Thursday, November 8, 2012

Four Ways to Mark Your Bible Study Book

The Fall Book Study will meet at my house on Sunday, November 18 at 6:00 pm. You can come to the study or read along at home. I hope many will come because we will have great discussions, fellowship and snacks. We will start in my home and decide which home to go to next. I hope for us to meet every other Sunday. Please pray about asking someone outside the church to attend. Give them a copy of the book if you have an extra.

Our book is Delighting in the Trinity, by Michael Reeves.

I have asked all those who are planning to attend to read the introduction and first chapter in preparation for our first meeting. I have some suggestions about how to mark your book as you read. These markings will help you keep track of things that would be good to discuss together as a group.

In addition to whatever other markings and notes you make, here are four things to note:
  1. I like this. Make a note of something you thought was well-stated, clear, or encouraging. 
  2. I want to know more. Note anything that inspires your curiosity or raises unanswered questions. Note topics that you would enjoy studying more deeply later or that you wish had been discussed in more detail. 
  3. I do not understand. Note anything that confuses you or you think is not explained well. 
  4. I disagree. Mark statements that cross you the wrong way, that you think are stated poorly, or that you believe are wrong. 
These highlight your book in ways that will prepare you to contribute to our discussions when we meet together. As a sort of legend, you may want to write these in the front or back of your book and give each of them a number. When you underline something in the text, you can then write the number in margin rather than writing the whole phrase. Enjoy your reading! I hope it stirs your imagination and strikes up your curiosity.

Wednesday, May 23, 2012

A Report on Kathi’s Health and Her Visit to the NIH

At the beginning of May, the National Institute of Health (NIH), a government medical research facility, finally brought Kathi to Bethesda, Maryland to participate in an ongoing study of Common Variable Immune Deficiency (CVID). We have been waiting for this for over a year, and it was good to finally have it take place.

What is CVID?

CVID means that her body does not produce the immunoglobulins that coordinate her body's ability to fight off infection. COMMON means that this condition is the most common of the immunodeficiency disorders (1 in 25,000-50,000). VARIABLE means that it manifests itself in a wide variety of ways that can be different for each person. Pneumonia, sinus infections, ear infections, and gastrointestinal infections are some of the many manifestations. This variety of presentations often leads to delayed diagnosis. IMMUNE DEFICIENCY means that the body cannot fight bacterial and viral infections like most people.

How does it affect Kathi?

Kathi’s manifestations are mainly twofold—repeated sinus infections, and gastrointestinal enteropathy. The sinus infections are inconvenient, uncomfortable, and fatiguing, and one may have led to an ear infection that made her deaf in her right ear a couple of years ago. However, her intestinal problems are the most acutely dangerous. They cause her either to not be able to eat or to not be able to absorb nutrition when she does eat. When her intestinal issues are acting up, she tends to lose weight quickly and dangerously and lose nutrients that are responsible for the proper functioning of her body—potassium, iron, vitamin B, etc. This condition has led to several scary emergency room visits.

At the NIH, Kathi was poked and prodded for two days by a wide variety of specialists who deal day in-and-out with CVID patients. The NIH is one of the few places in the nation where experts on her condition are gathered together in one place. At several points we sat in rooms with up to five doctors and several nurses for hours on end while they devoted every ounce of their attention and expertise to Kathi. She has needed that sort of attention for a long time now.

We learned several different things, and hope to learn much more in the months ahead. Here were some specific questions that we asked.

Q: Does Kathi have Celiac Disease and/or gluten intolerance or sensitivity?

A: For those who have CVID, Celiac Disease is a common misdiagnosis on the way toward getting a correct diagnosis. This is because Villous Atrophy is common in both conditions. The villae of the intestinal lining are like microscopic fingers which provide surface area that pulls nutrients from food as it passes through the intestines. In both Celiac and CVID, the villae can become blunted and the intestinal lining can become inflamed, preventing proper nutritional absorption and harsh intestinal discomfort. When a gluten free diet fails to reverse the villous blunting and provide relief, doctors often search for other conditions. CVID was confirmed in Kathi many months ago by measuring her immunoglobulin (Ig) levels. All of her Ig’s were very low, consistent with CVID.

Unfortunately, the most common tests available to doctors for confirming or ruling out Celiac as the cause of villous blunting require the presence of IgA, an immunoglobulin that Kathi lacks due to her CVID. Since CVID patients are approximately 10 times more likely to have Celiac Disease than the average person, no doctor to date has been able to confirm or deny that Kathi has Celiac disease. Likewise, no doctor has been willing to instruct Kathi to go off her gluten free diet, in spite of the fact that it does not appear to be improving her condition. Our (mine and Kathi’s) working theory is that she does not have Celiac, and the diet is unnecessary.

But at the NIH, they have tests available to them that are not commonly used by the average doctor, such as genetic testing. The NIH has taken blood to perform genetic tests that will place her into one category or another—1) genetically incapable of having Celiac or 2) genetically capable of having Celiac. To be in the latter category does not mean that she has it, just that she is capable of having it. The tests have not come back yet, but we have high hopes that she will be in the former category and I can finally buy her a Krispy Kreme donut.

