On Cancer


A hallway I'll remember.

This is the hallway to the Appriss on-site clinic. It’s at the end, on the left. I’ll never forget walking down this hallway on Wednesday morning, a week before Thanksgiving, because at the end of it, I found out that I had cancer. Or, more accurately, "a highly suspicious 2.1cm mass in the left testicle," according to the ultrasound.

But even then, deep down, I knew that was a nice way of saying “you’ve got cancer.”

Rolling Back a Little

To be fair, I had my suspicions when I walked in for my initial physical with my new doctor. My previous doctor had recently asked me if I was doing self-exams. When I confessed I had not been, she told me it was time to start. “This is the age when you’re going to get it, if you’re going to get it,” she said. That advice is what led me to start doing self-exams, and ultimately, what led to me broaching the subject with my new doctor that Monday morning.

So, on Monday, November 18th, at around 8:45 AM, I asked the doc I’d just met to feel my junk. She obliged, and confirmed that it definitely felt different. She said it very well could be nothing, and not to be alarmed. Before I left the office, I had an appointment for an ultrasound the very next day.

The Testis Concerning

You know how, if you get an X-ray, or an ultrasound, or whatever, you can’t help but ask the technician if everything looks OK? If it does, they’ll generally be happy to tell you that it looks fine to them, but they aren’t allowed to make a diagnosis.

The technician performing my ultrasound took what seemed to be an excessive amount of time mapping out the problem area, and left the room to consult with a doctor before telling me I could zip up and be on my way. When I asked her how things looked, she said “I can’t really say anything.” When you’re a patient being screened for cancer, that’s not the answer you want to hear.

I had concerns, but I tried to convince myself that there was no point in stressing out before I knew anything. I was somewhat successful in this convincing.

Getting My (Ball) Bearings

I got a call on Wednesday morning.

They asked if I was working in the office today. I was.

They asked me if I could come down to the clinic to discuss my results. I could.

This wasn’t good. When doctors have good news for you, they generally don’t ask you to come see them in person to tell you. And so I found myself walking down the hallway pictured earlier.

It’s difficult to explain what that walk felt like. It was surreal. For the first time since I’d worked there, I noticed the pattern on the walls repeated in such a way that they made the hallway look convex, and almost appeared to be shimmering in the fluorescent lighting while I walked. It was only fifty steps from the start of the hallway until the clinic door. I counted. It may have been five thousand, for all it felt.

After what seemed an eternity, the hallway ended, and I opened the door to the clinic. Shannon, the nurse practitioner, ushered me to an examination room. I asked, “it’s not good, is it?” “It’ll be okay,” she said.

After some waiting, Dr. Fortwengler arrived, and confirmed that it did indeed look like cancer. The report said I had a 2.1cm, highly suspicious mass in my left testicle. Someone on Twitter would later tell me that was roughly the size of a nickel. It sounded larger when you put it that way. I started to ask some questions, and apologized for this being such a crappy way for my new doctor to meet her new patient. She seemed surprised that I was the one apologizing, and was returning apologies of her own.

I think that’s about when the tears started. I quickly composed myself while they gathered some paperwork for me. When Shannon returned, she told me that the urologist I would be seeing tomorrow was the best – the one she would want for her husband if this was his cancer. Of course, it was my cancer, not his, but I did find the endorsement comforting.

I shared the news with my manager, and apologized that this would mean that I would probably be missing a few days of work. I will never forget that even though I had only just joined the company, and was feeling like this would impact the timeline of an important project I was just about to take on, the only question he asked before I left for the day was “can I pray for you?”

I shed the last tears I would shed over this news in my office before I left for the day, and called my wife with the news on the way home. Shortly thereafter, I posted a somewhat cryptic tweet, and held out hope that the urologist would tell me it had been a mistake, so I wouldn’t need to explain myself.

Hi, I’m Your Ologist

I met my urologist, Dr. Lindner, on Thursday afternoon. He had already checked out the ultrasound, and after getting his hands on the family jewels, he said, “This is cancer.” He went on to explain that there is always the outside chance he’s wrong, but that he’s not wrong. In either case, when cancer is suspected, they don’t do biopsies, which risk the spread of cancer cells. They just take out the testicle and spermatic cord, and do the pathology report after the fact.

For what it’s worth: if you are a guy, and you have to get cancer, testicular cancer is the one you want. First, you’ve got a spare. Second, it’s highly curable. As Dr. Lindner explained, testicular cancers are generally relatively fast-growing. That sounds like a bad thing, but since follow-up therapies like radiation and chemo only kill cancer cells when they’re dividing, this makes these therapies supremely effective at killing any errant cells that may escape the surgery. He wished I had seen him sooner, since I first noticed something a couple of months before, but still said that my tumor was small, and felt that we had caught it early. In these cases, with proper follow-up treatment, cure rates approach percentages in the high 90’s.

He had a nurse draw some blood from me before I left, to check for tumor markers and compare after the surgery. Tumor markers are only present in some kinds of cancers, so regardless of the results, he told me, the surgery would need to proceed.

