get me hydrated and built up nutritionally. Not only can’t I eat; I am also having difficulty swallowing. It hurts that much. Then, Lord willing, next week they will operate again to remove more dead bone and hopefully save the jaw. I’m not kidding on that one. If my mandible gets a pathological fracture, I’m looking at some sort of radical replacement surgery I DON’T EVEN WANT TO THINK ABOUT! Has my sense of urgency come across the page? Please pray for mercy for me in this regard. I have read about this procedure. I would really rather avoid it, if at all possible.

But if I do, my mandible mentoring, miserable as it might be, will continue with sovereign efficacy. God wastes nothing in our suffering, whatever its nature. In hard providences like these, I remember verses like Psalm 119:71.

It is good for me that I was afflicted, that I might learn your statutes.

This slow learner apparently needs an extra dose of afflictions that he might learn all the more the treasure of treasures, the law of the Lord. Mentor me, oh my Master (and I don’t mean my mandible, but my mandible-maker), but please, I beg of you, go easy on what’s left of this poor man’s miserable jaw. Amen.

Jaw Journey Update

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I gave this report in our church’s e-news this past week:

Thanks a ton for all your prayers as I continue to travel the healing road with the wound/infection in my jaw. I am now essentially under the care of infectious disease doctors for my osteomyelitis. They have put in play every strategy known to help my particular problem. It’s a two-fold approach. First, I have an at-home, every six hour, 24/7 antibiotic infusion—for four to six weeks. The hardest thing about that is the disruption of my sleep patterns. Pastor needs his sleep!

Second, the infamous hyperbaric oxygen dives. The toughest thing there is the time involved and somewhat the discomfort. I arrive at the hospital every morning, Monday through Friday, at 6:30 AM. They load the dive chamber somewhere around 7:30. It takes about fifteen minutes to pressurize the cabin to the equivalent of 45 feet below sea level. My sinuses tend to object strenuously on the way down. Think ice pick thrusts above the eye and you will get the idea. Once at depth, they install a clear plastic hood over my head. I breathe 100% O2 for 30 minutes, 5 minute break, another 30 of breathing, take five once more, a final half-hour of oxygen, and then 10 or 15 minutes or so back to the “surface.” I’m home in Altamonte usually by 10 AM. Fun, huh?

Needless to say, this treatment regimen has cut in significantly to my morning study time. As a result I feel I need to suspend the Genesis series until finished with this stewardship. I’m planning something less strenuous for Advent from the gospels. That will give me some breathing room as I keep on the healing path. My apologies for the disappointment this causes anybody. I just can’t bring myself to cheat study time on arguably the most challenging book of the Bible I have ever preached.

Most of my work hours for now will occur in the afternoon, evenings, and weekends, as energy allows. I appreciate the patience and grace I’ve received as I try to navigate the schedule with wisdom and grace.

Jaw Wars

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The Star Wars saga has nothing on me. I’ve got more episodes in my journey than the popular movie series will ever produce.

This just in. My oral surgeon today said he’s done all he can do surgically. The problem with my escalating pain must be medical. What to do? Two things. One, hyperbaric oxygen therapy. I report for the first of these tomorrow morning, Lord willing, at Florida Hospital. Can’t wait to climb into one of those rigs (see image above).

Two, infectious disease consult. The surgeon removed all the dead bone debris he could find. My pain can no longer stem from that cause. The only thing he can surmise on that score is osteomyelitis–chronic infection of the bone. My oral surgeon referred me back to my medical oncologist/hematologist for this consult, especially because I had multiple infections of the blood during my chemo treatments back in 2005. I am still waiting to hear back from his office about an appointment. My understanding at this point is that treatment protocol for this involves inserting a central line for six weeks of IV antibiotics. Something to look forward to. But I am trying not to get ahead of myself.

Pain remains high. Still pushing the drugs to cope. Lots of rest required. The saga goes on.

I’ve hauled out a familiar friend from ’05, the promise of God in 2 Cor. 12:9, to sustain me along the way.

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me.

Oswald Chambers says this about one of my all time favorite verses of the Bible:

God does not give us overcoming life: He gives us life as we overcome. The strain is the strength. If there is no strain, there is no strength. Are you asking God to give you life and liberty and joy? He cannot, unless you will accept the strain. Immediately you face the strain, you will get the strength. Overcome your own timidity and take the step, and God will give you to eat of the tree of life and you will get nourishment. If you spend yourself out physically, you become exhausted; but spend yourself spiritually, and you get more strength. God never gives strength for to-morrow, or for the next hour, but only for the strain of the minute. The temptation is to face difficulties from a common-sense standpoint. The saint is hilarious when he is crushed with difficulties because the thing is so ludicrously impossible to anyone but God.

