Rehydration Results in Response

We all know how dangerous it is for someone to become dehydrated. I warn my students about the body’s need for water in my nutrition classes each semester. Since the human body is made up of approximately 55 to 70 percent water, it is easy to understand how important the element is. According to my textbooks, if one loses about 2 percent of body weight in fluids, he or she becomes thirsty. Lose about 4 percent, and you become weak; but if you lose about 20 percent of body weight in fluids, you can lapse into a coma or die. Thus the concern of football coaches and their staffs for their student players in the Texas heat each summer and fall. The precautions taken by trainers, coaches, band directors and many more are legendary, since there have been tragedies in the past that no one wants to see repeated.


When infants are ill, doctors caution—plenty of fluids. When someone has a fever, we urge fluids to replenish what they are losing. Several years ago, I contracted salmonella food poisoning. I thought I had a bad case of flu and tried to “throw it off” for 8-10 days. Mom came to help take care of us while I was in bed and the boys went to school. She and my husband kept urging me to drink Sprite, tea, or water. But I was unable to hold any food or liquid in my stomach.

I kept lifting up the skin on my arm and saying, See, I’m not dehydrated. Yet when I finally gave in and went to a doctor, the first thing he did was lift up the skin on my stomach. This was much more startling than the skin on my arm. It actually “stood up” when he pulled on it. The second thing he did was send me to the hospital where I spent three nights recovering, receiving antibiotics and much-needed glucose and water.

Friday morning (Nov. 6), Joyce called Nancy to come help her with Mom. Mom’s blood pressure was low, and she would not respond to Joyce. When Nancy arrived, she was unable to get any response either, plus Mom’s blood pressure continued to drop. So Joyce called an ambulance, and Nancy called the sisters. We all dropped what we were doing and headed for McKinney immediately. I went by and picked up Pop. None of us uttered the words aloud, but later we admitted that we thought we might not get there in time to see Mom alive.

Several hours in the emergency room ensued, interspersed with trips down the hall for MRI’s and CT scans. Mother’s blood pressure came back up after a while, and we all just wanted to hover around and tell her we love her. She was not allowed to have anything by mouth, just the glucose dripping intravenously, while in the E.R. Joyce had given Mom her pills that morning, but after that there was nothing. Late that night we fed Mom a few bites of a sandwich and some fruit cocktail. Then everyone but Diane left, and she and Mom spent Friday night in the hospital. Mom was in pain only when her legs were moved, and we thought perhaps she had somehow aggravated the fracture from last May.

However, the tests showed nothing new, and all day Saturday Mom continued receiving glucose. When I called her room the ones there assured me that she looked like her former self, smiling and bright-eyed! At one point during breakfast she had some trouble swallowing, so the doctor determined that there should be a swallow test. (That did not happen until the next morning!)

Since Mom did not receive her daily meds after Friday morning, by Saturday evening she was becoming restless. Agitated by then, she began wanting to go home. Vicky stayed with her through the night, and she said Mom did not sleep at all, just talked continuously and fretted with her oxygen tube and finger clip (monitor for blood pressure). By Sunday morning, Mom was not a happy camper. Having regained some of her old spunk, she was determined to get out of that place!

After passing the “swallow test,” the doctor saw no reason to keep Mom in the hospital. So she was dismissed and transported back to her residence, where she promptly settled into her recliner. She ate what was offered and drank a glass of Ensure, then took her routine medications. The only med added was the Exelon patch to enhance the effect of the Namenda.

After much thought and discussion among the sisters, we believe it is very likely that this entire episode was brought on by dehydration. Many people nowadays carry bottles of water with them at all times; however, if a person has not ever formed a good habit of drinking water continually, it is a difficult one to adopt. Mom has never cared for water. She prefers tea but does not drink enough of it. The caretakers at her residence keep a glass of water on each of the resident’s trays. When they walk by them, they reach down and hand the glass to the resident to encourage them to drink more water. But it just has not been enough.

Mom’s dehydration caused many symptoms: constipation, swollen abdomen, and vague pain; and it worsened first her mental status and then her state of consciousness. Now we look back and think that it is no wonder her blood pressure dropped and continued to
do so for a time.

In Mom's fragile condition, the slightest of negative changes can cause havoc to her system. For example, they also found a slight urinary tract infection and started antibiotics in her ‘drip.’ As far as we can determine, both conditions played a part in her sudden decline. We are thinking that the urinary tract infection was
also caused by the dehydration.

