Meeting with Reznick

Before I get into all the medical stuff, I wanted to share some photos from last weekends "Boo at the Zoo" Halloween event. We took the girls on Sunday and had a good time. It was still pretty cold when we got there and that is why Briley has a jacket over her shoulders in the photo with Sponge Bob and Patrick. She was dressed as a hippie and it looked great. Although we could not get a white beard on Addison, she still went as Santa. There are a ton of jokes in that and I will let you formulate your own.

As for the Reznick visit, it did not go as well as I would have hoped. The chest CT showed 11 small spots on my lungs (3 on the right, 8 on the left) and the bone scan showed something on T12 of my spine. At this point, he took away the Chemo options of "EP" and said that correct course of action is to have 4 cycles of BEP as that will not only clear the lymph node, it will also clear up the lungs. He was a little more suspicious of the spot on the bone and wants me to have a MRI this week and he will then confer with Dr. Larry Einhorn, that man who developed the current protocol that "Cured" testicular cancer. I am schedule to start chemo on Monday November 5th and will need to get the following things taken care of this week:

• A pulmonary function test and Audiogram - Will test my lung capacity as the Bleomycin can have some affect of breathing and they need a baseline of my lung volume. I will need to do this throughout the treatment.
• Infusaport - A minor surgery to insert the infusaport into my chest as this is how they deliver the IV and take blood. It will be under the skin and it probably the only thing I have been freaked out by. He said, at the start of a chemo week, they will insert a needle in there that will be used all week.
• Pre-Chemo meeting - A meeting with the nurses and financial advisor. Jennifer and I will go in and they will answer all of our questions and give us some expectations on the next 12 weeks.
• MRI - Need the MRI on my spine.

I expect to hear from the various Dr's tomorrow and all of this will need to happen over the next 3 day. Although many of you emailed that you liked how detailed I have been, Right now, I just don'f feel like going into it. I will add more later including the schedule as it's more than I thought.

Sam

Reznick Follow Up

 

  Jen and I are going to the follow up at Dr. Reznick’s office today at 3pm. As you can imagine, we are anxious to hear the results of the scans and find out if we are still on the same treatment path or if anything has changed. I will update the blog this evening as I have heard from a lot of people who have asked that I get that info out.

 

 Caitlin gave me Lance Armstrong’s book and I picked it up Saturday. It was much more interesting than I thought, minus the chapter about falling in love with his now ex-wife, and gave me a good view of the chemo. He had it really bad and mine is no where near the level of his although, I could have a similar treatment. We went to the book store on Sunday and I must have glanced at 8-10 books on cancer and chemo and the only thing I am clear about is that this is going to suck.

 

Sam

 

 

 

 

CT and Bone Scan

I had the CT Chest scan and body bone scan today. Pretty simple although it took a long time as I had to get an injection at 10am for a 1pm bone scan. I went into the Nuclear scan department and received the shot of a radioactive compound called technetium. As I sat down for the shot, the lady pulled a syringe out of a large sealed container (about the size of a 7 Eleven big gulp cup). The syringe was oddly small next to the container and the amount of Technetium might have been a couple ml's. The shot was quick and then we went to the Rocky Mountain Cancer Center for the CT Scan. Since I was getting a IV, the nurse saw that I have been given a shot earlier in the day and called it a target and went right into the same area. I had to go yesterday and get blood drawn and now both arms have been hit. I'm sure this is a glance into my future....

As I mentioned last week, I expect these scans to come back clear. I follow up with Reznick on Tuesday afternoon and hope to get a start date on any further treatment. At this point, the waiting is the tough part as we talk about the rest of the year and then the conversation tails off with " unless that is a chemo week" or something similar.

We have heard from so many people and it would be hard to list everyone for fear of missing anyone. I just want all of you to know how great it is to have your support and thoughts and even if I have not had a chance to email you back, we (my family) discuss who has commented or emailed I appreciate it.

