Post treatment

December 24 - 25: Leg cramps started early this time with my left calf and foot letting off some pretty intense pain. So, I've been trying to load up on the potassium (bananas and other foods). Other than that issue, things are going really well.

Cycle 3, last day

December 23: Treatment went well again today. We were done in a little less than five hours. I iced the veins when I got home as they were fairly swollen and that seemed to help calm them down. Just a shot left to do on Sunday and then some time off.

Cycle 3, day 4

December 22: This was another good day of treatment. Only hitch was they had trouble getting the port into the vein. So, they went back to the arm used for the first three days and found another vein. After that, it went well. I was there about five hours. Later that evening, I was very tired but that seems to happen on each cycle about the fourth day of treatment. One more day of treatment and a shot on Sunday.

Cycle 3, day 3

December 21: Another good day of treatment. Not much to report. We were there just about five hours which is the average. We were lucky to get a bigger room this time but had to sacrifice the windows. Sunny blue skies when we went in and heavy rain when we left. Only two more days this week.

Cycle 3, day 2

December 20: Treatment went well today. We were done in about five hours. I'm feeling fine at this point. It's usually about 3 - 4 days after the treatment ends that it hits me. The doctor tells me that is when the cancel cells are killed and the body is getting rid of them. So, three more days this week and a Nuelasta shot on Sunday. Then I'm good until the CT scan on Jan. 5th and the last cycle Jan 9 - 13th.

Cycle 3, day 1

December 19: This ended up being a long (6 hour) day in treatment. Everything went well, just slow. They took the tumor marker blood draw and one of the markers they were watching was normal. We met with the doctor and talked about some of the side effects of the chemo and other drugs. She thinks the muscle pain is from the chemo and suggested eating foods high in potassium and magnisum or using supplements. She wants me to get another Nuelasta shot on Sunday to keep the white blood cell count up when the chemo is in my body at full strength. A CT scan was also scheduled for Jan. 5th to see if and by how much the tumors are shrinking. Part of what added to the length of the day was one of the nurses started the hydration at half the correct rate. We realized this about 30 - 45 minutes afterward and flagged another nurse to change it. I'm finding that we need to watch everything that's going on and ask a lot of questions.

Halfway

December 18: This marks the halfway point in the 12 week treatment schedule. The past week, I've been feeling fairly well - just a slight cold. I had a blood draw to check the white blood cell count. It has to be high enough to start the next cycle. Late in the day I heard from the nurse that it was at 7,500 which is well over the 4,500 minimum. So, that means that I'll be on schedule to start the third treatment cycle. Good news is always welcome!

Cycle 2 post treatment

December 5 - 10: It's been going pretty well this week. The last four days brought a lot of ear ringing - maybe it's the right season - but feels more like a torture treatment. Saturday brought a new issue that I didn't expect. Back pain and muscle spasms to an intense degree. These are on the list of many side effects of the chemo treatment. Sunday, the pain had eased considerably.

The shot

December 4: Today I received a shot of Neulasta which helps the bone marrow produce more white blood cells. It works over a longer period of time than the Neupoen shot I received last week - which was designed to get me through the treatment. Out of curiousity I searched the internet for the cost of the Neulasta shot. Average price for one shot came up around $3,000. I'm very thankful for insurance. Still feeling good - just a little tired.

Cycle 2, Days 5 - 6

December 2 - 3: Treatment went really well for the last two days of this cycle. There are less patients on Saturday and Sunday so the nurses can get the treatment going sooner. Sunday was a new record at 4 hours and 22 minutes! The self-portrait shown is the IV set-up. He's my walking buddy when I need to use the rest room. They don't allow me to walk up and down the hallway as some of the chemo drugs can be caustic if the bag ruptured. So, I'm confined to the room for the duration. So far, no back pain from sitting for 4 - 5 hours - which is nice.