 Not sure about the hilarious part, but definitely striving for strength in the strain of each minute. Appreciate all the prayers of the faithful on FB.
More importantly, regarding Nancy, there is not much to report. She continues to work her therapy program therapy. Thank you for your faithful prayers on her behalf as well.

Jaw Joy

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I won’t make this a long post. But post I must.

Jaw pain on my right side has plagued me since a root canal tooth failed in May. This morning I underwent oral surgery to remove dead bone on the right side of my jaw. The procedure exceeded my expectations. My surgeon cleaned out a bunch of junk. He did a superior job.  That I can work on a blog post the same day testifies to that effect.

I got to thinking about one’s jaw. I admit it. I take mine, both sides, for granted. I shouldn’t. My right side got hammered ten years ago with radiation treatment for head and neck cancer. Gotta love cancer treatment, conventional style. While cancer cells get killed, so also do healthy cells. Hey, I’m not complaining. I’m still preaching ten years later. My complications have been minimal. Couldn’t be more grateful.

Still, there is this jaw thing. Preacher’s tend to make connections from the experiential to the spiritual. Here’s mine, with the help of Puritan Matthew Henry, from Hosea 11:1-7.

He eased them of the burdens they had been long groaning under: I was to them as those that take off the yoke on their jaws, alluding to the care of the good husbandman, who is merciful to his beast, and will not tire him with hard and constant labour. Probably, in those times, the yoke on the neck of the oxen was fastened with some bridle, or headstall, over the jaws, which muzzled the mouth of the ox. Israel in Egypt were thus restrained from the enjoyments of their comforts and constrained to hard labour; but God eased them, removed their shoulder from the burden, Ps. 81:6. Note, Liberty is a great mercy, especially out of bondage (emphasis mine).

Do you see that phrase, I was to them as those that take off the yoke on their jaws? At this point in my spiritual journey, no other verse may matter more to me in the strengthening of my faith to finish strong. Do I long for the pain in my jaw to abate? Absolutely.

Would I trade that for the confidence that Jesus, by His gracious death on the cross and victorious resurrection from the dead, has TAKEN OFF THE JAW OF WORKS and given this unworthy ox the mercy of laboring under gospel grace?

Not in a million years.

Thank you, my great Savior, for using my frail jaw for reminding me once again of your great grace.

This jaw, what’s left of it, praises You.

Ten Years Cancer Free & Still Learning

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This month marks a decade since I finished treatment for head and neck cancer. By God’s grace I remain cancer free. I have remarked to others more times than I can recount a single thought: “Cancer is a terribly effective tutor.” Here are several lessons I learned through the healing journey and continue to learn as the Lord kindly gives me length of days.

  • One, the actual moment of a believer’s death is a terribly significant matter in the heart of God (Psalm 116:15).
  • Two, illness is a form of suffering which God uses to train us in holiness (Psalm 119:71).
  • Three, God’s grace is sufficient to sustain even when healing is delayed or doesn’t come at all (2 Cor. 12:9).
  • Four, one’s capacity to comfort others in their affliction increases significantly to the degree one has experienced comfort from God in something similar (2 Cor. 1:3-5).
  • Five, dying is gain for the believer, but remaining alive to serve others is better for them in God’s providence (Phil. 1:21-26).
  • Six, God sees the tears and hears the prayers of His people when they cry out to Him (2 Kings 20:5).
  • Seven, joy doesn’t depend on circumstances but rather on the filling of the Spirit which focuses on giving thanks in all things (1 Thess. 5:16-18).
  • Eight, true worth comes from who we are in Christ, not what we can or cannot do for Him (2 Cor. 5:17).
  • Nine, prosperity and adversity both come from God and require different responses in faith (Ecc. 7:14).
  • And, ten, life is a vapor, faster than a weaver’s shuttle, requiring one to live every moment’s anticipation of the future governed by a careful “if the Lord wills” (James 4:13-15; Job 7:6).

These lessons and more I have learned and continue to learn as I live one more day cancer free to the praise of His glorious grace.

A Cancer Reality Check

I Married Up

Yesterday Nancy and I spent the morning at the hospital. She was scheduled to have her chemo ports removed.

