Thursday, August 2, 2007

Update on Martin's AVM condition - Aug. 2, 2007

Update on Martin's AVM condition - Aug. 2, 2007

Hello, everyone. After I finish writing this update, it will be published to my blog (and from there imported into Facebook), posted to the Yahoo group dedicated to Martin's condition, and sent off by e-mail to various people (who all have permission to forward it to others in turn), so my apologies in advance if you get multiple copies, and/or if I am repeating information you already know...this is the easiest way for me to get the news out to all who are interested, including some I don't see or communicate with nearly as frequently as others. It has been quite a while since I have written an update on Martin's condition (basically because nothing happened medically speaking that I knew of since my last update and I didn't think anyone needed to receive multiple e-mails saying "nothing has changed"), so let me first recap what has gone on up to this point. (This will take a couple of paragraphs, so please bear with me.)

In August 2004, Martin collapsed at work after complaining of a massive headache and stroke-like symptoms. He was rushed to Sunnybrook hospital, where he remained unconscious. Scans revealed that Martin had two AVMs in his brain, one on each side, and that the one on the right side (the one I call AVM #1) had bled. (If you don't remember what an AVM is or weren't around for the first batch of updates to have found out, read this if you want more information: .) His condition was critical but more or less stable for a couple days, but after that time he deteriorated somewhat such that an emergency surgery was performed. This surgery removed the excess blood from Martin's brain (which was putting pressure on the brain as well as blocking the passages that normally allow draining of fluids from the brain) as well as AVM #1--the AVM that had bled (but without further digging around to remove AVM #2, as that would involve doing surgery on the other side of the brain as well and that have been too much for his brain to handle). After some days Martin eventually opened his eyes, got moved from critical care to the neuro intensive care unit at Sunnybrook (where he started talking, though he was still not fully "with it" and didn't make much sense), improved further and got moved to the regular neuro ward, improved further still and was transferred from Sunnybrook to an inpatient rehab clinic, improved further still such that he was allowed to come home in November 2004 and just attend outpatient rehab, and finally he was eventually allowed to stop attending rehab altogether.

Around this time, the medical team decided that Martin was stable enough to start discussing options for treating AVM #2. (AVMs have a 4% chance to bleed every year, so obviously it's better to be proactive and treat them before they bleed, especially if they're in the brain.) The three treatment options, if you remember, were surgery, radiosurgery and embolization (you can read about those treatment options at as well if you need a reminder/more information, but I will add a reminder that embolization is the treatment where they basically fill the AVM with a special kind of glue). Together with the medical team we decided that radiosurgery was the best way to go at that time for an AVM of that size (the AVM in question was about 2.5 cm or about an inch across at the time). Consequently, Martin received radiosurgery in June 2005. The radiosurgery itself only lasts for about 15 minutes total, but it required a whole day of prep, scans, and so on. I know when most people hear "radiation" in a medical sense they think of people going for multiple sessions, but that is not the case in AVM treatment; Martin received only about 15 minutes of highly-targeted radiation on only 1 day about 2 years ago, and that is the extent of his treatment...that is why I use the alternate term "radiosurgery" (a.k.a. Stereotactic Radiotherapy) to refer to Martin's treatment rather than "radiation." What the radiosurgery does is prompt the slow building up of scar tissue on the inside walls of the blood vessels in the AVM, such that they eventually choke off the AVM from the brain's blood supply. See, if no blood is going into the AVM, it can't bleed and cause brain damage. The downside of this treatment is that it takes 2 to 3 years for this building up of scar tissue and choking-off to finally complete, which means a lot of waiting to find out if it actually worked or not. Later that summer Martin returned to working full-time after almost a year away.

Okay, enough old news...on to new news. Now that August 2007 is here, we are just past the 2 year mark since Martin had his radiosurgery. Martin went for an MRI last Friday (at 11:30 pm, ugh...the MRI machines really must be in high demand here in Toronto, because MRIs are done 24 hours a day, 7 days a week...I remember in 2005 sitting waiting for Martin and hearing the receptionist call people to confirm their 2 am MRI appointments!). The MRI appointment itself was fine, but we couldn't really tell anyone anything useful after it because the MRI technicians don't tell you anything about what the scans indicate about your condition (they must have to do scans for a whole gamut of conditions, after all, and they aren't trained to interpret the pictures, just make 'em).

Today was the day we got to find out what the pretty pictures had to say. A more junior doctor came in to see us first. He asked Martin a bunch of questions about how his walking is going, the process to get him his driver's license back (which we're not pursuing until AVM #2 is fully treated), how his work is going, whether he had any complications after the radiosurgery, what medication he's currently taking, which of the AVM clinic doctors we saw last, who did the radiation, and so on. He reviewed the history of Martin's case and checked Martin for any residual weakness, his reflexes and his vision. He didn't tell us very much (not that we expected him to) and mentioned that he would have to look at the pictures with the neurosurgeons again, but he did indicate that the MRI seemed to show that AVM #2 is almost if not completely gone (where by "gone" we mean "sealed off and unable to cause any problems").

