Going Camping

Tomorrow is a big day. I am backpacking and camping for the full weekend.

I am nervous, excited and looking forward to the experience.


The details


I will be doing 34 miles over a 2 day hike in the Appalachian Trail, going from the Swatara Gap to Port Clinton (south to north). The plan is to do 17 miles tomorrow, spending the night in the Hertlein Campsite; I have arranged for a shuttle to take me from Port Clinton to Swatara Gap, leaving my car in Port Clinton; the challenge tomorrow will be to start early enough so that I can get to the campground at a reasonable time; I am estimating that I will actually start at 10 am and, walking at an average of 2.5 miles / hour, be there by around 5:00 pm.
I will use my tent for the first time in the wild. It supposed to be cool (50F) and dry- I will not have to use the rain fly and be able to sleep under the stars!!

I have my stove, my freeze dried food and, for breakfast I bought a French Press to make sure that I have my caffeine fix in the morning.
Sunday should be easier, getting up early (having my coffee) and getting to Port Clinton mid-afternoon.
Why nervous: well, it is the new experience, the unknown- it is a learning experience, building block for the next big thing. It is the step to independence from using guides (Inka Trail and Rim to Rim). It is like being a young adult again, working on my skills to be able to take care of myself.
I will post the results and pictures next week.
The map is:


View Larger Map

AVM Update - Challenge of first opinion

Background
After the second opinion, which agreed with the diagnosis but differed with the treatment, the question was the need for embolization prior to Gamma Knife Radiation.
Why embolization
According to Dr Rossenwasser, size is important (at least in treating AVM's).
My AVM is small (~3 in). Ther are only two 'cures' for AVM- Surgery and Radiation Therapy (Gamma Knife). What they know is that there is a minimum radiation required to successfully destroy the AVM. The larger the AVM the additional radiation required. It is more than the size - it is about the volume and the topology of the AVM. The borders of the AVM need to radiated with enough strength to be effective.
Effectiveness of the radiation therapy is calculated by the volume to be irradiated- in my case the estimate is that given the size of my AVM I would have 70-80% success probability with a single Gamma Knife radiation.
Embolization will reduce the volume of the AVM. 6-8 weeks after embolization, radiation would be applied. Embolization reduces the size of the AVM and makes the success probability higher.
Options are to do 2 radiation procedures, spread over 12 months, in order to guarantee a much higher rate of success of the procedure.
Dr Rossenwasser was involved in the review of the paper that questioned the effectiveness of embolization prior to radiation. The way I understood his observation on this paper is that the results had to do with the strength of the radiation used in the comparative studies- very low to measure the effectiveness of radiation.

Risks

Timing
October is the first window for embolization; radiation would most probably happen after my return from Australia.
Embolization is an overnight stay at the hospital (and, based on my prior experience with catheterization, 1 or 2 days at home).
Next Steps
Discuss with Ken
Wait for Rossenwasser schedule

My sandals

UPS delivered my new Teva sandals today.

My old sandals are being replaced by the new and enhanced model. The cycle of life.

My old sandals have been with me for a long time, walked me for many summers in Ocean City- on the boardwalk, on the beach; they have gone with me to Israel- walked Jerusalem and climbed Masada. Many summers of lazy walks- more recently, taking the dog for walks in the neighborhood.

Summer sandals- never had to take me to work.

Went to Machu Picchu, most of the time hanging from my backpack.

They were comfortable, we had molded well. Like friends over a long period of time, sharing long days and fitting together very nicely.

Do not remember when I got them, but they have been with me as Sara grew up, with Brandy and now Zoe and for many years with Barbara.

They have gone to Europe- our family vacations in Spain, France and Italy.

Not demanding at all; little maintenance - they were always there (sometimes lost under the bed) when I needed them.

Not only did they perform admirably as sandals- now they bring me back many pleasant memories reminding me to count my blessings as a lucky guy who appreciates small things in life, like my old sandals.

