Ben Ratliff

Time to watch a bunch of Star Trek TNG.

Back to Cleveland Again Maggie had a clinic visit this morning and everything is looking hopeful. Her blood work was good. And her echocardiogram showed no change in her pericardial effusion, which is what docs were hoping for. It will still be some time before we know if her TMA meds are taking effect. Our team gave Maggie the all clear to return home to Cleveland. We are very grateful. She will return to the clinic a couple times a week for checkups and infusions. Please continue to pray that the TMA medicine will repair her damaged cells and that the graft will continue to grow strong. Thank you!

Westminster Reader 1.4 is out! Optimized for the iPhone Duo. Free, as always. Update on the App Store. apps.apple.com/us/app/westmi…

"This is the errand on which sickness is sent, to quicken us to inquire after Christ, and apply ourselves to Him as our Physician." - Matthew Henry

Day 59 After a chest Xray showed Maggie’s pericardial effusion has not changed, they discharged her to remain local until her outpatient appointment Monday. Please continue to pray her TMA medication would be effective, and this complication would be dealt with quickly. caringbridge.org/site/5ce8e9…

Very grateful for the support of this community in praying for my daughter. Occasionally I feel silly posting so frequently during intense seasons, but many of you contact me personally and say thanks for the updates. So I’ll continue. Plus I’m convinced that prayer changes things. Thankful for you who seek the Lord for Maggie. Blessings.

Change of plans for our family. Maggie’s TMA has caused fluid buildup around her heart. (This explains the fatigue she’s had for a couple days.) The answer is to proceed with TMA treatment, but doctors want to admit her again to monitor her symptoms. Please pray for the medicine to be effective.

Maggie was discharged yesterday afternoon. Caitlin and her will stay in Jackson until her outpatient clinic appointment Thursday morning, where she will receive her first dose of medication for TMA. Please pray this medication would be effective at completely reversing the damage done to her body, and that she would be safe from side effects and infections.

As of this afternoon, the doctors have given Maggie a diagnosis of transplant-associated thrombotic microangiopathy, or TMA. The conditioning regimen of chemotherapy and radiation, and the transplants themselves have caused damage to the walls of her small blood vessels. This can cause a cascade of issues including tiny clots, the hemolysis we’ve seen, and organ dysfunction. While this condition is life-threatening when unchecked, if caught early, there is an effective treatment that can repair the damage. Maggie's doctors believe they have caught her TMA early. She will remain hospitalized until she begins the treatment, and eventually transfer to out patient treatments. The past several days have been a blow. Having our family together for a little while was wonderful. Along with the weight of this new diagnosis for Maggie, it has been particularly bitter to be separated again. We cry out with the psalmist, How long, O LORD? Will you forget me forever? How long will you hide your face from me? How long must I take counsel in my soul and have sorrow in my heart all the day? We have prayed for Maggie’s healing and for our family to be together. The Lord has other plans. As we wait in these uncertain days, we pray that we would also say with the psalmist, But I have trusted in your steadfast love; my heart shall rejoice in your salvation. I will sing to the LORD, because he has dealt bountifully with me. Psalm 13 “To be at rest in God is for the soul to sit down satisfied with what God does as best, and with what God is as all.” ⁃ Edward Pearse

Maggie’s doctors suspect TMA, a post-transplant complication that can damage red blood cells and affect organs. She isn’t diagnosed yet, but the markers are becoming clearer, and they’re preparing for treatment while more tests come back. Thankfully, she’s stable without severe symptoms. They’re also adjusting medicines for rising blood pressure. We expect her to stay at UMMC through at least Tuesday. Please pray for clear answers, wisdom for her team, protection for her graft and her organs, and healing.

Maggie's temperature started rising earlier this evening. She and Caitlin left for the hospital about an hour ago (two hour drive). Please pray for safety on the road, for quick processing through the Batson ER, and for the doctors to have wisdom as they tend to Maggie. Some of main team is on call this weekend and for that we are grateful. Thank you. We will update as we know more. The moon is always round and God is always good.

