Chemo Update

Things are going well.  Compared to my past treatments this was chemo lite.  For the first two days I did experience some nausea and fatigue along with ringing in my ears.  All of these were expected but the impact was less than I thought it would be.  By Monday the nausea had let up and I stopped taking the anti nausea meds.  Those have their own side effects so I was happy that I only needed them for 2 days.

After that I felt more like I had indigestion rather than nausea.  One way that is recommended to handle nausea from chemo is to eat several small meals.  Having an empty stomach can make it worse.  It may seem counter intuitive but you need to eat something even though you feel nauseous.  What I learned from my swallowing recovery program last time was the need to have an "In Case of Emergency Break Glass" food item.  Something that requires no prep time and has some nutritional value.  This time around I laid in a supply of those Special K protein shakes.  I just have one of those in between meals and I am fine.  As of this morning, 5 days after chemo, it looks like the nausea / indigestion feeling has gone away.  All I have consumed so far this morning is espresso and I don't have any nausea / indigestion.  I still have some minor fatigue but that is also fading.  The only thing left is the ringing in the ears.  This one may take some time.  That was one of the side effects that lasted quite awhile last time. 

More Like a Short Story Than a Sequel

I am almost 4 weeks out from the surgery and should be able to resume normal physical activities.  When I was first diagnosed I was expecting far worse than what I have gone through.  Even though this is my second time with cancer and testicular cancer has a very high cure rate getting a cancer diagnosis can leave you a bit rattled.  Part of that was because my only reference was my last go round.  I don't want to trivialize this, cancer in any form is definitely not a good time, but by comparison this was the express version. 

From the time I went in for the first test, the ultra sound, to the first and only chemo treatment on Friday 24 days elapsed.  In that short time frame the following events occurred:

• Ultra Sound Test
• Meeting with oncologist to get cancer diagnosis
• Meeting with urologist to discuss surgery
• Surgery
• Follow up meeting with urologist to discuss surgery and test results
• CAT Scan / chest X-Ray
• Meeting with oncologist to discuss test results
• Chemotherapy

In just 3 and a half weeks I went from the initial test to essentially being cancer free.  Quite the roller coaster ride.  Now I am on the surveillance program for the next few years.  Back to CT Scans and blood work every few months.  There is still a 2% chance of it spreading.  Even if it does the cure rate is up in the 99% range.  There would just be 3 rounds of stronger chemo treatments. 

Another Ride On the Chemo Train

Yesterday I had my one and hopefully only chemotherapy treatment this time around.  It was definitely a different experience than the last time.  Aside from it taking 4 attempts to get the IV in, just call me the human pin cushion, it went off without a hitch.  The weather forecast this time around is cloudy skies with a chance of rain.  No hurricanes in site. 

So far I am experiencing the normal side effects, nausea, ringing in the ears and some fatigue but it is nothing like what I went through before.  It's hard to get a handle on what the duration is going to be.  I have found some postings from people that have had just the single does of carboplatin and it appears that the side effects start to fade in a week or so.  I am planning on working from home this week and for the most part this shouldn't slow me down.

Food Of The Resistance

I don't think I have mentioned it before but one of the things I would do during my first go around with cancer is check out some of the food offerings they had at a express food stand in the lobby of the hospital.  They have things like coffee, pastries and a few other odds and ends.  Whenever I passed by I would take a quick glance at the display case and check it out.  Yep,  food voyeurism at its best.  Some people check out sports cars, other people.... not me, I check out food.  One thing that caught my eye was a raspberry cream cheese croissant.  When I could start to eat again and I was at the hospital I would get one.  Initially it didn't work out so well but eventually I got to the point where I could eat it without a problem.  This become a ritual for me and now whenever I am at the hospital I try to get one.  Aside from being tasty it also reminds me of where I have been and where I am at now.  (OK,  I am really rationalizing why I want to eat a very tasty and decedent treat.)  Anyway.... I picked one up when I first got to the hospital yesterday and ate it during my treatment.   It was absolutely phenomenal to be able to do that this time around.

