April 4, 20172 Comments

#KnowYourBalls Survivor Story – Brent Dirks

It's a weird way to think about it but I know my cancer was not about me. What does that even mean? It means that cancer helps me help others.

I've always been a helper. I'm the oldest son of 5 kids to a police officer and emergency room nurse. I had no chance. Public service is in my blood. I shot for the middle and became a firefighter/paramedic. I knew about the risks involved of running into burning buildings and crazy drivers on the highway while we tend to victims of car wrecks but never gave much thought to how the job could affect my health. All the old guys have bad backs so I've tried to stay healthy and active and "use good lifting form." Turns out, firefighters have a much higher risk than "the normal man" of developing testicular cancer. (Source)

I'd had a pretty hard couple days working out and noticed a little twinge in my groin but didn't think too much about it and it went away. I noticed it again after a good indoor rower workout and this time it hung around a little longer.

Symptoms and Diagnosis

I'm the father of two great, super fun, busy kids. We had all kinds of activities so I didn't put my health first and put off making a doctor's appointment. My right testicle felt like it was a river stone and somewhat painful. "I've got a pretty high tolerance of pain" says every tough guy ever. So when it got bad enough, I made a doctor's appointment and went to a urologist. The tests started! Blood work, ultrasounds, and ct scans. The diagnosis came in: stage 3 testicular cancer with involvement of numerous lymph nodes, 3 spots on my liver, and possibly my lungs. (Moral of the story and the key to awareness: early detection is critical in testicular cancer. When caught early, the involved testicle can be removed before the cancer is able to spread.)

Well, I wasn't expecting that. Through my faith in Jesus Christ, I knew He had me and my family in his hands and we were ready to tackle the unknown that laid ahead. All I knew was that I was going to meet a lot of new people that I never would have had the chance to without cancer. I was connected with a specialist surgeon who would take over the case from the urologist.

The first step was the orchiectomy, removing that river stone I had hanging. Of course all my firefighter brothers wanted to chime in about getting an implant. "You could get one that made noise or lit up or something." My son even thought that a steel implant would be awesome because every guy wants steel nuts! We found out that a real testicular implant is much like a breast implant and I decided that in my case, it wasn't needed. So the one nut and lefty jokes started. Firefighters and my immediate family are a different breed and love to joke around about the oddest things. It's how we cope and to me, it's fun.

The Treatment Process

Now that we stopped the source of the cancer, the next step was to stop the spread. I was referred to a great oncologist and we continued the treatment plan. The standard procedure was to do 4 rounds of BEP (bleomycin, etoposide, cisplatin) chemotherapy. In each round, I would go Monday through Friday the first week and then Monday only the next 2 weeks. We would reassess my blood work and lung function with each round. Remember that part where firefighters love to joke around; my chemo nurses had no idea what they were in for when I walked in. The first day I was giving them a hard time about how to start IVs and what quality patient care looks like. I never would tell them what I did and they would always give me weird looks. Pretty soon, my wife would be rolling her eyes and tell them I am a paramedic and not to worry about my criticism. I had a blast the first couple weeks. I still felt good and was making new friends everyday at chemo.

The first week of chemo started soon after my surgery so all the medications were administered by IV. My veins were quick to figure out that they didn't like how things were going and made it harder and harder for the nurses to obtain. We decided to get a port placed and I went in for the quick day surgery procedure. They keep you awake and chat with you while a plastic hub is placed under the skin of your R upper chest and a catheter is ran into your heart. No big deal. I didn't do all the research I should have and turns out your not supposed to do certain exercises with the port in. I found out later that some of the overhead lifts should be avoided with the port. I never had any real issues with it other than it clotting up a couple times. I guess they put mine in well.

Support from my Family and Friends

My firefighter and church families really stepped up! We set up a ride schedule where different people could drive me down to chemo and my wife could get the kids off to school and then come and meet us to bring me home afterwards. Firefighters can kill some time while waiting for the next emergency so the wait during chemo was no big deal. We would sit and chat and laugh. Pretty soon, all the nurse were eager to see which new cute firefighter was going to bring me in. Yup, all firefighters are good looking.

