The Hungry Haitian Donkey Plods Painfully Along Postoperatively

Hi All:
Today, it is 6 weeks since James asked me, “Dad, what would you like for your last meal?” He knew there was a Boston Market 2 blocks from the Family House we stay in at the University of Pittsburgh Shadyside Hospital and he and his father love the chicken, mashed potatoes and gravy. I like the corn that comes with it, but that has been off the tolerance list for over a year, so he had my portion. The surgery went well, though I felt snugged in a corset as the 4 inch section of my abdominal wall that had been taken out was closed and reinforced with a Zen Mesh sheet and things would need some time to stretch before we could do sit ups, as Dr. Bartlett explained in the postoperative visit. Karen laughed as she does them faithfully each night, me, not so much.

We got home 11 days after the surgery and settled into trying to eat a little, but never could get more than 3 bites of cream of wheat or a few bites of mashed potatoes before feeling stuffed, so I can honestly say I have had less than one meal total in the last 6 weeks. I got the drains out of my belly at 19 days after surgery and that really helped the nerve pain in the left side of my belly, as that drain must have been sitting next to the nerve and the suction of the apparatus constantly irritated it. At 22 days after surgery, my temp was running low grade and my blood count bothersome and my wound started looking a bit red and puffy. I removed a bunch of staples (I had 60 or so total, a lot of fun to remove) and after a day, some brown liquid started to drain through the staple holes. Dr. Dan De Cook opened it up wider and that is when we found the intestinal contents in the wound. So, nothing by mouth since except for my antibiotics, Zantac for the heartburn and a heart rate regulating pill in a sip of Tylenol Adult Liquid. It is amazing what 500 mg of Tylenol at 8 am and 8 pm will do for the incisional pain if that is all you can get, and am thankful that Karen found this, so we substitute a sip of Tylenol for the sip of water with the pills. Dan also placed a suction drain in the inferior aspect of my pocket of fluid in my abdominal wall and we try to irrigate and empty that several times daily.to keep the intestinal juices from chewing on my belly wall.

The incision has healed otherwise and, after giving myself 2 units of blood 9 days ago, I feel I am gaining some strength and endurance every day. My TPN gives me 2530 calories each day, plus I give myself 2 liters of Lactated Ringers to stay hydrated as the short gut syndrome I have inherited makes for at least 9 – 10 mad dashes to the rest room for rather watery stools and I need to replace those fluids. I have been able to work 5 hours daily in the clinic, which gives Karen a break from her needy husband and a chance to work on her multiple flower beds, yard, etc. It also gives me distractions from the incisional discomfort and the questions about the future of the fistula. So, we continue to pray daily and earnestly that the fistula will heal by itself, as allegedly about 60% do in 3 months, as the alternative would be surgery, surely a minefield of trouble for the surgeon as we cannot even see the fistula on the CT scan, undoubtedly I have tons of scar tissue to navigate, a potential to cause another hole in the process of trying to find and fix this one, and one often has to resect some small bowel in the area of the fistula and I have none to spare by this stage of the game.

I am thankful that Dr. James Webb, a retired general surgeon friend from Fremont I have known since the 80’s when I used to moonlight in the Gerber ER during my surgical training, has agreed to cover the surgery responsibilities at CSL for June and July. Dr. Fred Brown, who spent years training surgeons at Bonne Fin in the past, has graciously agreed to cover August and September and I hope, by the grace of God, to be able to return after that. I hope to be physically able to do more before that, but am in this experimental study where I have to return a week a month to Pittsburgh to have the vaccine injected on Monday and get 3 different chemotherapeutic agents given to me for the rest of the week and then repeat the cycle a month later. So, cannot be gone from the office in Jenison 2 weeks a month as that really cripples our ability to see our patients properly and also keep the office functioning, especially as Dr. Lugthart loves some time on the water in the summertime also.

