(benches and tree)

I can't find the words to express how touched we are by everyone's donations. Thanks to everyone's generosity, including that of the zoo, we were able to dedicate one tree and the two surrounding benches to Dea's memory.

The area we picked out is right outside the Garden of the Senses (map, info). It is a nice, peaceful area. It was a spot my parents rested at often, while us kids went crazy feeding the coy from the nearby bridge.

(plaque on bench)

(plaque behind tree)

Jennifer Russell & Dwight Warak, Jr. are organizing a memorial donation to the Omaha Henry Doorly Zoo in Dea's name. There are two types of permanent memorials commonly offered:

1. A memorial tree, with accompanying brass plaque, will be planted and maintained on the zoo grounds. This is available for a $1,000 donation.
2. A bench with a brass plaque will be placed and maintained on the zoo grounds. This is available for a $2,000 donation.

The donated funds will be used by the foundation to support zoo exhibits and programs. Upon receipt of donations, the Foundation will reply with a thank you note, and will also send a letter to Dea’s immediate family to tell them about the memorial.

Anyone who is interested can either send a donation directly to the Zoo Foundation. To send a donation directly (checks only please, no cash!), please include a note stating that your donation is on behalf of Dea H. Engle, and mail to:

Omaha Zoo Foundation
Attn: Lisa Dwornicki
3701 S 10th St
Omaha, NE 68107

Donations can also be dropped of with Dwight Warak Jr. at the Data Center (removed).

If you are interested in contributing, please try to get it mailed or submitted to J. R. by February 24.

All donations that we received at the service will also be going to the Omaha Henry Doorly Zoo.

it was dea's wish to be cremated. he didn't want to be remembered for being sick. therefore we want to focus on celebrating his life and accomplishments, and we will be holding the memorial service at one of his (and our) favorite places - the zoo.

the memorial service will be at the omaha henry doorly zoo on sunday january 22nd. visitation will be in the treetop restaurant from 7:00 - 8:00pm, and services will start at 8:00pm. afterwards, the aquarium will be available for people to walk through.

if you would like to say something at the memorial service, please send me an (removed) or give me a call (removed). we are also trying to get a rough idea of how many people from fdr will be attending the service, so please email brian bowlby or respond to this post.

p.s. flowers may be sent to john a. gentleman mortuaries on 14151 pacific street.

edit: we decided to forego the aquarium. the entire event will be held in the treetop.

we will let everyone know once arrangements have been made. in the mean time, we will like to spend some quite time together.

i want to thank everyone that has supported dea and our family during this fight.

dannie made it in fine, and char is on the way. we'll try and keep everyone updated!

right now his oxygen levels are back up, but so are his fevers. he has a very difficult time talking right now, but is still able to say a few things (like "i love you"). he is also getting medication to help him sleep, and is not alert most of the time. at this point, the tpn may be doing more harm than good and is currently paused.

dannie is flying in this afternoon, and char somehow got a flight back from japan for tomorrow. once everyone is here, we will try and move dea home so he can rest comfortably.

we may need help moving furniture in the house so we can get in a hospital bed. if so, i'll be making a few phone calls. (we may also ask for some help with food once we get home, but right now things are still uncertain.)

since he is still having fevers, he was admitted to bergan. he is now resting in room 503.

our oncologist has recommended we all come home as soon as possible. we aren't even sure if char can finish her current semester in japan. i'll be home sunday (1/15), and dannielle will be home tuesday (1/17).

so dea went home yesterday from the hospital. he started having a low-grade fever again, so they did more blood cultures (but decided he could still go home). he is also taking tarceva now to help battle the cancer. since being home, he had a moment of clarity and was able to talk at length with my mom.

the three of us are also taking measures to come home again. charlene (who is currently in japan) is going to defer a semester. after this quarter is over, i'll be returning home for some time. dannielle (in san diego) is also working on her options to be at home.

keep in mind though, the reasons we are coming home are twofold. first, we do all want to be able to spend more time with our dad. second, we all want to be able to help our mom and relieve some of her burden. as our dad reminded all of us, he is still a survivor, and still fighting.

