Dear All,

I once saw a summary of some military performance reports- in terms of interesting one-liners. One stands out. "This Officer has hit rock bottom- and has begun to dig". Lately, I feel we have started to dig.

Wendy told me she "existed" today.

My initial understanding was that the radiation treatment was very specific. Reality is that the radiation treatment is for all the brain; with intense focus on the two known tumours being reserved for the last three blasts. For the lesions to show up on the scans, they have to be a certain size. As the cancer cells grow, it may metastasise to other areas- and other cancer lesions commence. While we know of two tumours, there remains a chance that others may exist. As such, the radiation is very diffuse across the entire brain to get any other potential cancer "seeds". Rapidly growing cells are particularly susceptible to radiation, and hence potential "other spots" should be cleared. The downside is the destruction of good cells- the most outwardly obvious, over time, being hair. The dosage levels Wendy is receiving make it as close as you may get to very probable that she will lose, on a permanent basis, all her hair. We still have a wig from last year, and Wendy has advised she will be able to change her hair colour like her clothes. I will not encourage this greatly, as wigs cost a mint- but I guess she is worth it!

An immediate negative impact of the radiation treatment is that Wendy's throat has become sore and her voice is becoming just a little husky. When she received radiation treatment to the upper spinal/ neck area some 14 months ago, she had tremendous problems with swallowing due to damage to her throat. It may be that this area, once burned, is more susceptible to radiation treatment and the quickest to adversely respond.

Wendy has had some issues with depression. In this regard, we are in a quandary. The problem with depression is cause. Wendy was climbing out of the ravine, and has been thrown back in. Likely and permanent hair loss; sore throat; the fact the cancer is in her brain; all have the ability to cause a "down". Who could blame her? Fear of coping; of doing it all again; of the side effects. All are daunting, especially if you are tired, which she is. The treatment would be to get out, do some physical activities, and simply refocus. Alternatively, the depression may be linked to the radiation treatment. The treatment is physically tiring. In Wendy's case she has always been active, and the physical act of being tired and unable to venture far from bed may also cause depression. However, if this is the major cause, then the way forward is not to increase exercise and the like as you would for the first cause of depression. The treatment would be different- and indeed in a 180-degree manner to the first set of options, as physical exercise and getting out would simply add to the tiredness and indeed cause exhaustion, and further depression. Added to this is the dexamethasone.

The dexamethasone is a steroid. It is important to reduce the swelling around the brain lesions in the first instance and important to prevent swelling induced by the radiotherapy. Commonly dexamethasone produces insomnia and agitation and increased appetite with cravings. One of our doctor friends advised that in this scenario the usual adult dose his hospital uses is 16mg a day in 4 divided doses. Wendy was on 12 mg a day in 3 divided doses, and in the last day or so reduced to 8 mg per day. While certainly not on the higher range of acute dosage she has been definitely prone to all the problems. The dexamethasone is central to her care and no real alternative exists. The opportunity to reduce the dexamethasone will come when radiotherapy is finished and the swelling (oedema) is subsiding. In the interim, we are trying to address the specific symptoms. In the case of insomnia, Wendy was able to sleep well last night thanks to sleeping tablets. However, it may be the dexamethasone is adding to the severity of depression, either through further tiredness due to insomnia or simply through an amplification of greater mood swings. Significant mood swings are also linked to higher dexamethasone use, although it is also supposed to make you feel good!

This is all very complex- and no easy solutions exist.

Despite this, we have a lot to be thankful about. We are almost in June- and hence almost 12 months from the terminal diagnosis date. The support of the community and the friends who have given us a platform on which to survive continues to carry us.

There is some powerful imagery in one of the shortest books in the Old Testament- Jonah. As the "Wiggles" would say (and the fact I know this reflects the numerous times Daddy has had to sit through the "Wiggles" videos) it is a "Whale of a Tail". In chapter 2, verse 2 to 7. "In my distress I called to the Lord, and he answered me. From the depths of the grave I called for help, and you listened to my cry. You hurled me into the deep, into the very heart of the seas, and the currents swirled around me; all your waves and breakers swept over me. I said, 'I have been banished from your sight; yet I will look again toward your holy temple'. The engulfing waters threatened me, the deep surrounded me; seaweed was wrapped around my head. To the roots of the mountains I sank down; the earth beneath barred me in forever. But you brought my life up from the pit, O Lord my God. When my life was ebbing away, I remembered you, Lord, and my prayer rose to you, to your holy temple."

Like the seaweed for Jonah, we have been entangled with cancer. We are in deep waters, way over our heads. Like Jonah, I hope that one day I may be able to write about our rescue- just like he wrote about his rescue.

As for prayer, it is the wings of an eagle on which we continue to be lifted up, in spite of our adverse circumstances. A recent e-mail concludes with: "Our thoughts and prayers are with you through this new hurdle". A volunteer at work told me today that Wendy is one of five names he prayers for as he walks to the shops every morning- and he expects a good response to his prayers. The local church bulletin asks the church to prayer at 7 am and 7 pm for Wendy Boyd; we received an encouraging telephone call from South Africa a few nights ago letting us know that much prayer is being said over there; another Graeme (shame about the spelling!) told me his dad attends a church in Port Stephens and was praying for a Wendy Boyd- Graeme then told his dad that he could give him a lot of background. All this is but a sliver of the many e-mails, cards and calls of support all saying that many are in prayer.

We appreciate those thoughts and prayers.

Thanks again,

Graham for Wendy, Emma, Joshua and Samuel