Two Months

I know it's been awhile, but honestly there has not been much to say about TC in awhile. About two weeks ago, I had some blood work done. I got the results of that blood work this week when I had my monthly checkup with Dr. Barth.

Basically, everything is great. All the tumor markers were at normal levels, which means I'm two months free and clear. Huzzah! It is really perfect timing for the wedding and honeymoon. The thing is, you really don't want to have to be worrying about cancer when you are here:

Good thing, I won't have to. (Yes I know I ended that sentence in preposition.)

Oh, and I went back to the gym for the first time since my surgery. I was actually surprised at how much strength I had retained even though I was down and out for awhile. What's not surprising is how darn sore I am.

Hope everyone is doing well. Thanks again for all the love and support.

p.s. You can see a slide show of Venessa and my engagement photos here. Beware of extreme cuteness.

Stage 1

Well, folks, the results are in.  In the words of Dr. Neil Barth, “I am cautiously optimistic that you have been surgically cured.”

The last week or so has been difficult not because of any physical pain, but because of the uncertainty of not knowing if I still had cancer. Unfortunately, after my surgery I was referred to a HMO physician whose office staff was perfectly content to allow the HMO to delay authorization of the diagnostic studies needed to answer this crucial question. In fact, the authorization is still pending.

Given the difficulty with the HMO, I decided to take matters into my own hands. Luckily, my insurance also is PPO, meaning I can choose a doctor outside of the HMO network. Of course, the downside is higher cost, but I contend that the extra money was worth it as it bought peace of mind.

Enter my best man at the upcoming wedding, Adam. Adam's father is a cardiologist, who through his own successful practice and work at Hoag Hospital, knows perhaps the best oncologist in Orange County, Dr. Neil Barth. I talk to Adam, Adam talks to his dad, Adam's dad refers me to Dr. Barth. Here's Dr. Barth's curriculum vitae if you are interested.

Once I had the referral to Dr. Barth's office, things went quickly and smoothly. I received the results of my blood work. The two tumor markers, beta-hcg and alphafetoprotein, dropped dramatically post-surgery. In fact, the beta-hcg marker actually dropped to normal levels. The alphafetoprotein was still slightly elevated, but it also has a higher half life. More blood work to be done in a week or so.

Next, I had my first set of CT scans. The first time I went to Dr. Barth's office, I was incredibly impressed by what I call “the Newport difference.” Now for you out-of-towners, Newport Beach is known for being an affluent area of Orange County. Think Real Housewives of Orange County. Luckily, there was no snobbery at the doctor's office. There was extremely friendly staff, a receptionists who was not hard on the eyes, private changing areas (to put on your gown), lockers to put your stuff in, and white-fluffy robes to wear over your gown. Too bad the only cocktail they offered me was berry flavored barium.  Needless to say, I was impressed with the office.

Actually, I was really impressed with the process of the CT scan itself. The machine they use is so brand new and advanced that it talks to you! “Breathe, hold your breath,” it calmly instructed. I didn't have any problems with claustrophobia (you don't stay inside the tube for very long, as the machine slides in and out), and the technician did a good job of inserting the IV (for the iodine contrast). All in all, the CT went smoothly.

Yesterday, was the big appointment with Dr. Barth. My wonderfully supportive Bride-to-be, attended the appointment. While waiting, I'm pretty sure she read the entire FamilyCircle magazine. The Newport difference was on full display inside the examination room. Yes, inside the exam room was a 36-inch plasma screen hanging on the wall. Now you are probably asking yourself why one would need a plasma screen inside an examination room. Well, let me tell you, faithful reader. Dr. Barth used the monitor to go on a guided, narrated tour of the inside of my body. Using a wireless keyboard, we went through every slide of the CT. Essentially, we saw an animation of a cross-section of my body from my neck all the way down to my...ahem, pelvic area.  It was soooo cool.

Oh, it was also informative. First and foremost the CT scans did not show any evidence of metastatic disease. The also showed that I have freaking scoliosis!!! I exaggerate. Only one joint curves slightly to the right. Insert joke about lawyers being crooked. I also learned that my heart muscle is perfectly healthy and that I have fantastic abs.  Shoot, he could have just asked Venessa if he wanted to know about that ;-).

So where does that leave us? Dr. Barth was confident in the stage 1 diagnosis, but he wants to have additional information before advising us on whether or not he would recommend observation or adjuvant chemotherapy. In the coming week, he is going to have his own pathologist give a second opinion on the actual tumor. They are going to look at type of cell, internal vascularization, and whether the tumor had extra-testicular vascular access. Also, I am going to have a PET/CT scan on Monday. This will more clearly show if the cancer had spread.

