No Acute Intercranial Abnormalities!!!

OK, so I think the title of this post basically says it all -- the brain MRI I had yesterday at 6:30 AM revealed no acute abnormalities in my brain that would have signaled the presence of brain metastasis. While this doesn't mean I'm in the clear, obviously, this should (fingers crossed) be enough to keep me in the good (or at worst, fair) prognosis group come next Monday. The only thing left to check will be my blood Beta-HCG levels, which will hopefully stay where they are. I'll have these checked right before chemo starts on Monday. I'll post the details about my finalized prognosis and schedule of treatment then.

Thanks so much to everyone for the emails, calls, flowers, cards, books, cookies, soups, and everything else that you all have done. Anne and I really appreciate all of it, and we are looking forward to talking to all of you soon. If you haven't seen this blog before (which I'm guessing will be the case for many of you), you can see a little bit more about how I got diagnosed in the previous post. Please don't hesitate to call or stop by--Anne and I really don't mind, and we certainly won't think you're being nosy.

In any case, this week was one of the longest ones I can remember, and it was chock full of clinic visits, internet research, and me coughing up weird things. For me, at least, there's never been anything quite like the quite like the possibility of a brain tumor to get me to really pay attention to the way things look, taste, smell, or feel. And while the week wasn't entirely unpleasant, I certainly won't miss the momentary moments of terror I experienced all week whenever I would lose my balance or have a headache for a few minutes.

So, that's all the really important stuff (no brain tumor!). Here's the low-down-and-dirty details about my medical adventures, for those who might be interested:

Monday

The weekend in is pretty routine. On Sunday, we go to Unitarian church (sermon: Be generous!); followed by the Esquire for lunch with Kate, Graham, and Kramer (we watch Illinois lose to Michigan); then, nothing much except TV and napping for the rest of the day. My fast for surgery starts at 12:00 AM.

On Monday morning, I get to go gave a medport (a "Power-Injectable Smart Port") implanted underneath the skin between my right shoulder and right nipple. This port will allow nurses to draw labs and administer IV drugs things without starting a new IV line each time (chemo has a bad habit of collapsing veins, so this is more than a simple convenience).

The procedure is a pretty simple, straight-forward outpatient procedure, though I'm not sure I would have thought of it that way a few weeks ago. Anne and I arrive at the hospital at 8:30 and, after a few failed attempts to check in at various locations, are in the Interventional Cardiology waiting room at 9:00. We are the youngest couple in the waiting room by (at least) 30 years, and I am amused by the sign forbidding anyone in the waiting room from eating, on the grounds that it would upset those of us who are fasting. On reflection, though, this seems like good advice, as I consider the hijinks that might ensue were a octogenarian fist fight to break out over an illicit bag of Doritos.

Despite the signs assuring us we will be seen by 9:30, it takes until 10:00 for them to call us back, and then there is another hour or so of preliminary questioning from nurses. Someone (I'm not sure who) has requested that I get Xanax a half hour prior to surgery, and this is perfectly OK with me. I agree to a flu shot after surgery and wonder if this is the Xanax talking (I have a long history of refusing to be voluntarily poked, and this may well be my first-ever violation of this policy).

At some point, they ask me how much pain I am "OK with" on a scale of 1-10. I say "At 2, I usually take an ibuprofen" and then worry this is not a very hard-core answer. Shortly before surgery starts, I get a stronger sedative through my IV, and then, immediately before surgery, an even stronger, morphine-based sedative which makes me not care much about anything. I spend the time during surgery staring vacantly at the blue cloth they have covered my head with and napping.

When I wake up, it's time for lunch (grilled salmon, which is pretty good), and then more napping. Then, I go home and watch TV, take a nap, have a few vicodin, watch more TV, have more vicodin, and go to bed.

Tuesday

I'm able to go back to work today, but I have to get a ride from Kate since it has been less than 24 hours since I was anesthetized. I'm a little fuzzy in the morning but am able to do the work assigned to me for the week, which basically consists of formatting and proofing Microsoft Word files for posting on the corporate website (I'm working on the online ancillaries for a book called Successful Coaching, which was written by the Rainer Martens, who founded Human Kinetics).