Support is a huge part of the process. When you are used to being the one who helps others, it's hard to sit back and let others help you. But that's what I did and it was amazing to see how people responded. Rides were covered, meals were prepared and brought to the house, the kids were taken care of. Even bracelets and shirts were made in my support. I'm kind of a big deal. I totally felt like a pro wrestler with my own t-shirt! Things were cruising along, we were getting into a routine and I was feeling good.

Effects of Treatment

The chemo was doing it's job. My hair started falling out a little bit. Then one day in the shower, 10 days in, most of it came out. I kind of had a mad scientist look going that I wasn't too fond of so I trimmed it super short with the clippers. My bare head was pretty tender and I wore hats most days. I was pretty proud of my hair before the cancer and not a huge fan of the bald head but at least I didn't have to shave. That's right, all the hair falls out. You don't really think about that until you pull back the covers on the bed and see that all your leg hair has come out in the night and was trapped in the bottom of the bed. Gross.

I want to take a second and tell you about how much of a rockstar my wife is! From the moment of the diagnosis and on, she was my rock. We were lying in bed the night after the diagnosis and she turned to me and said, as nonchalant as possible, "Well babe, you've got cancer." We both just laughed and laughed. We talked of what the future held and that we would keep a positive attitude, no matter what. She literally took care of everything. She was my crutch on the days I wasn't feeling strong or in too much pain to get off the couch on my own. She's the best wife ever!

The chemo was really doing it's job. My tumor markers were slowly lowering on the blood work. So was my blood count numbers and I could tell. Standing up became a chore without getting too dizzy. Taking a shower was work. And I was tired of everyone telling me how pale I was. I didn't have much of a tan from the start but now I was almost see through. I went in for a chemo treatment in the third month and could tell the nurses were looking at me differently. They asked, "Are you feeling okay?" I wasn't feeling too bad, fatigued and a little dizzy from time to time. We started discussing a blood transfusion and a couple days later I was hooked up with 2 units of blood.

A couple days later the fever and cough started. My wife was getting a little worried so we headed into the hospital. Little did I know that would start an 11 day stay in isolation. My white blood cell count was so low that the doctors worried I would get too sick in the real world. Masked up, bald and pale; I didn't feel too studly but still had faith that we were on the right track. God's plan was still on our minds. We were able to chat with and meet many new people. I was half the age of most of the people on the floor and loved messing with the nurses. Why would they put so many buttons on a hospital bed if they didn't want you to see how high it would go up in the air? An ambulance came through and I asked for help escaping but they did not oblige. After some medication to get my bones producing blood again, I was released back in the real world!

I received my last chemo treatment while admitted so I didn't get to ring the bell showing everyone you've completed chemo. I loved visiting the chemo nurses and crew when I went back for follow up appointments and they let me ring it then. Those nurses had a huge impact on my cancer journey and I will be forever grateful for their care and comfort.

The chemo did a good job. The cancer had stopped spreading and some of the tumors shrunk. That was not the outcome we were looking for. We were looking to be cured from cancer and the oncologist and surgeons felt they could go in with another surgery and get all the cancer out. We scheduled a lymphadenectomy and liver resection. One surgeon cut open my abdomen from the bottom of my sternum to my waistline. He went in and cut out the 3 spots off the liver. The other surgeon went in and took out 30 plus lymph nodes and other tubes and parts that were affected. They stapled me back up and sent me on my way.

I always said that I would never tell the nurses I was a 10 on the pain scale but the second day after the surgery they decided I should stand up and move around a little. It took 2 nurses to get me up from the hospital bed and to sit in the chair. I knew by the look on my wife's face that I was not doing good. The nurse asked about my pain and I said "10" before she was done with the question. They reminded me that I could hit the button on my pain med pump and I quickly hit it.

Recovery and Life After TC

The rest of the recovery seemed to go by quickly and I was back to light duty work and going to physical therapy in no time. Everyone told me to take it slow but I knew my body and what it was wanting to do. I was ready to get back to fighting fires and saving lives. 4 months after my surgery I was back on shift at the fire station and happy to be back. My fire department family pulled together like never before and it was great to be back with them, sharing stories and doing life together.