AVM Update

The history
February, got some low level headeaches and felt somewhat off balance.
April, visit Dr Morrios (my excellent GP) who, after a neurological exams can't find anything- suggests a Brain MRI
May, MRI results come back- Dr Morris suggest that I go to the best guy in Philadelphia - Dr Rossenwasser to look at my AVM (Arterial Venous Malformation).
Mid June(20): Angiogram performed. I was told by Dr Rossenwassers nurse that an embolization (to reduce the flow of blood to the AVM) will be made and the Radiation (Gamma Knife) will be applied.
AVM
AVM is a congenital malformation of the Arteries and Veins, can happen anywhere, but in the brain it is delicate because of the risk of bleeding. Not genetic in nature. My case, after the MRI review and an Angiogram, is located in a low risk area of the brain - no motor or speech areas- more of the thinking area. In normal cases, arteries will take high pressure blood with oxigen to the brain and the capilaries will distrubute the blood through the brain; through the capillaries the blood pressure will decrease and oxigen content will drop. With AVM, there is a 'nidus' of veins that 'shunt' the arterial blood to the vein, at high pressure and fully oxigenated; the risk is that the vein (or the 'nidus') will rupture because of the high blood pressure.

Last update and next steps
July 16: Visited Dr R. Solomon in Columbia Presbeterian- Ken and mami came with me. Dr A\olomon agrees with the assessment that this is a small AVM (smaller than indicated in the Angiogram) and that the radiation option, given my age and the size and location of the AVM, is the best option. No concerns regarding inmediate bleeding risks (no aneurisms). His recommendation is radiation WITHOUT embolization. His argument is that embolization will 'hide' the full extent of the AVM making it difficult to plan the radiation therapy, the risk of the catherization for the embolization and the fact that the glue used will 'protect' part of the AVM from radiation. He stated that, in his experience, embolization + radiation, had lower success rates than pure radiation.
On August 14 I will meet with Dr Rossenwassser. If the difference of opinion is not resolved, a we will need a third opinion. I hope we do not get into this.

Link to Sara

Sara is submitting some great notes on her trip to Australia, including dogs in myspace (how cool is that).
The pictures are excellent.

http://sarainaustralia.blogspot.com/

Daughter

"Every thing she sees, she says wants
Every thing she wants, I see she gets

That's my daughter in in water
Every thing she owns I bought her
Every thing she owns...


Every thing she knows I taught her
Every thing she knows...

Every thing I say, she takes to heart
Every thing she takes, she takes apart

That's my daughter in the water
Every time she fell I caught her

That's my daughter in the water
I lost every time I fought her
Yes, I lost every time

Every time she blames she strikes somebody blind
Every day she thinsk blows her tiny mind

That's my daughter in the water
Who would ever thought it
Who would ever thought it"

From a song my daughte hooked me on!

Hiking Chile

I am starting to get excited about going to Torres Del Paine in the Chilean Patagonia. Last Saturday I got a book about traveling to Chile / Argentina Patagonia and I am starting to get a better picture of what it will take.
Some of the uncertainty is diffusing.
There are some decisions that have to be made.

• Tour vs Individual
• Timing
• Who

I have ordered a map of the Park and an additional book.

This is good.

Sara is on her way

My princess left this afternoon on her long treck to Australia.

The little Princess Zoe (at the left) will keep us company.

I am numb- happy for her but feeling empty that she is nt around.



After preparing for this moment fo some time, it is now here and there is no lookforward for us. For her, it is the culmination of the plans and the start of the new chapter. All the fears that she had will dissapear with the reality of being there - and things that she did not consider will come up.


One day at a time....


We talked about expectations- how this was something that was going to be great. It will, but it will be only in the perspective of time. Rain will still fall and it will be cold and damp- those inconviniences will be forgotten with time and the great experiences and learnings will be the ones that, hopefully, will stay.


Well, she is on her way.

Sara is getting ready to leave

I am sooooo jealous- my daughter is going to Australia for a semester abroad.
I am sure she is nervous- it is a long way from home, they speak funny and it is different. But having the opportunity to explore, to discover and to grow trumps all the butterflies that she might have.
She has worked hard for this and deservers this, no questions asked. She has what it takes to make this a good experience
This is a chance of a lifetime and in the perspective of time this will be defined in her life as BA and AA (Before Australia and After Australia).
Have to take the second Princess for a walk.