It's a good thing I take regular showers. I apparently am
very thorough. At the beginning of August I found a small lump on my right
testicle. It wasn't anything glaring; it didn’t hurt, there was no
swelling and I had no other symptoms. It was hard, about the size of a
pea sliced in half and stuck directly to the front of it. "That
can't be right," was my first reaction. It was an otherwise normal
Monday morning. My alarm had gone off at 4:30; there was the gym, an
effort at some meaningful scripture study and an attempt at a healthy
breakfast. If I hurried, a titch of time could be spent with Jamie and the boys
before off to work at 7:30. My mornings are my favorite part of the day.
Perhaps it is a bit selfish, but I love the reverent solitude of it.
I secretly hope I have the house to myself for just enough time to feel
the peace and comfort this routine brings. I find it keeps me grounded and
focused. Up until that moment, I had no idea I wasn't a perfectly healthy
34 year old husband and father of 3 boys. It is weird to think now of
what I didn't know then. I have often wondered how long the cancer was
present prior to me assiduously cleaning my under carriage. Ultimately it
won't matter, for it is far better to count the days until it's gone than
scrutinize about the days it was there. Since that is the attitude we
have, we are planning on it being gone in 127 days from that morning.
I thought about the possibilities of what my discovery meant throughout the
day. I checked and rechecked myself an exorbitant amount of times.
I showed Jamie my discovery the next day. I was sufficiently
concerned at this point and needed an expert’s opinion. We had just had
our 6 year anniversary a few days prior and she has soft hands, this qualifies
her sufficiently to be an expert. I gave her little warning of my show
and tell and her first words were “what are you doing?". She had
just returned home from the Temple and we were sitting on the couch in the
middle of our living room. Our conversation was undoubtedly very deep and
very fulfilling to both parties. Certainly it was eons away from a lump
on my testicle, and perhaps my outward display of my inner conflict was an awkward
interruption. However, to my credit, she found the lump immediately,
without being tutored.
First thing the next morning I was on the phone with my doctor's office.
My provider was out of town, so I told them I wanted the first available,
regardless of who it was. A day later, Thursday, Jamie and I sat in the
clinic room when a resident walked in. In short order we got to the point
and he did the exam. He thought it might be a cyst. I silently disagreed.
I asked him his bases for that very expensive, but well educated guess.
He thought it was too soft to not be a cyst. In that moment I
wondered how many cases he had seen of testicular cancer. I'll set the
over/under at 1, including me. I'm not a pessimist by any means, just the
opposite in fact, but I wasn't completely pacified. He didn't have me
convinced. What followed was a good conversation about a plan, including
the real possibility of it being testicular cancer. Eventually he gave
me what I knew we needed, and we set up an appointment to get an ultrasound the
following afternoon.
The ultrasound tech was very nice, and very comforting. She had obviously
been doing this for some time. I laid on my back and watched the screen
as she clicked away. She took careful precautions to ensure I was covered
up except for my newly minted models. She used a towel and with some quick origami
had my testicles propped up and on top of a masterpiece for her and mine eyes
only. I was unimpressed with how much actually peered through her
contraption. Perhaps she did it wrong, or perhaps I was nervous and cold.
She was very thorough, and got a plethora of images from several angles
and views. The last image she took was really the first time I was
worried about having cancer. I will never forget that moment. She
sat the transducer directly on top of the lump and snapped the picture.
The image showed a very clear lump of tissue, heterogeneous to the rest
of the testicle. It was solid, not fluid filled, and my initial thought
was a big fat negative on a fluid filled cyst. I distinctly remember
thinking the words “I have cancer." I immediately had tears well up
in my eyes, almost without warning. They came so fast, almost spontaneous.
There was nothing I could to do prevent it. I did not panic, but was for
the first time legitimately scared. I thought about Jamie, Austin,
Tanner, and Zachary. I thought about my Mom, my Dad, and my family.
