Monday, February 27, 2012

I'm Not Ignoring Your Calls

Another day of running around calling labs, visiting hospitals, faxing forms and requesting records.  I picked up the pathology slides (from my most recent biopsy) this morning from Sibley Hospital, at the same time I requested CDs of all of the CT & PET scans I've had there.  The slides were ready as I had already faxed over the request last Friday, but the CDs took about an hour to burn.  I also received photocopies of all reports that go along with those scans.

I also heard from my Urologist who had contacted GW on my behalf about the slides from my original testicular tumor.  This Urologist is the best, he's a great guy and did all he could for me to get those slides today.  It doesn't look like that's going to happen, but at least they'll be overnighted to Einhorn in Indiana before the end of the week.  And there is still a chance they'll be ready today, I'm going to call around 3 to see if they are ready.

Once I got back home I started scanning in all of the paper documents and copying the CD's onto my home network.  I'm starting my own one-man medical library.

When we got home yesterday from the beach and I had time to really review Julie's handiwork with my haircut, I realized it needed a lot of clean up.  In Julie's defense those shears we were using were for a beard, not for shaving your head/getting a haircut.  That's why she first has to use the hair scissors to get the hair short enough for those electric shears to even have a chance at cutting the hair.  The shears/beard trimmer has nine settings, one being the shortest hair (stubble), and 9 being about 3/4 inch long.

Since there was a lot of clean up needed on my head I decided to put the trimmer on the longest setting we had used and just run it all over my head for a while, trying to catch the many strays and uneven spots.  "Julie," I asked "was the longest setting we used 8 or 9?"
"7." Julie replied without hesitation.
"7?  Really?"
"Yes, 7." my lovely wife confirmed.

Well you can probably see where this is going.  Because of my love of and trust in my wife, I didn't put it on 7 and test the length by running the trimmer over a side-burn or anything.  I put it on 7 and went whole hog, starting at the front I took the trimmer straight back as I stood in the shower.  The trimmer struggled and sounded like a lawn mower that hits a deep patch of wet grass.  Uh-ho, I thought, as I watch what was left of my hair fall onto the tub floor.  Oh well, I had intended to shave it this weekend anyway.  So I continued over the rest of my head for the next 15 minutes.  I called Julie in to help me make sure I hadn't missed any bit patches of hair.

"You cut it really short!  It looks good though." Julie commented as she walked in and saw me.
"Yes, it does.  It turns out 7 was not the longest setting we used the other day"

Julie's confused face slowly turned to a big, guilty smile as she realized what I was hinting at.  "Ooops!" she said before we both started cracking up.

Mostly friends and family reading this blog.  I wanted everyone to know I appreciate the calls/texts/emails but I'm unlikely to return them all.  When I have info that can be shared on a very public place like this I'll post it, otherwise details will fan out via immediate family.  Things are really good right now, I'm not sitting around depressed or miserable.  Part of that is the busy work that's involved in red tape and tracking down records, but most of it is that so far that I'm really in good spirits.  Both Julie & I have our moments, but for the most part we're both doing well.

We've off to Indy in a few hours.  Assuming I'm back on Wednesday as planned I'll post an update then.

Sunday, February 26, 2012

Why Couldn't He Be At The University Of Hawaii?

Friday ended up being a lot more exciting than I'd anticipated.  Julie & I headed to the Oncologists office where I'll be receiving the chemo to meet with the nurse in charge of scheduling and administering the medication.  This was the trip where we'd finally hear the gory details of what this particular treatment (BEP) would entail.  

We'd met this woman before, back in 2010 when I first had that single dose of chemo (carboplatin) after the surgery to remove my left testicle.  The nurse is very nice, and she also levels with you.  She told us this would be rough, I'd lose my hair (as expected), and then went over the various other side effects and what to watch out for.  Basically this is going to be really rough, and it's going to suck.

The schedule works out as follows:  I'll receive 3 courses of BEP, each course is 3 weeks long.  The first week of each course I receive chemo every day for 8 hours a day.  That's right, week one of each course is daily chemo (Monday to Friday) from 9 to 5.  The drips are slow, and are often switched out to a saline bag to flush my system and try to keep my kidneys from being damaged.  Weeks two and three I only receive treatments on Mondays, and then it all starts over again the following Monday.