All in all, we are very thankful to have Mom back at her residence with a smile and a good appetite! We were concerned initially about the effect of moving her to the hospital, but she seems to have weathered the weekend quite well. There is one thing that is different from last week, and that is that Mom is not walking as well as she was before. Right now she is using a wheelchair, and it may or may not be permanent. Yet we are all so happy to have her with us. Thinking of her adds pleasure to each day!

Coach Broyles' Playbook

Diane mentioned Mom’s difficulty with language in her last article. Communication is getting more difficult for her every time we are with her. Yes, she has alert times when she remembers quite a bit. However, the actual calling up of the right word she needs is difficult as well as frustrating for her.

Recently a friend handed me a book to read entitled Coach Broyles’ Playbook for Alzheimer’s Caregivers. It is a “practical tips guide” written by the University of Arkansas Athletic Director Frank Broyles whose wife suffered from Alzheimer’s Disease.

In discussing how communication changes in the Middle Stage of the disease, he offers several tips for the caregiver. He states,

You may have seen that she does not talk like she used to. She is having more trouble finding words. Her sentences are short and choppy. The loudness of her voice may have changed. Her words may not make any sense. This is called “word salad.” As you listen, you know she is trying hard to tell you what she wants. The words just come out wrong.

Communication Tips

• Be patient and calm
• Touch (holding hands) is very important.
• Don’t use baby talk.
• Stop what you are doing. Really listen to what she is trying to say.
• Think about the feelings behind the words she is trying to say.
• Look at what her body is trying to tell you.
• If she looks upset or angry, then ask her if she is.
• Treat her with dignity and respect.
• Say exactly what you want her to do.
• Use ordinary words. Instead of saying “Hop in the bed,” say “Please get in the bed.”
• Turn your questions into answers for her. Instead of “Do you need to go to the bathroom?” say, “The bathroom is right over there. I can walk with you.”

A Few More Suggestions:

• Don’t argue with her. It is easier to agree with her and then do what you had planned anyway.
• Don’t try to reason with her. You will just get angry and she won’t know why. Change what you are talking about to something she likes.
• Don’t correct or fuss at her for getting something wrong. Does it really matter? It will only make her feel bad.
• Don’t say “I just told you that.” Just repeat the answer you have already given to her.
• Don’t ask her to “remember” things that happened in the past. Talk about what you remember happening and how she was a part of it.

You may find as time passes that she will not be able to start a talk with you. She may not ask many questions either. She may sit or walk around the room and say nothing unless you begin talking to her first.

Thank you, Coach Broyles, for sharing wisdom gained from your experience.


For Playbook copies and Alzheimer’s disease information:
www.alz.org
24-hour helpline—800-272-3900 (toll-free)
Playbook on the Web: www.alzheimersplaybook.com

Nan's Turn to Share

How different we all are! Yet we all dearly love the mother who gave us life and has helped us each through tears and years of all kinds of living experiences. Nancy expresses herself today, thoughts and feelings common to us all, but written in her own unique way:

Today I miss Mom! I am here with her, and I don’t want to leave. I keep thinking I can make her smile, even get half a smile. Maybe I’ll see a smile in her eyes. I have her repeat her five daughters’ names according to birth order. With a little help and coaxing, she does it! And I say, “Good job, Mom!”

Later…I wonder if calling our names is like a test to her, or is it a good mental exercise? I hope it's the latter. I want her to speak to me, to interact, to laugh out loud, but I would certainly settle for a smile. I want to do something that she wants to do. But she doesn’t know what that is. I try to guess, but Joyce (one of her caretakers) reminds me that she doesn’t know what she wants to do. So we settle for helping her move from the kitchen table to the recliner. There I can take her shoes off and rub her feet. That must feel good!

If I could curl up in her lap, I would. I need to be close to her. Does she need to be close to me? I wonder. I think she does because when I get near her, she always puckers up and I get to kiss that precious face. And she kisses me back. I thank God. That is my blessing today. I can go home now.

A Happy Visit

My September update is a few days late, but here I am to report on a wonderful time with Mom. She and I had one of the best visits we’ve had in a long time Friday evening (10/2).