Viva la resistance!

CT Scan is negative and thats good!

Today we met with the oncologist and got the results of the CT Scan and they were negative.  And as always negative is good.  The cancer has not spread to anywhere else in the body so they think that this was caught early.  Big time yippee! for that.  All of the test from the surgery, blood work and CT Scan show this as being a stage I cancer.  At this point it is undetectable.  Once again big time yippee! for that.

I should mention that there was some anxiety leading up to this.  It started when the person that did the CT-Scan wished me good luck.  The last time that happened I was diagnosed with my first cancer as a stage III/IV two days later.  Also the first business day after this test the doctors office called and said they needed to see me the next day.  They already scheduled the appointment for late afternoon not asking if I could make it or not.  That starts to get your mind wandering a bit. 

For follow up treatment there are two options.  The first is to just monitor with tests and see if it does spread.  There is about a 20% chance that it could still spread.  Given that the treatment for this cancer is highly successful they normally recommend this course of action.  The second option is to have a single round of chemotherapy with a single drug, carboplatin.  This reduces the chance of it spreading to 3%.  Either way I am still in the 99% cure group.  Given my past history the recommendation is to do the preventative chemo therapy.  The reason is that the treatment if it does spread involves three rounds of a 3 drug group, one of them being cisplatin.  I have already had some very high doses of that drug in the past and it did do some damage.  The concern is that I will have increased toxicity to those drugs and that could cause other long term problems that I may not fully recover from.

Supposedly the carboplatin treatment is nothing like what I have been through.  Basically there is some nausea, potential for some hair loss and fatigue but it lasts less than a week.  The plan at this point is to schedule the chemo for this Friday.  Hopefully there won't be any hurricanes that day.  :-)

What are the odds?

There are lots of benefits to having the Internet available when you have cancer.  You have access to all sorts of information.  Of course one of the downsides is that you have access to all sorts of information.  So... while waiting for the test results and having a weekend to mull it over you end up with postings like this one.

There are between 8,000 - 9,000 cases of testicular cancer a year in the US.  It appears that roughly 1 in 18,000 men a year will be diagnosed.  It is a pretty rare cancer but fortunately the cure rate is pretty high even if it has spread.  Interesting stuff.  However when taken into account with my prior cancer it gets even more unique.

Roughly 2,000 people a year are diagnosed with nasopharyngel carcinoma in the US.  Assuming half of those are men that means about 1,000 men a year are diagnosed with this cancer.  The 5 year survival rate is around 70%.   It also primarily affects older people. To get 18,000 men that have had nasophyrangeal carcinoma in the US it would take over 20 years worth of cases.  So where am I going with this?  There are probably less than 18,000 men in the US today that have had nasophyrengeal carcinoma.  If there were 18,000 men that have had nasophyrengeal carcinoma in the US this year the odds are that just one of them would come down with testicular cancer.

So basically the likely hood of having had nasopharengeal carcinoma and getting diagnosed with testicular cancer this year is one, as in one person, not one percent.  Talk about being a member of a select group. :-)

CT-Scan Scheduled Surgery Update

I have the CT-Scan and chest X-RAY scheduled for today.  This is to determine if the cancer has spread to the lymph nodes.  Fortunately either way I am still in the 95% survival group.  One bummer with CT-SCANS is that I am allergic to the dye contrast they use.  Basically they put an IV in and take a scan then inject this dye contrast and take another scan.  Then they compare the two scans. 

In order to handle the dye contrast I have to pre-medicate with steriods  13, 7 and 1 hour before the test and take Benadryl 1 hour before the test.  I should get the results back sometime next week.  These results will determine the next phase of treatment.

So far the surgery seems to be healing fine.  No problems there and in a few weeks I will be cleared for all activities.  As it is now I can pretty much do whatever I need to do.  I am holding off from exercising other than walking and lifting heavy objects but outside of that it seems be heeling well.

Surgery Update

I met with the urologist to follow up on the surgery.  Things are healing well though it is going to be 3-4 weeks to fully recover.  There isn't any pain with the surgery at this point.  It's more of a discomfort feeling. 