We spent a while with this nurse discussing the treatment, schedule, side effects, and various other matters.  After that we met with the doctor to get the results of all of my recent tests and to discuss the plan going forward.  All of my other tests looked good, and the doctor told me he had again discussed my case with Dr. Lawrence Einhorn, world famous (to those with testicular cancer) for saving Lance Armstrong.  Einhorn is the best there is when it comes to treating this cancer, literally changing the survival statistics from testicular cancer with his pioneering treatment.  Einhorn had a few recommendations for my doctor about my case, but also said he would be interesting in meeting with me if I was so inclined.  Of course Julie & I jumped at the chance, and contacted Einhorn's office immediately to schedule a consultation.

His office was able to fit me in on Tuesday, so we bought tickets to Indianapolis (Einhorn is associated with Indiana University) and immediately starting running around trying to obtain all of the necessary records from the various doctors I've seen.  This is harder than you'd think.  Paper records are no problem, my Oncologist said he could get all of that to Einhorn prior to my visit.  But actual electronic copies (on CDs, mostly) of the various imaging scans I've had are harder to obtain quickly.  Even more difficult, I needed to obtain the actual pathological slides from the two cancers which have been biopsied (the original in 2010 and the most recent in 2012).

I think I'll be able to get this all together on Monday, going from hospital to hospital, filling out forms and paying fees.  Our flight is at 6 pm Monday night so I hope to have it all completed before 3.

We don't know what to expect from Einhorn, most likely he'll review and agree with my current doctors, and give his blessing to my treatment.  But until we meet with him, we're really not sure.  As it stands now I start chemo on Monday, 3/5, but that is now subject to change depending on Einhorn's opinion.  We have flights back on Wednesday morning, but there is a chance (I suppose) that I would need to stay in Indy for additional appointments.

In other news I somewhat chickened out on shaving my head this weekend.  I cut off most of my hair, it's shorter than it's been in 5 years, but because I was flying I didn't want to look too different from my drivers license photo.  And hell I have another weekend now to complete the job.

But we did cut most of my hair off and it was funny and sad for Julie & I.  We filmed the entire thing on an iphone, it took about 45 minutes.  I've attached two clips that show the fun and easy beginning, and then a clip from near the end when we had a little moment.
PART 1 (About 10 Mins In)


PART 2 (about 38 Mins In)



Speaking of movies, we watched 50/50 last night.  It was a pretty good movie and of course it's about a dude with cancer.  Some of it probably hit home (considering Julie & I were off an on crying throughout) and it had me balling at the end.  No really for the movie really, I had not had a big cry since all this started and I probably needed it.  The movie helped.

When it comes to cancer films I'd put this up with there with Brian's Song and Champions.  Brian's Song is of course famous for being a film that can reliably get men to cry, but if you've not seen Champions it's pretty good.  Again testicular cancer, also based on a true story.  That one was hard for Julie to watch.

Thursday, February 23, 2012

Bald Is Beautiful

At least I hope so.  The last couple of weeks have been very surreal, the last couple of days have been crazy.

After the ct scan (6th month follow up from radiation) on 2/3 showed an abnormality, Jules and I have been worried but tried to be optimistic.  Then I had to have the biopsy on 2/16 which sort of cemented for me the uncomfortable path that lay before me.

I'd never had a biopsy before and it was a lot more uncomfortable than I had imagined.  It was a CT Guided biopsy, so I prepped just as if it were a normal CT scan only I couldn't eat or drink after midnight, and I couldn't take aspirin or anything that might thin my blood.  That morning I had to pick up barium from the Sibley imaging department, then check in at the admissions section of the hospital.  I think I checked in about 7:30.  Around 8 am I drank the barium and shortly thereafter was moved into a room where I had to take all my clothes off, put on an open-in-the-back gown, and was given an IV line with a saline drip.  Jules and I watched a couple of episodes of Psych via the Netflix app on my iphone, before I was wheeled away (a humiliating experience) from the second floor to the imaging room on the first basement level.

