Chemo – Day 4

The end is in sight. It’s now Thursday, October 9.

Woke up several times overnight with the hiccups. Finally, got up for good at 6:23am, though my alarm had been going off for a few minutes. I didn’t hear it because the heat had kicked on and drowned out the alarm (thanks creepy basement), and I forgot to set the one on my phone.

I took my usual meds, plus a Compazine because I had nausea. However, due to the super solid bowel movements I’d been having, I decided to not take my prescription Imodium, so I could see whether I would be just normal now. Then I washed and dressed and made myself the same egg, cheese, tomato, and muffin breakfast. My body has been out of whack, but this morning I had a good bowel movement, which I take as a good omen of something or another. From what I’ve read online, any good bowel movements during chemo should be celebrated. (TMI, I know.)

My dad dropped me off and they got me all settled in, in the fourth different room of the week, with the fourth different nurse of the week. I was now feeling nauseas and lost all appetite. I think I now have fatigue, too, because I’m tired but unable to sleep or really do anything to feel rested.

The nurse was unable to get a blood return on my now four-day old IV. She flushed it with saline and then with Heparin, which is an anti-coagulant. I get this every day before and after my treatment but today my blood did not return up the IV line. So we considered starting a new IV. However, the nurse decided to give it three minutes to see if the Heparin would do anything, and I suppose the omen of the morning portended this: I would not need a new IV! She told me that they used to only let you go three days with one IV in, but now they see how long they can get. I got four days so far, and I’m hopeful for finishing out the week.

In my chair with the IV rolling.

The morning went very very slowly. I had trouble concentrating and so reading wasn’t so enjoyable. My brain is getting foggy – chemo brain, they call it. Reading anything is becoming work. I’m able to write this blog because I’m home from treatment, I took a Zofran (huge help!), and was able to eat some soup. I’m temporarily focused. Got to take advantage of it.

They gave me the Cisplatin first again, and I was able to get a short nap in before I got a roommate. I’ve had good roommates thus far, but today’s was a TV watcher. And he watched like Cake Boss and two back-to-back episodes of Fresh Prince of Bel-Air. Kind of hard to concentrate for me. I like TV enough, but I don’t mindlessly watch it. I’m of the new on-demand generation, and I only watch what I want to, so background TV really annoys me. Plus I was nauseas, fatigued, and had no appetite, and they were bringing that food cart around again with that same chicken pastarini soup! I took a Coke to try to help out the stomach. Then the machine that goes ping went ping, but it wasn’t actually done delivering the Cisplatin. The nurse tried to reprogram it and it took an additional 45 minutes for some reason. When she switched me onto the etoposide, she hooked me up to a new machine. This was about 12:30pm, so I’d already been there for 5 hours. I was ready to go, but still had another hour left.

My roommate left by 1pm, so I could at least spend the last half hour reading, which I really didn’t because of the brain fog, fatigue, nausea, etc. Notice I have omitted the hiccups!!!!!

(I’d better not jinx myself.)

My parents and Anastasia picked me up and we came home. I took a Zofran and ate some food, then did some work.

My dad and I went out to get some chicken for dinner, while my mom made mashed potatoes. By the time we got home, the old hiccups had returned. Ugh. After dinner, we took out the garbage and played with Anastasia and I had to use the bathroom, only to find a very loose stool. So I took the Imodium again. I think the lesson learned here is that if you normally have loose or whatever the opposite stool, keep up whatever regimen you usually use. This chemo will mess with your body in all kinds of ways, so you need to be vigilant. I’m on omeprazole for the stomach, Imodium for the gut, plus taking a tablespoon of psyllium husks with water a day, plus doubling my dose of lactobacillus probiotics. My stomach isn’t iron, but it’s doing better than I could have hoped for.

Had some brownie and ice cream and played with the baby some more.

I ended up going to bed around 10pm, and was again up every 2-3 hours with the hiccups.