When I first arrived, I almost didn’t recognize her, but she knew me. The reason I had to do a double-take was because she looked so different. The beautician had not been there to wash and set her hair. I can’t remember when I have seen Mom without her hair fixed. But there she sat—with her hair brushed flat and straight. Her smile of recognition when she saw me calmed me down immensely. I was so happy to see her and happy that she was pleased with me being there that I forgot about the hair.

No, in the past Mom would not have been seen in that condition, but now is now. Things that matter now are: being recognized, seeing her roll her eyes at what one of the women says, and having her ask, “How’d you find me here?” And always that sweet smile when she responds to one of us with, “I love you, too.”

As we walked to her bedroom to have some relief from the volume of the ever-present television set, she seemed genuinely glad to see me. She appeared to have more strength in her legs than the week before. Perhaps she’s better because of something the doctor prescribed for her edema. (For a couple of weeks her feet and hands were very swollen.) We spent some time going through a photo album Pop had brought to her. Many of the people neither of us knew. Yet every time there was a member of her family, she would stop and look closely at the picture. She was calling the names of almost all the children, the grands, and the in-laws. I was amazed, and my heart was warmed by her alertness.

The whole time I was there, I could hardly keep my hands off her. I just wanted to hug and pat and tell her I loved her over and over. When we think about how well and how long she has cared for all of us, I suppose our purpose now is obvious—to love and care for her as much as we can for as long as we can. We love you, Mom. You’re the best!

For those of you who have been so kind to ask about Mom, I apologize for taking a while to get back. This summer of ’09 has been one for the records for several reasons. In order to stick to the blog’s purpose, I will sum things up by saying this. Mom was in rehab for about six weeks. Then we moved her to a lovely home in McKinney where she will continue to live for as long as possible. Now Diane will continue the narrative:

After Mom fell, it was clear she could not go back home. Pop used the time Mom spent in the rehab facility to locate a place for her to live. It is a hard decision to make. You have to consider so many things, such as leaving your loved one in the hands of total strangers, knowing that she can no longer tell you what happens when you are not there. The legal matters are complicated, and the financial burden is costly. There are many publications and websites full of information, but we received the best leads from the hospital social worker, along with doctor recommendations.

Mom has now been in her new home for a couple of months. We could not be more pleased with Pop’s decision to put her in a “resident facility.” She is now receiving her medications on schedule, regular bathing, and home-cooked meals. She can roam around the house as if it were her own and visit with the other residents. She has her own room overlooking a large back yard, and she can watch the birds gather around the bird feeder just outside her window.

There are now no more days filled with worry about Mom falling. We don’t wonder if she will go outside and wander down the street. The time now is spent trying to communicate. Mom’s speech is no longer what it was. She struggles with each thought, trying to get the correct word out. Most of the time the words she uses don’t make much sense, but at least she is still trying. We are hoping for approval for Mom to get the new “patch,” thinking that maybe it will help with her clarity. “Exelon” is the newest drug for Alzheimer’s/Dementia/Parkinson’s Disease.

I recently read a very helpful book entitled The Validation Breakthrough, by Naomi Feil. In it the author teaches simple techniques for communicating with people with Alzheimer’s-type dementia. I highly recommend this book to help people maintain a measure of communication with loved ones who are prone to withdrawing due to this awful disease, and possibly prevent progression toward a vegetative state during their later years.

The Rehab Center

The way I understand it, Mom will be in the rehab center for several weeks. The bone she fractured has to be treated in the same way an injured rib is cared for: with a great deal of patience and TLC, to allow it to heal properly on its own.

Mom doesn’t appear to be in any pain, except when she sits up. She requires help to get into a wheelchair. Then, once she settles into the chair, she seems comfortable again. She travels to the dining room in the wheelchair, and her appetite is good. She has never been an extremely picky eater, which is probably fortunate for her, since she is in for a bland institutional regimen now.

Today is Mom’s third day at the center; she entered Friday evening. Each day she has eaten her meals at regular times; she has taken her medications at correctly spaced intervals; and she is clean and wearing fresh clothes. She seems to be confused by the move, in that she doesn’t know where she is. Yet she is not acting out in the least. For so long, she has “wanted to go home” each evening, but now she says she is at home. Yesterday afternoon she told me that she and Pop had gone to lunch and then come back home. (Lunch was in the dining room, and we were in her room visiting.)

