Archive for fertility

It’s personal, but…

Posted in cancer, Cancer Life, testicular cancer with tags , , , , on June 24, 2009 by lawler

…isn’t all of this writing I’ve been doing on my life with cancer for nearly two years? When I first started writing this blog, I told you that there were two primary reasons for doing so: one, I wanted to be able to continue to focus on a writing project; two, I wanted to keep my friends and family informed about my life, about my illness, about Dawn, et cetera. I had no idea at the time that all of this would drag on for so long — no idea that it would affect my life in so many ways, trickling down as it has into my art, my self-identity, my relationships with friends, family, with Dawn…it goes on and on, and seems to be nearly limitless. The fertility issue is simply the most lasting trickle.

When I first got word last September that my cancer had returned — or recurred — I called one of my oldest and dearest friends and cried on the long distance line that what pissed me off the most about the news was that it meant that I would likely be left infertile. I cried, and told her “I just want to be a dad someday.”

When I have been in treatment I have found myself resenting those of you who are healthy and able to fully live each of the mundane, banal, seemingly uneventful moments of life; now that I have been told that I am infertile, I find myself resenting the young parents I see everywhere, clutching their children to their breast, holding their delicates hands. It’s unfair (obviously) but I think, “why did they get it so easy?” An exercise in self pity, yes.

But, Dawn and I have options. That’s for sure. Almost too many options. We are considering all of them, including using medical technology to create a child. We are also seriously considering adoption. I tell you this because I want to hear from you. I want to know what you have experienced that might shed light on how we proceed with our lives, how we decide to become parents. Tell us something.


My Boys Won’t Swim

Posted in cancer, Cancer Life, testicular cancer with tags , , , on May 24, 2009 by lawler

I’m in Eugene, Oregon this weekend attending a conference/symposium/festival called Earth Matters on Stage. It’s essentially a meeting of we theater artists interested in so-called green theater. It’s been a blast to be here, and it has served to remind me of why I love the theater, and how I hope to contribute as an artist in the future. And really, how I hope to lead my life.

While here, I have had the opportunity to catch up with both old friends and people whom I’ve until recently only known through the written word, or rare phone conversation. My brother Steve also made the trip down from Tacoma, Washington the day I got here to see me, stayed the night with me at the hostel I’m at, and then headed back home on Friday. It was great to see him, as always, and he was sitting with me when I received the following email from my oncologist, Dr. Arbaje:

hi Mike,unfortunately, your sperm count is zero so you would have to use the banking.
keep me posted about the MRI
feel free to use this route.,
Yamil Arbaje, M.D.

Here’s how it looked to me:

unfounouohn YOUR SPERM COUNT IS ZERO lkjlkmlkmvlkerouo lkjloijuou lkmlm
kjhknkln iaoierj MRI
lkyoum, MD

Should I start over? Okay…

Part I: Say the word, “deaf.”

“You need your ears cleaned!”

Ever heard that from anyone who thought you should’ve heard what they had to say to you? I have. My dad used to say something to that effect, but far more colorfully.

Nearly two years ago, on the same day my primary care physician told me that he thought I had testicular cancer he told me that I needed to have my ears cleaned. Naturally, the cancer took priority and the ears were not thought of again until over a year later when my hearing emerged from high dose chemotherapy treatment in a bad way.

The other day, my local oncologist, Dr. Arbaje, recommended that before I had a hearing test to determine the level of damage I’ve been left with that I have my ears cleaned out professionally. So, I did. It was brief, and the result was gross. I won’t go into that.

My hearing emerged from the cleaning as different, but not better. I had a hearing test immediately following the cleaning, which confirmed that my hearing is impaired, severely so in the higher frequencies.

Both of my ears dip sharply once they reach higher frequencies and the hearing loss for both ears in that range is severe. The surprise to everyone was how my right ear starts at a point that is barely in the range considered normal hearing, and is, across the board, much worse off than my left ear. I was told by both the audiologist and the ENT that hearing loss associated with chemotherapy is generally equal in both ears.

The ENT recommended that I have an MRI in order to rule out the possibility that (“considering your history”) there is a benign growth that has caused the more profound hearing loss in my right ear. I tried to stay calm when she started explaining that if something were to be found I would need to consult a neurologist. I said, “could it be malignant?” And she said, “I have never seen a malignancy in this area causing hearing loss.”

I had the MRI on Monday, and was not worried. I know that my hearing has been uneven for years, and that there are many, many reasons (most of them impossible to determine) for the discrepancy between my right and left ears. On Thursday the ENT left a message on my phone letting me know that the MRI came back all clear. Good news.

In other news, the audiologist said to me, “I think hearing aids would help you, but I don’t want you to use them for at least another six months.” Why? Because — and oh how I wish someone, somewhere had told me this six months ago — in the case of hearing loss like mine (from toxicity), the potential for further damage to the ear is greatest in the first year after initial damage. This means that I need to keep my ears very protected from any potential harm, especially overly loud noise for extended periods. Oops. The hearing aids, of course, are simply amplifiers in my ears, and could potentially further damage my ears. So, in the beginning of 2010 I will revisit the audiologist and determine if I do, in fact, want hearing aids.

Part II: Kokopelli is the Man (apparently)

Infertile. So what, you think, right?

I had no idea how upset I would be about the prospect of becoming infertile, let alone being informed that I am indeed so. It’s an odd, frustrating, often angering predicament. So much so that I am a bit speechless about it at present.

I can say this: I did bank sperm, as many of you may recall from my posts about the so-called Collection Room, and we’ve been paying rent on the stuff (about $50 a month) for nearly two years — insurance does not cover this. We have only just begun to take the steps necessary to even really learn about the process involved in putting my frozen boys to use. It looks to be an interesting, emotional, potentially tiring and aggravating journey. We are frightened of it, but joyous at its existence, for its potential. We recognize that not everyone feels as we do, but we have strong desires to be parents…so, we’ll see.

do-it-yourself chemo

Posted in cancer, Cancer Life, testicular cancer with tags , , , , , on January 28, 2009 by lawler

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:


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.