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You are welcome to apply any part of this article to your own personal use. Please do NOT publish any part of the article or apply any part of it to any non-personal use without the express written concent of the author.
Hi all,
I hope this finds you all in good health and spirits, that your holidays were special.
We finished the radiation treatments on January 2 as scheduled, and I've come through the process with flying colors. Thank you all for your thoughts and good intentions during this phase. Just knowing you're out there has given me the strength to hang in there with high spirits and (as one technician said) a "great" attitude.
We are now focusing on the next phase -- surgery. The surgery is scheduled for January 22, and will take place in Gainsville, Florida. We'll drive up on January 20, have a pre-operative appointment with the doctor and some pre-operative tests on January 21. We expect that I will be in the hospital for 2-3 days, then will be staying in Gainsville near the hospital for about 10 more days before returning to the boat. Hold the thought for us that the surgery will be extraordinarily successful and that full recovery will be realized in record time.
As I write this we're aboard "Volant" in Delray Beach. We will be moving her back to her normal dock in the middle of next week. She'll stay there during the visit to Gainsville, so we'll be coming back to her there.
For more medical details, read on...
I still have some of the marks on my leg that the radiologist technicians drew in their "special" ink. Each time I wash a bit more comes off. It should be all gone within the next few days except for the tattoos. If you recall, there were about 5 needle-point-size tattoos in the "special" ink to insure that the radiation would hit exactly the correct target area every time. These 5 points will stay permanently on the skin. Fortunately they are small enough that, unless you knew what you were looking for, you would not notice them at all.
The final 2 days of radiation treatments were a little different. We still had to go in at 9am and 3pm. The 3 separate zaps were still 7, 7 and 14 seconds respectively. And the amount of radiation being delivered was the same. The difference was in the area being irradiated. I am guessing that the area was about 25% smaller. Consequently the radiation was a bit more intense in the smaller area.
Having had only 3 days of treatments in that last week and none on Friday, I am recovering from the treatments quite nicely. During treatment days I had been napping after each of the two treatments as well as fighting to stay awake in the evenings until time for bed. Yesterday I had a short rest just before dinner, no nap at all during the day, and was up until almost 11pm.
And today I feel even better.
I will have to watch myself or I will start doing too much too soon. The radiologist told me that the radiation keeps working for 3-4 weeks after the last treatment, and that I can expect to become easily tired during that period.
In talking to the radiologist about the treatments I learned how the radiation works on sarcomas. As mentioned in prior dispatches, soft tissue sarcomas send out hair-like structures invading nearby tissues. Through some unknown mechanism satellite sarcomas develop in the nearby area. The radiation destroys the hair-like structures, and destroys the satellites if they have not developed enough to become masses in their own right. Radiation also effects the primary mass and the developed satellites. Healthy tissue "pulls away" from the cancer, "encapsulating" it. Thus the masses are easier to remove in surgery as radiation forces them to be more distinct from healthy tissues.
We've also talked to the Gainsville people about the surgery. They've said that the surgery will have to happen as there's no way of telling how successful the radiation treatment has been without actually opening up the area to inspection. Even if the radiation has totally destroyed the sarcomas, there will be enough residual dead tissue that it will show up in the pre-operative tests. If the mass has been destroyed, its residual tissue will be removed to facilitate healing.
As the mass surrounds a nerve and was likely invading the nerve, it will be important to remove the nerve to insure that there's no residual cancer cells hanging around within it. The Gainsville people feel that it's the sural nerve that's involved. They say that the sural nerve is not used in walking. In fact, it's of so little use that it is the nerve that surgeons take when they need to do a nerve graft somewhere else in the body.
Extra "healthy" tissue around the mass will also be removed within a "safe margin" area to insure that all cancer has been exorcised and that all residual hair-like structures and satellite sarcomas have been cleaned out. A sarcoma-experienced pathologist will be available during surgery to examine each bit of tissue that's being removed. The pathologist will let the surgeon know when the "safe margin" point has been reached.
Because some skin comes within that "safe margin" region, a skin graft will be required. Because the skin graft will be behind the knee where skin folds while bending the knee, I will be given a brace to keep me from bending my knee until the graft has strongly taken hold. My expectation is that I'll have the brace only for the 10 days or so that I'll be in Gainsville following the surgery.
Because some muscle tissue will be removed, a slight restructuring of the muscles behind the knee will be necessary. However I'm told that I will not notice the difference when I first begin walking again after the surgery. I have made arrangements for a friend in Ft. Lauderdale, a practicing physical therapist and chiropractor, to do the follow-up physical therapy. The focus on that therapy will to minimize the scar tissue buildup in ways that will hinder walking. I'm expecting that I will be 100% mobile before the end of March.
I guess that's all for now. Keep sending those good thoughts in my direction. It's working!
Fair winds,
Capt. Edmund "Bear" Downing
P.S. May your New Year be 10 times better than the old one.
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