Home

As is usually the case with these things, more information has come, more decisions have been made, and more actions have been undertaken.

But before I get to that, a brief endorsement. I haven't done a lot of writing lately. Fortunately and unfortunately, medical school doesn't require a lot of that sort of thing. So, it took me by surprise when I received compliment after compliment on my writing here on the blog. Not that I'm James Joyce, but that made me feel really good. So, thank you to everyone for that. Still, I'd like to give credit where credit is due. Those of you who know me through our Williams connection know: I wouldn't be able to write like this without my Williams liberal arts education. So, tell your friends. Tell your family. Yes, its true...Williams really is the best college in the nation. That's right...better than Amherst...better than Harvard...better than anyone else. I especially encourage you to tell everyone in Colorado and the West. I'm sick of hearing: "Oh...good for you," and "Oh, you mean William and Mary?" No, I mean Williams College, the best college in the US. Look it up. [End Rant]

Saturday now seems like eons ago. Long story short...my parents left. And though Teresa continued to take excellent care of me and sacrifice so much, I realized that I needed to be with my family. I needed to be home in Colorado to get my head wrapped around this thing. And poor Teresa was beginning to run low on gas. Emotions were running high. I figured that a trip home to Colorado would be a good way to recharge everyone's batteries before the surgery on February 27th. Besides, I could more easily wrap my head around the surgery at this point, then the idea of going back to school. I guess that I'm officially in health/healing/family mode now. Still, Dr. Kowal did offer good advice when he suggested going back just so you no longer have to feel like "the sick guy." I got a chuckle out of that.

One more test result to report: the alpha-fetoprotein fell down to 9 from 23. Anything under 19 is normal, and this is the drop we were expecting to see given the longer half-life of this particular marker. Healthwise, I'm doing alright, though I've had some increased pain levels lately. Stop reading now and skip to the next paragraph if you're squemish about details. Basically, there seems to be a small mass in my scrotum on the left side, which is very painful. After speaking with Dr. Kowal, it seems likely to be some fibrotic (scar) tissue from when they had to dissect the mesh sac from my old Orchiopexy away from the dartos fascia of the scrotum. Anyway, this sucker hurts and even feels like a pinching sensation sometimes. I hope that it goes away. Also, I have some increased pain just below my incision. I'm hoping that I didn't manage to give myself a hernia. Still, I'm a worrier, and everything is almost certainly fine. Sitting on a plane for four hours was still very uncomfortable, though.

Yesterday, I drove down to Boston and stayed with my friends, the Eklunds. It was so great to see them, and they are always so kind and caring and wonderful. It meant so much to me when Marion said, "I just want to lay eyes on you." And so she did. We had a delicious dinner, and a relaxing evening together. And as usual, I had a personal shuttle to the airport with free parking.

So, here I sit in "my office" (translation: the guest room) at home typing away to you. The flight home was uneventful, possibly a first for Jetblue out of Boston. Dad now calls them "Shitblue," and I can't say that I disagree. Now that I'm home, I don't exactly know what to do with myself. I'd very much like to avoid watching tons of TV and doing nothing. Annie is getting old and a bit more reclusive these days, so she isn't the company that she was this past year. I'm still not permitted to exercise, which is driving me nuts. I can already see the changes to my body. I can only imagine what I'm going to look like when this is all over. Hanging around with Teresa "perfection is my middle name" Rodriguez isn't the best for your self-image either. Besides, walking around the locker room at Greenwood Athletic Club with one testicle, profuse genital area bruising, half-shaven pubic hair, and a four inch incision on your abdomen doesn't exactly meet the requirements to be a cool kid. Anyway, I guess that this is family time. It will be nice to get up to Dad's house and relax in the woods.

Some more pictures for everyone:

Saba, my East Thetford dog:



From our trip to Penny Cluse in Burlington:


I especially like this one. I have such a funny look on my face, and Teresa is gorgeous as usual.





And a creative take on the idea of "TruckNutz". Fully appropriate given the type of cancer I have.