From there I had the first CT scan (lying on my back as is normal) to confirm that the abnormality was still there (it was, I'll be calling it a "node" from this point forward) and I had to roll over onto my stomach (exposing my derriere) and had a second scan.  I was wearing glasses and when I rolled over I took them off, and they had Julie come in and get them from me (she was in the waiting room across the hall).  There were three people in the room (four if you count me), the doctor/surgeon, his nurse/assistant, and the CT tech.  The CT tech was doing most of this initial work, giving me breathing instructions for the scans and marking my back with each repeat scan for the location.  Once they had the general trajectory the doctor stuck a needle into my back to administer the first local anesthetic.  It hurt. 

About 30 second later a second injection which hurt a lot less, but was still uncomfortable as I suspect it went in deeper to anesthetize deep down into the location.  I was extremely tense and uncomfortable, and it was about to get a lot worse.  Almost immediately after the second shot they began the biopsy, sticking the needle into my back which hurt like hell.  Obviously not as bad as without the local, but it was really uncomfortable.  It felt like it was the circumference of a straw, but it was probably only slightly larger than a normal shot needle I couldn't see it being on my stomach and all).  Once the needle was part way in, they did another scan to (I assume) guide the needle to the node that was being biopsied.  Three more times the needle went deeper, followed by a scan.  Each time the pain/discomfort was worse.  The doctor was on my left (the node being biopsied was on my left flank) and the nurse was on my right stroking my forearm and trying to coo reassuring words. 

After the fourth push and scan they were in position and took two samples.  I could hear a loud click as the samples were taken, one after the other.  Each time I could feel a sharp cramping in my gut, which still hasn't completely gone away. Before removing the needle the samples were send up to a lap to make sure they were sufficient, and a few minutes later the needle was out and I was bandaged up.  Julie was allowed in to see how I was doing (I was whispering to her "that hurt like hell, it still really hurts).

I had to roll onto my back back onto a gurney and wheeled back to the second floor for recovery.  This time I asked if I could walk instead, but they told me I could not.  It was about 11 am at this point and I'd had nothing to eat or drink since bedtime.  I was starving and thirst, but had to spend two hours in the recovery room before being send home.  The nurses there gave me some ginger ale and juice, a few crackers and finally a lunch bag.  I ate the crackers and part of the lunch, but it was true to the stereotype, terrible food.

Anyway a few episodes of Psych later (and a lot of "I can't believe this is happening again") we were on our way home.  We picked up Bica from daycare on the way, ate a late lunch at home, and napped.  I went to work the following day (Friday) and around noon got the call that the biopsy had tested positive for cancer.  I haven't been back to work since, and may not go back until treatment ends.

All of this week (after a great three day weekend in Philly with Julie & Bica) have been doctors appointments and tests.  You always hear people complain about being poked and prodded, now I know what they mean and it's no small complaint.  I've had my veins poked by so many needles, had to drink so much barium, had shots full of contrast, been run back and forth through radiation imaging machines, carried around a miniature plastic gas can that was collecting my urine for 24 hours, and have even been injected with radioactive glucose.  Today alone I've had an IV port stuck in my arm for hours while I drank a liter of barium, had the afore mentioned radioactive glucose shot into my veins, then spend 35 minutes lying on a bench being imaged from head to toe.  That was immediately followed by CT scan of my chest (shot full of contrast for that one).  After more than 2 hours at the Sibley Hospital imaging services, I was looking forward to my first food and drink of the day (I'd brought a PB&J and a thermos of coffee), but the bus I take home was at the stop so I hopped on (no eating or drinking on the bus).  Just as I got on the doctor called and wanted me to get a pulmonary function test today if possible.  I had Julie call to schedule an appointment while I was on the bus, they could get me in in a couple of hours.  So I took the bus back to the metro, then took the metro to MD.

It was an unseasonably warm day today so I sat outside on a park bench in front of Tiffany's in Friendship heights, put a spaghetti western on my cell phone via that Netflix app, and finally ate my sandwich and drank my coffee.  It was about 1:15.

At 2:30 I had my pulmonary test (breathing) to get a baseline as one of the chemo drugs I'll be taking can have an adverse effect on your lungs.  My lungs looked great, scored just 2% points shy of 100%, the tech said I could stand to lose a good percentage before being bothered by the drugs (which didn't comfort me, actually).

