Dr. Kresl of Phoenix Cyber Knife

First, I want to make one thing very clear: I really like my doctors. I have complete trust and confidence in their skills and abilities. Dr. Kresl and Dr. Willis both have excellent communication skills and caring support staffs. The doctors are not condescending; they treated me with complete kindness and honesty. They admitted that my treatment was no guarantee of healing; I appreciated the frank discussion. Thankfully, they are also very experienced in the treatment of cavernous angioma bleeds. I felt very comfortable with our decision to move forward with Cyber Knife radio surgery for my brain stem lesion. My husband and I knew there were no guarantees to the outcome of radiation, but we both agreed the treatment was better than doing nothing.

My treatment would include steroid use and 5 sessions of high-intensity radiation used around the perimeter of the lesion. To prepare for the treatment, I needed to be on steroids until the edema surrounding the lesion was reduced. It was necessary to get the lesion down to the smallest possible target area.

After a few weeks of steroid therapy, I needed a planning MRI. This scan is used in conjunction with a CT simulation to design an exact plan for radio surgery. I needed to have a plastic mask made---a mask specially fitted for my face-- that was also used in the planning portion of the surgery. The mask also has holes on the side so that during the radiation, your head is held in the mask.

I am not claustrophobic, thankfully. The plastic mask is quite fitted, but because it has holes in it I was not too uncomfortable.

Unfortunately, my brain stem treatment had to be postponed because the planning scan showed I had experienced 3 additional bleeds. I had 2 new bleeds in the supratentorial region of the brain; I also had a second bleed in the brain stem. I was completely unaware of these other bleeds, as I had no significant symptoms from any of them. It is by God's grace and mercy that I had enough steroids in my system--- I theoretically should not have survived another brain stem bleed.

On January 23, 2014 and on February 12, 2014, I had both left and right supratentorial lesions treated with Cyber Knife radiation. I remained on steroids during this time.

It is my understanding that Cyber Knife is generally not recommended for treatment of cavernous angiomas. Dr. Willis says that regular (invasive) surgery is generally recommended for accessible, symptomatic lesions. In my case, because all of my lesions are inoperable (too deep to access), Cyber Knife is used to cut off the blood supply to the lesion so that it shrink over time. In the case of a brain stem lesion, the radiation treatment serves to cauterize the lesion so that it theoretically reduces the risk of re-bleed. Since these are fairly new procedures, not a lot of information is available on re-bleed rates.

Neurosurgical Evaluation

After many phone calls and extensive research, my husband I a decided to consult with Byron Willis, M.D. of Arizona Neurology and Spine.

Because of the delicate location of the lesion, Dr. Willis told us the cavernous angioma could not be surgically removed without causing neurological damage. The only options for my case were either no treatment or radio surgery. The radio surgery (high intensity radiation) would act to cauterize the perimeter of the lesion, theoretically reducing the incidence of another bleed.  I was told brain stem lesions have a propensity to re bleed, and that if my lesion bled again, it would most likely be fatal. As it was, the lesion was so large that it occupied the entire Pons of the brain.

Dr. Willis did put me on Dexamethasone--- a heavy-duty steroid-- to reduce the edema surrounding the lesion. I did feel significantly better going on the steroid. The "falling backwards" feeling stopped within a few doses of the medication.

Dr. Willis did advise us to get all of our biological children screened for this genetic disorder.

Dr. Willis also referred me to Dr. Kresl of Phoenix Cyber Knife. 

Angioma Alliance

The best information I have found on Cavernous Angiomas is the website Angioma Alliance. This site contains a wealth of information on the disease, and also has links to helpful resources for the newly diagnosed patient.

The following is copied directly from the AngiomaAlliance.org

About Cavernous Angioma

Cavernous angiomas are vascular lesions comprised of clusters of abnormally dilated blood vessels.  These lesions can be found in the brain, spinal cord, and, rarely, in other areas of the body including the skin and retina. Multiple names refer to this condition:

• cavernous angioma 
• cavernous hemangioma 
• cerebral cavernous malformation (CCM) 
• cavernoma

Cavernous angiomas are typically described as having a raspberry-like appearance due to their composition of multiple bubble-like structures called caverns.   Each cavern is filled with blood and lined by a specialized cell layer called the endothelium.  Endothelial cells are the basic building blocks that work in conjunction with other cell types to form blood vessels.  In the case of cavernous angioma, the bubble-like caverns are grossly dilated vessels that leak due to defects in the endothelial cells and due to the loss of other structural components that are required for normal vessel walls.  Patients may present with a single or multiple cavernous angioma lesions.  Lesion size is variable, ranging from microscopic to a few inches in diameter and the lesions may cause a wide variety of symptoms including seizures, stroke symptoms, hemorrhages, and headaches.