I laid alone, silently on that table as an array of thoughts and emotions
flowed through my mind and heart. I eventually reminded myself that I am
not a doctor and actually know next to nothing about what I was self
diagnosing. Still deep inside, there was a feeling of deep concern that I could
not shake. It rocked me to my core. Soon the tech returned
after checking with the radiologist and confirmed the quality of the
images was sufficient. She said the radiologist should have the report up
soon, and I should receive a call from my doctor the next day.
That night after the kids went to bed Jamie and I had a decision to make.
As an employee of the very system I am now a patient in, I have access
and permission to view MY OWN medical records. Do we want to hear this
from the doctor over the phone according to his schedule, or do we want to do
this in the comfort of our own home, together, with no other distractions?
It was an easy decision for us and within minutes I had the report up.
It was short, and to the point. "Malignant tumor until otherwise
proven."
I have cancer.
Jamie and I cried. We held each other on the couch. We had a very
intimate, private conversation. That will always be a moment we remember
with just us two. It was sincere, it was raw, and it was emotional.
It was scary, and immensely loving all at the same time. It was
also filled with optimism, faith and hope. We prayed, and we counted our
blessings and no sooner than this happened and we heard the cry of our
youngest, Zachary. I got up and went to get him. I picked him up
and carried him back to the living room to be with Jamie. As I rocked him
I looked at his perfectly symmetrical face. He gets so much of his appearance
from his mother. He has the most round, sky blue eyes of any of the 3
boys. He is extremely calm and good natured. He has two older brothers that
split time protecting and checking on him with trying to jump over and wrestle
him. I remember distinctly thinking, and then speaking aloud “he is only
5 months old, and his daddy has cancer" It didn't seem fair to him.
I could not get my 3 boys out of my mind. What does this mean for
them? How do we tell them? Austin is 4. Austin is very
smart, keenly perceptive, super sensitive and deeply caring. Tanner is 22
months old. He might have 2 Y chromosomes and 0 X's. His latest
trick is taking his dirty diaper off and finger painting the walls of his room during
nap time. He is courageous, strong, ambitiously wild, but also innately
charismatic. That was beyond tough to think about. It cuts extremely
deep. I love my wife and my boys just as I should. The same really, as
any good father and husband does. It is eternal and knows no boundaries.
Jamie and I spent much of that night and the rest of the weekend dwelling
on these things. We spent good quality time with the boys and focused solely
on the important things in life. The truck needs repairs, and the house
needs work. We have bills to pay and deadlines to meet. None of
that goes away, but somehow seemed to fall off the radar rather quickly.
All our problems seemed less problematic in that moment. I learned
real quick the best medicine in this whole ordeal would be my wife and kids.
The following Wednesday we met the urologist and his team. Jamie and I
liked him very much. He is smart, kind, and gives us hope. He has a
nurse practitioner that works with him as well. She started the show by
giving me an exam of her own. She is much rougher than Jamie, and her
hands are not near as soft. I thought for a moment she might try an
excise the tumor with her bare hands. A lesser man would have made his
way along the bed and up the wall to escape her death grip. Jamie is
officially my forever go-to testicular expert. This was August 13, 2014
and we consider this the day I was actually diagnosed with cancer. We
actually heard it straight from the physician’s mouth. He too did an
exam, and reviewed my images once more. "This is textbook testicular
cancer." By this appointment we had a weekend plus 2 days to scower
the internet for what we are up against. We spent most of our time on pubmed
and other reputable sources pouring over papers and learning all that we could.
It is dangerous to Google cancer, in case you were wondering. We,
however, wanted to be as informed and educated as possible about the ensuing
decisions that would have to be made. He told us what we already knew. My
testicle has to go. The procedure is called a radical orchiectomy.
In our crash course on testicular cancer, we learned that it is normal
for one testicle to be larger than the other. I felt a sense of gratitude as I
was at least getting to keep the larger of the two. We count that as a win.
He explained that testicular cancer is highly treatable and we will
discuss things in terms of a cure. There is a definite process to all of
this, a very well outlined order of operations. We would first do some
blood work, specifically to look at tumor markers. Tumor markers are in
your blood and made by normal cells as well as by cancer cells;
however, they are produced at much higher levels in cancerous conditions.