Q: What is the mechanism that connects CVID and her intestines?

A: The doctors provided two answers, both of which can be and are probably true at the same time.

1) Her compromised immune system makes her susceptible to intestinal viruses, bacterial overgrowth and even microscopic parasites such as giardia. Like anyone with an intestinal infection, this can cause diarrhea, vomiting, dehydration, malabsorption, and the inability to eat properly. Unlike others, Kathi’s body cannot help fight off the infection, so the condition continues until it is fought off by extended antibiotic regimens that last longer than what is required by those with uncompromised immune systems.

2) The second answer is more complicated and is probably the more serious underlying problem that Kathi faces (this implies that the #1 above is simply a condition that complicates this more significant underlying problem). The body’s immune system requires properly functioning B cells and T cells, which are types of white blood cells which work together to protect the body from infection. The theory is that Kathi’s B cells do not work right, which is why her body does not produce immunoglobulins (IgA, IgM, IgG). This causes her T cells to overcompensate by working overtime to produce cytokines. Cytokines in turn overproduce interferons. These interferons are by nature inflammatory and somehow or another end up focusing their attention on the small intestine—producing gastrointestinal enteropathy. This inflammation of the small intestine is manifested as villous blunting, which presents identically to Celiac disease, although it has a different pathogenesis.

The doctors told her that this inflammation of her small intestines does not tend to resolve on its own in patients with CVID. In fact, without treatment it continues to get worse and can eventually be fatal. However with proper anti-inflammatory treatment, this inflammation can be reduced and even reversed, allowing for a relatively normal life inconvenienced by episodes or cycles of intestinal issues. It appears though that the underlying condition that causes the inflammation is not curable at this point. She will need to remain on some sort of anti-inflammatory treatment indefinitely.

Q: What is Kathi’s current and future course of treatment?

Every three weeks, Kathi has an immunoglobulin infusion (IVIG). You can think of this as a transplant of immunoglobulins extracted from several thousand different blood donors in each infusion. This builds up her infection fighting abilities for up to three weeks at a time, reducing the number of sinus and intestinal infections that she is susceptible to. This course of treatment will be maintained for the foreseeable future. IVIG is very expensive, costing several thousand dollars for each infusion. Thankfully insurance pays for a lot of this, but the remainder mounts up quickly.

That takes care of the infections. What about the more urgent intestinal inflammation? After trying a very expensive steroid (entocort) for several months that did nothing for her, her doctor put her on prednisone (thankfully a very inexpensive drug). Prednisone is a miracle drug for her condition. It has reduced most of the inflammation, so that Kathi has been feeling better for several months now. She can eat, has gained back important weight, has much more energy than before, and is generally much happier (and her happiness is so beautiful to me!). She has stepped down to a minimal level of prednisone daily. When she feels inflammation coming on, she steps up the dosage for a few days until it subsides, and then steps back down to her usual low dose.

Her NIH doctors have instructed her to remain on the prednisone for the time being because it appears to be working very well. But they would like to eventually get her on something else for two reasons: 1) Prednisone has other cumulative effects on the body that are not healthy, and 2) Prednisone is an immunosuppressant that can reduce the strength of her already compromised immune system. For the time being however, she has been instructed to stay on Prednisone because it appears to be working so well for her. They will explore other treatment options in the future.

What is ahead for Kathi?

Within the next few months, the NIH doctors will have her back for an extended hospital stay at the NIH during which time they will perform more tests. The tests that they perform will contribute to research that will expand medical science’s understanding of CVID. The results will also be used to formulate a particular path of long-term treatment for Kathi.

Before that though, we are going to the beach. Our first vacation in a long time in which Kathi has felt good.

Disclaimer:  I am not a doctor or a scientist so I cannot vouch for the complete accuracy of my word usage or explanations.  I am merely trying to summarize my layman's understanding of things.  No doubt, professionals could provide corrections.  While this might be useful information for others with similar conditions, please always consult your physicians before treating my explanation as anything more than a layman's imprecise summary.

Another Important bit of information:  CVID is not a communicable disease, so she did not contract it from anyone, and there is no danger of her passing it on to anyone else.

Monday, March 19, 2012

A New Life in New Martinsville West Virginia

This month has been a very busy month for the Bills family. I have started two jobs, one as the coordinator for the tutoring center at West Virginia Northern Community College, and the other as the pastor of Trinity Presbyterian Church. So I am now officially a bi-vocational pastor. I will have to write more about that later.

We closed on our new house this past Friday, meaning that we are committed to our life in New Martinsville for the foreseeable future.  I have disliked being a part of that generation that changes jobs frequently.  Perhaps now I can settle down and act like my parents and their parents and work the same job(s) for a couple of decades.

Our new home is on the north end of town.  We have a magnificent view from our back porch of a quaint, seldom used, grass airfield, the river beyond that, and the Appalachian hills of Ohio beyond that.  The house has been an incredible gift from God.  We marvel constantly at how beautiful and simple it is.  To date, we have only moved about 20% of our stuff from the other house.  It is a shame to have to clutter this house up with the other 80%.