Cycle 2, Day 4

December 1: Treatment went well today for the most part. The nurse forgot to open the valve on the first hydration bag so the saline solution went in instead. The delay was made up later by increasing the flow and I was done in five hours. No travel problems today as the weather has gotten warmer. Not looking forward to two more days - but after that, I'll be halfway through the treatments.

Cycle 2, Day 3

November 30: This was one of the best treatment days I've had. Everything was ready and my vein gladly accepted everything pumped into it. They place a port (see photo) in a forearm vein and leave it in for three days. That speeds up the process on the days it's already in place. So, I was done in 4-1/2 hours - a new record. Nice to have a good day follow a bad one. The steroids have also been cut down to reduce the jittery feeling. This is really helping me to sleep through the night.

Cycle 2, Day 2

November 29: This was a long day. Blood work was done to see if the white blood cell counts were up. The lab took almost an hour and during this time, they can't even order the chemo from the pharmacy. They finally started the first hydration bag to get something going. The count doubled from the shot to 2,200 which was good enough to restart treatment. So, after 6 hours we finally went home. Sherry came with me as school was canceled again due to the road conditions. It was very nice to have the company but I lost once again at cribbage!

2nd cycle, Day 1

November 28: This did not go well. They took some blood and discovered that my white blood cell count was too low to administer the chemo treatment today. Normal range is about 5,000 - 10,000 and I came in at around 1,100. The doctor prescribed a shot of Neupogen (G-CSF, or granulocyte colony stimulating factor) which stimulates the bone marrow to produce more white blood cells. So, treatment is moved out a day this week. Wednesday - Sunday. Now, I'm more susceptable to getting an infection. But the shot should help. The doctor also wants me to get another white blood cell booster shot next Monday after the treatment. This after braving the iced over roads to Seattle! Actually, there was much less traffic than normal because people stayed home. We got there in about 40 minutes.

Gone

November 27:
I lost so much hair the day after Thanksgiving that it seemed best to have the rest shaved off. Otherwise, I looked like an extra in a horror movie . Shannon did the clipping. Now, I need to wear a hat most of the time. Two reasons: 1) so I don't scare anyone and 2) to keep my head warm.

Tomorrow I start the second cycle. Five days of treatment and then 16 days off. Then, I'll be halfway through the treatment. I expect to have a hearing test this week due to the ringing in my ears (now stopped). I also expect to have a CT scan after this cycle to see if the chemo treatment is shrinking the tumors. If not, the dosage or type of drug will be adjusted. I'm hoping the steroids can be modified this time so I don't feel like I'm living outside my body. Either way, I'm ready for round two.

New look

November 24: I'm just about out of hair on the top and will have it shaved later today. It's amazing how fast the hair fell out - and still continues to fall out. We named the cats. There were several pair names considered: Bert and Ernie, Mutt and Jeff... But we settled on Marco and Polo. They're the adventurous type and calling them both at once is easier with this combination. Marco is the one with white spots and Polo is the dark tabby. (see picture below)

Beginning of the end

November 21: It's been two weeks since the start of chemo treatments. Prior to today, I hadn't noticed any hair loss. Today was very different. It's the beginning of the end of my hair as I know it. Handfuls of hair are coming out. It's not coming out in clumps but when I run my hand through my hair, my hand is covered with hair. Even knowing this effect was coming didn't make it any less traumatic. I expect it to be gone by the time I start the next treatment cycle on Tuesday, November 28th.

Major distraction

November 18: Since our 20 year old cat passed away a week after my diagnosis, Sherry and I have talked about getting a kitten. Our dog Wendy, the greatest Golden Retreiver and dog in the history of dogs, passed away in June 2005. Going from having several animals to none is quite a shock. So we've been looking at the cat rescue web sites and called on some of the ones we liked. PAWS (Progresseve Animal Welfare Society) utilitzes foster homes for their kittens. They operate a store front in Greenwood in North Seattle. We visited Cat City yesterday, filled out the paperwork and completed the screening interview. They bring just a few kittens in from the foster homes for the day so that people aren't looking at hundreds of cats and making "beauty contest" decisions. There were two male kittens about 2 months old in the storefront window. We were planning to adopt one female kitten. The kittens were cute and very interactive with humans. An hour and a half later, we were walking down the street each holding a cat carrier.

