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.