Now on to the good stuff.  The tests came back and it is indeed cancer.  There are two types of Testicular cancer.  I fortunately have the less aggressive one.  This type is called Seminomas.  Also the last of the blood tests came back and it was also in the normal range.   This means that all of the tests they ran for tumor markers came back normal.  The also tested some area around the testicle they removed and did not find cancer there.  The next step is a CT -Scan to see if it has spread to the lymph nodes.  We won't know if it has spread or not until the CT-scan however the current thought is that it may not have spread. 

The follow up treatment plan will be based on the CT-Scan.  Even if it hasn't spread they will most likely recommend one chemo treatment to make sure it hasn't spread.  I have been told this would not be like what I went through last time.  (Easy for them to say since they aren't getting it.)  If it has spread then the options would be multiple chemo treatments or radiation.  Either way I am still in the 95% + survival group.  Apparently this is the most treatable cancer for men to get. 

That's it for now.  Hopefully the CT-Scan will be scheduled for next week though I don't expect to hear any news until the week afterwards.

Quick Food Post

I was reminded that the meatball sandwich on my eating hit list from my prior cancel should have been updated to be a meatball sub from Vinies in Elmira.  At the time I was unaware of the culinary excellence that is the Vincenzo's meatball sub.  If you ever get to Elmira it is worth checking out.  I can note that my last lunch before surgery was a dressed hamburger with bacon and cheese from the Elbow Room in Elmira.  Probably one of the best burger spots in the area and if you ever get to Elmira it is also worth checking out. 

Recovery Day 1

Everything went fine with the surgery yesterday. The urologist went out to talk to Sue and once again mentioned the cure rate for this type cancer is 95%. Big time yippee! for that. Probably the most stressful thing about the surgery was the anticipation (i.e. abject fear) of getting the spinal anesthesia and being sliced into.  Fortunately the anesthetist came in a talked to me before hand and I went over my concerns. The anesthetist was able to look up the sedation they used for my past procedures.  They ended up doing sedation with the spinal.  The last thing I remember is them sitting me up for the spinal. Have I mentioned that one of my favorite things about anesthesia is the amnesia effect?  There are many things in life that would benefit from that.   

Anyway back to the surgery. Being a frequent visitor to the outpatient surgery unit (17 times and counting) over the last few years I was familiar with the process. That actually helped out. Prior to getting there I was a bit stressed out about the surgery but once they walked me back to the prep area that all seemed to disappear. At that point I was in a process that I had been through before and was pretty familiar with. A nurse that knew me from my prior visits came out and got me from the waiting area and got me situated.  Nothing like being known by your first name when you go in for surgery. 

Because of the spinal it took longer to recover from surgery than before. Basically it numbs you from the waist on down. One odd thing about that was they asked if I could start to move my toes and I did but I mentioned that my calves felt like every now and then there was something like a blood pressure cuff on them. Sure enough they had these contraptions on my calves that looked like shin pads that would inflate every few minutes. They were there to help with circulation.  

One of the other differences from the other procedures I had before is that I was able to eat right afterwards.  With the procedures on my throat I wasn’t able to eat much at  and my throat was very sore.  Not so this time.  When the nurse offered a cup of custard I of course said yes… three times… along with 3 coffees as well. J  Nothing like coffee and custard to help with the anesthesia hangover.  

Probably the most notable thing about the surgery so far has been that I have been able to get up and around without any pain.  I did take two of the prescribed pain killers yesterday but after that I have just taken ibuprofen.   In some ways it’s like the fistula repair I had after the PEG tube was removed.  I can feel where the surgery was and need to be cautious but there isn’t any pain.  It’s definitely not what I expected.  I thought it would be a lot worse. I can also get around the house pretty well. 

As for the cancer stuff I won’t know any more about that until the end of the week.  Two more blood tests came back that look for markers for Testicular cancer and they were both in the normal range.  They send out the testicle they removed for testing and I won’t know the results of that or the last blood test until later in the week.  After that they turn me over to the oncologist for more tests to see if any follow up treatment is needed.