Dr. William is hoping that the governmental hospital strike will end June 1 and that he can return to the residency program and get on with the show. We paid the government electrical company to run a wire to his apartment, but so far, no one has done so. It does make for difficult studying at night if you do have some time off to do so. The water seems to not be able to be arranged, so will have to purchase and haul water up to the apartment to clean himself (one does not drink that water, not advisable). We certainly are blessed when we can just drink water from the faucet in abundance both at the hospital (we have our own deep well) and in the US. Dr. Moise and Jon Bed have held the hospital down and now that Dr. Adulte dropped out of the residency due to health issues and is back at the hospital, I hope that will function smoothly even in my absence. Tom Failing and Dave Weener from BCBC (our home church) will join Dr. Webb on the 18th of June to do repairs, a never ending job at CSL, while he does surgery with Dr. Moise. Pray for wisdom for them and us as we try to negotiate the speed bumps on the road for the Haitian Donkey and his friends to arrive at the goal of doing God’s Work at CSL in a fashion acceptable to Him and for His Glory.

In His Service,

Bill, Karen, Rachel, James and Jenn Ten Haaf and the encouraging Haitian Team

The Speedbump develops into a Major Hole in the Road

Hi, All:
I wrote a couple days ago that we needed prayer as to the possibility, serious as that was, of a major wound infection in my incision. That option was troubling, but there were other, more severe but less frequent, options to consider. On Wednesday, with the redness, we started “big gun” antibiotics and hot packs as much as possible, to help things “come to a head,” if you will. While seeing patients on Thursday, I suddenly noticed that my many layers of shirts were soaked through with a yellow/white thick liquid. We checked the wound and it seemed to be seeping from two different holes that I had left when I removed some of the staples the day before. I tried teasing the wound edges apart gently to get better drainage of this troublesome fluid, but no success. We continued hot packs, antibiotics and changed dressings by the handful for this continuous ooze. Friday morning, I called upon my great, faithful and dependable friend, Dr. Daniel De Cook, to ask if he could squeeze me into his schedule and look at me, as I needed better drainage and a trustworthy surgeon to do so. He put in my ports in the office in 2013 and 2015 for free (as he put it, the “old way, as we used to do before radiology took over,” for which I would have had to pay $7000 cash for each one, so you can see what sort of special friend he is). He also repaired my complication of the second surgery in Holland Hospital for me (that the insurance did pay for), but needless to say, a most special friend.

Incidentally, next weekend, he and his doctor wife, Cecelia, will be going for a stint at HBB in Togo, where we were for 10 years full time, so as he says, he will have been all 3 places I have been, as he grew up as an MK in Bangladesh and has returned there multiple times for short term work and replaced me after the earthquake in Haiti and still has fond memories of working with Dr. William, but then, who doesn’t? In any case, he probed the wound gently and suddenly got into a huge cavity of fluid that gushed out but is NOT an abscess. It is the most dreaded complication for any of us surgeons who work on the bowel, that we get a leak from an anastamosis or other site of bowel injury to the skin or elsewhere, an intestinal fistula. Since the cavity was so large, Karen was right there and said his 8 inch q tip went in to the end, but who knows where in that dark hole the connection to the inside is, we don’t know how to approach things further. He applied a stoma sac to collect the fluid, as this is intestinal juices, ie secretions by the bowel and pancreas to digest the meat we eat, etc, so you can imagine what this can to my own tissues, the mesh, the repair, etc. So, will try to see if it will heal up by itself. This is by far the most serious complication I have encountered, just having this has a 20% mortality rate, so quite serious. Also, will likely get a huge hernia, although at present, that is the least of my concerns. I will take absolutely nothing by mouth for several months, in hopes that this will reduce in flow and heal, which about 60% allegedly do in 3 months. If not, surgery is the last resort and that would be a most difficult and dangerous surgery with all my scarring from the 3 previous surgeries and the heated chemo they put in my belly each time, something that could have led to this complication in the first place. For me, surgery is even more troublesome as I already don’t have enough small bowel and undoubtedly will have to sacrifice some in this process.

