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