Incidence

Cavernous angiomas are estimated to occur in approximately one out of every 500-600 people, that is approximately 0.2% of the general population.  While presentation of cavernous angioma is not uncommon in children, individuals often show the first sign of symptoms in their 20’s or 30’s.  Cavernous angiomas can continue to form later in life; therefore incidence rates and number of angiomas per person are higher among adults.  Generally, more than 30% of those with cavernous angioma eventually will develop symptoms.

Familial Cavernous Angioma

For at least 20% of those with the illness, cavernous angioma is hereditary. This form of the illness is often associated with multiple cavernous angiomas.  While familial cavernous angioma can happen in any family, it occurs at a higher rate among Hispanic-American families who trace their heritage to New Mexico.  This prevalence in Southwestern Hispanic-American families is due to a specific genetic mutation which has been passed through as many as 17 generations within this cultural group. 

Each child of someone with the familial form has a 50% chance of inheriting the illness.  Recent research has shown that there are at least three genes that cause the familial form of cavernous angioma; inheritance of a causative mutation or deletion in any one of these genes can lead to the illness.

Sporadic Cavernous Angioma

In addition to the familial form, cavernous angioma may arise sporadically.  Under this condition, there is no associated inherited genetic mutation.  The sporadic form typically presents as a solitary cavernous angioma that may be present at birth or may develop later in life.  Because sporadic lesions do not arise following the same genetic inheritance as with familial cases, related family members will not have a predisposition for the condition.  Additionally, children of those with sporadic cavernous angioma may have no greater chance of having cavernous angioma than anyone else in the general public (one out of 500-600 individuals).

Associated Venous Angioma

Up to 40% of solitary cavernous angiomas may develop in the vicinity of another vascular anomaly called a venous angioma. The venous angioma, also known as venous malformation or developmental venous anomaly, usually does not create problems unless it is associated with a cavernous angioma. It may make surgery more difficult; the goal is not to disturb the venous angioma while removing the cavernous angioma.In some people, a venous angioma may lead to the development of more than one cavernous angioma.

Other Vascular Malformations

The cavernous angioma is part of a spectrum of lesions known as "angiographically occult vascular malformations" related to the fact that they are not visible on an angiogram. Cavernous angiomas can not be seen on angiogram because they are low-flow anomalies in which blood flows through the lesion slowly. This is one quality that makes cavernous angiomas different from arteriovenous malformations which are high blood flow lesions that are readily visible on angiogram.

Symptoms  

Cavernous angioma symptoms are highly variable among individuals; in some cases no symptoms may be present.  However, when symptoms do manifest they often depend on the location of the angioma and on the strength of the angioma walls and their propensity for bleeding.  Cavernous angiomas can cause seizures.  A person who suffers from seizures is said to have epilepsy. There are many types of seizure including mild absence seizures and dramatic tonic-clonic seizures.  Seizures tend to worsen with age and frequency. Most cases of epilepsy can be well controlled with medications.  The type of seizure a person experiences depends, in part, on the location of the cavernous angioma. If a person has seizures and more than one cavernous angioma, it may be difficult to pinpoint which cavernous angioma is the cause of the seizures.

In addition to seizures, cavernous angiomas can cause neurological deficits such as weaknesses in arms or legs, vision problems, balance problems, and/or memory and attention problems. As with seizure, the type of deficit is associated with which part of the brain or spinal cord the cavernous angioma is located. Symptoms may come and go as the cavernous angioma changes in size with bleeding and reabsorption of blood.

Cavernous angiomas can bleed in a number of different ways:

• Angiomas can bleed slowly within the walls of the angioma and remain quite small.  A small hemorrhage may not require surgery and may be reabsorbed by the body.  However, continued small hemorrhages in the same cavernous angioma often cause deterioration in function.
• Angiomas can bleed more profusely within the walls of the angioma. This can cause them to increase in size and to put pressure on the surrounding brain tissue.
• Finally, angiomas may bleed through a weak spot in the angioma wall into the surrounding brain tissue. This is called an overt hemorrhage.