Early on in what normally is a fairly routine, simple procedure, the doctor discovered that the catheter of the port placed in her abdomen had gotten dislodged somehow. That meant he had to scramble to put some new equipment together so he could go laproscopic for its retrieval. That meant general vs. local anesthetic as well. No big deal except . . .

The doctor asked to see me following the procedure. While scoping for the catheter, he took a quick look around the region. He discovered visible signs of cancer on her diaphragm and at least one other place. He didn’t look everywhere, so we don’t know as of yet how pervasive a threat exists. That was not the purpose of the procedure and he was already overtime for getting to his other cases. He took pictures and even showed them to me. So apparently my previous post regarding her progress was premature.

But I was puzzled. We had acted positively of late based upon the last two blood tests checking her CA-125 levels, which proved to be well in range. I asked him about that. He used the word “meaningless” to describe that test’s significance at this point in the recurrence process. Imagine my shock. Neither Nancy or I ever got that memo. She had started to back off on aspects of her natural protocol thinking she was out of the woods. She is not. He took biopsies in several places to confirm the diagnosis, but I could read it in his eyes and hear it in his voice. He has no doubt. Cancer has grown from microscopic to visible in her body in the last eight months.

Where does that leave us? Nancy has resumed an all-in campaign for morning, noon, and night therapy of the natural kind to battle her cancer. I’m afraid that means she will not be returning anytime soon to a more mainstream pastor’s wife life or to her part-time work out of the house with her supplement customers. Her full-time job for now remains to get well.

We are investigating additional natural methods which have come to our attention. As always, we covet your prayers for healing and the grace to fight the good fight with the joy of the Lord as our strength.

Take That Ovarian Cancer

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It gives me great pleasure to rep0rt that Nancy’s latest blood test (she gets them quarterly now), came back with a CA-125 reading of 19. Above 35 is considered out of range. She remains well within acceptable results to give us confidence that healing from this stupid disease continues. She sees the doctor this week for his take on things. Thanks to all who continue to pray for us as we walk this path of faith. God is good. All the time.

Latest Update on Nancy’s Healing Journey

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Thanks to everyone who continues to pray for my bride as she works her healing regimen in the aftermath of ovarian cancer surgery four months ago. She had her second post-op visit yesterday with the doctor. She continues to heal quite nicely in terms of that procedure. For this we are certainly grateful.

Her physician had, in our estimation, surprisingly little to say about her CA-125 numbers from the blood test in March which showed a significant drop from 268 to 18 (34 or lower is within range). He prescribed another of those tests for three months from now at which time she will see him again to monitor her progress. He advised her that she should have these tests every three months for the next two years, her highest risk time period for recurrence.

Frankly, that’s all there is to report. But we praise God for His faithfulness in answering so many prayers for her recovery. She feels and looks great. Everything she ingests is organic, sugar-free, healthy as can be and its shows.

I joke with folks all the time that I am the only thing toxic in her life!

Gracious Uncertainty

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As I pass the one year anniversary of loss, I return today to the duties that lie nearest. Study, sermon writing, board meeting prep, pastoral care, etc.

Before me lies the uncertainty of Nancy, my bride’s, health and what the rest of 2015 will bring on that front, not to say numerous others.

This good word from Oswald Chambers expresses my desires in moving forward:

Certainty is the mark of the common-sense life: gracious uncertainty is the mark of the spiritual life. To be certain of God means that we are uncertain in all our ways, we do not know what a day may bring forth. utmostforhighestThis is generally said with a sigh of sadness, it should be rather an expression of breathless expectation. We are uncertain of the next step, but we are certain of God. Immediately we abandon to God, and do the duty that lies nearest, He packs our life with surprises all the time. When we become advocates of a creed, something dies; we do not believe God, we only believe our belief about Him. Jesus said, “Except ye become as little children.” Spiritual life is the life of a child. We are not uncertain of God, but uncertain of what He is going to do next. If we are only certain in our beliefs, we get dignified and severe and have the ban of finality about our views; but when we are rightly related to God, life is full of spontaneous, joyful uncertainty and expectancy. “Believe also in Me,” said Jesus, not – “Believe certain things about Me.” Leave the whole thing to Him, it is gloriously uncertain how He will come in, but He will come. Remain loyal to Him.

To quote Forrest Gump and perhaps balance things a bit, “I think it’s both.” The virtue of gracious uncertainty which embraces God in the future includes shouts of joy AND sighs of sadness.

Grateful that Ecclesiastes 7:13-14 is in the Book.