Chemo – Day 3

Today, Wednesday, October 8, 2014 is my third consecutive day of BEP. I have two more to go, then I go once next Monday and then again the following Monday for just a hour or so for bleomycin, and then I’ll be done with chemo.

As I mentioned in yesterday’s blog, I woke up at 3am with the hiccups. Ugh, I’m really getting tired of them. They are really starting to wipe me out, more so than the chemo!

I got up, took my meds, had the hiccups, washed myself and brushed my teeth, dressed, and made some breakfast. Protein again: two eggs, cheese, on an English muffin.

I drove myself to chemo today, to see how that would go. It went ok. I used the fancy valet parking option they have at Hillman Cancer Center.

One of the nurses came out to see me in the waiting room and gave me literature on chemo hiccups. It wasn’t very helpful.

I was put in another room today, this one adjacent to the first room, and there was already someone in there, but he was out pretty quickly.

These hiccups have been driving me nuts, so I reported this to my new nurse, who thought my only help might be to take some Compazine when I got home. (I did. It didn’t work.)

They ran my fluids and then brought in a big bag of some Emend, which is a three-day long anti-nausea medication. However, I wasn’t supposed to get this until the weekend, so then the nurse had to figure out what was going on. They eventually figured it all out and got me my regular steroid and anti-emetic.

Here is the Cisplatin.

This nurse wanted to run the Cisplatin first so that my body had more time with fluids to help flush it while the etoposide ran. I drank a lot of water again, but mostly to try to stem the hiccups.

Here is my etoposide.

I peed a lot, again. Said my prayers, read the lives of the saints, read more Reacher. Relaxed. They day went by pretty quickly, but I definitely felt the worse of the days so far. My appetite was gone and my stomach was upset. I forced myself to eat a turkey and cheese sandwich, but I didn’t enjoy it, and the soup was the chicken and pastarini – again. I guess it’s the soupe de la semaine. I skipped it this time around.

I scheduled my next weeks’ appointments. Hiccups.

The valet was $5 for parking and they didn’t take my tip. Not a bad system. Home I went.

I felt pretty bad when I got home. Taking a Compazine helped with the nausea, so I could eat something. I really craved something fresh, so I had a salad. The hiccups returned, so we know that the Compazine doesn’t help with them. I guess they are here to stay.

Alison wrapped up my arm and I took shower and shaved!

The nausea did not fully abate, so I took a Zofran at 3:45pm. I was also now starting to feel fatigue. Despite this, I went to the playground with Alison and Anastasia. Hiccups. I basically sat and watched, but began to feel better with the fresh air and getting out of the house. When we got back home, I fell asleep for a bit and missed the beginning of dinner, which I then devoured when I realized what I was missing. It was lasagna that my mom made with garlic bread, all of which should probably put my stomach into a world of pain, but thankfully did not! More hiccups! I wasn’t feeling 100%, so I took another Compazine. This nausea is here to stay, I suppose, too. Wondered when it would come.

I watched some TV from 7:30pm until 9, then turned in. I woke up at 12:15am with hiccups and again at 4:15am. And when I finally got up at 6:20am, I had them still.

Chemo – Day 2

I woke up at 6:15 am October 7, 2014, pretty refreshed from the night’s sleep. I peed in the creepy bathroom then immediately got the hiccups! I went upstairs and took my meds, then ate a spoonful of peanut butter, which knocked out the hiccups.

I had originally planned to eat light breakfasts without anything heavy like eggs, based on what I’d read here and there online. However, with the exhortation to eat lots of protein, and so far being able to tolerate heavier foods, I made myself a turkey bacon, egg, and cheese sandwich on an English muffin, and a cup of coffee. And then round two of hiccups. Cured with PB again.

Alison suggested I not bother with a shower since I still had the IV in and bandaged up and we’d have to contrive some contraption to keep it all dry. However, I may have to contrive something tonight because they kept the IV in again. I don’t smell yet, though, so who knows?

Anastasia wearing an armband for solidarity.

