Thank you all for your continuing encouragement and prayer on behalf of my family and me. We are so blessed to have such wonderful friends and family in our lives.

Monday was my first chemotherapy infusion. I spent about 4 hours in the clinic receiving the first drug, and then was connected to a 48-hour infusion pump for the second drug. Tuesday morning, I was not experiencing any negative side effects, and I was able to teach my classes and get some work done in the office. Around 2pm on Tuesday, things started to go downhill. I experienced pretty extreme fatigue and started experiencing nausea around 6pm that evening. 

On Wednesday, I returned to the clinic to have my 48-hour pump disconnected. At that time, I was given IV fluids and some additional anti-nausea medication. I have been taking additional anti-nausea meds orally since that time, and for the most part they are working. However, the fatigue is unbelievably taxing. I have spent the last two days mostly in bed, sleeping, and yet even when I wake up from a long nap, I'm still exhausted. I am hopeful that these symptoms will go away over the next few days, and that future infusions will be given with a new cocktail of anti-nausea meds to counteract those symptoms.

Here are the things you can continue to pray for:

• That the nausea and fatigue can be controlled or lessened with future infusions.
• That these symptoms will be short-lived so I can get back to work and provide for my family.
• For Melissa, as she bears nearly all the weight of the childcare and household duties due to my incapacitation.

Thank you all.

I just wanted to write a quick update and to again thank all of you who have been praying for us and encouraging us over the past weeks.

Last Thursday I met with my local oncologist (Dr. Thudi) here in Irving to discuss the chemotherapy regimen suggested by my team at MD Anderson Cancer Center. Dr. Thudi provided me with the results from the tests on my lymph node biopsy tissue - they indicate that I am not HER2 positive, nor am I a candidate for immunotherapy. MD Anderson will be conducting similar tests on the direct biopsy of the stomach tumor, but given these results, it is very unlikely that my specific cancer will benefit from any of the targeted treatments that currently exist for gastric cancer.

Dr. Thudi also scheduled an MRI for Monday morning (4/11) to examine the tumor in my nasal cavity once more to make sure it's not something that the chemotherapy will exacerbate. There is a small possibility that the nasal cavity tumor is not a tumor at all, but a fungal ball. Hopefully, the MRI will provide good evidence one way or the other about the nature of the nasal cavity growth. My first chemotherapy treatment has been scheduled for Monday (4/11) at 11:00 am. I will have blood tests and a health check during the first hour, then the two-hour infusion of the Oxaliplatin. I will receive a pack with the 5-Fluorouracil which I will carry around for two days to complete the 48 hour infusion. In addition to the chemo drugs, I will receive pre-medications containing anti-nausea drugs, steroids, and other pharmaceuticals to minimize the side-effects of the chemo. This regimen will continue every 14 days. In mid-June, I will go back to MD Anderson for CT scans and blood tests to see whether there is any progress toward shrinking the tumor.

On Friday, I had surgery to insert the Mediport right under my left shoulder blade, which allows delivery of the chemotherapy drugs directly into my aorta. Future blood draws and injections can all be done through this port, minimizing the need to continually poke me in the arms and hands during procedures. 

Over the past few weeks, I have been reflecting on the Biblical story of Ruth. In the story, Ruth ends up leaving her home country of Moab with Naomi, her mother-in-law, to live in a country that is not her own. Both of them have lost their husbands and are living in a culture where unmarried women are not valued. Ruth essentially ends up begging for food in the fields of Naomi's distant relatives so the two of them can survive. It's a tragic point in the story. Certainly, both Naomi and Ruth must have wished that their husbands had survived, that events had turned out differently so they weren't merely scraping by on the kindness of others. Of course, those who know the story of Ruth know that she eventually married Boaz, the owner of the field she was gathering grain in behind the harvesters. Ruth does find a happy ending to the tragic story. What struck me most about this story, though, was how Ruth never got to see the larger picture of how the tragedy of losing her family and finding herself in poverty in a foreign country was used by God. Ruth never knew that her great-grandson was King David - the greatest of all the kings of Israel. Further, she never knew that even further down from David, that her lineage would include the Messiah, Jesus Christ, through whom all the families of the world would be blessed.

As much as I wish events had turned out differently and as dificult as it is to accept the tragedy of this cancer in my family, the story of Ruth challenges me to trust that God has a bigger picture in view - one that I may never see, but one that I know is there. God will not waste my cancer. He has a plan and a purpose for it. Already, I can see the ways that this cancer has changed my perspective and my behaviors - pushing me to value every single moment, making the most of every opportunity.

Melissa and I continue to be so grateful for the encouragement that we receive from all of you. Those of you who are praying for us, please consider the following requests this week:

• That the side-effects of the chemotherapy would be minimal, allowing me to continue to work and provide for my family.
• For unusual efficacy of the chemotherapy regimen against my particular cancer.
• That God would teach me what He has for me to learn through this experience.

Thank you all.

Melissa and I would like to express our heartfelt thanks to all of you who have reached out to us over the past few weeks to offer your support, sympathy, and prayers for our family. We have truly been overwhelmed by the number of people who have loved us so well in so many tangible and intangible ways including encouraging cards, text messages, child care, care packages, meals, phone calls, and so many supportive messages via email and Facebook. It is truly humbling to have so many friends, family, students, former students, and colleagues who care so much for us.

Special thanks to my former students and Purdue colleagues who set up GoFundMe campaigns to assist with the extra costs associated with cancer treatment. We have been absolutely blown away by the generosity of so many. We really are so very grateful. 

