Archive for RPLND


Posted in art & community, cancer, Cancer Life, testicular cancer with tags , , , , on July 16, 2013 by lawler

In 2008 and 2009 I listened a lot to Wilco‘s 2007 release Sky Blue Sky. The title track has a line that resonated with me in an almost obsessive way at the time: “Oh, if I didn’t die/I should be satisfied/I survived/That’s good enough for now.”

As with any song lyric that sticks with you, it meant something very real to me that likely was hardly connected to whatever Jeff Tweedy meant when he wrote it. What I knew was that I had, in fact, survived–and although that survival meant that certain things would necessarily change, that my outlook and commitments would change (for the better I hoped, I planned), it also meant the hard work of life was ahead of me. And it would be doubly hard because I had a new perspective on what it meant to be alive at all. It meant that dreams would no longer suffice. Taking action, moving forward, listening to myself and making myself heard was what mattered more than ever. But that’s a daunting place to be. So, that lyric from Wilco helped me relax into the moment of simply living, knowing that “for now” being alive was good enough.

Now I am forty. Almost six years have passed since my diagnosis, almost five since my recurrence, and over four since my last bit of treatment (the infamous RPLND). Lately, I’ve been asked about turning forty. The questions (or comments) obviously fall within two camps: those from people not yet forty, and those from folks over forty. The under forty crowd ask things like, “how does it feel?” The over crowd says “trust me, you’re still a kid” or,  “welcome.” A friend recounted her brother-in-law’s thoughts when he turned forty. She said, “for him it was all about options.” I said, “what, like he was running out?” She said, “no, just that he was thinking a lot at the time about what his options were.” I’ve done a lot of that lately as well. I haven’t been rolling my options over and over in my head because I knew I was about to turn forty. It wasn’t a conscious thing. Somehow my gut was just telling me to do it. So I did it to the point of ridiculousness.

But the thing I kept coming back to was whether or not I lived up to the decisions I made about life when I was sick (while a mere 34 & 35 year-old kid). I haven’t combed through this entire blog recently, and I know I wrote about many things while in the throes of treatment and recovery, but my recollection is simple enough on this point: I decided to stop waiting. Stop waiting to write, stop waiting to take risks, stop waiting to tell people you love them, stop waiting to try ice skating or making a friend or moving on. Don’t wait because you’ve been given a second chance. Take it.

And I believe I have. It’s not the stuff of hollywood movies, of course, but I’ve taken risks, I’ve written my ass off (albeit in fits and bursts), I’ve said I love you to people more times than I could possibly count (my son hears it at least ten times a day), and I’ve made friends I might have been too shy to meet before my second chance. The struggle continues to be holding on to the feeling I had when I finally could stand up straight again after the RPLND and go back to work. It was a new era, a new chance–the kind of feeling you get only on rare occasions. It’s a hard thing to keep hold of over the course of years.

Thankfully it’s an effort that has been usurped by something different: being a father. Becoming a parent is by far the most important thing that’s happened since my cancer (in spite of my cancer). The difference between those in my life who are parents and those who are not is far greater than the separation of the under forty and the over forty crowds. Being a parent is profound and life changing in ways that getting older is not (at least so far). While the comparisons to my own father roil in my brain quite persistently now, it has more to do with myself as a parent than myself as a man. My son reminds me every day, by his simple presence, that things are not just good enough any more. They are good. Very good.

Three very important people in my life: my son Jack, my oncologist Dr. Arbaje, and my father-in-law Hartmut.

At my 40th birthday party, three very important people in my life: my son Jack, my oncologist Dr. Arbaje, and my father-in-law Hartmut.


On Scars, Langer’s lines, and Deafness

Posted in cancer, Cancer Life, testicular cancer with tags , , , , , on April 15, 2009 by lawler

I learned some new things today about the body, about my body. I visited a woman with a very cool name (Morel Stackhouse) who practices something called Ortho-Bionomy and spent an hour or so having my RPLND scar worked on to promote healing and reintegration of the scar tissue — or perhaps just integration.