The risk of hemorrhage is dependent on the number of angiomas.  The higher the number, the greater the chance of one or more hemorrhages occurring sometime over a lifetime.  On average, cavernous angiomas that have bled in the past are those that are the most likely to bleed again, particularly in the first two years after their initial bleed.  It is also important to note that a hemorrhage in a cavernous angioma in the brain stem can be life-threatening, as the brainstem is responsible for regulating critical life processes including breathing and heartbeat.

Finally, those with cavernous angioma may experience headache. This seems to be true particularly when a lesion has undergone recent bleed activity.

Cavernous Angioma Statistics

1. 1 in 500-600 people have at least one cavernous angioma.
2. At least 30% of those with a cavernous angioma eventually will develop symptoms.
3. At least 20% of those with cavernous angioma have the familial form of the illness.
4. Up to 40% of solitary cavernous angiomas may have an associated venous angioma.
5. Age at first diagnosis:

Under 20: 25-30%

Age 20-40: 60%

Over 40: 10-15%

1. Primary symptom:

• Seizure – 30%
• Neurological deficit – 25%
• Hemorrhage – 15%
• Headache – 5%

1. Odds of your child having cavernous angioma:

• If you have sporadic cavernous angioma, your child is at no greater risk for developing a cavernous angioma than anyone in the general population; that is a one in 500 chance (0.2%).
• If you have familial cavernous angioma, your child may have a 1 in 2 chance (50%) of inheriting the causative gene change and developing cavernous angioma. 

Diagnosis and Treatment

Cavernous angiomas are diagnosed most often when they become symptomatic. Although cavernous angiomas have been known since the 1930’s, they have not been reliably diagnosed until the advent of the MRI (magnetic resonance imaging) in the 1980’s. Previously, the illness may have been misdiagnosed as multiple sclerosis or as a seizure disorder with no known cause. Cavernous angiomas are not visible on angiogram and were only inconsistently visible on CAT scans. An MRI scan, with and without contrast and with gradient echo sequences or susceptibility weighted imaging, read by an experienced physician remains the best means of diagnosing this illness. The MRI scan may need to be repeated to assess change in the size of a cavernous angioma, recent bleeding, or the appearance of new lesions.

Most cavernous angiomas are observed for change in appearance, recent hemorrhage or clinical symptoms. Medications are available to treat seizures and headaches caused by cavernous angiomas. Surgery is advocated for cavernous angiomas with recent hemorrhage, those which are expanding in size, and in some cases, those which are causing seizures. Radiosurgery, by gamma knife, linear accelerator or new shaped beam techniques, is a controversial treatment that has been used on cavernous angiomas too dangerous to reach through traditional surgery.

For familial cases of cavernous angioma, genetic testing is another option for diagnosis.

Surgery

Cerebral cavernous angiomas are surgically removed (resected) using a craniotomy, or opening the skull. This is usually performed under general anesthesia, except in cases where mapping of the brain while awake is needed. Cavernous angiomas in the spine are removed using laminectomy or unroofing of the vertebrae.

Surgery for cavernous angioma has been made safer using the operating microscope (microsurgery) and image guided surgical navigation (also known as computer-assisted or frameless stereotaxy) to reach the cavernous angioma with as little disruption to normal brain or spinal cord as possible.

Risks of any surgery, including cavernous angioma, include stroke, paralysis, coma or death, although these complications are rare with modern surgery performed by expert neurosurgeons. Surgery on cavernous angioma in the brain stem and spinal cord is more risky, but these cavernous angiomas are more dangerous if left alone. While recovery is different for everyone, many patients leave the hospital within a few days and resume normal life within a few weeks of surgery. However, people with neurological deficits may require a prolonged period of rehabilitation.

What We Don't Know about Cavernous Angioma

While researchers continue to make discoveries about cavernous angioma every day, many important research questions remain.

• Genetic researchers and a growing number of other researchers are working to determine the cause of the illness and the mechanisms by which the defective blood vessels are formed.
  
   
• We don't know most of the factors that lead to angioma bleeding and re-bleeding. Efforts to uncover what causes a particular cavernous angioma to bleed will help us to be able to reduce the risk of bleeding.
  
   
• We don't know how to remove a cavernous angioma without brain surgery or how to prevent them from becoming symptomatic. Less intrusive treatment methods may allow for control of more angiomas before they become problematic.