My dad drove me in and dropped me off. I was a few minutes late for my 7:30am arrival and had to wait until about 7:50 until they took me back. I was brought to a different room than yesterday, across the hall from the coffee and goodies. I got a cup of coffee and two bottles of water.

As I drank the coffee, the nurse came by to check my IV and get my fluids started. I reported no fatigue or nausea, but that I’d been getting the hiccups. I again got the hiccups. She said she’d call my oncologist to see if they had anything. I looked up “chemo hiccups” online, because I remembered reading something about hiccups being a side effect. They can be caused by both the Dexamethosone and the Kytril, the pre-med drug cocktail of steroid and anti-emetic. Plus the Cisplatin also can cause them. So basically after I eat or drink something, they come back. I tried a breathing method used by divers to equalize air pressure called the “valsalva method,” which worked for the time after the coffee, but then I also was given Ativan, which also helped for about two hours after the water hiccups (round four) started.

When the 45-minute fluids started, I said my morning prayers, read the readings for the day, and read through some lives of saints. I couldn’t move my arm enough to make a full sign of the cross, but I’m sure God will forgive me that.

Overall, this was a pretty dull day, hiccups aside. Got the pre-meds, then the etoposide, the two hours of Cisplatin. Drank two quarts of water and peed a lot. They served the same soup again, so I got a ham and cheese sandwich today. I checked some email and read some more Reacher and took a nap. I woke up when the machine went “ping” several times. I was out the door by 1pm and my mom and dad, with baby in tow, picked me up. I got the hiccups again.

Chemo hanging.

Today’s youtube video, focusing on the Machine that Goes Ping: https://www.youtube.com/watch?v=_CCafpHpbuc

When I got home, some PB took care of them. I was a bit hungry so had a salad and more water and a few cookies my mom made. Hiccups came back again.

I did some work and emailed some students while I had the strength. Got the hiccups again. Got rid of them again. Helped my mom finish making dinner. Hiccups. Did the dishes. Hiccups.

By 7pm I was wiped out. My brother wanted to Skype, so we talked over Skype, then I retired to the basement to rest and drink more water. By bedtime, I had hit about 1.5 gallons and gotten hiccups uncountable more times. I even woke up at 3am with the hiccups!

Some really positive things happened today, too. Some guys I know from college emailed me to tell me that they too had had cancer. Both guys are doing great today and haven’t had any relapses, so there is real hope for beating this if you get on top of it. I’ve also been corresponding with some women who have recently been diagnosed with cancer. A friend’s mother just had a double mastectomy and she asked about how chemo was in case her mother pursued that option. I’m happy to see my story can be helpful.

GUYS: remember, check your testicles! Best time is in the shower when they’re happy and hanging low. Feel them, feel their size. Usually one naturally hangs lower. Learn what is normal. Then if you feel anything out of place, like a lump forming or one guy feels abnormally bigger, go talk to your doctor. It’s a pretty rare cancer, so your doctor might not figure on TC first, but if you has suspicions, ask for an ultrasound and/or a second opinion. The sooner you catch it, the easier it is to treat!

Chemo – Day 1

Sorry for this long post. It’s day one and I wanted to give a lot of background information on the drugs and the regimen, etc.

Monday, October 6 was my first day of chemotherapy.

I went to bed Sunday night around 11pm, having spent a wonderful weekend serving as a deacon at St. John the Baptist Orthodox Church in East Pittsburgh for the Archpastoral visit of His Grace Bishop Gregory of Nyssa (ACROD). I was honored to serve as the second deacon on Saturday night for vespers, along with Deacon Artemius Stienstra, Fr. Robert Prepelka, and pastor Fr. Jonathan Tobias, as well as Bishop Gregory, of course.

Sunday morning, it was just His Grace, Fr. Jonathan, and myself. I was serving my first hierarchical Divine Liturgy as a deacon. Good thing I studied! I still made a few mistakes, but nothing too big. The afternoon brought the Pittsburgh deanery’s Distinguished Diocesan Donors dinner at Edgewood Country Club. It was good to see many friends and share a nice meal. Then we headed home to prepare for “Hell Week.”