his ca19-9 numbers are four times higher than just over a month ago, before he started his latest chemo round. this tends to indicate that the chemo is not currently effective. also, his oncologist is very hesitant right now to give him any more chemo. he is already extremely weak, making chemo even more dangerous.

right now he is pretty incoherent. this might be a side effect of all the swelling he is having. the swelling continues to be a huge problem, and has spread to just about his entire body. because of this his pain medication (narcotics) are not being flushed out of his system in a timely manner. they did do a mri brain scan today however, just to check for other possible causes of his confusion.

he did get a blood transfusion today due to low red blood cell counts. it seems to also be alleviating some of the swelling. he also started another trial of tube feeding through his j-tube. they are starting slow, with a weak formula diluted with water. so far so good!

he recently had another study to see if his stomach is emptying. it was very taxing on dea, since it involves a series of x-rays over an extended period of time. it seems that there is still some sort of blockage between his stomach and intestine, tho a small amount of fluid is able to get through.

it seems he did win his battle with infection. there are no longer any signs of infection in his system. it sounds like he will be on antibiotics for another couple weeks just in case.

i'm hoping i can make several trips home to occasionally help out, and my youngest sister char will be home for about a month in late february.

dea is having a rough time right now. he is still battling the infection, and also the swelling has gotten worse. he recently had a paracentesis - but only 300ml was removed. meanwhile, the swelling in his feet is so bad he has a difficult time walking. he is still fighting hard though. he just had a mri, and has more doctor appointments coming up. hopefully things will improve soon.

i'll try and keep updating this website while in california, and also encourage my mom to keep everyone up to date.

thanks to everyone for their kindness and support. it means a lot to all of us, especially dea.

random note: we refer to the infectious disease doctor at bergan as 'dr. awesome' - for an array of reasons. we are all very comforted by the fact he is on dea's case.

oh... and happy birthday to my mom and littlest sister char. and happy holidays to everyone!

i'm guessing we will be in the hospital for awhile, so i wont be able to post another update until tonite.

dea is doing pretty good right now, although it was a rough day. he has been battling an infection for awhile, but it has pretty much been under control since day 1. he also had a small tumble down the stairs outside our house. he managed to catch the corner of the second to last stair when we were leaving for a doctor's visit today. if it weren't for the heavy tpn and dilaudid bags, he would have been able to catch himself (and almost did). instead, he ended up with some minor scrapes on his hands, knee, and face. the wonderful nurses at the oncology clinic cleaned and patched up the wounds when we got there. it was scary though!

unfortunately, there is no way to get to the main part of our house without going up some stairs. there are stairs leading up to our front door, stairs from the basement and garage to our family room, and stairs up our deck to our back door. from now on, we will leave from the garage. (at least those stairs have a railing and carpet.)

today he got another dose of chemo. he had oxaliplatin, avastin, and a bolus of 5fu. after his next round, we will get new ca19-9 numbers which help indicate how active his cancer has been.

again, thanks to everyone that made it! (and thanks for the warm wishes from those that couldn't.)

dea is still moving forward! today he had oxaliplatin and avastin. in two weeks if he is still doing well, he'll get 5-FU as well.

it seems he still has a little bit of fluid in his abdomen. so, monday he will have another paracentesis.

we also have a series of upcoming tests to narrow down his digestive problems. just to be sure he can tolerate tube-feeding fine, he is going to have a small bowel study monday. (basically they will put dye in his j-tube and take x-rays over time.) after that he may have another endoscopy to biopsy tissue around the obstruction in his intestine. this will tell us definitively if it is or is not radiation damage.

in general he is doing pretty well. he has started taking 'test drives' to work to test his stamina, and is starting to keep up on his email more. next week my sisters will start coming back home, so things are sure to get busy soon!

i also want to give an update on his surprise birthday party! we are really looking forward to it, and with his strength increasing we kinda wish we went for three or four hours instead of two! (after all, he does fine spending the entire afternoon at his appointments.) we'd love for everyone to stop by for awhile, and wish him a happy birthday. it should really help his morale!

we will be having the party at our house. for our address and directions, email me (removed). i think our address is also in the phone book. no presents are necessary!