“Are you ok?” The word that keeps running through my mind is “helpless”. “I feel helpless.” Our youngest daughter is fifty-two days past her second bone marrow transplant. At her clinic appointment today our team told us that her numbers are concerning. Our beloved doctors are still hopeful, but my wife said they looked like they were delivering bad news. We get that--some news isn’t horrible, but that doesn’t make it good. Hemolysis--the breakdown of red blood cells--is certainly not good. Could be her blood type converting to match her donor-sister. Could also be a drug side effect or a virus or a bacterial infection. It could also be a long-worded thing that they abbreviate to TMA. That would be very not good. “What can I do?” I can try to wash my hands more often, but that would be nearly impossible. The last year has been full of sanitizer and antibacterial Softsoap, and we’ve stayed sickness-free. (I spent a couple days with some friends recently and I pump the sanitizer every time I get in my car. “Is that a Maggie habit?” Yes, dear friend, a Maggie habit it is.) Unfortunately, more sanitizer won’t get rid of hemolysis. I can keep my distance from sick people, and keep my kids out of Sunday School a bit longer. That has helped keep us able to be around Maggie regularly, not afraid we’ll pass something along to her. But that won’t beat back TMA. I can’t adopt Maggie’s health issues as my own. (Not sure that my nearly forty-year-old and often tired system could handle it any better than hers.) Would be an easy trade for me to make, but we don’t yet have the technology. I can’t fix it. I’m helpless. I lack the strength or power to do anything useful or to control or protect my daughter. I may be helpless, but I am not without help. “I lift up my eyes to the hills. From where does my help come? My help comes from the Lord, who made heaven and earth.” (Pslam 121:1-2) At first it might seem off. Wouldn’t it be better to remind readers that our help comes “from the Lord, who is stronger than anyone else” or “from the Lord, who’s never backed down from a fight”? Why “from the Lord, who made heaven and earth”? I love Matthew Henry’s answer: “We must encourage our confidence in God with this that he made heaven and earth, and he who did that can do any thing.” He can do any thing. He will not let your foot be moved. He will not slumber or sleep. He keeps you. He shades you. He keeps you from all evil. He keeps your life. He keeps your going out. He keeps your going in. And He does it forever. In our deep valley we look up to the hills, straining our necks for the help of the Lord. And we remember that on a hill a long time ago, the Son of God was made helpless so that we would never be without help. The Lord has shown His intention to keep me (and my family and Maggie and you, Christian) by sending His Son to live and die and live again. All of God’s promises to us are yes in Jesus. So much so that George Swinnock rightly writes, “We must esteem His words as good as deeds and rely on all His promises as if it were already performed.” I may be helpless, but we are not without help. Maggie may have that long-worded issue that I can’t pronounce. She may need more medical intervention. She may get sicker still. And we will keep our eyes fixed on the Lord’s hill. Our help comes from the Lord who made heaven and earth. pulpitmatters.com/p/helpless

Maggie had a clinic checkup today (Day 52) and we have need for you all to pray. Our doctors described her numbers as "concerning," but the team feels they can manage what's happening. They remain very confident in the graft because her marrow is producing blood cells. The concern right now is what's happening with her immune system. She is experiencing hemolysis--the breakdown of red blood cells--and the challenge is figuring out why. There are several possibilities. It could be related to her blood type conversion, which would be the best-case scenario. It could be caused by her main anti-rejection medicine, a virus, or a minor infection. They're going to run viral panels and check for bacteria. They're also watching for something called transplant-associated thrombotic microangiopathy, or TMA. This would be more concerning, but they explained that it can still be managed if caught early. She does not currently meet the criteria for that diagnosis. Some of her lab findings are reasons to keep watching closely. Our team is hopeful, but their tone carried the weight of the concerns they were sharing. We're grateful to be going back home, even as we feel the uncertainty of what comes next. We are concerned. We're thankful her marrow is producing, thankful for a team that is watching closely, and praying for clear answers and healing. But through all of it, we keep trusting the Lord. Please keep praying with us. Psa. 56:3 "When I am afraid, I put my trust in you."

Maggie is thriving being at home with our family all together. Her energy and appetite are up. Playing with sisters has been a great medicine. Overall her doctors are encouraged by her blood count numbers and they feel that her engraftment is strong. Her white count is increasing, and they can see that her marrow is making red blood cells and platelets, although her hemoglobin is slowly decreasing. There is some process happening in her body that is causing the destruction of the new red blood cells (hemolysis) her body is producing. There are different things that can cause this hemolysis - such as viruses, - but they believe that it is actually her body switching from her original blood type to the donor blood type. As the marrow produces the donor type blood cells, it is attacking and destroying the old blood type cells. They will run tests to rule out other causes, and continue to watch her closely. If it is the transition to the donor blood type, this will eventually resolve on its own. If her immune system gets too aggressive in attacking the old blood type cells, they can calm it down with medication as her body continues the transition process. Please continue to pray that: - Her engraftment would remain strong - Her kidneys would be protected from the strain on them by medications - The hemolysis would be due to the blood type transition and resolve without need for medication - She’d be protected from viruses and infections

Leaving the Delta for a couple days at Covenant College. Pray for the work of the AI study Committee as we meet together and with students/faculty.