I barely slept and 5:15 am came quickly. I didn’t feel at all tired, mostly because my adrenaline was pumping. First thing I did was take my meds (I’m on meds to help clear up reflux and IBS), then I drank, nay chugged, a quart of water—I read that you need to be super hydrated during chemo to flush these toxic drugs out of the system. I took a shower, and Alison and I went to Ritter’s Diner for a hearty breakfast. I love bacon, eggs, and especially diner home fries, so I was happy to eat this stuff before I possibly a) lose my appetite, b) lose my taste, c) gain a metallic taste in my mouth due to the Cisplatin, or d) all three. Oh, and maybe get super nauseous, too. Yummy breakfast!

Then we went over to Hillman Cancer Center, across from Shadyside Hospital. I got there around 6:50am and was the first person on the outpatient cancer ward. They checked me in around 7:30am (I got an email saying to get there at 7am, but I guess that was inaccurate). I weighed in at 230lbs, which is higher than normal, but I had just chugged a quart of water and eaten breakfast.

The nurse came and set me up in a room with three chemo chairs and a couch. I picked the one near the couch so Alison could relax and nap if needed. I had read that the TC regimen, BEP, took a long time, so I knew we were there for the long haul. Emotionally, I wrote down on this paper that I was a 3 out of 10 distressed, but really, I might have been closer to a 5 or so. I was getting pretty nervous, and the IV-starting pain that would soon come did not help assuage my anxiety.

The nurse looked for a vein in the left arm, dug around (painfully), gave up, and found another on the right. She took three vials of blood for testing, then started to flush my body with fluids – just saline. This flush was one bag for 45 minutes, followed by another bag for maybe 25 minutes, then she slowed it to a drip and we got ready for the real stuff. While this was taking place, she gave me the talk about the all the nasty side effects and what might happen and what to do, and who to call in case of emergency, etc.

One thing you hear about is some people get this funny taste and smell when they flush your line before starting the IV. I get it every time. I’ve read accounts where chemo patients get nauseous just from this smell, because they know what’s coming after the line is flushed. My brother, Jay, called to see how I was doing and to talk about the woes of home ownership. No one wants to listen to me when I say that no “equity” can be worth the nonsense of home ownership. Oh well. I am a prophet un-listented-to.

The nurse started a small bag of anti-nausea meds, i.e antiemetics (Kytril) mixed with a steroid with the awesome name (should be a Transformer, or an 80s hip hop DJ) Dexamethasone. This heralded the beginning stages of chemo for real.

I’d say it was around 9:45am when the first chemo drug, bleomycin (the “B” in BEP), arrived from the pharmacy. This was given by IV over about 15 minutes. I guess this one causes all the bad side effects, though the others contribute.

Sitting in my chair getting the IV.

They have coffee, a fridge full of “pop,” juice, and water, and lots of carbohydrate-based snacks. They told me to eat a lot of protein to help with the chemo. I see a disconnect. Alison says the carbs help squelch nausea quickly, so that’s what’s up. I sent her for “Toast Chee,” and she returned with the Keebler version thereof. It was ok. No ToastaChee. She also brought me a cup of coffee and lots and lots of water inconveniently packaged in 12oz bottles. It was freezing in there, so the coffee was great. And it promotes frequent urination! My kidneys will thank me. They offered warm blankets, but I found it too warm to wear at first, but it came in handy later on, when I learned how to recline the chair and the towel cooled off a bit.

Here is a youtube video I took in the room: https://www.youtube.com/watch?v=wjbbYmDYzos&feature=youtu.be

Next up, around 10:05am, was the etoposide, the “E” in BEP. This was run for one hour. So far so good. By now, I had to pee every 30 minutes or so. Again, you’re welcome kidneys.