The Good By from Amy

The Good-by from Amy

Right now I'm on the plane on my way back to Denver. It was hard to say goodby to Ben and even harder on him to say goodby to us. It's a strange feeling after being together for the last ten days trying to cope with everything that has happened in our lives since that Tuesday night when Ben was told in the ER that he had a tumor in his testicle to suddenly separate and try to go on with our lives until the RPNLD surgery on 2/27. I don't cry as much as the days pass but of course the feelings and thoughts never leave me. And of course I'm crying now and the guy next to me is trying not to notice. This morning after Harry and I drove back to Logan airport, my friend Nan who lives in New York but was in Boston for the weekend met me at the airport with her son and husband. They were like a life preserver to keep me afloat for a bit longer so I didn't have to be alone while I waited for my plane to take off.I want to thank them for that. And I feel like I have a million thank yous to say to all our family and friends (new and old). Harry, you have been an incredible support to Ben and to me and you have made us laugh and forget for a minute or two here or there that life will be good again. Gary and Jan have been my rocks. I can never thank them enough for being there for us even while they were in pain themselves and trying to cope. And Teresa and her family for being our family on the scene. I know that the surgery won't be any cakewalk and that there may be more to cope with after that but with the support from all of you, I have faith that we will get through this and come out on the other side with a better appreciation for everything and everyone that we have in our lives. Again, to all of you have emailed and called (keep 'em coming) and been there behind the scenes, doing things to help us cope, I love you and thank you a million times.

Love,Amy

The Interim

First of all, thanks again to everyone who has written comments on the blog. I'm reading them, so keep 'em coming. Also, I've got confirmation that the email update feature is working and includes a copy of the new content for that day. So, I highly encourage you to use that feature.

Well, its Saturday now, and my parents are headed home tomorrow. I'm feeling much better physically, and my bruising is starting to come down. So, there's really no sense in them sticking around for now. Also, barring an unexpected result with the alpha-fetoprotein on Monday, I've pretty much got all of the information that I need to make a decision. And over the past couple of days, that decision has come. It seems overzealous to jump straight to chemotherapy at this point. If the doctors think that the RPLND is the best diagnostic and therapeutic step, then I'm going to follow their recommendations. Not that this surgery is going to be easy, but it seems as though pretty much everyone is in agreement that you should avoid chemotherapy if you can. If they find some microscopic disease in the nodes after the dissection, then I'll have the chemo then. The most screwed up part about it, though, is that I have even better odds that I wouldn't need the chemo, should they find and remove 1-2 diseased nodes, but the treatment algorithm still calls for chemo in that case.

One factor in my decision to go for the surgery has centered largely around a rather nebulous reason. Basically, it bothers me that people who go through chemotherapy have been through so much trauma, but typically have few scars on their body to show for it. I think that a scar is a sign that you and your body have been through a traumatic event, but that you have healed. It is a sign of strength and resiliency. I know that I have the strength to heal from such a traumatic operation, so I would wear those scars proudly. As far as I'm concerned, they would announce my status as a survivor. Chemo would only leave me with internal and uncontrolled scarring; scarring that might be debilitating. The Bleomycin in the BEP chemo can cause permanent loss of pulmonary function. BEP can cause neuropathy in the hands and feet. It can cause permanent hearing loss. Anyway, I'd much rather trust Dr. Seigne with a million dollar robot inside me, then let a bunch of poison run crazy inside me.

So, that big decision is in the bag. Well, what now? The surgery is scheduled for February 27th. So, I've got about three weeks until then. Should I go back to school, knowing that I won't be able to take exams? Am I ready to go back to school? I have a lot of anxiety about being apart from my parents during this time. Should I take that as I sign that I belong at home during this time. And here's an even crazier idea, should I just "get away" and go to Florida or something? I'm not sure what the right answer is, but I certainly know that I'm going to need to do something to get my head in the right place for the events to come.

And I've got other big decisions on my plate regarding school. For those of you who don't know, year 1 of DMS runs on a trimester system. Term 3 starts on March 23rd, so I very well might be ready to go back to school by then. In that case, I'd have to make up everything that I've missed from Term 2 over the summer. This sounds like a pretty appealing option. Still, this has been an incredibly stressful time. I may be ready physically on March 23rd, but will I be ready emotionally? Going back to school would be stressful, and then I'd go straight through the summer trying to relearn and master material from 6 months earlier. As Dr. Catlin (one of my anatomy profs said), "you don't want to go into the spring term on half a tank." And I agree. So, I'm beginning to lean towards simply returning to school next November and repeating term 2. That way, school is completely out of the equation, and my number one concern can be my own happiness. It would give me the time and the state of mind to actually settle into life in Hanover, so I could attack medical school from a more stable footing. If only for that, the year would not be put to waste.