An hour or so later, while my wife and I were having a late lunch and discussing what was coming next, Dr. Lindner’s assistant called and told me I was booked for surgery the next day at 4:30, and to arrive by 2:30. In about 24 hours, I was about to be under the knife, and with the diagnosis confirmed by the specialist, it was time to tell my stepdaughter. And, of course, my Twitter followers.

Having a Ball

I had to fast after midnight to prep for the surgery, so I tried to keep the day about as normal as possible, by driving to the office to attend a morning meeting, and then leaving to get the last workout I was likely to get in a number of weeks, since post-op instructions were to be pretty strict about not lifting anything. Note: strength training when not allowed to hydrate is probably not the best thing to be doing an hour or so before you have to report for surgery. Don’t try this at home.

Mostly I was trying not to think about the surgery ever since Dr. Lindner had told me that when cancer is suspected, they do what’s called a “radical inguinal orchiectomy.” What this means is that instead of going in after the jewels in the most… ahem… direct manner, they actually cut a 3 inch long incision just below the belt line and fish the goods out that way. It’s all to prevent the spread of cancer cells that can occur otherwise. Still, it made the surgery feel somehow more “serious” to me.

Thankfully, my Twitter friends were very helpful with distractions. Honestly, the 24 hours leading up to my surgery were a blur of tweets of support and horrible testicle puns (mostly mine). The always-awesome Corey Haines also created an awesome HugBoard for me and my soon-to-be-departed friend!

As for the tweets, I just have to share a few of my favorites here:

This one really cracked up the nurses who were setting up my IV:

I got to give probably the most epic Friday hug I will ever give:



I could go (and have gone) on and on.

So, You Kicked Cancer in the Nuts?

The pathology report came back the Monday after my operation, and it was positive for a “classical seminoma”. The follow-up CAT scan came back looking good. If it’s spread at all, it can’t be seen on the scan. At this point, I have some options, according to Dr. Albrink, my radiologist:

  1. Wait and see. Chance of recurrence: about 20-25%, depending on who you ask. Requires more freqent CAT scans and follow-up at first.
  2. Do 2 weeks of radiation therapy, 5 days a week. Chance of recurrence: 5% or less. Side-effects: possible nausea, exhaustion, and intestinal scarring.
  3. A single dose of single-agent chemotherapy. Chance of recurrence: 5% or less. This all remains to be confirmed when I consult with a chemotherapist on Wednesday, but as I understand it, this makes chemo extremely well-tolerated, and not like the horror stories you may have heard. With one treatment, it’ll also be relatively convenient.

I’m currently leaning toward option 3. It’s basically a “quality of life” decision, I’m told. For me, the potential side-effects from option 2 or 3 will be far preferable to having at least a 1-in-5 chance of this thing coming back. I’d prefer to fight it with everything I’ve got.

[Update (12/18/2013): Thanks to this article (link provided by Pete Keen) and the advice of the chemotherapist, I’m now leaning toward option 1. This is a crazy-difficult decision to make. I’m really thankful for doctors who don’t just rubber-stamp my first impulse, and a very helpful group of followers on Twitter.]

Otherwise, I’m exactly 3 weeks post-surgery as of today, and aside from a pretty noticable “healing ridge”, general irritability along the line of the incision, and an anxiousness to get back to working out, I’m doing just fine! It may be Friday the 13th, but I’m feeling exceptionally blessed to have caught this thing early and to have a really good prognosis. Not to mention, thankful to all of you who’ve been supportive through this process!

The Ball’s in Your Court

By now, you may be wondering why I’m sharing all of this here. It’s because, in case you haven’t noticed, our industry has no shortage of young white dudes, and testicular cancer is predominantly a young white (or at least, non-black) dude’s disease. While it’s relatively rare (only 7,920 cases expected this year), it’s also highly curable, especially if caught early. Check out the statistics for yourself. The 5-year survival rate on localized testicular cancer is over 99%! It pays to catch it early.

So, I’m hopeful that by sharing my story, you young men out there will start doing self-exams. It’s super-easy to do once a month while in the shower. You’re looking for abnormal lumps or firmness. How do you know what’s “abnormal”? If you’re doing checks regularly, you’ll obviously know what normal is. Heck, even if you aren’t, trust me, you’ll know. In my case, it was pretty obvious that “one of these things is not like the other” (with apologies to Sesame Street).

Still not confident you can do one? Here’s a HOWTO, with drawings. It’s from a site called “TeensHealth,” for crying out loud. You have no excuse not to do this.

If you find anything out of the ordinary, get it checked out by a doctor. You think it’s awkward? It’s probably not more awkward than discussing your testicular cancer on a public web site, which I just did. Man up and check your junk. It’s a lot less awkward than explaining to your loved ones that you’re in serious danger from a rare but highly-curable fast-growing form of cancer because you were too lazy or afraid to check things out. This is one case where ignorance is most definitely not bliss.

For any women who are reading this: you probably know and care about at least one young man out there. Please share this with him. And likewise, consider performing a regular breast self-exam.

For anyone with skin: skin cancer is also something you can detect early with self-screening.

In short, I love you people, and someone else probably does too. Take care of yourselves. If not for you, then for them.

Thanks for reading.

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