After we got home, I don't think I've been ever entertained for so long as I can remember. Never noticed any ringing in the ears!

Steriod hangover

November 16 - 17: The steroids given to protect the blood cell count have a profound effect. Even though I've been tapering down on the steroids from day five to day nine, the residual amounts are mood altering. Increased appetite, the jitters and not feeling like I'm the same person from time to time are just some of the things I'm experiencing. Staying asleep at night has improved with an additional dose of Lorazepam. The ringing in the ears is now non-stop. I've determined this would be a good torture treatment. Still, in general, I am feeling really good.

Cycle 1 post treatment

November 12 - 15: I have gone back to work and feel very good for the most part. Steroids are still giving the jittery effect which also causing me to have trouble sleeping at night. In the last few days, I've noticed some ringing in my ears and slight hearing loss which is another side effect of one of the chemo drugs. But I am suprised and delighted about how I feel right now. I fully expected to be missing days of work from fatigue. It's actually been the opposite with a lack of feeling tired. My appetite and hair are still intact!

Treatment days 2 - 5

November 8 - 11: Treatment continued as planned. Basically, five hours on an IV waiting for fluids to drip into the veins. I feel okay through it all, just a little tired. Anti-nausea medication is working fine - I feel like eating most anything. Steriods to keep up blood cell counts deliver a side effect of being wired. They keep a permanent IV catheter in my inside forearm for easier access. But the limit is three days so on Thursday one came out and a new one was inserted on Friday.

First treatment day

November 7: Today was the first day of chemo treatment. It started with a echo cardiogram for a baseline on how my heart is functioning. It's a sort of ultrasound in moving pictures of the heart. They look at overall size, how valves are functioning and valve wall thickness. I joked to the tech that it was a good sign so see it pumping on the screen.

Then, to the treatment room for blood draw to get a baseline on red and white blood cell and platlets. Video on chemo. Talk from the nurse about chemo and what side affects to watch for.

They started by pumping fluids to make sure my kidneys are up for the drugs. And early-on, I consumed quite a few anti-nausea pills in prep for the two chemo drugs. Without fanfare, they started the first chemo drug, etoposide along with the fluids. When that was done, they put on the Cisplatin. This one requires a lot of fluids so we waited for about an hour and a half for that one and the remaining fluids to get pumped in.

After that the day was topped off by a hearing test. Quite an extensive set of tests. These chemo drugs can degrade hearing so they wanted a baseline and then they'll test in another few weeks and in a few months.

Longest day and move to treatment

November 2nd: Met with the Urologist/Ocologist and he reviewed my files and pathology reports. He didn’t have access to the CT Scan which I brought with me on a disk. We discussed the staging and RPLND was the best option. He said he does about 20 per year and felt comfortable with the high and difficult location. Then, he took the disk to review with an Medical Oncologist. When he came back in the room, he informed us that the large tumor was 2.2 cm and there were at least three of four more adjacent to than one with one crossing over the Aorta to the right side. New category: Stage 11B. With this category, chemotherapy is the first treatment. More tests to get a baseline. Blood tumor markers and CT Scan of pelvis, abdomen and full lungs were done. Then, met with the Medical Oncologist. She recommended four cycles of chemotherapy using EP drugs.

Search treatment providers

November 1st: The doctor called back to say his colleague would be out of town until the next week and that I should start looking for other opinions/treatment locally. I called Virginia Mason and got an appointment for the next day. Time is of the essence to prevent further spreading.