When I stepped inside her home, just a few blocks from ours, she said “Blah blah leave blah blah blah here.” At least, that’s what I heard, my hearing still quite impaired. Nowadays, I’ve become half-way decent at deciphering what a person has said by hearing some of their words and applying context. I knew she had asked me to leave something by the door, and because my cell phone was in my hand I deduced that she had said “You can leave your cell phone here.” I took my bulky keys and my cell phone and set them on the counter and looked back to her silently.

“Your shoes,” she said, “I don’t care where you leave your phone and your keys,” and smiled.

As I kicked off my sneakers, I said, “I’m sorry, I don’t hear very well.”

“Too much loud music?”

“No,” I said, “too much chemotherapy.”

Dawn still marvels that I cannot hear the tea kettle whistling in the next room. It is too close in pitch, it seems, to the constant ringing in my ears, known as tinnitus. I’m still counting on recovering my hearing, and Dawn reminds me that it has not been that long. But not being able to hear people speaking to me — especially those who don’t already know about my condition — has grown tiresome.

On a brighter, more interesting note I also learned from Morel one of the reasons my first surgery was so simple and easy to recover from (in contrast with my RPLND) — and why the scar is so different, both in the way it looks, and in the way it feels. The reason is what are known as Langer’s lines and that surgeons take advantage of them. The lines represent the natural tension of skin, or how skin is held together on the human body.

My first surgery, an orchiectomy, was a small incision that followed the contour of the Langer’s line in that part of the body. My RPLND, on the other hand (as with most abdominal surgeries) slices right across several of the lines, as you can see in this diagram:


When I run my fingers down my scar, I can actually feel where these lines are because they have formed slight bumps in the scar tissue. I was quite happy to hear Morel say repeatedly, “Your surgeon was very, very good,” as she worked on the scar. At one point she said that one way to know this was by judging how well the Langer’s lines had been realigned when I was put back together. She said that sometimes they are not aligned properly and you end up with a scar that pulls against itself, causing even more discomfort and difficultly in healing.

She also got me thinking again about something that occurred to me a few weeks ago about my tattoos. In thinking about them in the context of this massive scar, I realized how forced they were — and how their meaning has diminished in my mind over the years, and especially now that I have been given (yes, it was a gift of sorts) this strange scar. Tattoos are artificial — albeit often beautiful — scars. Their meaning is frequently superficial, and is always imprinted with the owner’s subjective and sometimes misguided intent. They are, I must admit, affectations. They simply do not rise to the level of importance (or meaningfulness) of a scar of the sort that now runs down the middle of my gut. They were not really earned, and are merely art objects forever affixed to my skin. I never really understood that until now. The story that my surgical scars have to tell are so much more rich and inspiring than the tattoos on my body.


Before I forget…Dawn and I took the plunge this week. It’s one little step toward starting a family: a new, safer, more fuel efficient, environmentally friendly vehicle (isn’t it cute?):

The newest member of the Wisconsin branch of the Lawler family - a 2009 Toyota Yaris.

The newest member of the Wisconsin branch of the Lawler family - a 2009 Toyota Yaris

EVISCERATED; or, don’t expect to get a good sense of what I’m writing today from this title

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

That’s the word that one of my co-worker’s used yesterday to describe her impression of my surgery. She said something like, “Considering that you were just recently eviscerated, you look good!”

Last night, Dawn said, “you really should put up another post on your blog — everyone thinks you’re not doing well.” I hadn’t meant my last post to sound that way. I realize now that it had an odd, disconnected header that could be interpreted as negative — but that wasn’t my intent. Sometimes the titles for my post are just the fist thing that comes to mind, sort of a free association exercise. I suppose you could read into that.

Anyway, no one is “rolling over” here. Things are progressing, albeit more slowly than I would like, and I’m more and more back into life everyday.