I post Tuesday night after I talk with Reznick.

Sam

Vegas..

Had a great time in Vegas with the guys and also had the chance to see a handful of other people who were in town last weekend. On Friday night, Jeff and Paul showed up as they had flown in for the evening. Heather and David were in early Sunday afternoon and we were able to meet up for dinner and I had breakfast with Mike on Monday. It was good timing that so many people were there and we were able to spend some, although brief, time together.



I forwarded a copy of my pathology report to my mom and she sent it to Uncle Fred as he is retired Dr. He was able to show it to a pathologist and oncologist as well as doing his own research and he called the other night. According to the 3 Dr's, they felt I am getting good advice on the best course of treatment and he agrees with the Chemo. I discussed the differences of the BEP vs EP and said that I am leaning toward the EP, even though it extends the treatment for 3 extra weeks, as there are no long term side affects. Fred agreed as he understood the risks of using Bleomycin. So, it's like I now have my 5th opinion and they are all consistent which is a good sign.

Scans on Friday, Dr. Appointment on Tuesday where I anticipate hearing that the scans are clear and we can talk about a start date for the chemo.

I will get some photo's of the girls uploaded this week.

Sam

Dr. Reznick

This afternoon, Jennifer and I meet with Dr. Reznick, the Oncologist. It was the first time we were able to sit down and have a discussion about the current diagnosis, treatment options and what's next. We visited Reznick, who works with the Rocky Mountain Cancer Center, at the medical center in the Parker hospital.

The appointment started with him asking my medical history, how I am currently feeling and then a brief exam. For the purpose of this post, keep in mind that today's conversation was predicated on the thought that the 2 scans I need (bone and lung, scheduled for Friday 10/26) will come back clean as he felt I was very healthy. If these scans revel something unexpected, the information below will change.

According to Reznick, I am on the fence between a Stage 1 (cancer contained in the testicle) and Stage 2 (cancer has spread) diagnosis because I have a grand total of 1 questionable lymph node. At this point, there is no way to know if this specific node is cancerous and he gave us a few indicators to use as measuring points:

• Healthy Lymph Nodes are typically under 1cm. This one is at 2.1 cm and he said when these are unhealthy, they can get up to 6cm.

• With this type of Cancer, they test the blood for 3 markers: LDH, AFP and HCG. My numbers were normal for LDH and AFP and my HCG number was at 278. Reznick broke down this number and said that I fall into the Good Risk category as the number was under 1000. Any HCG number between 1001-5000 is considered Fair Risk and anything greater that 5000 is Poor Risk. He said that a healthy number is under 2 and sent me for blood work today as he thinks my number is probably lower than it was 2 weeks ago.

• According to Reznick, there is a 75% chance that the node is Cancerous (stage 2) and a 25% chance it's not (stage 1).

At this point in the meeting, I was feeling a tremendous amount of relief as he could have said there were 5, 10, 20 or any number of problem Lymph Nodes. Hearing that there is only one seemed to be a good thing and we started talking about treatments. He cautioned that, even though there is only 1, we still need to address this and that will require some treatment and he broke it down into 3 potential options:

RPLND - This is a surgery where they go in and remove the lymph node. The benefit of this procedure is they can send the node to Pathology and find out if it's cancerous. If it's clean, they change the diagnosis to Stage 1 where there is a 85-95% chance that they body is cancer free. If the node is cancerous, they lower it to 60-70% and suggest 2 courses of Chemo. Although there are some new "nerve sparing surgery" procedures, this is a risky surgery even done by the best surgeons.

Chemotherapy - Because I didn't know much about chemo, I will explain the process before talking about the options (this description is for the purpose of my care as I know there are many other types of chemo). The Chemo is broken down into Cycles that represent a 3 week period. I would go into the office for 5 straight business days and receive the Chemo via IV. The procedure would take over 5 hours a day as they give you the drugs and then flush them out of your system. He was very clear that my reaction to the chemo would be watched and I could be nauseous and tired and that they could offer some medication to help ease the discomfort (Unfortunately, there is no medication to stop hair loss and he said they often see that 2-4 weeks after the first course). Of Course, everyone reacts to this differently and we would have to wait and see what happens.