what: surprise party for dea's 50th birthday
when: tuesday december 20th 6:00pm - 8:00pm
where: engle family residence

P.S. In case you are wondering, my dad doesn't really read the website right now. He usually depends on me to read off the new comments and posts from everyone. So I'm pretty sure its safe to post this up here :)

he has been a lot more active since coming home, and his strength is increasing. he is somewhere around 150 pounds now (hard to tell with all the excess fluid), which is great. you may see him back in action soon!

the latest cat scan showed fluid in his stomach all the way up to his esophagus. any higher, and he would be at serious risk for pneumonia. it didnt show any difference in tumor size, which is great.

however, dealing with our gi doctors has gotten even more frustrating. it may be time for a switch. actually, it may be past time for a switch. it would be wonderful to have a gi doctor willing to fight at least half as hard as dea is willing to.

going back to bergan made me like the place even less. the doctors and nurses are wonderful. the hospital rooms arent. i wish they spend a fraction of what they spent on the new lobby on upgrading the hospital rooms. when we asked about being able to watch movies in the hospital room, the nurse offered a vcr. i'd like to see anyone try and rent a new release on vcr. i bet it isnt easy. plus, to get internet, we have to use dialup and tie up the phone line. this basically leaves just cable tv as the only source of distraction while in there. when you are in bed 24/7 at the hospital, just being able to watch movies and surf the web can help pass time so much easier. especially now, when dea is starting to really feel left out at work. he is trying so hard to get better and stronger so he can go back, but when he can't even check his email while in the hospital... well... what can you do?

the hardest part is that lakeside is about 5-10 minutes away from our house. i'm told they have free wireless internet in the rooms. i'm told that you can rent movies and watch them from your room. i'm told the food is good enough to eat at least 50% of it... versus the 10% of the guest trays i eat when at bergan. but... the team of people that look over my dad at bergan is indispensable. they are wonderful, and really care. in the end... physical health > mental health i guess. i just dont think you should have to choose between the two.

lab results from the fluid drained from his abdomen showed signs of infection, pointing to intra-abdominal abscess. this tends to cause peritonitis, which is quite painful.

given this, it was recommended that dea be checked into the hospital. he is now at bergan, room 519. here he can get his pain under control, get some antibiotics, and have some tests done. we hope this will be a short stay.

they only tap on location at a time, so if he wants to have the fluid drained from his left side we'll have to go back again later. the ultrasound showed quite a bit of fluid in his left side too, so hopefully he can get that drained soon. they did order some labs on the fluid that was drained, and we should have those results later this week.

he is officially on tpn right now. some adjustments to the formula are still being made to make sure he gets a good balance of nutrients. the little pump is quite annoying, but its portable. he was able to stay on his tpn during the entire paracentesis procedure. we are holding off on tube-feedings, but plan on starting it again (in small doses) once things settle down a bit.

he is pretty exhausted at the moment, but finally starting to gain (a little) weight. lets hope this trend continues!

this tuesday he'll be having a procedure called paracentesis to drain some of the excess fluids in his stomach region. its a very minor surgery, and should help him be a bit more comfortable.

the big issue is still weight. since he came home, he as averaged only 1260 calories a day. (he needs about 2300 calories daily.) dealing with our gi doctors has been frustrating at best. we are pushing very hard to get him back on a tpn or ppn so he can get nutrients through his port while we continue to struggle with tube feeding.

dannie also had a wonderful opportunity to visit a conference on pancreatic cancer in los angeles. hopefully she comes back with lots of great information!

our biggest obstacle at the moment is getting him to gain weight. we have a couple doctors visits and phone calls this week to see if he can start eating soft foods soon. until then, he is connected to at least one of his pumps most of the day and all throughout the night. (he only gets a 6 hour break on good days...)

i dont think he is going to be up for visitors until he gets a little bit more mobility. being connected to his pumps is somewhat awkward. i'll keep asking him though!

we are all learning how to take care of his g- and j-tube. it will take a few days to get the medicine and feeding schedule down. until then, we'd like to hold off on receiving any visitors. we'll be sure to post on the website once we are all settled!