At 2:00, Anne picks me up from work, and we head to the Carle Cancer Center for our chemo teach. The nurse practitioner is a professional looking, 50-ish woman who used to work at the IU cancer center, where they treated lots of TC patients. When Anne and I explain my chemo regimen (as we understood it), she looks a little baffled and says she doubts there will be 21-day breaks between treatments (which ends up being correct). Other than that, it's pretty straightforward. Chemo will (hopefully) be outpatient, which is possible these days because of vastly improved antinasuea drugs, which means I should be able to eat food, walk around, watch TV, etc., without undue discomfort. There will probably be some side effects, including fatigue and gods-know-what-else, but they don't anticipate any major problems (at least for now). This is very different from chemo back in the 70s or 80s, though, when a regimen like this would almost certainly require admission to the hospital for the duration (so, in my case, something like 9-12 weeks).

We head home afterwards, and I walk to CVS to buy Anne her a last-minute Valentine's Day Gift (a $7 two-dogs-hugging-each-other plush thingy and a card) and then to the library for movies (where I accidentally rent the wrong version of Victor Victoria, which is Anne's favorite musical). We get carry-out Pizza Hut for dinner (vegan Pizza Hut pizza is actually not too bad), and watch the first half of Big on Netflix.

Wednesday

I have two appointments at Carle today, so I'm only at work for about half the day. The first one is at Reproductive Health, and Anne and I go to this one together. From the urologist, I'd already learned that the high levels of Beta-HCG my tumors are producing have driven my sperm counts way down (even in the testicle that wasn't cancerous) and the nurse practitioner we talk to today confirms this. Plus, men with TC have generally lower sperm counts AND there's some sort of varicose vein in my surviving teste which may (or may not) be affecting its sperm production. (Way more than you wanted to know, right? I've somehow gotten to the point where it is *almost* feels normal to write this paragraph.) These problems are complicated by my upcoming chemotherapy, which can decrease or stop sperm production altogether. None of this is to say that my sperm production might not recover after chemotherapy, but this might take a few years, and it is certainly isn't guaranteed.

In any case, given all of this, we're likely to need to use assisted reproduction to have children (or adopt, which would definitely be an option). Given my low sperm counts, though, it sounds like in vitro fertilization would be our only option. This process (which I'm sure is google-able) involves taking a few eggs from Anne in a tube with a few hundreds of thousands of sperms and then plucking out the embryos after a few days and sticking them in Anne.

I get to do my part toward the engendering of our future children in a walk-in closet labeled "collection room." They tell Anne and I that we can do this together, but we decide that I can probably do this alone, on the grounds that this seems more like doing number 2 in front of your spouse than doing anything more fun. The room has a metal sink, a small vinyl loveseat, and a small, 2-drawer cabinet filled with dirty magazines. A sign directs me to "thoroughly wash your hands and genitals before collection", and they have also left a bunch of paperwork out for me to complete (With questions such as "Did you miss any? Was it the beginning, middle, or end?"). It's strange to think that this moment might end up being a pretty important one for our children.

In any case, I'll spare you all the salacious details (which aren't all that salacious, really). The reproductive health people have arranged it so that you can deposit your "sample" in a little metal drawer outside the collection room, and then exit the room without ever talking to anyone, which I think is intended to make people feel less awkward. I find it a bit strange, really, and think I would almost prefer if they treated this more donating blood or something, and gave you a cool little sticker to wear for the remainder of the day.

I head back to work for a few hours, and than it's off to Carle audiology to get my baseline hearing taken. The oncologist has told me that Cisplatin (one of the chemotherapy drugs) might damage my ability to hear high-pitched sounds (e.g., women's voices), and that I'll have to get it checked before beginning each new cycle. The hearing test (given by a middle-aged audiologist and her 20-something grad student) is rather pedestrian, and involves me saying "I can hear something now" and repeating words like "baseball."  At night, I go to the YMCA and do an easy 30 minutes on the sit-down bike (my first "workout" since surgery!), and feel OK afterward.