I have 2 options for the Chemo: BEP or EP and these letters represent the drug combinations. BEP requires 3 courses (9 total weeks) and is a little riskier because of the B which is a drug know as Bleomycin. According to Reznick, there is an increased chance of lung problems and If this is the direction I pick, there are many tests on the lungs before and during the chemo to make sure it is not negatively affecting me. The second option is EP and that requires 4 courses (12 total weeks). I have not had a chance to read about either of these yet including the risk potential of BEP in terms of percentages. Reznick said the risk was under 10% of any long term breathing problems and I'm not sure that is low enough for me as I can't risk losing even 5%. Don't forget, I have my Thursday night Men's League hockey career to think about.

Surveillance - This option takes a distant 3rd position as it requires a ton of maintenance of the first 2 years, including monthly visits, scans, blood work, etc and (although I can't remember the percentage) a high percent end up going through option 1 or 2 within the first couple years.

If we were discussing 10 or 20 problem Lymph nodes, I feel it might make sense to get in there and clean all of them out. At this point, with 1 stinking Lymph node causing these problems, I am very clear that I want to avoid any more surgery and would consider Chemo. As I stated above, I have not researched these options and weighed the risks yet so I do not know which option I am leaning toward. I asked Reznick, if he was in my position, what option would he take and it was a quick answer of Chemo. I also asked the same question of Dr. Sarram, who I visited with after the Reznick appointment, and he also said Chemo.

I have the Bone Scan and CT Scan scheduled for Friday 10/26 and a follow up with Reznick on the afternoon of 10/30. At that point, if the scans are clear, we will pick the course of treatment and set a start date and I believe it could be as early as the following week (November 5th). If the scans show anything different, it's back to the drawing board.

Thanks for listening and let me know if you have any questions. Not sure I can answer all of them but I might be able to direct you to the right place.

Finally, The 12 of you that have taken the poll and said you would be cool with Addison running around your house with the squeaky shoes on are hilarious. She is my kid and it makes me crazy. I know a couple people who responded and I know they wouldn't put up with it for 10 minutes. Again, I can only thank GG and know that the next time I drop Addison off at her house, I will give Addison her first taste of Mountain Dew.......

Sam

Update

Although I left a note this morning stating what I expected to happen next, I received a call from Dr. Reznick's office and they want to see me on Wednesday at 1pm. I will leave a post tomorrow night with the info.

Scan Results

On Monday afternoon I heard back from my Urologist, Dr. Sarram. He had just finished reviewing the CT scans and x-ray and he confirmed that the cancer had spread to the lymph nodes (I believe in my abdomen). He also mentioned that the x-ray showed a spot on my left lung and they want to do a CT scan of my lungs. Since he is the Urologist, he referred me to Dr. Reznick, an Oncologist. I called Reznick's office and they are in the process of getting my records and getting insurance approval for the CT Scan and a Bone Scan. They anticipate it will take at least a week for me to get the insurance approval, have the opportunity to schedule the scans and take them. After they get the completed scans and my medical history, I will have a consultation with Reznick and discuss the diagnosis and treatment options. Unfortunately, I do not have any answers to most of the questions I am being asked and anticipate the initial appointment with Reznick will fill in many of the gaps.

Dr. Sarram told me, after the initial surgery, there was the potential of a hernia if I physically overdid it. Although I felt I took it easy, once the swelling went down, there was a very painful, hard area just under the incision and the only literature I could find was consistent with the signs of a hernia. I asked the Dr. yesterday and he said it was not a hernia, it is the Healing Ridge. According to the Dr, this is where he made the incision and since it's in such a hard area to heal, where he added extra stitches for protection. He said it will be firm for a few weeks and then it will soften and go away. Although I am glad it's not as bad as I though, it would have been nice if the Dr., prior to or just after the surgery, would have told me what to expect over the next few weeks. If he has to answer these same questions with everyone that has that procedure, maybe creating a little handout or sending an email the day after surgery would help his patients and alleviate the need for him to have this conversation again. In the future, I think I might ask some more questions and was a little unprepared for this one as it came on so quickly. With the exception of the Healing Ridge, I feel better than I have in a while.