Background--- Cavernous Angioma

To those who don't know, I suffered a brain stem hemorrhage (cavernous angioma) on November 10, 2013. I remember the date very well, as it was my husband's (and my father's) birthday. Great birthday gift, huh?

On November 11, I woke up to a vague numbness on my left side. I did not think much of the symptoms, as I have a hereditary peripheral neuropathy--- which means I occasionally get temporary numbness in my hands or legs. This numbness, however, was significant enough that I bothered to mention it to my physician husband. When I told him of the symptoms, he immediately blanched. It was the same look he got on his face when I was delivering our first child--- kind of mix of shock and disbelief. He immediately said, "I think you've had a stroke."

I completely dismissed my husband's concerns. After all, if I had had a stroke, certainly I would not feel well, right? I felt just fine, perhaps I little more tired than usual, but fine. My symptoms were very mild and not too troubling. I was not concerned in the slightest.

After a few days, I conceded that perhaps this was not my usual peripheral neuropathy flaring up. The numbness was gradually increasing, and I was feeling slightly weak. I was not able to get an appointment with a neurologist until November 22, 2014. Who knew neurologists were so difficult to get an appointment with?

My new neurologist was very kind, but was not familiar with brain stem angiomas.  He was rather baffled by my symptoms. We did not realize my history had any bearing on my current condition--- and neither did my doctor. Although I had had a documented grand mal seizure in my twenties due to bleed of parietal/occipital lobe cavernous angioma, none of us considered the possibility of a cavernous angioma being the cause of the symptoms. My neurologist suggested blood work and an EEG to rule out a tumor or any seizure activity. We all felt this was appropriate, although conservative. My neurological exam did not show significant weakness, and my coordination was still pretty good.

As time progressed, the numbness and weakness grew. The full effect of the bleed was not evident to me until over a month after the first symptoms appeared. Now, my entire left side was weak and numb; additionally, I had some right-side involvement. Almost overnight, my entire head, face, and jaw went numb. My balance was poor, and I could only get up the stairs in our new house by gripping onto the hand railing. I constantly felt like I was "falling backwards" in my head, even when I was walking forwards. I had a strange pressure in my face and around my eyes. My vision was not sharp anymore. I had some occasion trouble with swallowing. I finally acknowledged to my husband that something was majorly wrong.

A friend of the family pulled some strings to get me an MRI.

On December 2, 2013 I finally had an MRI. The scan showed a huge brain stem hemorrhage. The culprit? A cavernous angioma occupying the entire Pons of my brain. In addition to the brain stem lesion, I have approximately 12 additional lesions scattered throughout both brain hemispheres. Each of these lesions represented a past bleed. Needless to say, my husband was horrified at the sight of the MRI. He didn't know what to do... but he started making lots of phone calls.

With new evidence in hand, I was able to schedule an appointment with a Phoenix neurosurgeon who has extensive knowledge of cavernous angiomas.

New Blog Beginnning

It's been a long time since my last post. My former blog became such a drain on my time; my hope with this new blog is to actually save some time. I will use this blog primarily as a way to communicate updates with family and friends. So often, I spend my time calling or emailing many in my circle to provide updates. Unfortunately, I always manage to leave someone out of the loop; I do not multi-task well these days. My apologies. In addition to communicating updates, my writing also provides some much needed "life processing" for yours truly. If you dare to read my blog, you will undoubtedly read of the many blessings difficulties bring along the way. My hope is that you will see that difficulties and hardships pave the way for much needed growth in life. A difficult journey almost always precedes a time of tremendous spiritual growth, if we allow the process to change us in a positive manner.

I chose this photo for my blog because I believe we are all on a journey. It is a walk we must all make alone, for it is the road that the Lord has appointed you and to you alone. God is Sovereign, after all, and He alone choses your personal journey and its destination. Sometimes the journey of life is exciting and thrilling--- like when you get engaged or have a much-yearned-for new baby. Other times, the journey becomes grueling and seemingly without point. Perhaps you've lost a loved one, or you struggle with endless financial crises. Or maybe you're like me--- enduring health challenges that shake you and your family to the core. But our journeys are never without point. God always has a purpose and a plan for our pain. Sometimes we fail to grasp pain's purpose, or perhaps its meaning may be hidden from us at this particularly time. Nonetheless, as people who chose to follow the Lord, we must find a way to continue the journey--- painful or not-- trusting God, and acknowledging our total dependance on Him.