Thank you all.

First, a bit of information from last week. I was able to complete a head and neck CT scan to visualize the tumor in my left sinus cavity, as well as meet with a head and neck specialist, who visualized the tumor with a nasal scope. His opinion is that the nasal tumor is a benign schwannoma which has likely been growing there for quite some time. I will have an MRI in the coming weeks to help confirm this preliminary opinion. If true, this is good news, as it means the stomach cancer hasn't somehow metastasized to my head.

On Thursday, I was also able to have a second endoscopy and biopsy of the primary stomach tumor.

Today, Melissa and I drove back down to MD Anderson to meet with my medical oncologist. Although the lab results from the tumor biopsy had not been completed yet, we discussed beginning chemotherapy as soon as possible. She has recommended a FOX-48 regimen (Oxaliplatin and 5-Fluorouracil) to treat the gastric cancer. As soon as the testing on the tumor biopsy comes back, if I am HER2 positive (8-13% chance), a third drug can be added to the regimen that will specifically target this type of tumor. I will also find out whether or not my particular cancer can be targeted with immunotherapy drugs in addition to the chemotherapy.

If all goes well, I will have a mediport placed late this week that will allow delivery of the chemotherapy drugs directly into my aorta. Once that is complete, I hope to begin chemo treatments early next week. My particular regimen occurs in 14 day cycles, with a 2-hour IV infusion of Oxaliplatin on day 1, and a 48 hour continuous infusion of 5-Fluorouracil on day 1. 

Melissa has been so loving and supportive through all of this. We are, in many ways, mourning the loss of a future together that is filled with so many plans and dreams. And even as our future is so uncertain, we are cherishing every day that we have together all the more. It makes James 4:14 all the more poignant: 

You do not know about tomorrow. What is your life like? For you are a puff of smoke that appears for a short time and then vanishes.

Even as we do not know about tomorrow, we know the One who knows all our tomorrows, and place our trust in Him.

Thank you to all of you who continue in prayer for me and my family. Here are the specific things you can remember:

• That my particular cancer would have a profile (HER2 positive) that would allow targeted chemotherapy drugs.
• That the mediport placement and insurance approval for chemotherapy drugs would go smoothly so that treatment can begin quickly.
• For unusual efficacy of the chemotherapy regimen against my particular cancer.
• For rest, peace, and comfort during this tumultuous season in our lives.

Thank you again for your support and care for us. We love you all.

Today I met with a medical oncologist from MD Anderson who reviewed my records, the PET scan report and images, and discussed my prognosis.

Due to the advanced spread of the stomach cancer beyond the local lymph nodes, I am not a candidate for surgical resection of the gastric cancer. As such, she is recommending that I begin chemotherapy as soon as possible to slow the growth of the cancer. She did note that for Stage 4 gastric cancer (which is what I have), there is no cure. Most patients live around 1 year, with smaller numbers living longer (2, 3, 4, 5, or more than 5 years). Some patients have gone into remission with chemotherapy alone, but that number can be counted on one hand.

Obviously, this was difficult news to hear. 

When you get news from a physician that you may have only a year to live, a lot of thoughts go through your mind. After that flurry of mental activity slowed down, I was left with this: God loves me. God knows how my story ends. God knows when my story ends. I must trust Him through this journey, recognizing that He has all things in His control.

I am waiting to hear from MD Anderson about a second tumor biopsy so they can do some testing to determine the best options for chemotherapy. They will also be doing a biopsy of the possible tumor in my nasal cavity to see if it is malignant, and if it is related to the primary stomach cancer.

Here is how you can pray for me and my family at this time:

• That the appointments for the follow-up testing would be scheduled quickly. I plan to be here in Houston until Friday, and would really like to avoid having to make another trip down here if at all possible.
• That my particular cancer would have a profile that will allow the doctors to use targeted chemotherapy regimens that are more likely to devastate the cancer rather than just slowing it down.
• For peace and comfort for my wife and my family as we process this news.
• That I might be one of the exceptional 3% who lives 5 years or more after a Stage 4 gastric cancer diagnosis.

Thank you to the many of you who have reached out and offered your support and love at this time. We are so grateful for all of you.

To God be the glory.

This is a hard entry to write, so I'm going to keep it pretty short.

Melissa and I met with my oncologist this afternoon to discuss the results of my PET scan. The PET scan shows increased metabolic activity in the body that is often caused by cancer.

As expected, the tumor in my stomach, and many lymph nodes in my abdominal cavity, and some beyond, showed extremely high levels of metabolic activity, indicative of cancer that has spread from the stomach tumor to the lymph nodes.

More concerningly is an area of heightened metabolic activity in my left sinus cavity. The doctor admitted that this could be caused by infection or a number of other processes, but it is possibly another malignant tumor. 

My oncologist suggested that if the cancer has spread this far, that likely a surgical resection of the tumor and lymph nodes in my abdomen will not be possible. Chemotherapy may be used, but only as a means of slowing the cancer - no cure will be possible.

PLEASE join us in praying fervently that the spots in my sinus cavities are not cancer and that something can be done to treat the stomach and lymph cancer that exists in my abdomen.

Through a wonderful friend from grad school. I was able to get an appointment at MD Anderson Cancer Center in Houston for tomorrow. I will likely be in Houston for 3-5 days for follow-up tests and to receive a concrete diagnosis and treatment plan. Please pray for wisdom for the doctors, for peace for Melissa, and for healing from the One who Heals.