i'm going to take this opportunity to fly back to davis. i barely have enough clothes for a week, and will certainly need to get my winter coat at some point. i'm also planning on grabbing my computer -- my beautiful widescreen lcd monitor is feeling quite lonely right now :) of course, this means i'll have to drive back to omaha instead of fly back.

i fly out thursday. dannie is going to fly out to davis friday, and together we are going to drive back down to omaha. we should be back in omaha by monday, allowing my mom to go back to work sometime next week. dannie will return to san diego on tuesday - so we won't get to see her too much.

since i already have this quarter off, i'm going to spend it all at home. as long as my dad's health holds, i'll return to school at the start of next year. i'm pretty excited. i haven't gotten to spend this kind of time with my family in a long time! of course, i'll be working on my research from home. can't let my mind rot too much!

they did find a blood clot in his left arm. they gave him medicine for it, and it should clear up in a couple days.

oh, and no fevers! if this keeps up, we **might** get to come home later this week. it seems like every day he makes a small step towards coming home.

it also sounds like char made it to japan just fine. i bet she is already exhausted ^^

on a different note, i am leaving for japan on sunday. i don't really want to go just yet, i was hoping to see my dad back home, but i'm confident when I come home for christmas he'll be able to enjoy (or at least pretend to enjoy) some of my experimental cooking and baking. i just want to say thank you to everyone who visited and posted, your support is incredibly cheering and i feel much better leaving for school knowing that Dea has such wonderful people all around him.

once again, thanks for everything! i hope we'll all be seeing each other soon, but no where near a hospital. ;P

the surgery consists of inserting two tubes (a g-tube and j-tube). one will be placed in his stomach for drainage to prevent vomiting. the second tube will be placed in his small intestine for liquid food and medine - yum!

i'll post an update on how it all went later today!

update:
dad is currently back and resting. the surgery went well. they didnt have to cut through any muscle, so hopefully it will be a fast recovery!

either way, he should be able to go home pretty soon here. (either his digestive system starts working again in the next couple of days, or they put in a feeding and drainage tube and send him home.)

so, it is true that he doesnt have mrsa. but it *does* turn out he has c-diff. it isnt really a big deal, but it does mean that visitors technically have to put on a gown/gloves when they come in and/or avoid contact with him.

update: i dont even know anymore. there arent any special visiting restrictions anymore. you can come in gown/glove free! i'm starting to think that being able to update from the hospital *isnt* a good thing!

Dad was transferred out of the ICU today, he seems to have completely warded off his infections and his blood pressure is stable. We met a new GI doctor today whom we all like very much, and they preformed another endoscopy to look inside his stomach again, but the time the doctor wanted to also look at his lower stomach and small intestine, and was able to maneuver the scope farther down his stomach and discovered that the valve connecting his stomach and small intestines is swollen almost completely shut.

After all the tests to rule out a blockage, we have found a blockage.

The swelling is probably a result of the radiation treatments, and although this explains a lot he may still have gastropareses and need treatment for that as well. In the meantime, we are meeting with some surgeons tomorrow to discuss putting a feeding tube into his small intestine area and also inserting a tube into his stomach so he can drain the contents of his stomach and avoid nausea and vomiting.

Whew. It was an eventful day. Visitors are welcome again, now that we are back on the fifth floor. His room number is 526, and thank you everyone for all your support! We read the guestbook and comments to dad whenever we can, and it always puts a smile on his face. It means so much to us all to have this kind of support, and it lifts our hearts to see him smiling.

well, dad had a PICC line put in. this should alleviate some of his iv problems.

without the blood pressure medicine my dad was at 86, 4 points away from where he needs to be to leave the icu. they put him back on the medicine for now.

the recent tests with barium show that there is a blockage in the small intestine. however, doctors fear that this is a functional blockage. this means his bowels arent functioning anymore. between the chemo, radiation, diabetes, and narcotics, his nerves in that area might be damaged beyond repair. where this puts us we wont know until monday when we can talk to more doctors.

update 1:
dad has been having problems with nausea and vomitting. the gi doctor thinks that its caused by leftover barium in his stomach. since it is thick and chalky, it is not getting sucked up in his current (small) stomach tube. they plan on sedating him tomorrow, and placing a larger tube down his stomach to remove the leftover barium. they are also considering putting in a drain for his stomach so that he does not have to have the tube down his throat. i'll post more when i know it later.