So it is my hope that this blog inspires people to live without fear. I also hope it encourages someone in the midst of battle. You are not alone, even if you feel that way on occasion. God is always with you, and He will never leave you or forsake you--- even if you can not hear His voice or feel His comfort when you want. Every battle and difficulty has a reason, but God may or may not chose to reveal His purpose in your pain and trials. We must trust that in all things, God will allow circumstances that are for our ultimate good and His ultimate glory. His plans are not necessarily for our personal comfort or for our personal peace. We must learn to embrace His plan, while learning to forgive ourselves when we fail to wholeheartedly believe.

And that is where I am. Praying that God would help me in my unbelief. I don't like the painful circumstance that I find myself in, but I am learning to cope with life as He chooses.

Happy Father's Day!

The man who puts up with me... 

Happy Father's Day! Yes, you are the man who truly puts up with me:  the man who works three jobs to provide for the family... the man who lets me bring home stray animals... the man who blesses and supports my dreams of welcoming home 8 kids... the man who doesn't comment if the house is messy or if it's eggs (again) for dinner... the man who encourages me to be ME... nuts and all. Thank you. I love you, Sweetie! 

Happy at Home

I honestly feel kind of embarrassed--- and a bit guilty. The transition with S. has been so easy and positive that I almost feel reluctant to share. I know many of my friends and acquaintances have had extremely trying homecoming and transition times. For us also, all of our past adoptions had significant troubles and difficulties. We have endured biting, hitting, running away, inappropriate urination and defecation, food challenges, stealing, hoarding, lying, learning problems, overwhelming grief, etc. We know hard. We know what it feels like to need the Lord so badly to help you, that you constantly pray--- begging God for mercy and direction. We were fortunate that the hardships passed with time. Yet, we are keenly aware that many families necessitate counseling and family therapy to find some way to function and thrive as a new family unit. I grieve for some of my friends who never seem to enjoy relief. It pains me. But it also makes me very aware--- and very grateful and humbled by the Lord's gift of S. He has been such a sweet joy! I literally feel like this child has always been here.

And it's not just me who has felt this ease. Dear husband has experienced it, too. The moment S. saw his new daddy, he beamed from head to toe! His smile lit up the entire world--- for just that moment. His face seemed to speak love and joy... and "Where he heck have you been?" He did not want to let go of his daddy's neck. And even 2 weeks later, S. runs to greet Dad when he comes comes home from work. It's like "instance love" between these two. It melts my heart.

Upon meeting the rest of his family, S. was initially shy. He smiled and hugged everyone, but didn't totally warm up for a couple of days. Now, S. is running around with all of the kids, calling them all by name. He is not aggressive, likes to tease, and enjoys joining in with whatever is going on in this big family. Yes, he's had his times of grief and anger, but they have been short-lived and he has allowed me to comfort him. He was truly ready for a mommy.

Interestingly, my little man calls himself by his new name already. I initially called him his given name of Asfaw; then I called him S. Asfaw. Now, it's just S.  It always fascinates me how readily and easily four of my kids accepted and desired to use their new American names. A name change just didn't seem to bother them.

S. seems to accept change readily and goes with the flow. He is not reserved in the slightest, yet he is also not hyper or demanding. He is simply happy.

S. derives great joy from the little things: a warm shower, sippy cups, swings and a playhouse, new food, ice cubes, and rowdy play. The only things he has been afraid of are doctor visits, blood work, and snakes. (Doesn't seem too out of the ordinary!) His only "dislikes" have been brown rice and mixed berry smoothies. He child eats vegetables, fruits, and meats--- everything.  Although he does eat a good, maybe too healthy portion of food, he does not eat to the point of sickness.

S.'s adjustment has been going so well, we even took him to church last week. He quietly played with his bag of toys, and was so well-behaved. We are even going to try putting him in Sunday school tomorrow; I imagine he will do just fine. Additionally, he (we) survived a trip to our local CVS Pharmacy; he didn't even try to grab everything in sight, and didn't pout at all when I said "no" to a second treat. I am simply amazed at how this little guy is adapting to our family and to life in America!