So, have had not a drop to drink (except a tiny sip of water twice daily with my acid reducers) or eat and am not taking any of my meds, including my vitamins, Tylenol for pain, etc. I have the TPN in place already, thankfully, and ask you to join me in prayer that God would see fit to heal this complication soon and without surgery if possible, though His Will be done. The ever optimistic Haitian Donkey is stumbling a bit and needs a special touch of the Master’s Hand to keep going. I cannot express my thankfulness to the whole team of people who support me, from #1 being Karen, who just does whatever it takes to keep me alive a bit longer, to Dr. De Cook, a most treasured friend and surgeon, to my most supportive office staff and patients, who put up with a stumbling Donkey for a doctor, to the host of friends who have done so much to help me keep going in so many different but appreciated ways.

In His Service,

Bill, Karen, Rachel, James and Jenn Ten Haaf

A Troubling Speedbump on the Road to Recovery

Hi All:

We are at 23 days postoperative now, the Donkey still eats nothing, though the heartburn finally seems under control and I am cautiously backing down on the pail of meds I was taking for that. Still have some retching episodes at night, not a lot of fun and not feeling all that great on the incision, but we seem to be making slow progress.  Am totally dependent on the TPN to live, but that also may present a problem.

I have been on Tylenol every 3 hours since surgery, as that is the only pain med I can tolerate, so don’t know if I have a fever and with each surgery I have fluctuated between freezing and sweats, sort of going through my male version of what the ladies a bit younger than I experience. However, my blood white counts took a huge jump this Monday and I started looking for the most concerning and likely cause, the huge flaps I have in my abdomen with the section of my abdominal wall they had to take out for the cancer and then replace it with the large mesh. This morning, after my shower, both Karen and I felt the upper aspect of the incision was infected, so have started myself on a “big gun” antibiotic to try to stop this before the infection gets out of hand as I cannot have them have to remove the foreign body, the mesh, as will have nothing to hold my insides where they belong.

The next couple of days will likely show us how serious this is, but would appreciate your prayers for wisdom in knowing how to best attack this. I have several special surgeon friends who I can call on and have, as I cannot be totally objective in such a potentially difficult situation. Pray for wisdom for all of us, that we can stop this infection before it gets out of hand.  It not only could jeopardize the abdominal incision but also prevent me from having TPN, as that already has a high risk of infection and this could infect that catheter, etc.

In His Service and Under His Control,

Bill, Karen, Rachel, James and Jenn Ten Haaf

The Somewhat Disappointed Haitian Donkey Stumbles Along Between Speedbumps

Hi All:
For the third time around, we do not have the road all figured out by a long shot. I have continued to struggle with the long promised diarrhea (didn’t happen the first two times at all, as “he has a lot of extra colon there”, but this time is quite evident and troublesome). They took a goodly amount of bowel out again, we are now running in the “none to spare zone,” so am sure that contributes to the situation also. Plus, I have had trouble with considerable gastric reflux since the first surgery (only had it before with coffee, OJ, pineapples, so avoided them and did fine) but that also has become quite unmanageable despite maximal therapy attempts so far. So, have been struggling with trying to figure what to put down the mouth without making things worse while trying to maintain hydration with the other. So far, am at home with an IV going to keep hydrated.

We received one unit of blood to drive me up to 8.2 (normal for them is 13-17) and that has made me less wobbly. I have been keeping the pain as tolerable as possible with one Tylenol ES every 3 hours as anything else seems to have unacceptable side effects but it does hinder ambling around the old homestead for the donkey. We managed to get discharged on Wednesday, the 20th and see Dr. Bartlett on the 21st with a positive report, he is hoping to have given me a couple years of life with the surgery and we are thankful. Our dear friends from church, Howard and Kathy Sytsma again brought us home from Pittsburgh, coming in our Durango and bringing us home on the 22nd, quite uneventfully, although I ate and drank nothing to keep from unneeded pit stops, especially at inappropriate moments. So, I am safely back in my home and my hospital bed, so much nicer nights, even when I don’t feel so good, it is good to be home.