When he was done with his examination, he left us for a time while he presumably went to consult with the neurosurgeons again, returning afterwards with Dr. Chris Wallace, the doctor who performed Martin's original brain surgery (i.e., the one to remove AVM #1). Dr. Wallace pulled up the MRI that was done in 2005 side-by-side with the MRI that was done last week. It seems Martin does have a scar in his brain where the original hemorrhage occurred, but that's really not of much consequence to us. What was more important was when Dr. Wallace pointed out a bunch of "black marks" indicating AVM #2 in the 2005 scan...and the corresponding area where they are pretty much missing in the 2007 scan. There are a few marks there that look kind of like grey smudges (Dr. Wallace said, "I don't know what this crap over here is"...comforting from a brain surgeon, but this is the humor we've come to expect from him :)), but yes, just like the more junior doctor said, it does look like Martin's AVM #2 is just about treated. It is too early to say that AVM #2 is fully gone, however. As good as an MRI is, it's still not detailed enough to confirm that an AVM is do so requires an angiogram to be performed. Because the MRI may indicate that the AVM is *almost* but not fully treated, the team is going to allow the third year to elapse before doing this Dr. Wallace said, we could do the angiogram now, but we may well find that it says the AVM is still there, so we'd have to do another angiogram in a year anyway...we might as well wait. Martin *hated* getting the angiogram done 2 years ago (it involves having something threaded through an artery near his groin up to the blood vessels in his head, and on its way there last time it made him feel like he got kicked in the crotch), so he didn't protest waiting another year to get another one of those done. Martin will not have another MRI done in 2008 because this year's MRI already shows so little of the AVM; he'll just have the angiogram in 2008, followed by another follow-up appointment at the AVM clinic. Incidentally, Dr. Wallace also pulled up the angiogram that was done in 2005 and showed us the old picture of AVM really showed me why an angiogram is needed to confirm that the AVM is gone, because the amount of detail in the angiogram is stunning, clearly showing blood vessels that are less than 1 mm thick.

All in all, this is good news...AVM #2 is definitely responding very positively to treatment, and Martin is almost cured! Hooray!

For those of you who are not in regular contact with us (which I suppose will be some in my e-mail-only audience, so my blog and Facebook readers will have to bear with me here), I'll also give you a brief update on what is happening with us apart from the AVM issue.

Martin's work: You might recall that Martin's loss of his driver's license for medical reasons meant that he had to take the TTC to and from work, which was quite annoying for him because it took considerably more time out of his day. After some time, however, Martin began carpooling with someone from his work, which ended up being a great arrangement. A few months ago, however, Martin found out through a friend about a job opening with his friend's company which would allow Martin to switch from fixing electronics hardware to doing more computer IT stuff--something in which Martin is very interested but has no formal training. Martin sent in an application with his friend's recommendation, and before you know it he was on the phone being interviewed by someone in New York, then on the phone again being interviewed by a team of people in England, and then heading downtown for a face-to-face interview here in Toronto. He got the job...and his new company promptly shipped him to England for 6 weeks of training! I remained behind as we did not want to spend the money for me to go over there...Martin wasn't put up in a large city, so there wouldn't have been much for us to see on weekdays (though there was freedom to travel around on the weekends), plus Martin spent a large part of each day training, and while some people wouldn't mind being left alone to entertain themselves, I generally like company when I'm exploring. Martin returned to Toronto July 22 and is enjoying his new job. Because he's in a new field in which he's not formally trained it is challenging and a little overwhelming at times, but hopefully with time he will feel more at ease in that respect. He does take the TTC to work, but since it is downtown and the night buses service the route he takes it is not nearly as much of an issue as it was at his old workplace.

Joy's life: The last update I wrote was our Christmas web page update in 2005, and since then I have finished both my Honours Bachelor of Science degree (with a major in chemistry and minor in physics) and my Bachelor of Education degree (with qualifications to teach high school chemistry and physics). This means I am now looking for a job teaching high school. While the job hunt is going very slowly at this point, I am on the eligible-to-hire list for the Toronto District School Board, which means I passed their board-level interview and am now waiting for principals to grant me a school-level interview and decide to hire me. I have also applied to positions in the Peel and Durham regions (and I have had 2 interviews in Durham, both of which went very well even though neither of them resulting in my getting the position) and I have a board application in with the York Region District School Board. At this point in the year most principals are enjoying their vacation rather than doing further hiring, so I am sitting tight for now, continuing to watch for postings and waiting for the hiring to start again in mid- to late August. Being on the eligible-to-hire list is apparently a good sign that I will have at least supply teaching work in Toronto in the upcoming school year if not a permanent position, and I know teachers get hired as late as October, December or even February. Obviously I am hoping to land a permanent contract in my own classroom rather than doing supply work, but I will do what I have to to get my career started (and start pulling my own financial weight in this relationship, as gracious as Martin is about telling me I don't *have* to work). Oh, and yes, I did finally get my G2 level driver's license, which means I am out there on the roads of Ontario driving a stick shift all by myself! It is wonderful to have the freedom to go where I want, when I want, although there are times I still walk, carpool or take public transit in an attempt to get some exercise, be a little more environmentally-friendly and avoid gas prices, rush-hour traffic, core/downtown traffic and parking fees.

That is about all I can think of to pack into this update. If I didn't cover something you're curious about, feel free to drop me a line. By the way, my primary e-mail address is changing because Martin and I are going to be switching Internet Service Providers, so please do *not* mail me at or any longer. I have several e-mail addresses you may use instead; probably the easiest one for me to give out right now is . Alternately, if you're getting this update via the Yahoo group, you probably see my e-mail address as , which you may use instead, although I would much prefer it if you'd use . If you have a different e-mail address for me, it's probably OK to use it as long as it doesn't end in . Questions, comments, concerns? Let me know. I hope all of you are well and enjoying the summer as much as you can...even if you're not currently on vacation like I am ;). As they say all the time in England (just ask Martin),