Around 11am or so, I was joined by an older woman. She was doing her 8^th chemo treatment, and came in every three weeks. Her treatment only took an hour, and with fluids I think she was there from when the sandwich and soup cart arrived at 11 until I was done at 1:05pm. She was pretty impressed that I was the first one in and was doing 4-6 hours of chemo for five days in a row. We had a nice discussion of how different chemos work on different cancers, and she knitted a chemo hat, which I gather has become her hobby—making chemo hats.

I got a turkey sandwich, Alison got the chicken and pastarini (is that a word?) soup. The sandwich was ok—no cheese—the soup was better, and she ran out and got me my own soup, too. As an aside, the Hillman pharmacy, by the way parents, has great deals on children’s Advil, we discovered.

Around the same time, the machine that goes ping pinged and it was time for more chemotherapy drugs. The last one of the day was Cisplatin, the platinum-based wonder-drug that Dr. Einhorn first found cured TC in September of 1974. It is also the “P” in BEP, because of the platinum. It will give me a metallic taste in my mouth, I am told. This is what I really came for! It was to be administered over a two-hour drip. I checked email, read some Jack Reacher on the kindle app (“Personal” – the newest Reacher), and fell asleep a little after noon. So did Alison. We both got up when the other lady’s machine began to ping, but then it was not long for mine, too. It did its duty and the nurse unhooked me and bandaged me up so I could go home with the IV in.

The machine that goes ping, and delivers the chemo.

We stopped at the Pitt pharmacy to pick up my anti-emetics and then planned to grab some brand-new Palestinian food at the Conflict Kitchen in Schenley Quad, but found no parking at just the same time that I got dizzy, confused, had all kinds of tingles, and suddenly went from freezing to burning up. When I left the pharmacy and walked 100 paces up a slight grade to the car, I started to get a bit light-headed and felt my heart rate increase, which led into these other symptoms.

When I got home, I sat down, drank some water, made myself a sandwich, noted the metallic smell in my nose and taste in my mouth (side effects), and ate anyway. It was ham and cheese with a slice of tomato, if you must know. Alison checked my BP and declared me fine. By about two hours post-chemo, I felt normal. No noticeable side effects. I have been banished to the creepy basement bathroom for the duration of chemo so that the chemicals I excrete can’t hurt anyone if they splash or whatever. I cleaned the creepy downstairs bathroom well last week, so we’re ready to go. A brief note on the bathroom issue: chemo causes either diarrhea or constipation. I didn’t poop all day, so I was nervous. However, by the night, before bed, I had a very solid bowel movement. I attribute this to my body’s natural desire to produce non-solid bowel movements coupled with the chemo trying to bind me up. It’s a win-win for me! (Too much info, Marc).

I’ve also been banished to the basement couch for the duration, too, because I might sweat chemicals (is this true?) and I might lose my hair, and I tend to make a lot of noise at night and my only other option is sleeping in the baby’s room, which is a disaster in the making for us all. My parents are visiting and we have ceded the master bedroom to them. All of this is just part of the fun of chemo!

The rest of the day went by well. I helped my mother make dinner (I wore latex gloves so no chemicals on my skin could get on the food). Played with my daughter. Had an ice cream party. But by 8pm I was pretty wiped out. I helped Alison pick out curtains for a few rooms that she researched while at the hospital (so her coming was somewhat productive). Then I filled up a 32oz bottle with water and went to my man cave/bedroom/creep bathroom area and watched a bit of a movie while I tried to hydrate myself one last time. I was getting an inkling of nausea and took a pill to help me out. Overall, I had about a gallon and a half of water for the day. Then I fell asleep at around 10:30. Good night!

Why I am Writing this Blog

I decided to keep a journal of treatment for testicular cancer (TC). Partly this is to help me make sense of it, and partly this is because I want to share my story. I want to share my story because when I got diagnosed with cancer, and knew I’d be starting chemo, I could only find a few blogs and such that gave the blow-by-blow account of chemotherapy.