A CT scan only shows structures. It is useful, but not foolproof. For example, all of my lymph nodes in the CT scan were within the normal size range. That doesn't mean that one has a small amount of cancer in it. To help get a better picture, you do the PET scan, which images the cancer as it metabolizes radioactive glucose. Essentially, a PET scan actually has the ability to see cancer as cancer.

Another thing Dr. Barth is going to do is send the tumor off to genetics lab to do a complete genetic profile of the tumor. This is where Dr. Barth is on the cutting edge of oncology. The idea of getting a genetic profile of the tumor is to determine whether or not it would be genetically-predisposed to being aggressive. They are going to learn information about the very first cancer cell such as did it go from being a normal cell because it was promoted to become cancer or because the gene for preventing cancer failed.

Once we have as much information as possible we will roll the dice. That's actually a pretty accurate description. Dr. Barth is going to assess the odds of a recurrence, and how much that chance would be reduced by adjuvant chemotherapy. If the odds of recurrence are good and those chances would be reduced by chemotherapy, he might recommend the chemotherapy. On the other hand, if the tumor didn't have vascular access, and isn't the type of tumor that would be aggressive, he will likely recommend observation.

So stay tuned. The odds that I have been cured are very good. I, like Dr. Barth, am cautiously optimistic, but there is a part of me that is reluctant to believe the news. I love you all for thinking that I am Stage 0, I just don't know if I can believe it quite yet.

The Know-Nothing Party

Following my appointment with the oncologist on Tuesday, I have changed my political party membership to the Know-Nothing Party. Shout out to Mr. Curro and AP US History!

Basically, no news. The oncologist is unable to determine the stage of my cancer because I have not yet had the diagnostic tests that would allow him to do so. These tests include blood work which looks for certain tumor markers and CT/PET scans. Even though he was unable to determine the stage, he did give me a breakdown of possible treatments subjective to what stage my cancer.

In the event that my cancer is anything higher (read: worse) than Stage 1, I will have to do several cycles of chemotherapy. This would be bad, and not just for my hairline. The biggest concern of chemotherapy is the effect it would have on “lefty”. There is a very good chance that undergoing chemotherapy would render me infertile. No body wants this.

Now, if I'm lucky enough to only have stage 1 cancer, meaning the cancer had not spread beyond the testicle, then there are three options. First of all, know that the doctor's opinion as to what stage is still an opinion. Even if the blood work and CT scans suggest stage 1, they are not fool proof. With that in mind, there are three treatment options. Those treatment options are (1) observation, (2) 2 cycles chemotherapy, or (3) further surgery. Given the problems with chemo, and the fact that no body wants a surgeon digging around their abdomen to remove lymph nodes, I would likely choose observation. Observation involves monthly blood tests and CT scans every three months. It would be annoying, but it would help catch a relapse early.

Speaking of annoying, I STILL haven't had the damn scans. Apparently, the insurance has to authorize the scans before I have them. I may not know what stage cancer I have for another week to two weeks. I don't know if I can take that much waiting. To make things worse, I am trying to get into the best oncologist in Orange County for a consultation and second opinion. This doctor has all the diagnostic equipment on site, so it would really speed up the process of getting results. The only problem is that this doctor won't schedule an appointment until he has a chance to review my medical records, and the urologist is delaying sending my medical records. No matter what option I pursue to get the diagnostic tests, it would seem that I am doomed to an interminable wait.

Thanks to everyone who has messaged, emailed, or called in the last couple of days. I really apologize for not getting back to everyone. I have just been overwhelmed with well-wishers. Your love, prayers, good vibes, and positive thinking is very much appreciated.

First back day

I had my first day back at work today. Got to say it was kind of weird. I am really kind of sick of having "the conversation." It's actually a nice problem to have. I mean the only reason people want to have "the conversation" is because they care about me. That being said, it gets kind of monotonous.

Appointment with the HMO oncologist. Can't wait. I'm ready to get this over with. Actually, I'm also trying to set up myself with another (better) oncologist at Hoag Hospital in Newport Beach. If I need a second opinion, I am going to him.

That's it for now. Thanks to Carlos for coming over and hanging out.

