1/29/2011

So I’m officially calling this “oncology week”.  This past Tuesday and Thursday I met with cancer doctors—oncologists—and got a pretty good idea of what lies ahead.  On Tuesday I met with a doctor and he performed a tumor marker test and looked over my CT and bone scan results.  He explained to my parents and me that there are three possible treatment methods:  observation, surgery, and adjuvant chemotherapy.  Considering the type and aggressiveness of my cancer, he suggested I follow the chemo path.

This was basically all we got out of him.  The doctor seemed very pleasant and I don’t question his acumen.  But I feel, and I know my parents are on the same page as me on this one, that we want to deal with someone more professional and forthcoming.  The waiting room’s pea-green paint job and oscillating wall-mounted fan, the doctor’s dress shirt that could have been buttoned up one more button, and his general casualness didn’t bode well with us.

On Thursday, however, I think we met our man. This doctor works in a cancer center and his waiting room is replete with couches, tables, good magazines, and a “patient library”.  This doctor read my test results and took the CDs (the CDs of my scans) to look them over himself, ensuring the accuracy of the radiologist’s work.  He sat down with us, drew diagrams, and fielded all the questions we could conjure up– a perfect stew of professionalism and light-heartedness.

So what exactly is happening?  Well, as I mentioned above, there are three treatment options.  And all three options have an ultimate cure rate of 98%.  The first treatment option is observation.  As its name implies, one observes their health for the foreseeable future.  This entails having CT scans and tumor marker readings every two months, and keeping your fingers crossed nothing pops up.  This option carries a 20% chance that the cancer will come back. The most common place for the cancer to reoccur is in the lymph nodes or the lungs. The second option is surgery, or more specifically, a retroperitoneal lymph node dissection (RPLND).  Testicular cancer typically spreads through the lymph nodes located behind the major organs in the belly (the retroperitoneal lymph nodes) and spreads upward toward the lungs and brain.  This surgery removes these lymph nodes, making it virtually impossible for it to spread.  The crux, however, is that this surgery is highly delicate and requires serious expertise.  There are countless nerves surrounding this part of your body and if the surgeon isn’t careful, the effects are consequential.  Among them: retrograde ejaculation.  This is where one ejaculates and the sperm ends up in the bladder.  If having one ball weren’t enough, this would certainly kill my chances of making it big in the porn industry.  Lastly, there’s adjuvant chemotherapy.   The idea behind adjuvant chemotherapy is that the chemo drugs are more effective after the primary tumor is removed.  And as I mentioned in previous posts, the primary tumor (the cancerous testicle) has been removed.  Chemotherapy reduces the chances of a reoccurrence to roughly 3%.

Chemotherapy regimens are referred to in acronym form.  The type of chemo cocktail I will have is BEP: Bleomycin, Etoposide, and Cisplatin (which contains platinum complexes, hence the “P” in BEP).   I will need one or two cycles.  A cycle consists of one week of treatment (Monday through Friday, roughly 4 hours a day), then a treatment session the following two Mondays.  So seven total treatments in a three-week period.

Anyway, I feel this post has been too wonky so I dare not be a bore any longer.  I’ll post more later…

1/26/2011

Boredom.  I can’t even draw stick figures.

1/19/2011

Fear no longer! My absence may have led some (read: no one, really) to believe I met my demise two Thursdays ago.  But the opposite is, in fact, true.  The anesthetic was measured, the nurses were attentive, and the doctor’s hand proved steady.  I’m back on my feet, back at work, and hanging out.  The way I see it, the sack is half full.

Anyway, let me not get too ahead of myself.  I’ll try to detail the events of the past two weeks, starting with being wheeled into the operating room…

So there I was, lying on a gurney in the operating room with nothing but socks (fully equipped with the cool rubber traction strips), a backless robe, and a shower cap.  A few young looking doctors/interns shuffled in and out of the room and each shifted around medical instruments, calling out names like holding forceps, clamp, and, most unsettling, blade.

To break the ice I looked at one of the shaggy, longhaired doctors and inquired, “So what CD will you guys be listening to today?”  He gave me a quick look, smiled and said, “What do you want to hear?”  I quipped, “You look like an Eagles greatest hits dude.”  Then without much notice, and most likely to shut me up, a mask covered my face and after three big inhales I was out.

Anesthesia is a time warp, a free pass to another spot on the time continuum.  It is the fast-forward in life you wish you could summon at will.  It is the reprieve that makes modern medicine possible. It is one of science’s greatest achievements.

A moment later I woke up in the recovery room having been shaven, cut open, sutured, re-clothed (I’m still trying to figure out how they got that jock strap on me), and numb.  A few moments after that my parents walked in.  My mom says I looked dispirited and contemplative.  I was really just trying to act composed, trying hard to maintain my stoical façade.

