Sunday, June 22, 2003

I admit it. I am wrong. As it turns out, I've been wrong for over 20 years. What I, and many health professionals have been calling Hemangioma is in fact something else. The lumps of blood filled veins I've been calling Hemangioma is more correctly called Venous Vascular Malformations. This I learned after I had twice passed through the SARS gauntlet this week to see a Doctor at Toronto Western's vascular lesion clinic. Don't worry, Western hasn't had any reported cases of SARS so chances of catching something are non-existent. I know it would be cliche to say this, but you still have a higher risk of being hit by traffic in this city than any naturally virulent disease. I'm glad to see some people are finally seeing some humour in the SARS media epidemic (see the SARS Art Project).
Entering a hospital in Toronto lately has been similar to Dustin Hoffman suiting up in the film "Outbreak". You stand in line as someone helps you tie a mask on, then you hold out your hand as if to take Holy Communion, only to receive a dollop of anti-bacterial hand gel and then you get your temperature taken whilst completeting a form stating your name telephone number and whether you've been in contact with any monkey pox-infested prairie dogs. Again, on leaving you receive another glob of hand gel and discard your mask into a large waste bin. The cost of hand gel and disposable masks alone must be running the health system dry.
A little recap may be in order here; after seeing my GP in March about my blood engorged face, I was referred to a dermatologist in April who referred me to a Plastic Surgeon at Toronto Western who in turn said "Toronto Western just happens to have a vascular lesion clinic - you can see someone there." Oh, I says - I guess living in Toronto is turning out to have a bright side. Ontario Healthcare may be in crisis, but it's state of crisis is still better than most in a state of normalcy.
Thursday, I went into the hospital to meet another doctor, the Chief of neuroradiology at the Toronto Western Dr. TerBrugge (it's Dutch so don't bother pronouncing it, though I've gotten by with Tur - Brewg - I'm sure it's more likely - Tear-Brew-Guh - and this guy is very Dutch). He was in some sort of emergency and couldn't see me. I joked his emergency had more to do with losing his pitching wedge on the 9th hole. I went back on Friday, at noon, having already been told by his assistant that 11 was no good. Finally, I get called in to see him when I start forming a picture that perhaps I wasn't the most important case he had to handle. It becomes clear that this guy normally works on vascular lesions - in the brain. Dealing with something on the face was really approaching cosmetic surgery to him. Like swatting a fly with laser guided missiles, I suppose. Yet, he was very helpful and explained my condition (gruesome PowerPoint presentations seemed necessary), explained how MRI's were much better than angiography (which they don't use for vascular malformations anymore) and what could be done to get rid of it.
It's pretty simple really. Basically, the swollen area are tiny sacks of blood which are always filling and emptying of blood. As you get older, the sacks become less elastic and stay filled with blood. So you identify feeder veins using the MRI images, and inject alcohol into those veins. The alcohol irrates and attacks the tissue lining these little sacks which begins to disintegrate and collapse until they close and heal shut. With no more blood able to enter those areas the swollen area goes away. If you are lucky, an entire, extensive network is connected and more than just the local area is affected - meaning more goes away. Usually though only the area locally targeted will dissipate. Apparently, there is a new technique being carried out by a physician in South Africa in which, mild doses of drugs used to treat cancer are used instead of alcohol and the results have been that more extensive areas of the malformations disappear. But that treatment may be years away from use in Canada.
So for me,
Step 1) Have the MRI - which will be used as a benchmark from which to follow the progress/change of the malformations for years to come.
Step 2) Once the MRI is done, consult the necessary physicians to decide whether to attempt treatment.
Step 3) If treatment is decided, book a time and wait.
Step 4) If I decide not to go ahead, I guess I should probably plan to have another consultation in the future.
For me though, if treatment looks reasonable, I'll probably go ahead with it as the area of my face that is currently swollen seems to be sticking around. I've decreased the swelling a lot with heating but you know, you can spend a month reducing the swelling and then one day I'll wake up and it's as large as it was weeks before.
Right now, the MRI should happen in late July and I guess treatment might take longer to arrange. For that you need an anesthesiologist, and with the SARS backlog of surgeries, that particular group are overworked at the moment. I've been surprised by the speed that things have progressed so far but if I were to have this done by the autumn I'd be surprised.

That's it so far. I'll let you know more as I know more.
Peter

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