As far as the adjustment of my existing family members, our family is also doing exceedingly well. We have literally had about 30 minutes of jealousy... total... from one person. And that person is now okay. Sure, we have some rolling of the eyes when S. has cried due to grief. Yet even then,  the older adopted kids then think to ask if they were the same way. I think Samuel has helped some of them to have a bit more compassion for people.

Thank you to all of you who have prayed for us over the course of this year. Your prayers have been answered (and we liked the answer!). Although I realize we are bound to have difficulties--- that's just life--- I am going to enjoy this delightful time of joy and blessing. Thanks be to God.

Last Day in Ethiopia--- Addis Ababa, Part 4

On our last day in Addis, we attempted to spend some time sightseeing. Mainly, we wanted to see the Addis Ababa University Museum.

Outside the Addis Ababa University Museum

Big sister and S. posing by exhibit

S. screamed when he saw the lion!

Still a little scary, even if it's stuffed!

Outside the museum

As quickly as you were able to view the above photos is about the speed at which we went through the entire museum! S. was way too excited to pay any attention to ancient artifacts and historical displays. He was running full-speed through the main room--- I was quite concerned that he was going to jump into one of the open exhibits! So... our best laid plans took a bit of a detour. I think the museum tour lasted about 20 minutes. Good thing it only cost 150 birr. Our driver was rather shocked when we appeared at the mini-bus, ready to go. S. told him that he really didn't like all this driving around; he just wanted to go home. The boy knows what he wants. 

In effort to avoid an immediate return to the guest house, our driver took us to a wonderful Italian pastry shop. It was a little dicey finding a parking spot here--- and equally dicey maneuvering across a very busy street with no pedestrian crossings and plenty of pushy street vendors trying to gain our attention. This was probably the one time big sister felt a bit uncomfortable; she does not like being surrounded by strangers. I grabbed her hand and pulled her next to me, just like I did S. He didn't like it, either.

Once across the street, we walked into a pleasant little shop that could have been in Europe. Flower vendors sat outside the entrance, greeting us with kind smiles as we entered. This is a very busy little shop, and it has been open everyday since the Italian occupation of Ethiopia; it has remained a popular place to enjoy miniature cream puffs and various other goodies. Considering no desserts exist in traditional Ethiopian cuisine, this establishment has enjoyed much success! The pastries are only made twice a day, and the locals have figured out when the pastries come out of the oven. People wait in line for their treats, enjoy a plate there... and then take a pink box home with them. S. happily tried everything put in front of him; he liked most of the items, with the exception of the creamy custard filling in the cream puff. I was a little leery of eating dairy products in Ethiopia, but figured the custard had been boiled. No problem. No sickies.

After the pastry shop, we had delicious buna at Kaffa Coffee House. I had my first Ethiopian macchiato; it was delightful! This store was also jammed full of people, both local people and tourists. The shop was about the size of a small Starbuck's, and had multiple tables where people stood to enjoy their buna. We also purchased some coffee to take home. Now that I've opened the coffee and brewed it at home, I so wish I had bought a lot more of it! It is simply the best coffee I've ever had. 

After buna, we headed back to the Ethio-Comfort to pack our belongings and spend time with Tsebay and her family. It is always so hard to leave friends. I think it's easier to be the one leaving.

Our flight left Addis Ababa on Friday night at 10:15 p.m. We took the advice of our travel agent and did arrive 3 hours early at the airport--- this was a good move. Friday was the kick off of an Ethiopian holiday, so the airport was absolutely jammed full of travelers and families picking up travelers. Due to a recent change in airport security, drivers and families must wait for passengers in the parking lot. Thus, the parking lot is not only full of cars, mini-buses, and people, but apparently also pick-pockets, too.  Our driver warned us not to exit the car until he brought over a person to help us with our bags. He also instructed us to stay close to the valet and put our purses over our necks and close to our bodies. We had no problems, but were very thankful that we got the the airport so early.

When you enter the airport, you wait in line and have your bags screened. Security has opened my bags every time we've traveled; they always find some metal object in the luggage. Next, you to the ticket counter and wait in another long line. Use this time to fill out your customs exit form. After leaving your baggage and obtaining your boarding passes, you walk through customs and have your passport stamped. After that, you head to another screening at the gate. Moral of the story: give yourself at least two and half hours minimum to get through all of this. It takes forever!

The plane ride home was sweetly uneventful. Thankfully, I do not have any post traumatic stress issues from the infamous Christmas Day Underwear Bomber episode we had the last time we were bringing home kids from Ethiopia. Thank you, Lord.