Quick Update

The surgery this morning went off without a hitch.  As always one of the benefits of anesthesia is the amnesia effect.  I remember nothing of the surgery.  Big time yippee! for that.  I am able to get around more than I thought I would be able to.  While it is tender in the area of the surgery I can walk around for small intervals, go up and down stairs and in general get around much better than I had thought i would be able to.  While they told me this is like surgery for a hernia I think the impact is going to be less. 

Cancer II The Sequel

So like any good movie there has to be a sequel.  There seem to be two ways sequels go.  The first is a continuation of the same story the second is a different story of the same type maybe involving the same characters.  In my case I choose the second option and have been diagnosed with testicular cancer.  

Like the first movie the plot line is also about cancer with some of the same characters.  New to the case is my urologist.  More about that in a bit.   

The way this came about is I went in for my checkup with the oncologist and I had been noticing a tightening / pulling sensation in my groin for a while.  The oncologist did the normal checkup for the first cancer I did have (also the namesake of this blog) and ordered up the normal blood work.  He also did a groin exam and ordered up an ultrasound.  Fast forward a week and I had the ultrasound.  The oncologist offices are in the same building and my oncologist happened to be there at that time so they asked me to wait to see him.  BTW It’s never a good thing when you have a test and they ask you to hang around to see the oncologist.  It's not like he wants to ask you how your golf game is going .

So it turns out the ultrasound in the groin revealed cancer in the left testicle.  They immediately set me up with an appointment to see the urologist the next morning.  Talk about being on the express train.  I think the normal process is to see your regular doctor, then the urologist, then get the ultrasound and then see the oncologist.  I went from the oncologist to the ultrasound to the urologist in about a week.  Getting a bit ahead of myself (spoiler alert!) I have surgery scheduled for Friday.

Anyways back to the plot line.  This morning I met with the Urologist and he pretty much confirmed what the oncologist thought.  He went over the treatment options (and I use the term options very lightly) with me.  Basically the first step is surgery to remove the testicle that has cancer in it.  They then evaluate that to see what type it is.  There are two types seminomas and non-seminoma.  The seminomas type is slower growing and less likely to spread to other parts of the body.  They won't know what type I have until they look at it under a microscope but the thought is that it is the seminoma type.  

The surgery is outpatient surgery and similar in scope to surgery to repair a hernia.  I won't be able to drive for a few days and it will be 3-4 weeks until I can resume normal physical activities.

After the surgery they will do some tests, blood work and CT Scans, to see if it has spread to other areas.  If it has then the treatment is chemo and / or radiation.  I am told that it is nothing like what I have been through with my other cancer so big time yippee! for that.

Once again the team approach is used for treating cancer.  So far the cast of characters includes myself and my oncologist along with his staff from the first movie.  The urologist is new for this movie and seems to be a good guy.  He is considered the best in this area for this type of thing.  If there is a need for radiation we will have to get a new actor to play the part as my radiation oncologist has moved on to other things as in out of the state.  Once the surgery is done the urologist turns me over to the oncologist who handles the rest of the program from there.   It’s kinda like a space flight.  The guys at Cape Canaveral handle the blast off and then turn it over the Houston for the rest of the trip.  

The overall cure rate is somewhere between 95% and 99% depending upon who you ask.  In general the prognosis in my case looks to be pretty good.    Having been through this before I am less anxious about the treatments and what follows.  The treatment I had for nasopharyngeal cancer was one of the more nasty treatment programs.  Things that have been discussed here are maybe one or two chemo treatments that are lighter than what I went through and maybe 3 weeks of radiation once again lighter and only if needed.    As with the first movie the thing I am most anxious about is the surgery.  

So I had thought I would just let this blog fade into the land of lost internet blogs  never to be updated again.  Instead its getting dusted off for the sequel.   Personally I thought the first movie didn’t need a sequel. Let’s just hope this doesn’t become a trilogy.  J