September 18/2008

Good morning to you all:

Well its been an eventful couple of weeks since my last post. Most recently, I've developed "pitting edema" in both my lower legs/ankles and feet. For those of you unaware of this condition (as I was) Edema is observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. All tissues of the body are made up of cells and connective tissues that hold the cells together. This connective tissue around the cells and blood vessels is known as the interstitium. Most of the body's fluids that are found outside of the cells are normally stored in two spaces; the blood vessels (as the "liquid" or serum portion of your blood) and the interstitial spaces (not within the cells). In various diseases, excess fluid can accumulate in either one or both of these compartments.

The body's organs have interstitial spaces where fluid can accumulate. An accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. In addition, excess fluid sometimes collects in what is called the third space, which includes cavities in the abdomen (abdominal or peritoneal cavity - called "ascites") or in the chest (lung or pleural cavity - called "pleural effusion"). Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time.


What is pitting edema and how does it differ from non-pitting edema?

Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema.

In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.

The focus of the rest of this article is on pitting edema, as it is by far the most common form of edema.

So yeah, in a nutshell, I have been fitted with compresssion stockings to hopefully force the fluid back up through the body and out through the normal route of release. You don't even know what sexy is until you've seen me in these black stockings! UGH!!

On a positive note, I am flying out to Calgary on Sept 27th for 8 days to visit my ex-military friends. Brad Norman and his family have graciously opened thier home for me to stay at while I am there. I am very much looking forward to seeing some old frinds and being able to thank them in person for the contributions both in fund-raising as well as the work they did with Westjet to get us 3 complimentary return flights to Florida or California.

To top off this good news, I was/am to travel with a very dear friend of mine who has been very supportive of me throughout this whole cancer mess.

Cathy V. totally surprised me yesterday by telling me that her, along with her boyfriend, had paid for my airfare to Calgary. Cathy had intended on travelling to Calgary to visit her son,his wife-to-be and thier beautiful new baby and asked if I was still interested in going and did I want someone to travel with. Once again, people's true colours come shining through and in this case, I am ever so grateful to both of them.

In regards to my health status, I have been experiencing a number of headaches still since my last surgery and after looking at my dexamethazone (anti-swelling med for the brain) weaning schedule, all my headaches appear to coincide with when I've reduced my intake of this drug. That being said, twice now my home-care nurse has consulted with my surgeon's nurse and have increased the dosage of this steroid back to its previous level and subsequently, my headaches subsided. To me, this equates to one of two things. Either there is still substantial swelling in and around my brain that requires intervention OR the weaning schedule was too agressive for my brain to cope with.

Hopefully I will have some answers to this and other questions when I return to the Cancer Clinic this Friday for a 3pm appointment.

My options at this point (to my knowledge) and as written in the last medical report states: "There is no further role for radiotherapy.(radiation) Further chemotherapy would be considered but the platelet count needs to improve. Options for chemotherapy include changing the Temozolomide schedule to a longer schedule, either a 21 day each, 28 day schedule or a continuous daily schedule.Alternatively, Lomustine (CCNU) could be tried. Neither treatment is guaranteed to produce a response. I outlined the common concerns regarding myelosuppression and other toxicity with these treatments."

Myelosuppression is a decrease in the production of blood cells. Normal blood contains large numbers of cells, including red blood cells to carry oxygen and white blood cells to fight infections. The blood also contains platelets, tiny cell fragments that initiate blood clotting. These cells and fragments are made in the bone marrow, a reddish substance found in the centers of some bones. Healthy bone marrow makes large numbers of red blood cells, white blood cells, and platelets each day to replace those that wear out. In myelosuppression, the bone marrow makes too few of these cells.

Yesterday I also met with Joel and Paul Davies Sr for lunch. I haven't seen Joel since we were kids! What a blast from the past that was. They were kind enough to bring along some childhood pictures of us all on our 7 day canoe trip in Algonquin Park. Boy, did that ever bring back some memories!!

I will update you all of the Friday appointment results via this blog and/oer e-mail.

Thank you all for everything :)

Sincerely,

Ed