The scariest thing for S. was the flushing toilet. Unfortunately, S. was sitting on the toilet and reached back and accidentally hit the flush button. The poor kid freaked out--- a serious freak out--. He jumped off the seat and hit the bathroom door, yelling and crying. Poor guy. After that, he insisted on leaving the bathroom before I flushed the potty.

Oh, one word of advice: make sure you have some diarrhea medication in your carry on. Thankfully, S. could swallow the tablets. It could have been a very long and sticky flight.

To pass the time, S. used the bathroom every hour or so and hit every button on the interactive screen in front of him. The child did not watch one movie or television show for longer than about 3 minutes; he also didn't listen to any musical choice for longer than 5 minutes. I can't believe the T.V. screen kept him busy for most of the trip home. He tried every meal placed in front of him, but usually only wanted the sega (meat). He only slept about 2 hours total, until right before we boarded the plane in Washington, D.C. to head home. He slept the entire last 6 hours of the trip. Such a welcome relief!

We arrived in Phoenix a bit after 8:00 p.m. S. was so excited to meet his new daddy and all of his brothers and sisters. He gave everyone a big hug, with the exception of the dogs. Initially, he was fearful of the dogs; within a week, he thinks they're the greatest ever!

Our little guy stayed up until about 12:30 a.m., and then managed to settle in for a short night's sleep. He got up by 3:30 a.m. So did I. So did big sis. It would be a long few days... darned jet lag!

Farewell Party for My Little Man: Thomas Center

After a somewhat gloomy afternoon at the YWAM Mercy Development home, we headed over to the Thomas Center to enjoy a Farewell Party for S. and his good friend, A.

Great, hand-clapping music

Let me just say from the get-go: S. is no wall flower. The child loves to be the center of attention--- singing, dancing, and celebrating. The Thomas Center offers a great little party for the leaving children, complete with traditional sweet bread, roasted grain, popcorn, soda, coffee, and a gift of traditional clothing for the child. S. loved the music; a couple of the staff members played guitar and sang songs with the kids. It was difficult for me not to cry; all of this joy generated from a bunch of fatherless children. They all celebrated with S. and A.--- happy that they were about to start a new life with their very own families. I just prayed that each lovely child there eventually finds a home and parents of their own.

My new superstar,  singing at the top of his lungs

Joy!

My little man, dancing

Traditional sweet bread/cake

Dabo!

S. attempts to cut the first slice

Mom's turn to cut the cake

Squirmy man doesn't like posing for photos

Happy to clap and sing

Yummy chickpeas

Such sweet children!

A., Pastor Abdissa, and S.

The Children's House staff seemed a bit apologetic that they no longer offered a big evening out with exiting children and parents. In December of 2009 when T-man, my step-son, and I traveled to Ethiopia to pick up our other three children, we did enjoy the usual farewell party. Then, the celebration started at the Thomas Center, and ended very late at a traditional cultural restaurant, complete with dancing and musical entertainment. (Oh, I do remember that night: B. was high-strung, chugging Coca-Cola; G. and A. were running all over the place, ignoring everything anyone said. Not exactly relaxing, and nobody slept very well that night.) It was fun for the kids; over-the-top for the parents. After all, it's right at the end of a very emotional week. All that to say, I didn't miss the traditional dinner out. I was happy to have a shorter, lower key, early evening with my son and his friends. More than that is simply not needed. The evening was perfect.

Addis Ababa, Part 3: YWAM Mercy Development

The streets of Addis Ababa

Women selling vegetables, roadside

Lots of busses and tons of traffic

The streets are always filled with people

View of nicer area of Addis, near Ethio-Comfort

Any home with any value has razor wire on top of walls

Construction

On Thursday, May 24, 2012 we had a pretty leisurely start. I was unfortunately up at 3:30 a.m. again due to the Muslim call to prayer. Between the barking dogs, jet lag, and the Muslim call to prayer, a good night's sleep is pretty close to impossible!

This morning, T. and I are regretting the fact that we forgot to bring lots of dried fruit. Last trip, we stocked up on whole-food bars, nuts, and a variety of dried fruits. Since I traveled alone with T., I was quite reluctant to venture to the local mini-mart. It was a short walk, but one I was not going to risk making. 

