In great calamity, pain and loss, Job declared, "Though He slay me,I will hope in Him..." (Job 13:15). It only seems fitting to start there. For in God alone to we hope and put our trust. There is no other. There is no rival, no equal...no one greater! It especially seems fitting in light of the report from Thursday's appointment at Duke.
Every time I write the updates, I try to be brief and to the point. I will seek to do nothing less this time. However, to assist the reader with greater understanding, I'll need a few moments of explanatory note.
We traveled this past Thursday morning, June 28, to Duke for our visit with the GI doctor. It was approximately nine weeks from surgery. Normally (that is, on average), eight to 10 weeks is the time frame for children with biliary atresia who have the Kasai procedure performed to show a favorable outcome.
At our visit, the doctor noted from his examination that Micah's liver seemed to be somewhat enlarged, but that his spleen was small (a good sign) and that there did not seem to be any fluid build up or collection in the abdominal cavity (also a good sign). However, he did want us to go for an ultrasound to insure there was no bile leak and pockets of bile that had leaked out and collected in the abdominal area. The report from the ultrasound was good; no bile leak noted.
Micah also had blood drawn to check his level of bilirubin and other levels specific to the liver. On Friday morning, the nurse called with the results. Two important levels checked were not the result we had hoped. In the middle of May (when we last visited the doctor and had blood taken), Micah's bilirubin level was 12.9. On Thursday, the level showed to be 18.8. This escalation of the blirubin level indicates that the surgery (Kasai procedure) has not accomplished what we had desired. While it is still possible that the procedure would "kick-in" later (sometimes it does take longer), it is more probable that it will not achieve all that we would have wanted it to.
But more concerning for the doctor and for us was another level checked. The liver plays a vital role in the ability of the blood to clot. When checking Micah's blood and levels, they check what is called the Prothrombin Time. Prothrombin time is affected by the liver's ability to synthesize proteins. Specifically, whether the liver is able to incorporate Vitamin K metabolites into a protein affects the clotting of blood. The normal level of the Prothrombin Time Test (PTT) is 11 to 13. Micah's level on Thursday was 35.3. While the higher bilirubin level indicates the surgical procedure has not achieved the desired outcome, this higher level indicates that Micah's liver is potentially becoming more unhealthy and diseased by the back-up of bile and the liver's inability to excrete the bile.
The doctor has started Micah on daily vitamin K supplements. We will then repeat the blood tests next Thursday to measure the prothrombin time again. If the levels return to normal, then the synthetic liver function is intact. If not, the nurse indicated the doctor might begin conversation about a transplant and the transplant process.
In spite of all this, you'd never really know anything was wrong with Micah (well, except that nagging yellow color and the weird bowel movements). He eats well, sleep well and at this point has been developing well. He even gained weight since surgery, which is great. But unless the liver is healthy and can function and excrete as it should, these outward signs of health will eventually end. The weight will stall, the health will decline and he could even begin to slow in his development.
Now...we return to our hope. All of what I have shared is what we can see and know right now. But God lives and works and acts in the impossible. Sure! He is part of every day, routine life. However, He makes His business being able to do what is impossible for you and me and even the most intelligent and skilled men and women. Jesus once responded to His disciples saying, "With men it is impossible, but not with God; for with God, all things are possible." God can, if He so chooses, still allow the procedure to work and the liver to function as it should. God can, if He chooses, still touch Micah's body and heal Him so that ALL, both doctors, believers and skeptics, would be speechless. God can, if He chooses, still allow Micah to be sick and undergo a liver transplant. God can, if He chooses, take Micah to live with Him because our time of stewardship over his precious and sweet life has come to a close. All in all, above any and all else, God will be glorified. His ways are higher than our ways...His thoughts are higher than our thoughts. He is our Sovereign King over EVERYTHING. And though He slay me, though He take our son, we will hope in Him.
We do ache and hurt. We do cry and experience pain. For there is much uncertainty and we have no assurance of the next moment for our son. But then again, we don't have that for ourselves. But thanks unto our Lord and Savior Jesus Christ for the "great manner of love the Father has bestowed upon us that we should be called the children of God" (1 John 3:1). Because of His love for us, we have the promise of heaven and we enjoy the blessing of eternal life right now.
We ask you continue to pray for our family...pray for our son...pray for all three of our boys...pray for grandparents who are struggling with the news. But MOST of all, pray that God uses us for His glory. We know He's using Micah. He's used Micah in 5 months of life more than He is able to use some who live 95 years. We want Him to be lifted up.