Thursday

It's brain MRI day, and I'm at the main Carle radiation lab by 6:15. The lab tech, a friendly, somewhat pudgy woman who looks to be in her late fifties, gives me an IV with some saline and sticks some ear plugs in me. and slides me into the machine. I can see why claustrophobics wouldn't like it, but I don't really find it that bad. It's makes lots of loud, repetitive noises at a variety of frequencies and reminds me a bit of a bad techo album. If I weren't nervous about the results, I could see the appeal of taking a nap. After about 20 minutes, they inject me with some contrast through the IV; after 10 more minutes, I'm done.

I spend the day worrying about probabilities, which I guess is appropriate, because I've often taught probabilistic reasoning to my students using cancer diagnostics as a test case, and have written a few papers on how strength of belief relates to probability. A few hours on Google Scholar and PubMed, combined with my own number-crunching neurosis, gives me the following probabilities:

• My chance of living for 5 years (i.e., of being cured) if I DON'T have a brain tumor is around 90%
• My chance of living for 5 years if I DO have a brain tumor are less than 40%, and it varies according to tumor size, location, and number
• The chance of brain metastasis given stage 3 metastatic testicular cancer is around 20%, but goes up slightly given lung metastasis (which I have). However, around 40% of people with brain tumors will have acute symptoms like seizures or migraines, which I don't have, so this brings my chances down again. So, I think maybe 25% or so?
• Lance Armstrong aside, metastatic testicular cancer is really pretty rare (I'm very likely the only person in Champaign-Urbana who currently has it), and this is all based on really small retrospective studies. So, really, these numbers are really just shots in the dark.
• I don't hear from the oncologist by the end of the day, which I think is good news; but then again, the oncologist's office hasn't returned my call about another matter either, so maybe that's bad news.
• Wait a second? Do I feel dizzy? That would have a high likelihood on the hypothesis of a brain tumor; but then again, it might have a high likelihood on the hypothesis that I don't have a brain tumor, but am sleep-deprived and suffering from a cold.
• And so on....

I'm distracted in the afternoon for a while by a baseline ventilation test, which involves me blowing into various tubes (blyomycin can impact lung capacity, which is why Lance Armstrong refused it). When I get home, I eat a bunch, briefly worry my wound has a slight opening (it doesn't, but I don't realize this until after I've already talked to the on-call nurse) and go pick up Anne from work at 9:45. During the evening, I also read eight articles about Jeremy Lin, although I have no intention of a watching a single NBA game until at least game 3 of the finals (I love college basketball, but find the NBA annoying, for whatever reason). I don't sleep terribly well.

Friday

I stop by Reproductive Medicine in the morning to give another sample, since it turns out my sperm count is too low for them to get enough for multiple IVF tries from a single sample. Then, I'm off to work for the rest of the day.  At work, I've basically finished everything I've been assigned to do, and I spend some time composing a sample midterm examination for the book I'm working on.

Over the course of yesterday and today, I figure out that Anne and I had originally misunderstood the chemotherapy protocol (or perhaps, the doctor hadn't explained it accurately). We had the thought there would be a 21-day cycle, a 21-day break, then another 21-day cycle, and so on. It turns out that there won't be any breaks between the cycles, which makes more sense. I find out quite a bit about the regimen I'll be on, which I'll describe in a little more detail next week (when this whole thing actually gets under way).

The day is a long one, and I still haven't heard back about the MRI results by 3:30, when both my dad and my coworker encourage me to call Carle and ask. I do, and the nurse calls back at 4:00 to tell me there weren't any acute abnormalities on the scan (woo-hoo!). She also checks with the pharmacist about the details of the chemo regimen I'll be on, and confirms what I've figured out over the last two days.

What's Next

I'll be at work Monday and Tuesday, then headed to Minnesota (and maybe Wisconsin) until Sunday, though I'm going to try and keep my traveling relatively contained. Then, on the morning of Monday, February 27, they'll take my blood levels and start chemotherapy.