T. and I never felt uncomfortable or unsafe while in Addis. We did have a male driver with us at all times within the city, and did not venture out without him. We chose not to go out at night, and did not eat anywhere but the Ethio-Comfort. Some might call us too careful, but when you have a beautiful and novice traveler as your daughter, and a sweet little boy--- I'd rather err on the side of being too careful.

Today we spent much of the time driving through Addis Ababa. The city is teeming with people, cars, busses, donkey, goats, and construction. The city is literally changing over night, with old and run-down areas undergoing demolition and new, high-rise building taking their place. Since none of the land is privately owned in Ethiopia, when the government wants to build, they build. Home owners are reimbursed for their homes, but I am told that often times the reimbursement is not too favorable for the home owner. 

Indeed, much of Ethiopia is undergoing such change. The Indian government is leasing huge areas of land (the size of Addis, I am told) and introducing mechanized farming; the Indians are also building various manufacturing facilities. When the Indians (or the Chinese) come into the area and decide on a particular plot of land, the government takes the land from the Ethiopians living and farming on it. The Ethiopian families are told to go elsewhere. This has created anger on behalf of the displaced Ethiopian farmers, in some cases. In other cases, Ethiopians surrender their land and end of working for the Indian companies. Additionally, I learned that the Ethiopian government makes a large amount of money through leasing the land, and through taxes on the exported materials. From what I understand, the farming and the manufacturing do not benefit the people of Ethiopia; all the food and products leave Ethiopia, and are exported. I do wonder how much of the new construction is government funded, and how much of it is foreign-government funded? With all of the obvious changes in Addis, there is certainly a lot of money coming from somewhere. 

T. and I did manage to spend a bit of our own money, purchasing beautiful items from the stores near the Addis Post Office. We did not have Kassa, our Lalibela tour guide with us to bargain... so I'm sure we paid about double what we did last shopping trip! Nonetheless, we enjoyed shopping in Addis and appreciated the helpfulness of the shop keepers.

Next stop, YWAM Mercy Development.

Outside of YWAM Mercy Development--- no overhead shelter  for outdoor benches

Outside YWAM MD

Not much room for kids to run and play, and what is here is not very safe 

Main entrance to YWAM MD. Note the sofas and chairs on the porch. The facility has no room inside for them.

Let me introduce you to a busy place: the YWAM Mercy Development complex. Well, it used to be a complex. Just last December, YWAM occupied 3 separate buildings. Now, due to lack of funding, YWAM occupies only one house. Many of the children are no longer able to stay at the houses. All of the ministries are run out of this one facility. Two of the missionaries left; the discipleship training school is defunct. The compound itself  is woefully inadequate--- overcrowded, messy (due to lack of storage and usable area)... and down-right upsetting. 

The YWAM home used to have separate boys' and girls' houses. Now, they are under the same roof--- adults staying in the main rooms, providing supervision for the kids. If I recall, the age range of the 15 children living in the complex is from 8-16. The home provides shelter, food, and funds for school; it also provides some Christian discipleship and accountability. 

In addition to the room and board aspect of the ministry, YWAM MD also runs a school-day feeding program for about 20 kids. Everyday, these kids come to get good food and hopefully, the sweet love of Jesus.

Lunch time feeding program

Outdoor food storage area

Kids enjoying lunch and fellowship

Some were bashful for the camera...

You can smile...

Gotcha! Such a beautiful smile from a great kid!

Indoor eating area for the younger kids

Inside main living area of home

Cramped quarters; the extra refrigerator is in the hallway

Computer work area for older students

Main area, looking out to front of property

Scripture decorates the walls

Tiny indoor kitchen area--- shown to us my Pastor Abdissa

I am not pleased... the kitchen area is so inadequate

Outdoor cooking and washing area

If I remember correctly, YWAM Mercy Development needs about $1500 USD to operate each month, and it is not meeting current budget needs. In order to grow and to serve more children in the surrounding community, the ministry needs to rent another home. There is a home currently available to rent--- almost across the street from the existing house. If YWAM MD can secure more faithful donors, more children can seek and find refuge. As it stands now, YWAM and all of its ministries are in jeopardy. That means no housing, no food, no community feeding program, no water program, no discipleship training program. If you would like to share in the burden to bring relief to these children, please make a donation online at http://ywamethiopia.com/donateus/ (indicate that the funds are for YWAM MD). Please consider making monthly support payments. The US dollar goes a long way in Ethiopia (exchange rate is 17:1).