We don’t really know what to expect from day to day. She may wake up one morning soon and decide she doesn’t want to be in this place any more. But for now, she is comfortable, as much as possible with the fractured bone. And the Lord has used this fall that caused her pain to ensure that her needs are met.

Pop, on the other hand, is probably not doing so well. I use the word “probably” because no one really knows how he feels most of the time. He is not an expressive person. Opinionated,yes, but not one to talk about feelings. So we assume he is lonely without Mom at home with him. He has no one to talk to, no one to eat with, and so on. He is spending several hours a day at the rehab center, watching television with Mom. He has even mentioned taking a more comfortable chair from home out to her room.

It is heart-rending to imagine being separated from your best friend of 20 years and being unable to help the situation. He has tried to hang on, to keep Mom at home, to take care of her himself, to make the best of things. But now his best-laid plans are not working. He can take comfort in the fact that she is well cared for, but now he must take care of himself. And we must continue to pray for the Lord’s protection over him.

Romans 8:28

And we know that all things work together for good to them that love God, to them who are the called according to his purpose.

On April 5, I wrote of frustration. Today I write with a grateful heart of Romans 8:28. Feeling so helpless, I have continued to pray for the Lord’s protection over Mom and Pop. Not knowing what to ask Him for, I ask Him to keep them safe, wherever they are. I gave up a while back that Pop was ever going to make any moves on his own. He does not seem able to make a decision to move Mom from their home. He and I had a little “showdown” one afternoon when I confronted him about leaving her by herself while he went to church. It was then that I saw the light—he was not going to take any of our suggestions. Period. Whether he didn’t want to, or he was not able, I don’t know. Since then I have continued to pray for them.

One evening recently, Mom fell and fractured her pubic bone. The next morning she was unable to get out of bed. By noon, Pop was calling Diane to leave work to help him. That evening, about midnight, Mom was finally resting in a hospital bed after much aggravated waiting in the E.R. and many x-rays.

Two days later we moved Mom to a rehab center where she has been resting well. To be continued....

HBO's "The Alzheimer's Project"

These programs sound very worthwhile. I copied and pasted rather than try to summarize:

Beginning Sunday, May 10, tune into HBO's "THE ALZHEIMER'S PROJECT," a groundbreaking documentary series that will change the way America thinks about Alzheimer's disease. This four-part film, airing over three nights exclusively on HBO, gives the public a rare inside look at the faces behind the disease and the forces leading us to find a cure.

Many of the researchers and families featured in the series are part of the Alzheimer's Association community. We applaud their willingness to share detailed information and personal stories in order to further the fight against Alzheimer's disease.

Mark your calendar to watch "THE ALZHEIMER'S PROJECT"

Sunday, May 10
9 p.m. EST"The Memory Loss Tapes"

Monday, May 11
7:30 p.m. EST"Grandpa, Do You Know Who I Am?
With Maria Shriver"

"Momentum in Science, Part 1"

Tuesday, May 12
7 p.m. EST"Caregivers"

"Momentum in Science, Part 2"

"THE ALZHEIMER'S PROJECT" is a presentation of HBO Documentary Films and the National Institute on Aging at the National Institutes of Health in association with the Alzheimer's Association, The Fidelity® Charitable Gift Fund and Geoffrey Beene Gives Back® Alzheimer's Initiative.

All films will stream free of charge on www.hbo.com/alzheimers and will be offered for free on multiple platforms by participating television service providers.

Compassion

I picked up a book a couple of days ago entitled When Love Gets Tough, The Nursing Home Decision, by Doug Manning. I was not familiar with the author, but as I began to page through the book, I quickly became interested. Talk about seeing both sides of a situation: Mr. Manning sees more sides than I could have ever dreamed up. And I am grateful to him. I intend to pass this little book along to my sisters because it makes the reader think of areas ahead of time that one might not otherwise have thought to deal with.

Odd that I would choose to read this little gem the day after I blogged to all the world of my frustrations! But maybe it’s not so odd. After all, my steps are ordered by the Lord. So why wouldn’t my reading schedule be?

I will excerpt one paragraph from the chapter about caregivers:

Perhaps one of the toughest decisions of all is the one made by a mate who must place a husband or wife in a nursing home. Nursing home personnel report that a husband placing a wife is probably the hardest of all. The husband seems to have an inborn urge to be the caretaker for the wife. It is a difficult thing to go against this natural urge and not feel like a failure or a traitor.