We also would need a CT scan of my chest, abdomen and pelvis. These were
scheduled for that same day and surgery was set up two days later.
Following surgery we would have to wait about a week or so to get the pathology
report back. At that time, we would take another blood sample to see if
my tumor markers fluctuated post surgery. With the pathology of the
tumor, the CT scans and the various sets of tumor markers, we would be able to
tell exactly what we were dealing with and we could then know what, if anything
would be next.
There are two main types of testicular cancer, seminoma and non-seminoma.
It is clearly advantageous to have a seminoma. Non-seminoma's are
generally more aggressive of the two. The doctor thought we had caught it
early, which gave us some relief. He explained the typical route for
metastasis (spreading) is first the lymph nodes and then the lungs.
Again, the CT scan would tell us this. There are 3 stages with
testicular cancer. Each of those stages has 3 sub stages. These are
basically defined by how far the cancer has spread and how large the subsequent
tumors are. Generally speaking, stage I is confined to the testicle and
usually requires no further treatment since the testicle is gone. Stage
II involves the lymph nodes and stage III is beyond, usually the lungs and if
bad enough the brain. Typically with stage II and III one is facing
additional treatment. We therefore were hoping and praying for a stage I,
seminoma testicular cancer. Time would tell.
We learned really quickly the toughest part of all of this would be the
waiting. With cancer you are always waiting. Waiting at clinics,
waiting for news. waiting for labs, waiting for images, waiting for
intervention to start, waiting for side affects to start, and then immediately
waiting for them to stop. If you are going to get cancer, you are going
to have to get used to waiting.
On
Friday, August 15, I had surgery. It was as uneventful as a surgery could
be. It takes about an hour; they go in through my abdomen by making a 2-3
inch incision and pull out my right testicle along with all of its adjoining
vessels through the inguinal canal. Prior to the operation, the surgeon
discussed with us my exam results. The CT scan showed that the cancer had
spread to a para aortic lymph node. It is slightly less than 2 cm. One of
my tumor markers was elevated, although not terribly, and the other two were
normal The elevated marker, HCG, was about 8 times the upper limit
of what is considered normal. He was staging me at stage IIa metastatic
testicular cancer. He wanted to see me a week and a half after surgery to
see how I was healing, check my tumor markers, and discuss the next round of
treatment. That treatment would depend on whether it was a seminoma or
not, and the level of my markers. At that moment, 3 treatments were on
the table; radiation, a RPLND (operation to remove my lymph nodes) or
chemotherapy.
I recovered quite well after surgery. It would have been flawless other
than the stomach bug that ravaged our household. Austin and Tanner had
diarrhea for 11 straight days with the occasional vomit to keep us on our toes.
It was relentless, and honestly quite disturbing. Jamie had it, and then
I had it the Monday following surgery. The very moment Tanner started
getting over it he got an additional virus causing a nasty set of hives,
Zachary then got an ear infection, and spent the better part of one night in
the ER for an unrelated episode. Jamie gets mother of the year for caring
for 4 babies, all the while herself being sick. We were an absolute mess. The
Wednesday following my surgery, ready or not, I went to work at my office, solely
to escape the carnage.
The next week and a half post surgery passed slowly. Like I mentioned,
the waiting is tough. I healed quickly, and got better and stronger each
day. The plague of viruses vacated our house and we were recognizing a
similitude of the life we had prior to cancer. We hoped and prayed for
good test results. Declining tumor markers and pathology showing seminoma
gives us the most options and the best outcomes. The antagonist to this
is non-seminoma and elevated markers. That means we won't be candidates
for either radiation or surgery and it’s straight to chemo.
On
Wednesday, August 27th, we had our follow up appointment with the surgeon.
