do-it-yourself chemo

I met with two doctors yesterday in Indianapolis. Now that I am back in Madison, it occurs to me that each of them said at least one memorable thing — one of them was funny (see the header), and the other was a bit depressing (though not entirely surprising).

First, I met with Dr. Einhorn. The mere mention of his name — according to Dawn, anyway — causes Dr. Arbaje’s eyes to glaze over with admiration. He is the czar of testicular cancer, one might argue. And today, in explaining his reasoning for recommending I endure more chemo post-surgery (oral VP-16) said, “it’s like do-it-yourself chemo.”

Dr. Einhorn also said more important things like 20% of IU’s testicular cancer patients have a recurrence after undergoing through high dose chemo. When they relapse, it’s “very hard to cure.” They have been administering VP-16 post- high dose chemo since 1995, and have found that this reduces the rate of recurrence by about 5%. As I drove the six hours home yesterday, I thought a lot about these numbers, and tried to determine if they were indeed encouraging. 8 out of 10 men do not have recurrence, I thought. But, two do. What’s separates the 8 lucky men from the 2 unlucky ones? Holy shit, I thought, 20%?!? That’s 20 out of every 100 men. What separates the 80 lucky men from the 20 unlucky ones? Okay, so the VP-16 is probably a good idea. That makes for 15 unlucky men, and I don’t plan on being one of those.

Whew, and that was the conversation that I found humorous.

Later, I met with Dr. [name withheld], the surgeon who will perform the RPLND on me next week (anyone hear my knees knocking together?). Once we got over his initial refusal to let me record our meeting (yes, that’s why his name has been withheld), things progressed smoothly, and he was very helpful, informative, and kind. I gave the doctor my word that the recording would not end up on the Internet (as he said happened once to his dismay), but as I am writing I worry that he meant he didn’t want any of the conversation on the Internet. Therefore I have withheld his name and have removed any mention of him in earlier posts. I do not want to break my word, or upset my surgeon.

The bad news here? Well, the worst potential side effect…

Okay, wait. Perhaps a disclaimer is in order: if you don’t want to read about extremely personal stuff that has to do with my sexual life, skip to “OKAY, IT’S SAFE (I THINK).”

…where was I? Oh yes, the worst potential side effect is that I may lose the ability to ejaculate. Too much? I warned you. The reason for this is relatively simple, but first a brief lesson in related anatomy:

This the average male anatomy

The average male anatomy

What isn’t shown in the diagram above are the bundles of nerves that run parallel to the Vena Cava and the abdominal aorta. These nerves can be damaged during the procedure, and in some cases are deliberately removed. This can result in an inability to ejaculate, though it does not affect erection or the actual orgasm/climax.

All of this is disappointing, and frankly a bit creepy if it happens. Fortunately, Dr. [name withheld] did not think this would occur in my case. He said that some of the nerves will be removed, but not all of them (or something like that), and I should retain my…ejaculatibility. That’s my word, by the way, not his.

But what he said that was so memorable was his own response to telling me that I may not be able to ejaculate in the future:

OKAY, IT’S SAFE (I THINK)

he said that after everything I’d been through it was very likely that I was no longer fertile. He followed this by asking, “do you have children?” I said no, and for a moment he was disappointed. But when I followed by saying, “but I did bank sperm before I had any chemo,” he nodded his head and said, “that’s good, good for you, that’s good.”

Now students, if you would direct your attention to the diagram above again. The surgeon will be removing all of my abdominal lymph nodes on the right side of my abdomen, which is where my tumor is — just to the left of where the aorta starts to fade away on the diagram. This will leave intact all of the lymph nodes on the left side of my abdomen, which they tell me leaves plenty to do the lymph node work for that region of my body. If they were removing all of the abdominal lymph nodes, it is my understanding that that would be a different situation.

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One Response to “do-it-yourself chemo”

  1. And did you find out the answer to my question?

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