Yes, I was filled with contrition when I read this; and yet I can say that most of the time I do feel compassion for Pop. I understand that he is Mom’s age; he is not in excellent health himself; he feels a heavy weight for making the decision about Mom’s care.

I suppose that I also have an inborn urge that parallels his to be Mom’s caretaker. Mine comes from being a daughter. So, Frustration can be tamed by Compassion, but it is just one more difficulty to work through on this path we are presently walking. And so we pray!

FRUSTRATION

Frustration: when your hands are tied! How shall I approach this subject today? My hands appear to be tied so tightly that I can hardly type.

Frustration is when you find yourself powerless. It’s when you feel that your mom needs to be in an Alzheimer's care facility, but her “caretaker” does not agree. It’s feeling that you can do nothing for someone you love so much because you are in a position with no authority. It’s when any idea you come up with won’t work because it won’t be implemented.

Frustration is the absence of the ability to communicate when it is such a necessity. Yet conversations seem to go ‘round and ‘round without ever coming to a worthwhile conclusion. It’s when perspectives do not coincide so your perspective is cast aside.

Frustration is seeing two sides to everything but feeling that one side may be more urgent. It’s wanting your loved one clean, wearing fresh clothing, eating nutritiously and on a good schedule. It’s wanting medications dispensed at correct intervals as well as always having another adult present.

Frustration is seeing and caring about the other side, too, but not being believed. And not knowing what to do about it.

Too Strong for Words

Mom, I have been thinking about you a lot lately, in particular, how strong you have always been. I think of you as strong physically, though you aren’t very big, and mentally (a very sharp lady!), but especially emotionally. All my life you have been like a rock, always solid and always there when I needed you.

When my first marriage didn’t work out well, when Daddy died, when we lost our grandparents, when Keith and I went “broke” (but we didn’t file for bankruptcy), when brothers-in-law have come and gone (the list could go on), you have always been a refuge of strength for me.

I speak of strength as an admirable quality, and I have always admired it in you. Yet, today I find myself wishing you weren’t quite so strong, at least in one respect. Throughout my life you have controlled your emotions, almost always. Only once or twice can I remember you upset enough to cry in front of people, and then only briefly. As I was growing up, you would encourage me to be strong, keep a stiff upper lip, and keep going (you knew I could make it).

But now I wish you would “let down” just a little. You are still keeping up a strong façade, even though you may not understand that you are or why you are. I feel that sometimes your facial expression suggests that you are aware of something wrong, but you just cannot pinpoint the problem. How I wish that when the puzzlement comes on, you would admit it and open up! How I would love to be able to answer a question for you! How I wish I could make something clear for you at times when you look so bewildered!

You somehow straighten your little shoulders and go on. You don’t ask the question that seems so close to the surface. Then the moment passes, and we go back to our superficial conversation. And you try to look strong, even at this point in your life with the disease that is taking you away day by day. But I’ll be strong because you taught me how. I love you, Mom. Thank you for the virtues you modeled so well for your children.

GUILT

Feeling guilty indicates that you are assuming responsibility for something you may or may not have done, caused, or had control over. Diane shares…

My husband offers a gentle reminder as I rant around the kitchen, trying to come up with a good excuse not to go running over to Mother’s house again. The calls are getting more frequent each day. I hear Pop say, “Come help me with your mother.”

Then, I stop and think for a moment. My husband’s words are true: When your mother was well, you couldn’t spend enough time with her. I ran by there almost every day because I enjoyed her so much. Now, it’s hard, very hard. Mentally, she’s not there any more. The reasons for going there are all different now, and it’s not fun any more.

With each day Mom’s confusion gets worse. Her morning times are best, and she sleeps a lot. As the day progresses, she begins to feel lost and confused. Then it seems that she becomes desperate to find whatever it is that she has lost. She wants to go home. I try to be patient with her as we gently try to distract her. Her frustration builds as we continually try to change the subject and get her to think about something besides “going home.”

Finally the rage breaks through, and she becomes impossible to reason with. By now it has been a long day, and I find myself losing my patience. I try to push back my own frustration because I know that this is the disease, but it’s very hard…especially when I know that tomorrow will bring a repeat of it all.