Recognition

In my haste to catch up on the blog, I made a terrible omission. You might have noticed that I used the pronoun, "we," quite a bit in my summaries. I can't tell you how grateful I am that it wasn't just "I". There's no way that I could have done this without my superstar support team. So, here we go:

First off, Teresa. Dear Teresa, you have been by my side from the very moment that life came to a screeching halt. You dropped everything, and it wasn't even a question. You and your family took me into your home. You made everything ok, just with hugs and sweet kisses. Being apart from you is tortuous now.

Second, Mom. Dear Mom, you too dropped everything and headed for the airport as soon as was humanly possible. For the duration of both our lives, you will always be my primary caregiver. No one in the world is more like me that you (and the other way around too). Your presence alone is all that I need to feel at home. I know that you feel like this has happened to you too, and for that I am deeply sorry. All that I can do is be here for you. I already cringe at the thought of your necessary departure during these tough times.

Third, Dad. Dad, you are another who has dropped everything and crossed the country to be with me. And the best part about it is that you have been like a rock during this time. You've just been there and been yourself. Nobody, and I mean nobody, has made me laugh more throughout this whole process than you. And nothing has made me forget these decisions and find more clarity than that. Thank you Dad.

Lastly, Barry, Sarah, and Saba. You guys got way, way more than you bargained for when you took me into your home. Little did you know that I'd soon be sick with the beverly hillbillies descending upon your home too. But throughout this whole process, you haven't flinched. You've been so kind and generous, and you've been very honest and upfront about your needs and desires too, something that I appreciate more than any other quality. So again, thank you.

Pictures!

No blog is complete without some low-quality cell phone pictures. So here they are. Enjoy.

Email Update Feature Added.

Friends and Family-

I was finally able to figure out how to add an email subscription widget from Feedburner on the blog. Upper right hand corner. Enjoy.

~B

Catching Up!

Before I start, I want to say thank you to everyone who replied to my original email about the blog. The outpouring of support is simply incredible. I wish you guys could see these emails. It feels so good to have a trail of people all over the country and world who can give me the warm fuzzies with just an email. I want to encourage you all to comment on the blog, so that you can see what others are writing and so that my iPhone doesn't explode. Also, I forgot to mention in the original email that you should feel free to forward the blog onto anyone who you might think would be interested.

OK...so, I've realized that I'm never going to catch up to the present on this blog unless I take some liberties or devote my whole life to it. So, I've chosen the former. I assume that all of you out there are equally anxious to know what is going on NOW too.

To summarize the past week or so. Basically, I lounged around and acted funny on vicodin for a couple of days at Teresa's house. Somewhere in the middle of that my mom came. Somewhere in the middle of that, we found out that my CT scan was totally clean too. Last saturday, we relocated back to my house in East Thetford, VT, and my Dad joined us after a cancelled flight the previous day. The first major medical appt after the surgery was on Monday at 1pm. Basically, Dr.'s Kowal and Seigne met with us and checked out the carnage that they had dealt to my groin. The bruising, etc. is more significant because they had to do more dissection due to my prior orchidopexy. Anyway, the bulk of the meeting was spent revealing and discussing the pathology report. The tumor was about 1.5cm in diameter and had no significant vascular or lymphatic invasion. It also did not invade past the tunica albuginea. These are all good things. Still, the tumor was a non seminomatous germ cell tumor that was mostly embryonal with some teratoma. English translation: the cells are comprised mostly of a particularly nasty type. So, the docs presented me with my three options, which have consumed my life ever since: surveillance - CT scans and bloodwork every 3 months for several years, retroperitoneal lymph node dissection - serious abdominal surgery in which they remove the lymph nodes that are most likely to have received drainage from the diseased testicle, or 2 rounds of BEP chemotherapy. Dr. Seigne would do the surgery with robotic assistance to avoid an incision from my sternum to pubic bone. When asked what they would do if it were them, Dr. Seigne said the surgery, and Dr. Kowal said the chemo. We were told that the tumor board would be meeting on Thursday night to discuss the case and make a recommendation. So, again...we were pushed into limbo. We made an appt with Dr. Ernstoff on Thursday, the medical oncologist to discuss what chemo would look like. We spent the evening in Hanover to avoid going home to think about things. We had some Indian Food and watched a terribly depressing movie called "Hunger." One of my biochem profs was given permission for a one time screening of this unreleased Cannes Film Festival winner about the IRA boys who starved themselves to death in a British Prison. Not exactly the most uplifting choice after the news of the day, but it was then or never.