For the medical side of things, I’ve seen my GP three times in the last two weeks — which is a hell of a lot considering the last time I saw him was August 30, 2007 when he told me he thought I had testicular cancer. Since then it’s been a whirlwind of medical appointments, but none of them with him. When I saw him again yesterday, he asked to be kept more in the loop from here on out. It’s a sign to me that he is not only a good doctor that cares about my treatment, but also that he thinks my medical life will be much more mundane in the near future. Sounds good to me. It’s one thing in life I wouldn’t mind being mundane.

The reason he has seen me so frequently lately is a small issue with my incision wound. The area where it swoops around my navel did not like the staple removal, and we’ve been keeping a close eye to make sure it does not become infected. So far, it is sensitive and sometimes uncomfortable (and itchy!), but not infected.

Next week I will be traveling yet again to Indianapolis to see the surgeon and Dr. Einhorn. I had planned on driving myself, but when Dr. Nettum got wind of this plan (via his nurse Christina, who received the information during what we thought was casual conversation), he told us he would prefer if someone escorted me there. Fortunately, Dawn’s dad, Hartmut, will be able to make the trip with me so that Dawn doesn’t have to worry about shuffling her schedule around. It’s especially difficult for her because of her teaching studio, and all of the students clamoring for lessons! Thank you Hartmut!

I will be sure and put a post up next week to let you know how the Indy trip went. Thank you for reading — and thanks to everyone for your concern, your love and support, your prayers, food (we’ll get those containers back to you as soon as we can), your positive energy, and constant showing of hope.

rolling over

Posted in cancer, Cancer Life, testicular cancer with tags , , on February 19, 2009 by lawler

The other night in a dream I looked down at myself and where there is now piles of gauze over giant steri-strips there was nothing but a simple, long, almost attractive scar running down my belly and past my navel. When I told Dawn she said, “that’s a good sign.”

But when I awoke the following morning it was after a nearly sleepless night spent tossing and turning, and trying still to get comfortable. After two nights in a row of taking a dose of pain medication to help me sleep better, I decided to forgo the meds from now on, and I guess I paid the price. I tried to move my body (and mind) forward into the day, but couldn’t muster the energy. I teleconferenced in to a staff meeting for work, though I had planned on being there in person. I managed to stay focused throughout the phone meeting, but it was quite hard to hear distant colleagues through the phone line — like being in a crowded shop is for me now, my hearing still suffering from the rounds of high dose chemo in November and December.

Today I’m feeling much better, having somehow achieved a decent night’s sleep sans pain medication. I know that being active, and increasing my physical activity is the only true path to normal health, normal life, so I’m doing everything I can to push myself to take walks, and be up on my feet (standing upright!) as much as I can. I can’t help but think that — though I was feeling mostly back to normal following the high dose chemo hospital stays by the time I went back to Indianapolis to lie down for this surgery — this lack of energy and motivation is a cumulative effect of the last nearly four months of cancer treatment. Sometimes it’s hard to envision a Mike like the old one.

Sometimes, I don’t want to envision him, because I’m not that guy anymore — aren’t I more than that now? Hasn’t cancer given me something greater than what it has taken away?

The truth about (my) staples

Posted in cancer, Cancer Life, testicular cancer with tags , , on February 16, 2009 by lawler

I know that you all meant well. I know you did. Truly. But, well, I don’t know how else to put this: you were wrong.

Or were you just trying to reassure me? My friend Keri said to me today while chatting, “Yes, I did lie. Sorry! I didn’t want you to worry. Sorry sorry sorry.” She had experienced staple removal in her knee area when she was much younger. “It feels like it’s never going to end,” she said.

The thing is, when I had my fifty two (yes, they counted them) surgical staples removed today it was not only uncomfortable through the entire process, it really f#$%ing hurt about a fifth of the time. I’m not exaggerating, folks. At one point, after my doctor had removed a particularly testy staple, I let out an expletive that I usually don’t let loose in examination rooms. Dr. Nettum said, very patiently, “you say whatever you need to, Michael.” I said, “Don’t worry, I will.”