I go home after each trip beating myself up for the guilt I feel. She is my mother, and I love her beyond words. I pick up the phone to talk to one of my sisters, as it is calming to talk to someone who is going through the same thing. At least I know that they truly understand.

Valentine's Thoughts

Mom, Sweet Mom. How I love you! I want to tell you Happy Valentine’s Day, and you are the best mom in the whole world! How I wish you could read this today.

Oh, I know you can still call the words, but they don’t seem to stick together long enough to make a thought for you any more. Lately I’ve seen you with a section of the newspaper lying in your lap. You pick it up, read the headline aloud, make a brief comment, and lay the paper back down. About five minutes later you do the same thing, then again and again, for as long as we sit there.

I think of waiting until tomorrow, to post this on the real Valentine’s Day. Yet I know the distinction of days is no longer one of your strong points. A year and half ago, when we first met Dr. Tee, she asked you to tell her the day, month, and year. You weren’t able to answer her, so I rationalized that you were under too much pressure to be able to do it. Just sitting in her office seemed stressful enough, much less being asked to identify such specifics.

I know that I have trouble remembering what day it is sometimes during the summer when I have been home for a few days without doing anything special. When I am out of school, I don’t pay as much attention to time as when I am there, unless an important occasion is upcoming or something in particular calls my attention to the day or date.

Since that first day in Dr. Tee’s office, so much has changed! The calendar and the clock just no longer make any sense to you, do they? This past summer you gave me two birthday presents (one was before my birthday, and then you apologized for being late as you gave me the second present). You completely forgot the next two family birthdays in September and October. And about Christmas, well, I guess we will just say things were “confusing,” with so many people in the room and all….

I digress but now return to my original wish, and that is, “Happy Valentine’s Day to the world’s most wonderful mother! I love you with all my heart.”

Come to think of it, I guess it doesn’t really matter what day it is. Every day is a good day for saying, “I love you!” Last week when I took you that big Ghiradelli chocolate bar, I remember how your eyes lit up. You were your sweet kind self to offer it around the table, and you still ended up with two-thirds of the bar for yourself. Then you ate the whole thing! You appeared to enjoy every single bite! Happy Valentine’s Day—again and again. I’ll bring chocolate from now on, just to see you smile.

And to my reader family and friends, a reminder: every day is a real opportunity to share words of love, hugs, kind gestures, etc. Why should we wait to tell someone dear to us just how much they mean to us? We need to fill each day with love by inserting time into our schedules to appreciate those we love for all the little (and big) things they do, before time escapes us. Happy Valentine’s Day, today, tomorrow, and whatever day it is!

Mom's discomfort

December 4 (when I last wrote) seems like light years ago! So much has taken place in the world at large and in my world near at hand. While the wider arena of our national election has resulted in “historical moments” of giant proportion, in my neighborhood we have been getting Mom to the doctor, through the holidays, and eventually to a hospital stay of five days. No wonder there’s not much time to blog! (And thank Goodness, there are five of us daughters!)

To begin with the catching up, a few weeks ago Mom began complaining of itching and some discomfort “down there.” Pop did not know what to do except ask his daughters. The one he mentioned it to advised him to get Mom to her gynecologist as soon as possible. So off they went, only to come home with a report of a “growth” in the vagina that needed to come out.

Our (the daughters’) first impression from the report of that visit was that Mom had a small growth, self-contained, that could be removed, and there was nothing to worry about. The second bit of info we were given was that the biopsy showed the growth was malignant. We later found out from the surgeon (on the morning of the surgery) that the growth was actually on the vulva and was quite involved. That morning was the first time we heard the words “lymph nodes” mentioned!

Pop asked the surgeon for reassurance that he would “get it all.” The doc said, “As we discussed earlier, I will not know until I am able to check the lymph nodes. We hope the cancer has not spread, and we will look at the lymph nodes carefully.” Meanwhile Mom’s daughters stood with mouths agape! That was the first we heard of the possibility of this much involvement with the growth.

To end with a happy report, the surgeon came out several hours later to report that Mom came through the procedure very well. The “growth” was quite large, as he showed us his fist to illustrate its size, and much more involved than he expected. This required an inordinate number of stitches and caused quite a bit of swelling which lasted several days. The best part is he believes he “got it all,” and the biopsies he took of the lymph nodes came back clear. Praise the Lord!