Since monday, no significant decisions were made, but plenty of agonizing was done. Tuesday night, we saw "Slum Dog Millionaire." Highly recommended. On Wednesday we went to Burlington for a late breakfast at a fantastic place called Penny Cluse. Highly recommended, but not quite as good at the Walnut Cafe (the original) in Boulder. Peripheral decisions were made. For chemo, it just seems like it would make sense to go home to Colorado. For surgery, we should probably stick with Dr. Seigne, who is clearly a pimp with a presence. My cousin Ari, a radiation oncologist in Denver, sought the counsel of the testicular cancer guru and Lance Armstrong's cancer doc, Larry Einhorn in Indiana. Dr. Einhorn prefers observation if I'm ok with that, with one round of BEP treatment second to that, but still said, "All three options correct." We're talking about one of the most sought-after cancer docs in the country, and he replied to Ari's email within 6 minutes. Stunning. Still, many things were contingent on Thursday and beyond.

So fast forward to today: Thursday. Talk about a marathon day at the hospital. We were at DHMC by 7:30am, so that I could give blood for my follow-up tumor markers before meeting with Dr. Ernstoff. Dr. Ernstoff spent over two hours with us getting a complete history, physical, and simply talking about my options. Originally, he didn't even present chemo as an option if my tumor markers fall as expected, but revealed that it was perfectly viable after I asked about it. He prefers the retroperitoneal lymph node dissection, like Dr. Seigne, so he expected the tumor board to concur with that as well. The problem for me with the RPLND is that you undergo major surgery, and if they find microscopic disease in any of the removed nodes, then you're headed for chemo anyway. So, why not do the chemo up front and get it over with? Well, as it turns out...I mean...in case you didn't know, chemo is really nasty stuff. We're talking about the possibility of permanent neuropathy, hearing loss, loss of pulmonary function, etc. And, in all likelihood, the RPLND wouldn't find any diseased nodes. Still, RPLND has its risks too. If they nick your sympathetic chain (~20% risk), then you won't ejaculate for the duration of your life. Anyway, we went round and round in circles for a while. My beta-HCG came back nearly zero, so that's good. We're still waiting for other tumor marker, alpha-fetoprotein, which won't be in until monday, though we are all expecting it to fall.

At 11:30, we met with Dr. Bill Boyle (my senior advising dean and a pediatric oncologist), Dr. Joe O'Donnell (another senior advising dean and "the heart of DMS"), and Sue Ann Henessey (head of student affairs). Talk about a tough meeting. The gist of it was good. Basically, the school will work around whatever I need for my health, but there is a chance that I won't be able to return for the Spring (3rd) term and makeup exams over the summer, if I miss such a large chunk of the winter (2nd) term. In which case, I would be forced to return next November after Thanksgiving to repeat the 2nd term and go from there. Keep in mind that I've already completed a majority portion of the winter term too. Anyway, the faces of the med school were extraordinarily kind and understanding. Some discussion was had about be returning to school for the next few weeks (sans exams) up until my possible RPLND surgery on Feb 27th. Even this is contingent upon me making a decision to follow that route, and I don't exactly feel ready, physically, but especially emotionally, to return to med school on Monday! Our nerves were worn a bit thin, so there was some tension between us. Not exactly ideal to set the mood for the second round of sperm donation that was to follow. We were all so blasted by the day's events that we ended up loitering around the hospital for some time before our departure. After some loitering around town, we came home to a wonderful dinner (as usual) made by Barry.

In the days to come, I have some heavy decisions to make that will affect my immediate and long term future in significant ways. Somehow, I'm going to have to find some relaxation and clarity in the midst of all of this craziness. I hope that that can happen. Anyway, it feels good to be caught up on the blog at least. Feel free to ask any questions using the comments section. Again, thank you to everyone. I feel very, very loved.