I wondered, going into this how the procedure might be painless. I tried to imagine how the staples might be engineered to make them painless upon removal, but I couldn’t get the image of a standard office staple out of my mind — the way it punches through and then curls at the end to trap the paper. I wondered if my staples were more like construction staples, fired with pneumatic guns, going straight in, without bending at the ends. But that didn’t make sense, because what would give them their strength?

Well the fact is, at least for the fifty two staples in my body, that they do curl at the ends in order to keep the wound bound together better. This requires a staple remover tool that essentially pinches the center of the staple, causing either end to bend upward — the idea being to create an easier exit for the staple. This worked in a relatively pain free way most of the time. But some of those pesky things must have liked where they were, because they clearly did not want to come out.

Dr. Nettum and his nurse, Christina, worked on my staples simultaneously. She started at the top, he at the bottom (like digging a long tunnel, they met in the middle). The first staple he removed hurt like hell. By the end of the ordeal, I told Christina that every one of you that told me that the staple removal would be easy, pain free were going to get an email letting you know how wrong you all were. She laughed. I didn’t.



There was one area of my incision that opened up a little when they removed a staple. Because of this, my abdomen is covered with a very big bandage and I will be seeing Dr. Nettum again tomorrow to make sure it’s okay.

Beyond that, we still do not have dates set for appointments in Indianapolis with Dr. [name withheld] and Dr. Einhorn. We’ll keep you posted on that.

I will be seeing my local oncologist on Friday, but not for a medical visit. We are interviewing him for the Cancer Stories Project.

standing up, sleeping, pooping, and other things we take for granted

Posted in cancer, Cancer Life, testicular cancer with tags , , on February 13, 2009 by lawler

Dawn said the other day that she was visualizing my progress with the “evolution of man” image in her head. You know, like this one:

I think Dawn must’ve been visualizing me as the third troublemaker from the left. Since Wednesday night I’d like to think I’ve least moved on to the fifth creature in the series. But not all the time. If you were a fly on the wall in our house this week (or one of our cats), it would not be uncommon for you to overhear Dawn saying something to me along the lines of “Stand up, Mike.”

As some of you have probably already heard me gripe, this dang surgery has thrown me for a loop. The pain, discomfort, and general disruption of even the simplest tasks and events in life were things I severely underestimated when I walked into the operating room a week and a half ago.

While I am no longer taking any pain medication (I stopped the regular dose on Sunday, I think, and stopped entirely a couple of days ago), I am in constant discomfort still. Not enough to warrant the side effects of pain medication, however, but still enough to make life uncomfortable — you know, things like walking, lying down, sitting down, working on the laptop, simple stuff. I’m just glad the constipation nightmare is over. Holy cow. I never thought I’d be so pleased to be gulping Metamucil!

Thanks to everyone for your support — to those of you who have dropped off food, well, you have especially endeared yourselves to Dawn. She is extremely busy at this time of year, and is still dealing with an invalid at home…so, thank you.



For those interested in such things it might be worth noting that I received a copy of the pathology report for my surgery/tumor from IU this week. Here’s the gist (from my obviously layman understanding):

They removed sixteen lymph nodes that came up negative for cancer.

They removed one tumor assocciated with one lymph node, sized 2.1 cm that contained “small foci of matura teratoma and cystic trophoblastic tumor.”

They removed (as far as I can tell, though I don’t recall this being discussed) “right gonadal vein and mass.” The mass (1.7cm) was not found to be malignant.

So, there you go. I will more than likely be headed back to Indiana sometime in early March to meet with the surgeon, and Dr. Einhorn for follow up. At this point, I am still under the impression that Dr. Einhorn is strongly recommending I take oral VP-16 for three cycles/months.

How did I get talked into this?

Posted in cancer, Cancer Life, testicular cancer with tags , , on February 6, 2009 by lawler