Archive for March, 2009

All things considered

Posted in cancer, Cancer Life, testicular cancer with tags , , , on March 12, 2009 by lawler

When I saw Dr. [name withheld] last week, he said to me, “considering what you’ve been through, you’re doing really well.” I took it in a glass-half-full way to mean, “you’re recovering well after harsh treatments and surgery, and better than most people in your place.” But it could also be taken in this way: “you are recovering, there seem to be no setbacks, but you have been through a lot of things that are not good for the human body and though you are doing well, you have a ways to go.”

It’s this second interpretation that seems most honest at this point.

Today, I went to see my Madison oncologist, my trusted doc, and to get my white blood count checked again to determine if I can begin the oral chemo. My WBC came in at 3.0, or 3000. Higher than last week’s 2.5, but not as high as they’d like it to be — 3.5 or higher.

The thing is, even if my WBC is up to 3.5 next week, the likelihood that such a low number will endure much of the VP-16 is slim. In other words, if my WBC is still trying to recover from all of that nasty high dose chemotherapy then it’s probably going to take a hit when (and if) I start the VP-16. A week, a day, a pill…and they’ll have to stop the drug.

So, what’s the point? That’s what I’d like to know.

This week has been sort of a rough one. I’ve been intermittently physically ill and in pain since Sunday night, and yet everyone still thinks I’m doing well. My oncologist said, in essence, that none of this stuff surprises him: not the low WBC, the low platelets, the illness, the pain. “Considering what you’ve been through…”

It’s funny. Everyone I encounter lately, from friends, to co-workers, neighbors, even doctors and nurses say to me basically the same thing: “You look great, Mike!” I take that to mean, “Wow, what a difference a little hair makes to one’s appearance!” It’s difficult to counter such a reception with something honest, like, “Yeah, I do look better, but man, I still feel like shit a lot of the time. How’ve you been?”

And so, I asked Dr. Arbaje today: “Doc, I have to live in this body for the next fifty years — is it wise to pursue more chemotherapy, and take the VP-16? Considering what I’ve been through, that my body is still trying to recover, that I am clearly not back to full health, and that some of the effects of all this treatment will be with me for a long time, perhaps even my entire life — I mean, how much more can my body take?”

“I don’t think we should make any decisions at this point,” he said, ever the even-keeled scientist.

And so there we are. My doctors telling me to follow the “maintenance treatment” route. My body telling me to cut it out.

Two weeks ago, I had prepared myself mentally (if not physically) to begin the three months of oral chemo. But then they gave me a way to squirrel out from under the plan — and now I’m not sure what to do.

For now, I will go and get the tests done, see what they tell us, and listen carefully to the opinions of my doctors. Either a continued low WBC will make the decision, or I will.

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silver nitrate and white blood cells

Posted in cancer, Cancer Life, testicular cancer with tags , , , on March 2, 2009 by lawler

It’s Always Something

I spent much of this afternoon in various rooms of the IU Simon Cancer Center in Indianapolis. I was there to meet with my “Indiana oncologist” Dr. Einhorn, and the surgeon who removed nearly twenty of my abdominal lymph nodes exactly one month ago, known here as Dr. [name withheld]. I arrived early, and stayed much later than expected.

First, it was the oncology clinic to have blood drawn and wait to see Dr. Einhorn. And wait we did (my father-in-law, Hartmut, was there with me). When I finally did see Dr. Einhorn and his nurse Jackie there was (as usual, it seems) one surprise: although my tumor markers were all normal, my white blood count (WBC) was unexpectedly low at 2500 or 2.5. Although a low WBC is not abnormal for someone who has recently undergone high dose chemo, it did seem odd to everyone that my WBC had recovered before my surgery — it was about 7000 then — and now had taken a nosedive.

“It may just be an aberration,” Dr. Einhorn said.

The trouble with this low WBC is this: they will not start me on the oral VP-16 (aka Etoposide) if my WBC remains at this level because, of course, the chemo’s main side effect is a lowering of the WBC. Because the VP-16 is a “maintenance” measure, rather than treating an existing cancer, Dr. Einhorn told me that he would not want to risk the dangers when the benefits are not wholly known and may not be worth it.

So, next week, I will have my WBC checked again. It is entirely possible — and very likely according to Jackie — that my WBC will come back normal at that time. If it does, I will begin the VP-16; if not, we will have another discussion and make a decision about further treatment.

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Proud Flesh

Two weeks ago when my local GP removed fifty-two staples from the incision running down my middle, he placed about eight large Steri-Strips across the wound to hold it all together. Today, Dr. [name withheld] tore off the remaing six (along with much of my hair). There were a couple of spots in the lower third of the wound that didn’t fare too well during the staple removal, and they were dealt with today with something called silver nitrate.

“Ah,” the doctor said after removing the final two Steri-Strips, “I see what we have here.” He stepped over to a cabinet and as he began pulling out little sterile packages said, “it’s called proud flesh.”

“Proud flesh?” I said.

“Yes,” he said, “so what I need to do is cauterize it with silver nitrate.”

Cauterize? Cauterize? I didn’t like the sound of that and winced a little when he said it. When I think of cauterization, I think of burning. And I also think of it as a means of coagulating. But, in this case, it was a means of destroying damaged tissue to let the affected area heal. And so, he pulled out what looked like a very long Q-tip and set about cauterizing an area of my incision that is about an inch and a half long. It stung a bit, but was not overly painful. The area is now sort of grotesque looking, almost completely blackened by the process.

My body looks very strange to me now, a long still healing scar slicing through the center of my body — my belly button misshapen, seemingly forever. It will make it very hard to forget this cancer experience of mine. Maybe that’s a good thing.