I still have both drains in my abdominal wall to protect the large sheet of mesh as well as over 60 staples, all of which I will remove when the time is appropriate and I can stand the fun. Overall, I am making good progress, just the reflux and diarrhea is not manageable despite my vigorous attempts to do so. Pray for wisdom in treating these two problems so that I can return to normal health and function. I am still waiting to hear when we have to return to Pittsburgh for leukopheresis (not sure I spelled it right, they will draw off my white cells to incubate with my cancer cells to try to stimulate some of my own “killer T cells” against the cancer left in my body) and then 3-4 more visits of a week each to receive injections of the vaccine they created plus 3 different meds to try to slow down the cancer. This is all very experimental, no idea if it will help, hurt or do nothing, so also need prayer for that. However, first of all, I need to get the donkey back on his feet from the GI issues to be able to even consider the next treatments.

Once Again, Thank You so very much for your prayers, encouragement and help.

In His Service,

Bill, Karen, Rachel, James and Jenn Ten Haaf

Easter Sunday

Dear family and friends;

We had a great camp while the Athletes in Action youth team was here. The campers love all the new activities at camp Mahanaim and it was a special time for several of them as they were challenged to a deeper, more consistent walk with God.

We had a situation happen three weeks ago at Renault (Easter Sunday). On that Sunday, we had the youth Athletes in Action team with us, and after the Sunday school, when all 1,300 children had departed, one of the local men moved his little car in front of the gate and blocked us in the yard. He was trying to force us to give him some money for repairs on his car, claiming that we had damaged it. The man is the son of Delmas, from whom we bought the land 8 years ago. Anyways, when we refused to give money, and then told him that I was calling the police to have his car removed, he then started throwing rocks at us. Big rocks. The youth team had to get out of the vehicles, and Deb gathered them in a back corner of the building out of reach of the flying rocks. The rocks made dents in the metal gate at Renault and also, dents in the roof of the Sunday school building itself.  When the police arrived, the man ran off and hid himself, and we were escorted out of the area. The youth team responded well and they didn’t overreact. We were so thankful that Katie and the younger Yordy girls had remained with the other missionaries at City Lumiere, for the Easter service, and they didn’t experience any of the incident. We are also thankful that nobody was injured, although a couple people were hit with pieces of rocks, and the vehicles miraculously were not hit either.
We have prayed and  discussed this with Myrlande a lot, and we feel that the Lord has a plan and we need to take a break for a time and wait on Him. We aren’t sure what changes will happen, or what the Lord will show us, but we have not returned to Renault since Easter Sunday. We have had several delegations of children from Renault come out to the camp and encourage us, and assure us that they are all praying and we have told them that we hope to return at some time, but we are waiting on the Lord, to see how He leads. We truly believe that this is of the Lord and that He has a plan and will be glorified. Deb and I have been wondering about the number of kids (1,300 plus) that have been coming each Sunday and how to better minister to them. We don’t know if that means buying a larger, different piece of land, or renovating the existing building. Scott Yordy already built us extra benches, so we honestly cannot seat any more kids in the existing space.

We haven’t shared this in hopes that it would be resolved quickly and we would be back at Sunday school, but the Lord has not directed that way. We would really appreciate your prayers so that we will know God’s will in all of this.

With rainy season on it’s way, we decided to do some heavy work at the mouth of the river, right beside the Camp Mahanaim yard. We hired an excavator and lots of
dump trucks and removed a lot of gravel that had built up in the river. We had some excitement such as the dump truck that went in the river, but it was a very successful
project and the river has a large opening and our banks are much better protected.

We have also started work on the “shop” project. Lord willing, this will be a storage / shop area so that we can remove most of the sea containers from the yard. The sea containers have served us well, but they are all rusting and leaking are no longer “critter proof”. The army truck still works great, although we no longer take it out of the yard. It is now 30 years old and still going strong, however very rusty.

We had opportunity to harvest some beautiful Eucalyptus trees from a nearby forest. Cutting them down was easy, but we used a group of friends as a skidder to get the logs out of the forest and loaded onto the dump truck. It was hard work, but they did great.

We are planning to take a short break back with family in British Columbia and will be leaving on Saturday, April 24th, Lord willing. We are scheduled to return to Haiti
on May 18th. We would really appreciate your prayers during this time, especially regarding the Renault Sunday school ministry.

Thanks for everything,

bye for now,

Love Rod, Deb and Katie