update 2:
i'm pretty sure the problem he has right now is called adynamic ileus. tomorrow, the will do another scope to get a better idea of what is going on.

today was a bit rough. they think dad has an obstruction in his small intestine. they gave him barium so they can track its progress through the digestive system with several x-rays. his last x-ray should be saturday morning. hopefully we will have results by saturday afternoon.

all the moving around for the test took its toll on my dad. it was exhausting and the moving around was painful. he had to have two ivs removed and two new ones put in. one of the ivs went bad, prompting the nurse to give my dad ten small shots in the area to make sure his tissue wont be damaged by the leaking fluids. (this was very painful for him.)

he didn't have any fevers today, and it seems his infection is under control. he'll be kept on antibiotics for awhile. however, the moving and iv problems caused lots of fluctuations in my dad's blood pressure. it was the first time i've seen it up to 120 since being in the icu, but it also dropped to the upper 70s several times today. now that he is settled, his blood pressure is normalizing again. they have been able to decrease his dose of dopamine (for his blood pressure). once he is stable and in the 90s without the medicine, he can go back to a normal hospital room.

I finally had a chance to read the site, and I'm so grateful for all your support. It truly warms my heart to know Dea has such a wonderful network of well wishers. We'll be periodically reading all of your posts to Dea. I know this will warm his heart and keep him motivated. Amazingly, his great attitude and spirit has helped me through this more than he knows.

Our girls - what can I say! Dea and I are so lucky and blessed with three great kids (should say young ladies). They have been our constant source of pride and motivation to do better.

I'll leave medical updates to the girls, but would like to say that here at Bergan we have awesome nurses and doctors looking after Dea and answering all of our questions.

Sophie has deferred one quarter of her PhD program at UC Davis. It has been so wonderful to have her with us, especially helping me out whenever and whatever. Sean came out to visit Dad and just returned to Davis. It was hard for him, and hard for us since we did not want to see him go (for entirely selfish reasons).

Dannielle just started her first lab rotation for her PhD at UC San Diego. Of course, not being here is very frustrating for her, but knowing that we are not deviating the girls education too much helps lesson the stress level for Dea. She has been helping us as much as she can, especially by looking up medical terms and researching conditions on the Internet since we do not have access while in the hospital.

Charlene just received her itinerary to Japan (leaving October 2nd). Her departure draws near, and since she is spending all of her time with Dad in the hospital, her packing method will be most interesting. Keeping Char's study abroad program as planned will also lessen Dea's stress level. He was quite disappointed when Char was considering canceling her program.

I'm having a sort of leave at the moment from my work, and like Dea, I have great support from my work which enables us to concentrate on getting Dea better and being by his side.

All of you, thank you so much for all your concerns, prayers, and support. As you can see, we are all good and will be coming out of these bumps on the road very soon!

just a quick update: dea is doing pretty well. he has been fever free for some time now. he just needs to have a normal blood pressure to leave the icu. it may be a few days before that happens though, as it is a pretty tough infection he is fighting off.

if anything changes, i'll be sure to keep everyone updated.

update (11:35am):

he had a fever again last night, but that wasnt unexpected. they still think he is on track for beating this thing soon. they had to put another iv line in (pumping all his drugs through one vein was slowing up the delivery of his medicine).

the cat scan he had yesterday didn't show any new signs of cancer. (but he still has cancer, and will need more treatment once he is stronger.)

due to high temperatures and low blood pressure, my dad was transfered to the icu (room 4) this morning. it looks like he as a new infection. they will be monitoring him closely in the icu, and giving him medicine for the low blood pressure if necessary. we'll know more tomorrow after some of the tests get in.

for the time being, we ask that everyone wait until he gets out of the icu to visit. thanks for everyone's help and support.

update:

dea is doing well. he has stabilized, although his blood pressure is still a bit low. they did have to add a tube through his nose to his stomach to drain his accumulating stomach acid. he is resting well, and we decided to head home to get a good rest ourselves.