For those of you with TC, here are my stats:

• 8/3/2014 – Pain in groin and left testicle
• 8/19/2014 – diagnosed with prostatitis
• 8/21/2014 – ultrasound of testes
• 8/22/2014 – diagnosed with testicular cancer (not prostatitis)
• Blood Results for tumor markers came back Normal.
• 9/11/2014 – Left I/O
• 9/17/2014 – Pathology: 100% Embryonal Carcinoma (EC) 3cm x 2.5cm x 2.5cm, no metastasis
• 9/19/2014 – CT scan of abdomen, pelvis, and Chest is clear
• 10/6/2014 – begin adjuvant 1x BEP

As you can see, I really don’t 100% know that I NEED this chemo. There’s a 30-40% chance I do. My EC might have spread. My body isn’t producing tumor markers so 50% of surveillance is useless. I’m pursuing the “European” method of chemo—the one blast and done. If you’re doing this, too, then maybe this will give you some insight into what it’s like. If you’re doing 2x or 3x or 4x, this might give you some idea of what it’s like at the beginning of chemo. For what life is like at the end of a 3x BEP, this blog has lots of nitty-gritty info, written by a guy who went through 3xBEP: http://bep-chemo.blogspot.com/2011/07/day-0.html

TC and Me: My diagnosis

(originally published as a Facebook note on September 27, 2014 at 6:24pm)

I want to share my story of testicular cancer. Maybe it will convince other men to check their testicles on a regular basis for lumps or abnormalities. I’ll add notes as my treatment progresses. Mostly, I want a record for myself, but also I’d like to share my experiences with diagnosis, surgery, and chemotherapy with anyone interested. Maybe it can help someone.

In early August, 2014, I began to feel some pain in my lower abdomen. I thought it was from carrying a heavy object downstairs on Sunday, August 3. Maybe I pulled something. We were scheduled to leave for vacation on Friday, August 8 after Alison got off work, so I wanted to get it checked out before we left. I waited until Wednesday (of course) and then called my PCP. She was not in, and no one was available to see me because of vacations. They suggested I go to the Urgent Care. I packed up Anastasia and off we went. By this time, I had a pretty painful feeling in my groin, like someone was perpetually kneeing me in the genitals.

The physician’s assistant at the Urgent Care checked me out and declared me hernia-free, but suggested I get an ultrasound of my testicles in case there was a cyst or something causing the pain. She wrote me a prescription for the scan and I left. I called and scheduled the scan for 3pm Friday, August 8. Alison and I talked and we decided to cancel it because we were heading out of town and the pain seemed to go away when I took some ibuprofin. It was probably nothing.

Vacation was a blast! We visited with my parents in the Ocean City, MD area. I was blessed to serve a Sunday liturgy and the Dormition with Fr. John Parsells at Christ the Savior Mission. I was pretty intimidated to serve according to the full Russian rubrics, but by the second time, I had it mostly down. We went on a boat ride in the ocean and Anastasia got to see dolphins up close. We visited some really good craft breweries (the Burley Oak http://www.burleyoak.com/ in Berlin, MD is awesome), and some pretty terrible ones (the OC Brewing Co. was not very good). We spent good time with Jay and Erica and my parents, and the Archers came for Anastasia’s 2nd birthday party. The icing on the cake was my parents agreed to take Anastasia for two weeks — Alison would go back Labor Day weekend to get her. Freedom! (lol — and it was not to be.)

Alison and I headed home on Sunday, August 17. All was well! Except that groin pain hadn’t gone away. And I developed headaches that wouldn’t go away with any pain relievers, and then I started having night sweats. I’ve never had those before. I woke up soaked for a week. I finally broke down and called my PCP again and this time got an appointment on Tuesday, August 19. I went to liturgy for the Transfiguration in the morning, and then headed to the PCP. She agreed it was not a hernia but thought it might be an infection of the prostate, called “prostatitis.” Very original name. She said she was going to do a prostate exam. Well, there’s a first for everything. She said it shouldn’t hurt, but if it does, to let her know. It HURT!!! She diagnosed me with the prostatitis and prescribed a six-week antibiotic regiment of Cipro — they use Cipro to treat anthrax, by the way. She also said I should have listened to the PA at the Urgent Care and gotten the ultrasound.