Better news but more uncertainty

October 30th: Met with the doctor and the results showed that the marker went down to 2.5. Best news yet. But this marker is not full evidence that the other tumor is benign or not carrying the taritoma. The doctor said he put my case before some local colleagues and they weren’t in consensus about which treatment. Some thought that doing the RPLND could miss anything that’s spread to the lungs. Others thought the RPLND was the best course of action. He said he would call an expert at MD Anderson in Houston to see what they recommended.

More tests

October 27th: Blood draw for the tumor maker.

Bad news defined

October 18: Meet with the doctor to review the CT scan. We looked at a 1.94 cm tumor located higher than usual up behind the Aorta and in front of the left kidney near the renal veins and arteries leading into the kidney.

New category based on this evidence: Stage 11A, pt2, NX. Still need to get the results of the upcoming blood tumor marker test in a few weeks to see if this other tumor is emitting Alfa-Fetoprotein levels. But the doctor is very concerned about doing a RPLND that high and feels that there may be undetectable cancer spread into the lungs. The RPLND will only remove lymph nodes outside of the lungs. But we are still strongly considering the RPLND. The doctor also tells us he’s leaving the practice and the state at the end of December and therefore didn’t want to be doing the RPLND. Our news for the day seemed to be going from bad to worse. We discussed traveling to the MD Anderson Cancer center in Houston for the surgery. But still needed the tumor marker for the next treatment step options.

Bad news coming

October 17: Call the doctor to see if the results were back and they scheduled an appointment for the following day. I knew at this point the results weren’t good.

Tests

October 10: Abdomen, pelvic and lower lung CT scan to look for metastatic tumors in the lymph nodes in the retro perineum. Then wait for the results.

Pathology results

October 9: The Urologist reviewed the pathology results of the small masses. One mass about 1.5 cm was seminoma (see types) and the other mass about 2.9 cm non-seminoma with some immature taritoma. Now the Urologist was “eating a little crow”. The blood tumor marker Alfa-Fetoprotein level was 26. Anything over 6 indicates evidence of cancer. Other markers came back negative which ruled out possible brain invasion and other types of carcinomas. CT scan was scheduled for the next day. Next blood marker tests were scheduled for four weeks out (to see if the levels go down after removal of the initial tumors). Cancer category identified at this point: Stage 1B, pT2 (see staging). Treatment options were discussed pending results of the CT scan. Retroperitoneal Lymph Node Dissection (RPLND) and/or Chemotherapy. The doctor thought the RPLND was likely.

Surgery

October 4: Surgical removal of the testicle (left radical orchiectomy) It was about a one hour procedure with an hour of recovery from the anesthetic and then home for recovery. The recovery went well. Just some pain standing up and sitting down for a few days.

Day before surgery

October 3: The meeting was very short with the Urologist. Emergency surgery was scheduled for the next day. He told my wife and I that men my age who get testicular cancer usually have a seminoma type cancer which isn’t as fast spreading and threatening as non-seminoma.

The day I found out

October 2nd: I went in for the ultrasound test and knew something was wrong when the technician brought the radiologist back in the room. He told me they discovered two masses in my left testicle. I told him that I now proved my doctor wrong about being too old for this type of cancer. Then, he told me that he had already scheduled an appointment in an hour and half with my original primary care doctor to go over a plan of action.

Back at my doctor’s office, he met with me and “ate some crow” about the statement of being too old. From there, he had me do a panel of blood tests and a chest x-ray. After those, he told me the testicle would need to be removed and arranged an appointment with a Urologist for the following day. The doctor called later in the day to report that the chest x-ray didn’t show any cancer evidence.

The beginning

A few weeks following my 49th birthday – around the end of September 2006, I felt a pain in my left testicle. I visited my doctor a few days after onset of the pain on September 28th and he asked me if I did any research on the internet about it. I told him I found out it could be testicular cancer but he informed me that I’m too old for that. (see statistics) He thought it might be an infection. An antibiotic was prescribed and an appointment for an ultrasound was scheduled.