I got back home about 3:30, got a few wiggles and kisses from Bica, and then settled onto the couch with a beer to finish that Western I had started on my phone.  The home phone got me off the couch though when it started ringing, I have to go to the doctor again tomorrow at 11:30 to get the scoop on my chemo treatment which might start on Monday, the following Monday at the latest.

I think I'll be shaving my head this weekend.  I'm going to feel like Ponyboy from the Outsiders.

Saturday, February 18, 2012

The Best Is Yet To Come

The title of this post is my attempt to be positive, which has been hard these last couple of days as  my second follow up scan (6 months after radiation treatment) came back with an abnormality near my left kidney.  A follow up CT guided biopsy of that abnormality on my "left flank" tested positive for cancer, so I'm once again looking at cancer treatment.
The type of cancer I've had, pure seminoma, is (I'm told) the most predicatable and easiest to treat of all cancers.  It follows a set path and responds well to both chemo and radiation.  Which is why when I was first diagnosed in 2010 with testicular cancer I had three options:  radiation, single (but big) chemo dose, or observation (no treatment, frequent ct scans).  I went with that single big dose of chemo which was supposed to take care of any cancer cells that might still be lingering in my body after surgery.

Well we all know how that went, my cancer came back a year later but it came back exactly where it should have if it was going to come back.  I wasn't happy about this, but it wasn't the end of the world.  I knew the cancer could come back, and since it came back where the doctors expected, radiation was still a viable alternative.  I did the weeks of radiation which killed off that cancerous node, and also treated the entire area where the cancer might have gone to next.  Three months later I had a CT scan that showed me as cancer free.

But here we are three months after that first CT scan and the cancer has again come back, but this time in an area where no one would ever think to look for it.  As the doctor told me on the phone pure seminoma statistically never does this, it always follows a set path.

Except when it doesn't.  Radiation is no longer an option as that would just treat this one node, but they have no idea where else the cancer may have gone.  A full on, unpleasant, chemo treatment is now my only option.

We're going to see the Oncologist on Tuesday.  He's a great guy and I really like him, but now I'm no longer sure he'll be the treating physician.  I've now been diagnosed with cancer three times in the last three years, two of them statistically should never have happened (and hell even my getting testicular cancer was statistically low).  So I'm going to ask this doctor on Tuesday for some recommendations for other specialists (Sloan-Kettering, Mayo, etc.  Hell maybe even the Cancer Treatment Center that you always see commercials about).  We now know that my case is not normal, and I don't expect these cancer centers to offer up an easier treatment this time around; I've resigned myself to tough chemo.  But I need someone to look at the big picture, and to give me some realistic expections of the future.  I don't want to hear "we're 99% certain your cured" again.

Sunday, November 6, 2011

One Test Down, Rest Of My Life To Go

Thursday, 11/3/2011 was my first CT scan since finishing radiation treatment on 8/3/2011.  I'll get these CT scans every three months for the first year.  I was pretty worried about this, I mean, I knew the cancer was almost certainly gone and there shouldn't have been anything to worry about; but that was true this past June when I had my first CT scan after surgery and chemo.  But at that June scan the cancer had come back, so naturally I was concerned the same might be true this time.

Well I needn't have worried.  The scan showed the tumor was completely gone and there were no signs of cancer remaining.  That's the first time since this ordeal started in June of 2010 that a test has shown I no longer have cancer.  It's hard to explain just how that feels to write.  Great, obviously, but something deeper than that too.  To borrow a phrase from the 1960s hippies, it feels heavy.

This latest test was at 10 am on a Thursday in Sibley Hospital.  At 11 am in the same hospital, just a different building, we had a follow up with the doctor who treated me with radiation (Dr. Sibley, no relation).  He opened the scan results on the computer in front of us (the first time any of us had seen these pictures that were just taken) and then he pulled up the images from June and did a side-by-side comparison.  One side showing the tumor in my abdomen back in June, the other showing that same location in my abdomen from the photos taken just an hour earlier.  The images looked identical, save for the fact that there was a 2 cm mass in the June photo which was missing from the image taken that morning.