Long Day

The next morning (Wednesday, January 28th, 2009), I called the office of Dr. Brian Kowal right around 8am as instructed the night before. As I was on the phone with the receptionist, though, Dr. Kowal himself called and said to come on down right away, but to first give some blood across the hall from his office and to not eat anything. Dr. Kowal's habit of excellent communication has continued throughout this entire process. So, Teresa and I headed down to the hospital. I took my backpack, prepared for the long waits that never happened. Talk about a jam packed, crazy day.

After giving blood, we met with Dr. Kowal, gave him my old ultrasounds (8 months old), and went through my complex history. I should mentioned that I had an orchiopexy on the left side when I was 8 years old. My testicle had gotten knocked back up and had to be brought back down surgically. There is a statistically relevant correlation between orchidopexy's and testicular cancer too. Dr. Kowal and Dr. Seigne (pronounced "Sing" -- his attending), looked over everything and returned with the news. They concurred that it was a tumor. The calcifications in the testicle had become much more course over the previous 8 months, and only in hindsight were they able to see the suggestion of something developing on the old ultrasound. In any case, they recommended that the testicle be removed, and they wanted to do it that day. Holy crap. Teresa and I were both pretty scared, but I knew that it had to happen. Dr. Kowal recommended that I bank some sperm before the surgery and said that they were waiting for me up in the "production room." After that, we were to head directly down to the surgical waiting room.

So, Teresa and I headed up to the OB/GYN section of DHMC where we met with a PA who talked to me about the virtues and shortcomings of sperm banking. Before we knew it, we were in a small room with quite a bit of...um...aids. Anyway, the job was done. As we walked out, we passed an entire gaggle of nurses that all looked at us as if to say either "We know what you just did," or "he's the one with cancer (in a whisper of course)". As we entered the main hall, Dr. Kowal rushed up and said, "we're ready for you in surgery." He walked us down to the surgical check-in and put us at the front of the line. After only moments, I headed back to a pre-op room where I changed and met my wonderfully nice surgical staff. Teresa was there too. I remember them rolling me out of the pre-op room, but it all fades to nothing after that. I have some faint memory of seeing Dr. Seigne (my surgeon) before the surgery.

I awoke in a post op room and was grogged out for a while, but soon Teresa and my nurses appeared. I was definitely in pain, but I didn't feel like I had been hit by a truck or anything. So, when offered the option to have my CATscan that day, I said, "let's do it." I hadn't had anything to eat or drink for quite some time, so the tang-flavored constrast die tasted quite good. Roseanne, my nurse, was very, very nice. Shahid, Begem, and Kolene showed up too! Teresa's mom came by to check in as well. After my CT scan, I was the last patient there. Shahid went out to find Teresa's car to clean off all of the snow from the huge snowstorm that day. Begem and Kolene helped to get us out the car. And Teresa shuttled me home to her house, where I would spend the next couple of days. Teresa was deathly afraid of crashing on the way home, so she crept down her long, steep driveway at 1 mph. The seatbelt didn't feel so good on my incision, but she delivered me safely. There I zoned out and ate a delicious pizza. Obviously, I wish that my family had been there, but being with the Rodriguez's was second only to that.

The "First" Post

Alright...so fast forward a little more than a year. Originally a trip journal that petered out, this blog is being reborn as a medical journal to keep friends and family apprised of my medical happenings. A lot can happen in a year, and there are people out there reading this to whom I haven't spoken in some time. So, let me give you a quick summary. The year at home in Colorado was a complete success. I mountain biked a ton, met great new people, did some traveling, and got into Dartmouth Medical School (my first choice). After moving to Hanover, NH with the help of my Dad, I dove head first into medical school. The fall term was tough with "quizzes" every two week and a very nasty roommate situation. Still, it was clear that I had chosen the right school. My classmates and professors are the most caring of the caring. I returned from winter break ready to attack the remainder of the winter term from a fresh living situation in Thetford, VT. A little more than three weeks back from winter break and with the first set of exams done, it happened...