I've been cancer-free for a little over a year! Since the surgery, the blood work, x-rays and ct scans have all come back normal. There will always be reminders of my cancer journey. The big scar down my abdomen (second surgery), one just below my waist line (first surgery) and 2 on my upper right chest (from the port). The tingling/numbness in my right upper leg and right index finger. It took a while for my lungs to get back to normal but I'm pushing it in workouts with the guys again and holding my own. Oh yeah, and I only have 1 testicle. All these issues are a small price to pay to be cancer-free and still alive and kicking.

I hope my story sheds a little light on what the testicular cancer journey is like. I hope it helps others going through it or those who have a loved one fighting cancer. Guys: check yourselves, know your balls and tell someone if you find something new or different. Don't be shy, we all have balls and want to keep them. Thanks for taking the time to read this. Love y'all.

April 3, 2017No Comments

Owning my Balltrasound

When I was younger, I was terrified to put myself out into the world. The few times when I did, I had a tendency to feel uncomfortable, abdicating the narrative of my own life to people who really had no business being the storytellers.

It took time, heartbreak, healing, and a healthy dose of self-confidence (both earned and given) to finally own who I was, good and bad, warts and all.

Not that I had warts, mind you… at least not the physical ones. But I digress…

This is never more apparent to me than in March, the anniversary of my stage-three testicular cancer diagnosis. Each year during the first week of the third month of the Julian calendar, I get my reminder phone call from my oncologist’s office.

Blood work. Chest X-ray. Testicular ultrasound.

I will never forget my first one. I had just had my port inserted for my impending chemo. As I came to, I was told that I was about to have my bed wheeled into the ultrasound lab to check the lads.

“Ultrasound?” I asked. “Like as in pregnancy ultrasound?”

Indeed.

In my anesthesia-induced haze, I can’t say I remember the physical experience too much. It was basically a red-haired beehive hairdo’d nurse working the wand like a Corvette stick shift through my Netherlands. I also remember the diagnosis: a core on the left side, calcium deposits on the right.

They caught my cancer kinda late, so they’d have to treat it in a different way. I’d have enough chemo to treat Rhode Island, followed by the eviction of Lefty. Hey, sometimes a guy just doesn’t want a roommate.

They would then monitor Righty annually for the rest of my life to make sure he wouldn’t try to kill me like his evil twin.

I get to have this happy little indignity every year? Super!

It’s amazing what cancer treatment does to you, the most astounding to me being its utter ability to give you perspective. When first diagnosed, I simply told people I had cancer. Sadly for me, that answer was never good enough.

“What kind?” they would ask.

“Uh, testicular.”

Guys would either snicker or wince, usually the latter. Girls would say, “Oh.”

At first, I totally understood both reactions. But as time went on, I realized that not only was I consumed by my embarrassment, but I was also embarrassing others by my blatantly obvious discomfort discussing the matter.

So on the day of my third or fourth diagnosis anniversary, while in the shower as I extra-scrubbed the hinterland in preparation for my impending blitzkrieg of shame, I simply said out loud, “I’m going to own this. I’m not going to be embarrassed anymore.”

It did not help my cause that the entire Visiting Nurses Association was doing a rotation, and were morbidly curious to see something that they hadn’t seen before. There’s nothing quite so vulnerability-inducing as eleven insanely attractive young women staring at you when the only thing staring back at them is your face, your socks, and your sack.

‘You’re doing this in the name of science,’ I kept telling myself…silently.

And do you know what happened? Not one of them laughed. One even said that I had a lot of guts agreeing to let them be present in the room. And then she asked for my number.

Okay, kidding about that last part.

But I came to the realization that it was me that was in control of my embarrassment, and by using that control to quash it, not only was I helping myself, but possibly others who are not yet comfortable about owning one of the most sensitive of maladies a young man can endure, the age this disease seems to target more than most.

