The History (most entries will be pretty short, this one is long...feel free to just read the short version)

Today is August 1st, 2011. I start chemotherapy in 2 days on August 3rd and have decided to blog about it. Why? First, I have found reading other's experiences very helpful while going through this so maybe I can help someone else.  And second, I'm not a facebooker or tweeter so this is a way to keep family and friends up to date on how I'm doing.  If you have found my blog feel free to forward it to anyone you think might be interested.

Anyway, here's the series of events which has brought me to this place...

The short version:

Oct 20th, 2010- woke up with huge testicle
Jan 2011 - Diagnosed with Testicular Cancer
Feb 1, 2011 - Right Radical Orchiectomy (Cancerous testicle removed)
Pathology indicated Pure Classic Invasive Seminoma (this is a good thing)
Oncologist recommends Surveillance (monitoring with blood work every 2 months and CT scan every 4)
July 2011 - CT scan shows retroperiteneal lymph nodes at 1.3 cm (up from 9mm in previous scans). Oncologist recommends treatment. Option 1: Radiation Option 2:Chemotherapy
Chemotherapy to begin on August 3rd, 2011.

The very,very long version:

I woke up on October 20th, 2010 with a huge right testicle. This is unusual for testicular cancer so it may have been growing for a while and I hadn't noticed but I don't think so. It wasn't a grapefruit or anything but it was pretty impressive. I know by the time it came out it was the size of a large egg but I can't remember exactly how big it was when I noticed it. 

I went to work and asked a few guys if they'd ever woken up with a monster nut. No one had. That was all I needed to hear, I for sure had TC. I gave it a few days but when it didn't go back to normal I called my doctor and his receptionist got me in very quickly (a couple of days later I think).

He examined me and said it could be a number of things. He started me on antibiotics, ordered an ultrasound and blood work, and referred me to a urologist. Three weeks later the antibiotics had had no effect and I hadn't even received a notification as to when my ultrasound would be. I had done some reading and found out that the average wait time for an ultrasound at The Grace Hospital (the hospital closest to me here in Winnipeg) is 9 weeks. So I potentially had cancer but wouldn't know for sure for months. I called my doctor and his receptionist could tell I was very concerned so she squeezed me in to see him that morning which was awesome. When I saw him an hour later he prescribed another 2 weeks of antibiotics just to be sure. I also told him that I would not be waiting 9 weeks for the ultrasound but planned to drive over the border to Grand Forks, ND where I could pay about $800 to have the ultrasound done and read within a few days. He called the Grace Hospital and had me moved from the "urgent" list to the emergency list for my ultrasound and by the time I got home there was a message with my appointment for the following week so I decided not to head to the US.

The ultrasound wasn't as bad as I thought. I know that there's nothing physically invasive about an ultrasound but the thought of someone gelling up my nuts and poking around down there for a half an hour didn't appeal to me (8 months later and lots of poking around down there later I couldn't give 2 shits anymore). I returned to my Dr. a week or so later for the results. He said I did NOT have cancer but simply a Varicocele which is very common (1 in 10 men will get one) and unless it is causing pain they are often not even fixed which would require minor surgery. This was awesome (unfortunately very inaccurate) news. The report ,which I didn't actually read, recommended an abdominal CT scan to ensure that "there were no other issues in my belly" which could be causing this condition. After doing a little reading I was convinced this condition was caused by advanced Kidney Cancer. Thank you Internet!

My CT scan happened about 3-4 weeks later during the week before Christmas. Because of this I wouldn't find out that the results had come back normal until the first week of January.  I tried not to think about it over Christmas and during a trip to Vegas right after Christmas with my wife Adrienne (our first trip away together since our son Anthony was born in Oct 2009) but it was always in the back of my mind.

So I went to my Urologist appointment on the last Friday of January pretty relaxed knowing I had a minor condition which may or may not require a minor surgery to correct. That changed pretty quickly when he read my ultrasound report, underlined the term "malignancy", slid it across the table and asked me if I knew what that term meant? I did. It meant cancer. Then I read the whole line: The diagnosis of exclusion is malignancy. "So...does that mean malignancy is excluded then, as in, I do not have cancer"? "No, that means that by excluding everything else that it could be, that malignancy is the preliminary diagnosis". This can't be positively confirmed until the testicle is removed and the pathology is done though. I insist that my GP told me I did not have cancer. The urologist then decides the best way to proceed is to examine me. I'm happy to hear that I have a perfectly normal looking left testicle, perfectly normal looking penis but one huge right testicle which screams testicular cancer. He wants to remove it on Tuesday. I ask if we can wait until the following Friday because my in laws will be back from out of town and can watch my son. He said we can, but he doesn't think it's a good idea. I don't argue. He then sends me for more blood work, chest xray and an ECG and schedules surgery for Tuesday afternoon. This seems really fast but anyone who knows anything about testicular cancer knows that's how it works. Get the cancer out before it can spread.

Side note: The ultrasound report talked about cancer but the last line which is usually the diagnosis line described the varicocele. So I'm thinking my GP obviosly skimmed the report without reading the whole thing but it was also a confusing report apparently.