New Martinsville is a wonderful, small town.  It has all the essentials very conveniently located within a couple of miles of our new home.  What we cannot find here, we can find by taking monthly trips to either Wheeling or Parkersburg.  Those towns are only about an hour away either direction.  And what we cannot find there, we can find in Pittsburgh, which is only two hours away.

We have been incredibly busy.  Kathi with setting up the house, Spencer with his new school, and me with my two jobs.  The big boys are getting a bit of a break from school, but will have to pick it up after we get everything moved.  They will likely be working well into the summer.  But the consensus of us all is that we are loving being here.
New Martinsville, WV
Kathi has been feeling much better recently. This is definitely related to getting a good grasp of how to best treat her immune deficiency with medications and diet.  She is stronger now than she has been in a couple of years.  Some of this may also be due to the fact that we have moved out of an unbearably stressful situation. Regardless, we now live with the expectation that at some point she may begin to spiral down, beginning another cycle of ups and downs that will last several weeks.   Our hope is that if she does begin to spiral down, her up and down cycles will be less extreme, less frequent, and more manageable.

We are praising the Lord for our new church home, for the opportunity to freely minister in accord with my conscience and vows, for our new house, for our health, and for God's provision for our needs.  All green grass has brown patches, and there is no telling how large our brown patches will be.  But for the moment, we are enjoying the foliage, sweet aromas, and beautiful sounds of a fresh springtime in our lives.

Saturday, February 4, 2012

Biblicism One and Biblicism Two by Carson and Keller

The following snippet is from a post by DA Carson and Tim Keller found here:
"There is a kind of appeal to Scripture, a kind of biblicism---let's call it Biblicism One---that seems to bow to what Scripture says but does not listen to the text very closely and is almost entirely uninformed by how thoughtful Christians have wrestled with these same texts for centuries. There is another kind of biblicism---let's call it Biblicism Two---that understands the final authority in divine revelation to lie in Scripture traceable to the God who has given it, but understands also that accurate understanding of that Scripture is never supported by bad exegesis and always enriched by the work of Christian thinkers who have gone before."

Sunday, January 22, 2012

A Brief Explanation of my Resignation from Winifrede Presbyterian Church

This morning I told my congregation in Winifrede that I have accepted a call to pastor another church.  That church is a small PCA church in New Martinsville WV--Trinity Presbyterian Church.

As I explained from the pulpit, my reasons for leaving are very complex.  The simplest way to explain it, and hopefully the most gracious, is to say that insurmountable differences make it necessary.  Early in my ministry here, the Lord impressed upon me that my call would serve a much more narrow purpose than I had anticipated when I first came.  That was to bring this church to a certain crossroads, at which it could make a choice of direction.  I did not at the time know when that crossroads would come or exactly what it would look like, but my sense of calling was clear.

Earlier in 2011, that crossroads became obvious, and the choice of which direction to take was made.  That made clear to me that my calling here was complete.  When that choice was made, I began asking the Lord for another call.  He answered that request, reassuring me once again that that my calling here was complete.

Whether or not one direction is better than another for this particular congregation is no longer for me to say.  I only know that my denominational vows and the conviction of conscience that led me to take those vows prevent me from traveling the chosen path with them.  I pray that the Lord blesses this congregation on its path.   That it continues to enjoy and grow in the grace of the Gospel, that it grows in its desire to have the Word of God clearly preached from its pulpit.  It has been a light in this community, preaching the Gospel clearly, for over 100 years, and I hope that it remains so for the next century.

I have no regrets about coming to Winifrede. My greatest joy has been to preach the Word to them every week.  The congregation is filled with wonderful people who have poured out their love for us in ways that we could never repay.  So many have been patient with me as their pastor, and they have really stepped in to show love, care and concern for my wife and family as she struggles with her illness.   I have learned so much that hopefully will make me a better pastor to the next congregation.  I only regret that I do not have the personal gifts that would best fit this congregation.  I pray the Lord will bring them a pastor that is better fitted to meet their needs.   I fully trust that my time here has served the purposes, both for me and for the church, that he desired it to serve.  This is his church, and he loves it dearly, and he will continue to work in its midst to accomplish his will.

The Presbytery will take up the matter of my relationships to this church and the next church at the Presbytery meeting this Saturday.  Since we will not be able to move until we have a home in New Martinsville, I have asked the Winifrede Church to continue to allow me to preach until we close on new home in New Martinsville.  That will take between 45-60 days from the time that we have a contract on a home.  We are very close to making an offer on a house.  Until the day comes for us to move, if the church is willing, I will continue to faithfully preach the Word and minister to the needs of this congregation.

May God bless the leaders and members of Winifrede Presbyterian Church.

Sunday, January 15, 2012

Jesus Invites us to Pray

The following sermon was preached on Sunday, January 15, 2012 at Winifrede Presbyterian Church.  The Title is "Jesus Invites Us to Pray."