We had a very frank, honest discussion about where I was at. It was very
sobering. It was not the news we were hoping for. My pathology
shows that my cancer is classified as a non-seminoma. Specifically, it is
95% embryonic carcinoma, and 5% seminoma. There are a few subtypes to
non-seminomas, embryonic carcinomas is one of them. All 3 of my tumor
markers were higher than they were prior to surgery. Two of the three
were above the upper limit of normal. The highest, HCG, was almost 400
times that upper limit. It is very apparent there is still cancer in my
body. He explained that my only viable option at this point is
chemotherapy. Surgery might be an option later, but the risk of pulling
my lymph nodes now is that the cancer could be past them and I would still end
up doing chemo. The plan is 3 cycles of BEP. Following the
chemotherapy they would do a follow up CT scan to see what was left. Any
residual tumors would be removed with surgery. There is a very good
chance we get it all with the chemo. Despite the tough news, we are still
looking at about a 90% success rate. Assuming we get it all and I go into
remission, he thought the odds of it returning could be as low as 5%. My
care would now be transferred over to an uro-oncologist. The surgeon said
there is little time to waste, so he set up my appointment for me for two days
later on Friday to see the oncologist. The hope was that I would start
chemo on the following Monday.
On
Friday, the 29th, we saw the uro-oncologist. He is a specialist in this
type on cancer and sees only testicular, prostate, and bladder cancer. A
few years ago my office used to be located down the hall from his. He
walked in and recognized me immediately. He is a fantastic physician,
very smart, and very accomplished. He explained my cancer in much greater
detail as well as the chemo regime I would be facing. He explained that
embryonic carcinomas grow extremely fast, and spread very quickly. He
explained that it is the same type of cell that first exists when an embryo is
in its earliest stage of development. These types of cells must replicate
quickly to form an embryo and eventually a baby. He said to think of how
fast cells must replicate to form a baby. These are the same type of
cells that make up my cancer. He said that usually these types of cells
go away, but for some reason they have come back as cancer for me. The
good news is that chemotherapy specifically targets fast replicating cells.
This means since my cancer replicates, grows and spreads so quickly, it
is extremely sensitive to chemotherapy and specifically cisplatin based chemo
regimes are very effective. He was extremely optimistic, and so are we.
My chemotherapy
will consist of a cocktail of 3 types of chemotherapy agents. The main
one is cisplatin, and it will be coupled with etoposide, and bleomycin.
My therapy will be given in 3 cycles, each lasting 21 days. Days
1-5 (given on a Monday-Friday) of each cycle are the heavy chemo days.
They said to plan on about 7 hours each day. They will start me out
on a bag of saline to keep me hydrated and to protect my kidneys from the toxic
nature of the drugs. Next will come dexamethasone (a steroid) and either
1 or 2 anti nausea medications. One is short acting, and one lasts for 3-5
days. After each of these has been infused via IV they will start the
chemo drugs. Again, depending on the day, I get 2 or 3 of the drugs
mentioned above. After those bags have been hung and infused they will
follow all of this up with another bag of saline. After that I go home,
and then come back again the next day for the same thing. Easy peasy.
On the second week, I come in on day 9 (Tuesday) and get labs drawn, and
see the physician. One of the main side effects of this chemo is it
reduces the agents in your blood that help fight infection. Since I will
be immunocomprimised they will check my blood counts each week to ensure it is
safe to move forward with therapy. If they are too low, treatment would
be delayed until they reach a safe level. After I see the physician, and
he gives me the green light it is off to more chemotherapy. I only receive the
bleomycin on this day and it is a much shorter day in infusion. I get the
rest of that week to rest and deal with the side effects of the therapy.
I come back the following week, on day 16 (Tuesday) of the cycle to get
the same chemo I did on day 9. After that, I get the rest of that week
off to recuperate and prepare for the start of the next cycle which would start
the following Monday and we would repeat this process over again.
Again
the physician stated it was important that we start right away. The plan
was to start on Monday, September 1st. Unfortunately they do not start
new chemo patients on a holiday (Labor Day). I need the chair for the
entire week so my cycle 1 day 1 start date was pushed back to Monday, September
8th. We are excited to start
chemotherapy and are extremely optimistic about our prognosis. We will always have faith and hope and we
will always keep fighting.