I am scheduled to fly to Las Vegas on Friday to meet up with Chris, Brian, Vince, Dennis and Jeremy. Someone said it's been over 10 years since the last time we got together and I am looking forward to it. Heather and David will also be in Vegas on Sunday as David has a conference next week and we are going to have dinner on Sunday night. Mike and Cindy are flying into Vegas on Sunday night and I will try to see them, if possible. I asked the Dr. if this trip is okay in terms of timing and any problems and he said it was okay to go.

So, now I wait to schedule the CT scan and Bone scan and everything will happen after that. I will update as soon as I know more.

Sam

New shoes for Addison

Earlier this week, GG (My mom-Stands for Grandma Gayle) came over with a new pair of shoes for Addison. As you can see in the photo, they are adorable shoes for a little girl and Addy took to them right away. We just can't thank GG enough as they have quickly become Addy's favorite pair of shoes and I am sure that Cousin Evan's parents also love his pair. I have included a video below and maybe you will understand why her school asked that she not wear them again.....

All you grandparents, if you need to know where to get these because you want to get back at your children, contact Gayle as I'm sure she will be glad to help.

Although I know this has nothing to do with my current healt, I wanted to share with everyone as it does not all need to be bad news.

Sam

Video

The video is a little dark and I am sure, if you have the sound up, you will quickly understand why these shoes are so much fun for Addison. At the bottom of the page is a poll, let me know what you think.

Sam

On Thursday morning, I was required to drink 2-15oz bottles of Barium Sulfate Suspension before I went for the Scans. Although it had a scent of citrus, it didn't taste like it. When I got the the office, they told me I would also have an IV for "Contrast". The Scans might have taken 10 minutes and it went pretty smooth. The interesting thing is when they release the contrast into the IV as you feel like you've walking into a giant oven but only for a minute or so. The tech told me the Dr. would have instant access to the scan (and chest x-rays) and I should expect to hear back within 24-48 hours. I did call the Dr's office (2 times) to see if they had reviewed the scans and have yet to hearback. I have a follow up appointment on Wednesday afternoon and we hope to hear back before that visit.

Attached are a few photos of the girls:

• Briley's First Day of 7th grade
• Photo of Briley and Addison after we returned from the CU football game
• Addison goofing around

CT Scans

I was finally able to schedule the scans and I go in today at 8:30am for the following:

CT scan of the abdomen and pelvis
With and without Contrast
Full Chest X-ray

The best part is the 2 bottles of “prep” that I am required to drink before I get there. I appreciate the catchy name they use and know it’s going to taste awful as it looks like wallpaper paste.

I want to thank everyone that has either left a message, emailed or called us. It’s really incredible to see how great people are when something like this is going on. Thank you.

October 9, 2007

On Friday September 28th, I went to the Dr. and they diagnosed me with testicular cancer. Unfortunately, the only way to be sure is to perform a procedure known as radical inguinal orchiectomy (I have added a link at the bottom where you can read more) and they scheduled this for Wednesday October 3rd. The procedure went well and I heard back from the Dr. on Friday the 5th and he said that I did have testicular cancer and it was classified as Stage 3, T3. At this point, we are waiting to hear back on a time for a CT scan as that will show the Dr. where and if the cancer has spread. I believe we will then discuss the different types of treatment which could include another surgery, chemo or radiation.
Our goal with this blog is to keep everyone informed. We will update as frequently as there is something new to share.
Sam

Testicular Cancer

TC-Cancer