Getting up to speed

As I mentioned on the Welcome Page (you did read the Welcome Page, right?), I was diagnosed with testicular cancer on April 15, 2010, but the story of my TC actually begins several weeks before that. Sometime in early to mid-March, I felt an abnormality in my right testicle. To call it a lump would not be accurate. It was more like a small bulge. I was slightly concerned, but because it did not feel like a lump on the surface and it was awfully small, I did not pay it much attention. I'm a tough guy and this problem would simply go away on its own, or so I thought. It didn't. It got worse, and it started to hurt. I mean that mother really started to hurt.

At this point, I brought the problem to the attention of my loving, beautiful, amazing, best-person-on-the-face-of-the-Earth Fiance, Venessa. She adroitly advised me to go to the doctor. My dumb ass insisted on procrastinating for another week. “If it doesn't go away, I'll go see a doctor,” was my plea. The truth is that I was scared. I was scared that going to the doctor would only confirm my worst fears. I wasn't prepared to face the certainty of having TC. Another week of pain, and a clearly diseased right testicle changed that.

So I went to my primary care physician who thought it might be an infection. She gave me some antibiotics, but she also ordered an ultrasound just to be on the safe side. The ultrasound could not have been more clear. There was a mass in my right testicle.

With this result, I was referred to my urologist, Dr. Greenberger, who took one look and said, “Yup, it's cancer, and it's got to come out.” Now, due to the particular anatomy of the testicle and the scrotum, it is standard operating procedure for the doctor to remove the entire diseased testicle (and the attached tissues) rather than biopsy the tumor. The overwhelmingly majority of testicular tumors are malignant, and biopsying the tumor would only serve to delay treatment.

The procedure to remove a testicle is called an inguinal orchiectomy. Mine was scheduled the day after my first visit to Dr. Greenberger (who was also the surgeon). Not to be too graphic or anything, but to perform the surgery, the surgeon makes a four inch incision in the lower abdomen (think bikini line). The testicle and associated tissues are then pulled up and out of the incision where they are removed. The surgery itself takes about 30 minutes, and they due use general anesthesia. Mine was done on April 16, 2010.

Prior to the surgery, Dr. Greenberger said there would be some mild incisional pain, and I might have difficult sitting up or down. That bastard lied. That shit hurt, like a monkey as Venessa would say. I will forever compare all pain I have in the future to that pain. It hurts because they cut through your abdominal muscles which at least for me, made getting up and down nigh impossible for about three days following the surgery. I also discovered I have a Vicodin allergy, which did not make things any easier.

After the surgery it took about four days before I could walk or stand with any real success. I had to use a walker for awhile, and I was still in a lot of pain at that point. However, here I am a little over a week from my surgery, and I can finally walk, stand, get up and down, with not too much effort. Amazing how the body heals itself.

As I have recuperated nicely from the surgery, the $64,000 question has become, did they get all the cancer. Unfortunately, I still do not know the answer. After the surgery, a pathologist looks at the diseased testicle to determine the type of cancer and whether or not it has spread to other tissues or accessed a vein (this is called vascular invasion). I got the results of my pathology on Friday.

According to the pathologist, I have a type of nonseminoa testicular cancer called embryonal carcinoma. While I am no expert, here's what I know so far. Typically, old guys get seminoma TC, and young guys get nonseminoma TC. Nonseminoma is also typically more aggressive.

The good news from my path report was that the tumor was relatively small (2.5 cm) and had not invaded the spermatic cord or the epidimisis. The bad news is that there was probable vascular invasion, although the pathologist hedged his bet by saying that the vascular invasion could have been a result of manipulation during the surgery.

This brings us back to the big question of whether it has spread. Like I said, I don't know. Normally prior to the surgery, the patient will undergo a bunch of CT scans to look for tumors in the lymph nodes of the lower abdomen (or elsewhere). However, because the first available time for my surgery was the day after my first appointment with the urologist, I have not yet had those scans. For now, I must be content to sit, stew, worry, and wait (and write blogs).

My appointment with the oncologist is on Tuesday. The oncologist will very likely order additional blood work and the CT scans. Hopefully, pray to God hopefully, the blood work will show normal levels of tumor markers (my pre-surgery levels were markedly elevated) and there won't be any tumors in my lymph nodes or anywhere else for that matter.

That's pretty much it. I'm sorry for posting such a long entry, but I just wanted to bring everyone up to speed. If you have any questions about my tc or my treatment, please let me know.

Oh, and in case you were wondering testicular cancer is the most treatable kind of cancer. 90% of men are cured with the initial treatment, so nobody needs to freak out.