I started my regimen and scheduled the ultrasound for Thursday, August 28. On Friday, August 29, around 10am or so, my PCP called me. She said she had just gotten off the phone with the PA from the Urgent Care who called her to check my results. There was a 2.7 cm mass in my left testicle and it had to come out. No one suspected cancer at first because I’m 38, and it usually strikes guys in the 15-35 year range, and I had pain. Normally, you don’t have pain with TC (only 10% of TC patients report pain, so I’m an outlier here, too). I was told to stop the Cipro.

During this conversation, I was on a Skype call with my parents and Anastasia, so I muted it to talk to the doctor. I didn’t think about the fact that I only muted the sound, not my side of it, and my parents heard this conversation and became quite worried. I told them it was ok, and then I called Alison who was already on the road headed down to OCMD. Then I made an appointment with the urologist.

I met with the urologist on Wednesday, September 3. He said, “Yes, it has to come out.” We scheduled a left radical inguinal orchiectomy — the surgical removal of the left testicle through the inguinal (like bladderish) area. They remove it here in case there are cancer cells, so the cancer doesn’t get into the scrotal fluid and spread quicker. They always remove the testicle first if cancer is suspected. With some cancers, 80% of patients will be fully cured by this procedure. My blood work revealed negative tumor markers, which means not much at all at this point, but I guess can be useful later on in treatment. Their being negative means my body didn’t respond to the invader tumor. My third check in the outlier box. By now, my left testicle felt HUGE, around the size of a golf ball.

Testicular cancer comes in basically two forms: seminoma and non-seminoma. Treatment usually consists of orchiectomy, then they biopsy the tumor to see which kind it is, then they go from there. Stage 1 is the tumor is only in the testicle. Stage 2, it moved into the lymph nodes. Stage 3, it got out and is now somewhere else, usually the lungs. All have pretty good survival rates. In fact, testicular cancer is cured in something like 95% of patients. The reason for this is platinum-based chemotherapy, particularly the drug Cisplatin. It just works really well at killing these particular types of cancers. Before the 1970s, if the orchiectomy didn’t get it all, then it was a terminal diagnosis. Then they invented Cisplatin, which is great at killing non-seminomas. I guess it’s not clear if it works so well on seminomas. I think they do radiation therapy for those.

Update: Turns out September 27 was the 40th anniversary of Dr. Lawrence Einhorn curing the first TC patient in 1974 with Cisplatin. He’s at Indiana University. He’s the go-to guy in TC treatment (he worked with Lance Armstrong, who had stage 3 pretty much terminal cancer). My oncologist co-chairs the TC board with him, so I’m in good hands.

I had the orchiectomy on Thursday, September 11. An ominous day for sure. Plus, we celebrate the feast of the Beheading of St. John the Baptist on this day. Fortuitous, no doubt. I went in at 6:30am and was out by noonish. The procedure went well. I had a lot of pain post-op but they doctor only prescribed fentanyl, which apparently gets me really high but doesn’t actually get rid of the pain. I kept asking for something else or something stronger, at which point, after loading me full of fentanyl — my incision really really hurt — the nurse asked if took oxycontin recreationally. No, I do not. I’m just impervious to opioid pain killing. She finally, in her best bedside manner, told me that it was just going to hurt and to deal with it. I told the next nurse that I had no pain and was ready to go. In fact, they prescribed another opioid for me post-op to take at home, but I got much better pain relief from a few advil.

Alison was amazing. She took the week off and took care of me, the baby, and the house. I couldn’t lift anything over 10 lbs, which includes the 30lb daughter. I was mostly bed-ridden for the first few days. Then Tuesday, I felt better and worked on my dissertation, same with Wednesday and Thursday. On Tuesday night, my friend took me out for wings and a few beers. It was so great to just get out for awhile. However, everyday I waited and waited for the urologist to call with the pathologists report on the biopsy. They said they’d call early in the week, and by Wednesday afternoon, I just called them. The urologist called me back that night with the results.