Before I start, a disclaimer. I apologize if this is my first communication with you in a while or if this is how you're finding out or if this was forwarded to you by someone else. It doesn't mean that I care about you any less. Honestly, the hardest part of having cancer so far has been trying to keep in touch with everyone. So please, please don't be offended.

Last Tuesday (Jan 27, 2009), I was having some diffuse pain in my testicles throughout the day. Nothing new for those of you who have been around in recent years when I've had problems with my cremaster muscle followed by a nasty bout with epididymitis while at home last year. Still, the pain escalated throughout the day and eventually localized to the left testicle. Teresa and I were going to go for a walk, so in the course of suiting up for the cold temps, I thought I would do a quick self exam. I was horrified when I found my left testicle to be much larger than usual, very hard, and very, very tender. So, we called the PA on call at Dick's House (the infirmary on campus). Both she and I were concerned about torsion, so off to the ER we went.

At Dartmouth-Hitchcock Medical Center, I was taken back quite rapidly where Teresa soon joined me to wait. After a quick exam, the ER doc ordered an ultrasound. I was pleasantly surprised when the ultrasound technician was a radiology resident named Ben. Both previous ultrasounds I had were performed by women, which didn't bother me. Still, it made me think that most women don't have a good understanding of the physics of how testicles move around. Things went much smoother with Ben up until he put the ultrasound on the left testicle. Immediately, I thought, "just wait for him to say it." And then he did, "So, you're probably noticing that this looks abnormal. There is a large avascular mass in the center of the testicle." Teresa responded, "I feel like I'm going to throw up," and put her head down on the examining table.

We went back to the ER room and waited for the doc to come back. Obviously there were some tears and phone calls, but mostly just waiting. The doctor came back and relayed the news again. He said, "There's no diagnosis yet, but I just want to tell you that I went to Dartmouth Medical School, and I was diagnosed with lymphoma during my first year at Dick's House. I had all of my treatment at DHMC and made it through ok and finished school, and the same thing is going to happen for you." Very nice to hear. He called the urologist on call who was also a DMS grad and a personal friend of his.

So, we returned home at about 12:30. Sarah, one of my landlords, made me promise I would wake her and Barry up with the news. I felt somehow guilty assuming the status of cancer victim when I told them, but that was the reality of it.

The Interviews

Last Tuesday I headed out east for a week for the first of many medical school interviews. Below is a summary of the trip.

Tuesday: Flew to Hartford, CT. Drove down to New Haven, CT and met up with Steve, a fellow Williams grad. Steve is probably the nicest guy in the world. I can't imagine anyone better to stay with before my first med school interview.

Wednesday: Interview at Yale. Both interviews went well, though the pathologist wanted to talk about my breakup with my ex-girlfriend more than anything else. Yale itself was very nice, but I'm just not sure that it had that perfect feel for me. Clearly, the students are very self-motivated because their curriculum has very little accountability. New Haven is meh.

Thursday: Dartmouth interview. Stayed with Liz, a williams grad. Both interviews went very well. Hanover is the shit. Imagine a preppy Boulder and Williamstown mixed. Couldn't be better. The hospital there is the nicest I've ever seen. I actually like the every two week test thing. The curriculum itself seems pretty standard. Excellent rural health program.

Thursday night, I drove down to Gardner to Laura's house where her parents, Bill and Anne babied me to death. Anne made a fantastic dinner and sent me off with an entire coffee cake. It was definitely a major battery recharge after the interviews.

Friday: Drove back to Williamstown...craziness. I stayed with Bruce and Jodi, who were so great about the whole thing. Had lunch with Prof Lynch. Had dinner with all the cycling team kiddies. Saturday, I had my coffee shop muffin, and spent much of the day at Jack Miller's house, which was great. Saturday night, Jodi made a fantastic dinner for the three of us.

Sunday: Lazy morning, but interesting drive to Rochester. Freezing rain for much of the way, but roads weren't too bad. Made it to Glenn's house, where I met Lucy (see picture below), who insisted on sleeping in my bed.

Monday: Rochester interviews were great. People were great. Clearly the best medical education currriculum and the most serious program. Rochester is meh. Barely made it out of Rochester due to serious snow. Very, very nice American Airlines lady put me on United and saved me. Our plane skidded back and forth as we took off, but we did...then I was home free.

I'm happy to have a week with without travelling. Next interview is Monday...University of Colorado.