personal note: the dad i remember from my childhood looks different from the dad i know today (mostly, i remember him being... softer). but there is one thing that has never changed, despite all the weight lost. every day, despite how rough, he smiles the same large goofy smile that i remember and love.

it sounds like dad will have surgery tuesday to insert a feeding tube into his small intestine (called jejunostomy). he'll use this for nutrition and medicine if needed (but he'll be able to eat normally if he wants).

this should help him gain weight and strength while he continues his fight with pancreatic cancer, diabetes, and now gastroparesis.

well since dad is still not better, the doctors have ruled out lingering ulcers or inflammation of the stomach. The x-rays have ruled out any blockage in his digestive tract as the cause of all the vomiting/nausea. so after a conference of his oncologist, family physician, and GI tract specialist, they've come up with a new diagnosis of GASTROPARESIS. also called "lazy stomach" it is a condition where the stomach just stops contracting to pass food through, and if the diagnosis is correct there is a high chance this will be a condition that Dea has for life. It can be caused by his diabetes and is possibly completely unrelated to his cancer, though probably irritated by the treatments.

for more, http://www.acg.gi.org/patients/gihealth/gastroparesis.asp

more updates later

today was mostly quiet. my dad seems to be feeling much better. there is even talk of him *maybe* going home sometime next week.

we are hoping to catch the numerous doctors looking after dad together, at the same time, on tuesday. we should know a lot more after then.

also, dannie put together a great writeup about pancreatic cancer. you can now find it in the about section.

friday morning my dad had another fever. from the blood cultures, the doctors discovered a yeast infection in my dad's blood. they suspect his port is the culprit. he went into surgery friday afternoon to have it removed. he is already feeling much better, and the infection specialist we saw today thinks it wont take more than a day for my dad to recover from the infection.

there was a slight scare after the surgery, when my dad's blood sugar dropped to 24. the nurses scrambled and got him back to 120 very quickly. it seems the main problem was having to switch nutrient mixtures after he got his port removed. since my dad is on a heavy dose of medicine, they actually had to start two iv lines on him. he now has tubes coming out of both arms.

he was moved to increased doses of zofran and reglan, and is also taking new anti-nausea medicine (phenergan). the increased doses and new medication seem to be more effective. hopefully, his fevers and infection problems will be gone by tomorrow and he can focus on gaining strength and teaching his stomach how to work again.

around 10:30pm last night, my dad started to get a fever. it got up to 104 degrees before coming back down around 4:00am. as a result, he will be getting an additional antibiotic and another chest x-ray. he still isn't keeping down any food. at this point, it looks like it will be awhile before he gets to go home.

hopefully tonite he will be able to rest better. he has been pretty much fever free all day.

mid october, my dad started suffering from jaundice. he was later diagnosed with pancreatic cancer. early november he went into surgery. he had the whipple procedure, which removed a third of his stomach, the head of his pancreas, gallbladder, bile duct, lymph nodes, and surrounding intestine. the operation left an 11 inch scar across his stomach area.

since then he has had two rounds of chemotherapy (more information in history section). my dad suffered relatively mild side effects with the first round of chemo. unfortunately this was not the case with his last treatment.

in the four weeks after last his treatment ended, my dad lost at least 40 pounds. he was checked in to the hospital mid august to find the cause for his intense nausea. they discovered several severe ulcers and gastritis. his stomach had also stopped working normally.

he seemed to recover very quickly, and was released from the hospital in time to make our trip down to san diego. however, it quickly became clear he was not getting better. the trip was cut short, and my dad was readmitted to the hospital as soon as he arrived back home. at that time, he weighed only 140 pounds. he is 5'11" tall.

he has been at the hospital since. now that he is getting fluids and nutrients intravenously, he is looking much better. eventually, the doctors found fungus growing in his esophagus. now he is on anti-fungal medicine, pain medicine, anti-nausea medicine, and antibiotics (in addition to getting liquids and nutrients).

this is a website i created to chronicle my dad's battle with pancreatic cancer. it is a battle that started almost a year ago. at the moment, it is unclear who is winning.

as i get more time away from the hospital, i'll add more information to the website. once i have everything setup, i should be able to post regular updates on my dad's condition.