The biopsy came back that it was a pure embryonal carcinoma, which is a non-seminoma. It measured 3.0cm x 2.5cm x 2.5 cm. And it did not spread at all. CT scans taken on September 19 of the chest, abdomen, and pelvis also came back negative. Good news all around! I read online that only 0.02% of men with testicular cancer have a pure embryonal carcinoma (EC), but most non-seminomas contain some percentage of EC. It’s the second most aggressive form of testicular cancer.

I was faced with three options, of varying weight. 1. Retroperitoneal lymph node dissection (RPLND), where they cut open your whole chest, move your organs, and (hopefully) expertly remove the lymph nodes without harming the nerves — if they harm the nerves, you might not have any feeling in your penis and you probably won’t be able to ejaculate. From here on, you might only have “dry” ejaculation, with no semen. 2. Chemotherapy — the particular chemo used is BEP, which stands for bleomycin, etoposide, and cisplatin (Platinol). 3. Surveillance — regular blood tests and CT scans for the next 5 years. If the cancer spread, then it will be noticeable in the first 2 years, usually.

I did my research and was ready for the oncology appointment. I went to Hillman Cancer Center across from Shadyside Hospital for this. Hillman is an interesting place. They have greeters and cheap valet parking and everyone is really nice. I am now a cancer patient, so I get afforded a certain amount of extra care. Oddly, even when I went for my CT scans at Hillman the week before, I felt like I belonged, like I was in the club. Normally, I feel kind of like I’m in my on world on this. I know I only had testicular cancer and it’s easily cured, but it’s true what they say about cancer changing you. It kind of isolates you insider yourself.

On Friday, September 26, we met the oncologist. We discussed my three options. We all ruled out RPLND immediately. Too invasive. The flow charts and algorithms point to surveillance, as I have like a 30%-40% chance of recurrence. If the cancer recurs, we do 3 rounds of BEP and I’m back in the 95% fully cured realm. We discuss adjuvant (preventative, prophylactic) chemotherapy. The American doctors recommend surveillance–5 CT scans a year, blood tests every 2 months, the Europeans recommend one round of BEP and just move on with your life. I like the Euro model, as did my urologist, and secretly so did the oncologist. The blood tests won’t be useful since my body isn’t making tumor markers, the CT scans each carry the radiation of 300 chest x-rays. The uncertainty is palatable. I have the best health insurance in the state and I’ve got a fellowship that will continue to pay me in times of serious illness and co-workers and supervisors who are especially supportive. My parents were scheduled to visit in early October anyway.

We decided on one round of BEP, starting October 6. I will get chemo IV treatments Monday, Tuesday, Wednesday, Thursday, and Friday of that week, then once again in week 2 and once again in week 3, then I will most very likely be fully 100% cancer-free. No more worries. I was told I should invite Anastasia to help me shave my head, so she doesn’t get freaked out when the hair falls out. I was also told I probably won’t lose beard hair. That’s interesting.

I go in for a pulmonary fuctions test on Tuesday, September 30, to make sure my lungs are healthy enough to take the chemo. I’m also going to my local public radio station to meet with local legend Bob Studebaker and record a testimonial of my love for NPR — completely unrelated.

Throughout all of this, my family has been my strength. My faith has sustained me. Our wonderful clergy had remembered me in their prayers. My friends have visited, cooked meals, and helped watch Anastasia when I had to go for doctors visits. Thank you all!

Now, unto the breach!

Update: There are lots of testicular cancer resources out there if you want to learn more:
Testicular Cancer Resource Center: tcrc.acor.org
Testicular Cancer Resource Network (great forum for discussion): http://www.tc-cancer.com/
My favourite Liverpool TC resource: http://www.checkemlads.com/