I had planned to go to work after the tests were run, thought I'd be in by 1 pm.  Well both Julie and I were feeling pretty emotional, which seems natural to me now.  But when I'd made the appointment I thought it would just be relief and then back to work, but like I said in an earlier paragraph it hit me deeper than I'd imagined.  So instead of work we went to lunch in our neighborhood, then sat at home on our laptops connected to our offices and worked from home.  It wasn't much of a day off I suppose (especially when I had to burn a vacation day, but still billed four hours of work) but I needed to spend the day with woman I love next to me.  It was worth it.

I don't want to get ahead of myself, of course, it's only been three months.  I don't expect the cancer to come back, but it has before so I have to accept that it could come back again.  I have another CT scan in three months, and then three months after that, and so on.  The scan that will be the most worrisome to me (after this first one) will be the one at the 1 year mark, August of 2012.  It was 1 year after my original treatment in June of 2010 that the cancer came back (my first CT scan after surgery and chemo).  So that 1 year mark is the big hurdle up ahead for me.

Saturday, August 13, 2011

FU Cancer, Redux

I've beaten cancer TWICE.  How many people get to say that?  Well I hope that's the last time I have to mention anything about fighting cancer.

Treatment ended about 10 or 11 days ago, 8/3 to be exact.  After 5 weeks of treatment (two weeks were partial 3 day treatment weeks) it was finally over.  On Wednesday, 8/3, I took a nausea pill in the morning before my treatment and never took another.  I still felt nauseaus, but I was sick of taking pills and the worst of it subsided by the weekend.

I'm almost 100% again.  Still have a slight metallic taste in my mouth, still a little more tired than usual, and some of the things I've always loved to eat and drink (coffee!) I still don't have a big taste for.  But it's all coming back.

The weekend following my last treatment my dad & his wife came up to visit.  It was a very gluttonous weekend including homemade biscuits, homemade cinnamon buns, lots of meals out with desserts...  So all of this past week we were making up for it.  5 mile runs everyday but Monday & Friday (2 mile runs those day), pilates after the runs, granola for breakfast, and salads for dinner (no meat, no booze).  By the end of the week I felt cleaned out, slimmed down, and a lot  more like my old self.

Next cancer screening isn't until November 3rd.  That day will not be fun b/c I'll be so nervous about the results, but at least there won't be any waiting.  I get the CT scan run, then about an hour later meet with the doctor to go over the results.  Assuming there is no new cancer (FU, Cancer) then it will be another three months before the next scan.

I probably won't have any updates until November 3rd.  I hope I never have to update again.

Saturday, July 23, 2011

You Don't Get Points For Bravery

My first radiation treatment didn't begin until mid week on a Wednesday.  So that first week I had just three treatments, and then weekend break, before beginning again the following Monday.  Three treatments was enough to make me feel puny, but I mostly felt ok.  Tired and a little sick, but nothing very severe.

Each Monday after my treatment I see the dr (the only time I see him during this treatment) and that first Monday (following those first three treatments) the dr asked if I had taken any of the nausea medicine.  I replied that I had not, and he said great, then you won't need it.  You either feel sick or you don't, it is not cumulative.  Well, I corrected, I haven't taken any medicine for the nausea, but I do feel nauseous.  Well by all means take it, stated the dr, you don't get points for bravery.

I didn't correct him, but of course you get  points for bravery.  Either that, or you don't get points for anything.  Has the man never seen Road House ("Pain Don't Hurt")?  I'm not a tough guy, I've never been in a real fight in my life.  To quote JJ Walker on Good Times, these arms were made for lovin', not fighting.  But I still think of myself as a man, and one who knows a thing or two & lives by a certain code.  I hold doors open for ladies, return money when someone drops it, help stranded motorists push their car out of the streets (much to Julie's dismay), etc.  You get points for those things too, at least in my book you do, and my book is the one that matters to me (well Julie's book too).  So accepting cancer treatment and not needing nausea medicine built up points in my book.

But that same Monday the dr said those words to me, I started taking the medicine.  The radiation combined with the hour long bus ride out and back to the hospital is just too much for me.  I've lost some points.  I now take the medicine at least once a day, often twice (three times is the limit, every 8 hours) and it does take the edge off, although it doesn't remove the nausea all the way.

By not removing it all the way, I figure I get to keep some of those points.