Jim's TC Story

Last Thursday evening a routine Testicle Self Examination (TSE) and close visual inspection brought on a chill like cold water on a hot neck. My remaining "left one" seemed bigger than I remembered from my last TSE, looked twice as large as I recalled seeing it, and the attached epididymis was decidedly lumpy at the connection. Big Chill!

It's been 9 years 4 months and 13 days last Friday since right inguinal orchiectomy, but the recollection of my initial discovery: how it looked to the eye, how it felt under rolling fingers, and the unexpectedly intense but brief pain right there, like crossing the legs too fast in unloose pants; all flashed back in a Big Chill as I lay there in bed last Thursday night conducting an increasingly unroutine TSE.

Friday I surfed and soaked in data in ways that would have been equally therapeutic had such been available 9 years back when the chief resident of urology at Norfolk Naval Hospital in Portsmouth said, "son you're staying right here; we're in the business of saving lives here, and whatever work you think is important back on your ship, somebody else will just have to handle it for you."

Nine years of self-deprecating jokes about "one-hung-low" to lighten the presumptive gravitas of a dimming chapter in my timeline. Thursday, the slack in the line tightened perceptibly. Friday, the TCRC jumped out of Motherload-Metacrawler search results, and I whacked every level to local hard disk. Printed gobs of good reading, but only snippets about dread prospects of recurrence.

Hadn't seen a urologist since mid-94. Had to scour the PPO directory, then made a call and asked for one well acquainted with TC. Yes, there was a slight tremor in my voice at requesting soonest possible appointment, Monday being just fine, it'd give me the weekend's perspective. The good doctor favored me with kindness, yes the nut feels hard, and the cord is swollen, but probably just epididymitis, a bacterial infection down there, but let's get you in for ultrasound, say, tomorrow? And I'll take a tube of blood from you myself, right now.

My best friend in the whole world doubles as my wife and housemate, and well understands my sensitivity to the prospects of becoming a eunuch. She wasn't there on the timeline for first encounter 9 years ago, but she's with with me now until my timeline ends.

Ultrasound is today at 1:30. Probably will turn out ok. Sure hope so.

Well, fellas, 'twern't good. I had trepidations about the woman ultrasounder handling my nether parts; but then imagined my wife and the fun she must have with Mr. Gyno and his speculum. The nice young woman was ever so dignified, and responded to my questions in a way that confirmed my suspicion she'd be much more comfortable scanning a pregnant belly. But when she called in her radiologist for a look see, well, that chill feeling returned...

The radiologist said epididymis did not look oversized, noted fluid in the scrotum, and said yep, definitely, where there should be fluid in the testes she saw tumorous growth. Said she'd get her report typed and faxed to my urologist, whom I met just yesterday, poste haste.

Things are happening quick. Flashback to 31 August 1987. Big chill descending. The good doctor just called, gave it to me straight: scheduled for surgery this Thursday, nut 2 must go.

He says the AFP and bHCG are within normal limits, but the ultrasound is conclusive enough for prognosis that something ain't right in a way that waiting likely won't alleviate. A few well placed words, like "anaplastic" and "seminomas" and "consult with oncologist for second opinion on node dissection" and "replacement testosterone", made that Big Chill shiver-me-timbers.

My dear good wife listened on speakerphone while I took notes. Then my partner-for-life picked my chin up off the desk, and asked sensible questions of the scheduler, like, "which entrance to hospital for same day surgery?" and "was that NO-EATING-OR-DRINKING-AFTER-MIDNIGHT-BEFORE day of surgery?" and "how long before stitches come out?" so she can plan our Christmas travel accordingly. The love of a good woman kinda puts things in perspective. If she can say "it will all be okay", then by God things will be okay.

I'm feeling awfully bummed out just now, and that sensation of being kneed in the groin is palpably real. Posting this note is somehow therapeutic; but right now I need to go stare off into space for a while.

I'm now staring forcefully back at the new world, two days into testosterone patches, thinking if it weren't for this lingering stinging pain in my sliced-up inguinal muscle area, I'd be out punching the heavy bag and giving my wife reason to say, "down boy."

Swapping notes with others out there who've got first-hand accounts to relate has been extremely therapeutic and informative in a way that Chris Brewer described best, "Knowledge is Power." Indeed it is.

When you find yourself not out of the woods yet, start chopping down trees. And if you find yourself walking on thin ice, may as well dance. I'm feeling that way now, and it's a good feeling.

No guts, no glory; no nuts, my story...

Surgery to take the remaining left tumorous little piker occurred 19 Dec, follow-up pelvic CT scan and Chest X-ray happened 30 Dec, had a nice black-tie formal New Year's Eve party at home with wife and a dozen-plus good friends, then met with the oncologist today (6 Jan). My hat's off to the good Dr. Ueno, he was thorough and even-handed in our Q&A exchanges.

I'd come prepared to chat knowledgeably, having benefited from the TCRC webpage and the wonderfully well-informed responses from you all interacting via TC-NET Listserver. Anyway, the good doc gave me a slow, meticulous once-over, making me do lots of deep breathing while he did lots of squeezing and feeling around.

He was impressed with the detail recorded in my active-duty Navy medical records and the TC-insider vocabulary in my responses to his questions. I asked him the odds on recurrence of TC, and the further odds of having non-seminoma one time, then seminoma the next. 10% and 50-50 were the answers.

Then we talked "what next." The good news is: it's seminoma, it only spreads through lymph nodes, not the blood stream; the bad news is: it's seminoma, it cannot be monitored with blood tumor markers.

Sure enough, just like you fellas said, he recommended low-level radiation to be "next to 100%" sure of eradication. He compared the low but attendant risks of radiating with equally low risks of "watchful waiting" approach. But the one thing he dwelled upon, and I kept badgering, is, if I forfeited all my lymph nodes during the RPLND first time around, and seminomatous TCs only spread via lymph nodes, what's the worry? He said the little node buggers are really hard to see, even by the best of cutters during RPLND, even if they ARE strung together like beads on a gossamer strand. Might just be some teenie weenie ones still there. And therein lies the worry.

Well, he's gonna examine the pelvic CT photos himself, then wants me to have lymphangiogram and chest CT and on and on, then repeat the process 6 months down the road if I elect the "watchful waiting" approach. Wants me to have a chat with a Radiation doc just to hear it out.

I don't fear the unknown of wait-n-see. But I'm still in the Navy as a drilling Reservist, and next month my 40th birthday requires a full physical examination. I have to tell the Navy doctors everything, and they'll have to determine whether I'm fit for duty so I could be recalled to active duty for national emergency. If I elect Radiation, will that put me in the "cured" box and good to go?

There's a line from a Jimmy Buffett song "Off to See the Lizard", he says "answers are the easy part, questions raise a doubt."

So therein lies the question: just how bad is rad?...

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