Adrienne and I met my urologist at his office late Tuesday morning to finish the paperwork and then headed staright over to the hospital for the surgery which would happen at the end of the day as long as they could fit me in.
I was admitted and was wheeled down for surgery a few hours later. When I got down to the surgery department my urologist was waiting in his scrubs. We chatted, he wrote something on my scrotum with a permanent marker, the anesthesiologist gave me the low down on what he would be doing and then it was into the operating room. I wasn't too nervous about the whole thing until I saw the operating room full of people, the stark walls and metal lights, etc. My urologist chatted with me, I'm pretty sure to distract me, until the anesthesia kicked in and I was out.

My memory of recovery is pretty vague. When I woke up, a nurse was at my side immediately and asked if I had any pain. I remember feeling the incision but the pain wasn't terrible. She gave me some morphine and I don't remember too much after that. I remember Adrienne stayed with me for a while and then had to go home because visiting hours were over and we did have a son at home.

A note of thanks to our friend Diana who took the day off work to watch Anthony in the afternoon and who came to the hospital afterward to stay with Adrienne while I was having surgery. Thanks also to Phil and Christina for taking care of Anthony that evening and all the other days and evenings since. To our friends who visited, brought food and/or helped out in any way. To Adrienne's Mom and Dad for anything and everything you do for us on any given day! And to Adrienne who has been great through all of this. Thank you in advance for looking after me during chemo. Back to the story...

I spent the rest of the evening trying to pee. If you don't pee within 6 hours of your surgery they start a catheter. I drank a ton of water but my brain is just not wired to pee lying down so finally I got the nurses to shoot me full of morphine and I stood up and finally peed with only a half an hour to spare.

I spent the rest of the night in the hopsital which isn't typical after an orchiectomy. Usually you spend about 6 hours and then you go home. My 6 hour mark would have been at 11PM so I just stayed over night. I was also having quite a bit of pain and the nurses figured it was better to stay at the hospital than rush home where Anthony would be jumping all over me. I think it was late afternoon the day after the surgery when I got home. The pain wasn't crazy but it was what you would expect from a 4 inch incision in the groin. That's right, if you thought they removed the testicle with a little cut in the scrotem you would be wrong. You see, the testicle empties into lymph nodes in the back but the scrotem empties into lymph nodes throughout the body so they don't want to disturb the cancer in there. Instead they make a big cut in your groin up to just under the waistline running parallel with the crease where your leg meets the groin. Then they push the testicle up and out through that and cut it off outside the body. When I read the detailed surgery report I almost passed out. Anyway, what was I talking about? Oh ya, recovery. I was in bed for 3 or 4 days and then slowly got back on my feet over the next week or so. I saw my urologist a week and a half after surgery and got my 18 staples removed. That wasn't fun but it was quick. I also healed better once the staples were out. My pathology report wasn't back yet but the Dr. actually called me later that day with the results. The cancer was confirmed as Pure Classic Invasive Seminoma that showed no signs of chord invasion. This basically meant that I had the better or more easily treatable type of testicular cancer which showed no sign of spread up the spermatic chord. This was good news.

My urologist said that Cancer Care would take it from here. He figured I would meet with my oncologist in about 3 weeks and if any treatment was required it would probably start about 3 weeks after that. He also said they would be in no hurry to see me because my tumour markers before the surgery were not elevated, the CT scan was normal and the type of cancer I had was slow growing and it looked like they got it all. This was a Friday. I was surprised when Cancer Care called me on Monday and wanted to see me on Tuesday. This worried me. It turns out that one of my tumour markers was slightly elevated and that the CT scan showed some lymph nodes that were on the high end of normal, 9mm where anything under 1cm is normal. So more bloodwork and another CT scan. I met with my oncologist a few weeks later and found out that my tumour marker was back to normal and my suspect lymph nodes had not grown. So my Dr. recommended surveillance, meaning more bloodwork in 2 months and another CT scan with more bloodwork in 4 months.

The 2 month bloodwork was fine. That brings us to my 4 month CT scan which I had done on July 6th. It showed that the suspect lymph nodes had grown to 1.3 cm. This pretty much confirms the presence of cancer in my Retroperiteneal Lymph nodes. This is typically where testicular cancer spreads after the testicle. If not treated it will spread most likely to the lungs and then to places like the brain, the liver, etc. And so my oncologist recommended treatment which could either be radiation or chemotherapy. The side effects of chemo aren't great but the long term effects of radiation are potentially other forms of cancer. They would have to radiate through my organs, bowls, etc to get to the affected lymph nodes. Also, there's a chance they could miss a lymph node and then I'm no better off. Chemotherapy would be a longer process but would kill the cancer anywhere in the body and the long term side effects seemed better.

And so I am set to begin 3 cylces of BEP on August 3rd. BEP means bleomycin, etoposide and cisplaten. The cycles are 21 days long. I will receive all three drugs on days 1-5 ( I believe) and just bleomycin on days 9 and 16. I've read about the drugs and lots of blogs by others that have gone through it. I am not looking forward to it but at least it's pretty short compared to most chemo's.

That's it for now. I plan to post short comments every few days as long as I'm feeling up to it. We'll see how it goes.