The doctor informed me that the surgery went well and that the testicle didn’t have observable lesions and didn’t appear overly metastatic.  When I received the pathology report the following Monday I received good and bad news.  The good news:  the cancer had not spread to the epidiymis or the cord.  The bad news:  it was a bad form of cancer called nonsemenoma mixed germ cell.  I needed scans, and lots of them.  And, in a few weeks, I may need chemotherapy.

After a day of bed rest and a few others filled with nothing but reading and watching movies, my parents granted me medial leave.  I was freed from my confine and allowed to meet the insalubrious world that inhabited all space beyond the walls of my makeshift infirmary.  During my first trip out of the house I went down to the sneaker store with my mom.  I bought myself a pair of new Nikes.  Behind the register hung a black Livestrong shirt, the yellow circle emblem staring at me.  Very appropriate placement, I thought.

Last week I completed the series of scans.  Tuesday I had the bone scan and on Wednesday the CT scans of my brain, chest, abdomen, and pelvis.  Over the two days I had barium sulfate, iodine, and radionuclide flood my veins and Gama rays pierce my body, all aiding in the search for malignant growths.  Now, these diagnostic centers prepare written reports and send the results to the doctor.  But they also provide the patient with a CD of the study.  So, naturally, I popped it in my computer to take a look.  From experience, I warn all who get one of these CDs to never do what I did.  I googled “bone scan + cancer” and “CT Scan + cancer” and browsed the images.  After three minutes of training I declared myself a board certified radiologist.  Certain my impressions were nothing but accurate, I began preparing a mental will, for I clearly had advanced stages of lung, thyroid, and pancreatic cancer.  Red Foxx knows how I felt—this was the big one.  (By the way, Sis, I’m leaving you everything.  The Xbox isn’t technically mine, but the guy I borrowed it from is never going to ask for it back.)

Fortunately my predictions proved wrong.  Yesterday I found out that all my scans came back negative.  No lung, thyroid, or pancreatic cancer.  But just because these tests came back negative does not mean I’m in the clear.  There is no evidence of definitive tumors, but there may be a few lose, radical cells floating around in my body, waiting to grab hold of the nearest tissue.  I have appointments to see a number of oncologists next week.    If I need chemotherapy it will, most likely, be tailored to prevent a reoccurrence rather than to cure.  I will spend a majority of my free time over the next week learning about this type of treatment and readying myself to ask the doctors all the appropriate questions.

I wrote in an earlier post that this road would be long and that I’d be on it for a while.  Well, here comes another turn.

1/4/2011 – Happy New Year

To my anonymous two hits a day, Happy New Year.  I thought I’d take a moment to give an update.

Today I visited my dad’s urologist for a second opinion.  I brought along the results from my ultra-sound, MRI, and tumor-marker blood tests.  He read the reports, did a quick physical examination, and listened to my story.

He assured me that I have been properly guided, and that up to this point I have followed the proper protocol.  This Thursday, January 6^th, I will have a left inguinal orchiectomy.

I am very ready to have this procedure.  Now that is probably a weird thing to hear and, trust me, it’s a weird thing to say.  But every single day that thing is in me, the stronger and more metastasized the cancer becomes.  Every single day the chances increase that the cancer is spreading to my lymph nodes, abdomen, and lungs.

As much as I would never wish this upon anyone, I’m comforted to know that I will not be alone in my one-ballness.  As one can imagine, I have tirelessly researched this sort of cancer.  Although Lance Armstrong may be the most famous, perhaps infamous, one baller, there are many kindred spirits out there:  comedian Tom Green; baseball players Mike Lowell and Jon Kruck; and football player, and namesake of park near my parent’s house in Pembroke Pines, Brian Picollo.  Also, though not due to cancer, it is believed that Arnold Schwarzenegger and Tupac have/had one ball.  But I’m sure Maria Shriver’s lips are sealed and I’m not about to unearth Tupac’s corpse.

I am also indescribably pleased with the sincere support I’ve received from everyone I’ve told.  I’ve been surprisingly unembarrassed by this and have found that talking about it with people makes the situation much more bearable.  The casualness about the surgery stems from the fact that the effects are, in almost all cases, very minimal.  As my boss put it, “That’s why you got a spare!”  The true fright and uneasiness comes from what lies ahead.  When I receive the pathology report next week  I’ll know the severity of the cancer and the likeliness that it has spread.  I’ll then undergo a number of scans and tests to pinpoint where it has, or, more optimistically, has not spread.

When I find myself fretting too much or when I have a fleeting moment of self pity, I force my self to put my situation into perspective.  And the angles of perspective are countless.  I may think to myself, Wow, this is bad.  But what’s worse?  I could have been one of those forty-five people blown up by grenades last week in that Pakistani marketplace.  If I find that too existential, then I can answer the same question with:  well, it’d be worse if I didn’t have the unwavering support of my parents.

Anyway, I will post again after my surgery.  With luck I’ll get some good meds and won’t be able to form a cohesive sentence until early next week.

This, too, shall pass.