Do I still feel a twinge of I really don’t feel like being here each year? Absolutely. I’m human. But the feeling that I get when I hear, “There is no noticeable change, Mr. Duffy” is worth it beyond measure.

And by owning my balltrasound, and in reality, my testicular cancer in general, I’ve figured out a way to help others in the same boat.

I’m just going to lay it all out there and hope the response is as warm as the jelly I have to mop up from down under each year.

G’day, y’all.

December 22, 2016No Comments

TBT04: The Urologist

Editors Note: This post originally appeared on A Ballsy Sense of Tumor Blog

I had starting vlogging my cancer story from this point. My face wasn't sure how to comprehend what I had been told.

All things really came to a head that day. My urologist appointment was scheduled for October 26 with Dr. Dumont. In the waiting room, I was easily the youngest person by a long shot. I peed in a cup (to this day, I’m still not sure why) and waited to see the doctor.

Wow. Even though I had been believing this since I first called, it was still vastly different to hear it from a doctor. Furthermore, I had only called for an initial visit eight days prior. I went from having an area of concern to being a cancer patient in just over a week.After the customary “drop your pants and let me examine you,” the doctor looked me in the eye and said, “So I am going to be straight with you. You have cancer.”

I did appreciate how straightforward and frank he was being with me. He said based on his brief examination and the ultrasound, he was 99% certain that it was cancer.

“Is this something I get a second opinion on?” I asked.

“In most cases, I tell my patients to get a second opinion. In your case, we don’t have time,” he replied.

The good news about testicular cancer is that it is very treatable. While 1 in 250 men will develop it, only 1 in 5,000 of them will die from it - roughly 1 in 300,00 of all men. On the whole, it has a 95% five-year survival rate. The bad news is that it is very aggressive. It can quickly spread to other parts of the body and become more complicated. Dr. Dumont said I had been smart and caught it early. Thank goodness I did catch it fast and called immediately. I had experienced no pain in my testicles, unlike Lance Armstrong who had felt pain and still put off getting it checked.

“So what’s next?” I inquired.

“Surgery. We need to remove the mass immediately. We can probably get you in tomorrow.”

source unknown

I went home and talked to Mallory. Up until this point, I had tried to minimize what was going on because I didn’t want to worry Mallory. As I have said, I didn’t want to burden people and generally hold my emotions in. This is fine for when I am frustrated at work or something minor is bothering me, but not so much in this situation. The weekend before, Mallory knew all of the unanswered questions were bothering me, but I refused to open up because I am a man and society says men can’t feel things. On the Sunday morning before my diagnosis, while I was waiting to hear back from the doctor’s office, she had said some minor comment and I exploded. It wasn’t the comment, but the culmination of everything to this point. Once I had calmed down enough, she admitted that she provoked me a bit to get me to open up. Sneaky, but effective. Moving forward, I knew I needed to be open with her, and as I told her about the surgery, I was, even though it was hard for both of us. Being open with others? That would have to wait.Double wow. Not only had I upgraded to cancer patient, I was also further promoted to surgery patient. Honestly, it was a lot to process. I told him I couldn’t commit to surgery tomorrow and needed some time to think. I also wanted to talk to Mallory because I had stupidly told her not to come with me to the appointment. He totally understood, but reiterated I had to move fast.

At this point, I knew surgery was inevitable and necessary but it was still a lot to process. I cried during this time. I don’t cry often. I can count on one hand the amount of times I’ve cried since I’ve lived in Virginia. It was a lot to handle quickly and it kind of build up.

After talking with Mallory (having decided to go forward with the surgery), I called back and the office was already closed because of course it was. The following morning, they called back and the surgery was scheduled. I would be going under to have the mass removed on Friday, October 28th.

Now that I had more concrete information, it was time to let more people in.

On Thursdays, I am chronicling my journey from discovery to the beginning of chemotherapy. To read through my story up until this point, please click here.

December 15, 2016No Comments

TBT03: The First Visit and Ultrasound

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Editors Note: This post originally appeared on A Ballsy Sense of Tumor Blog

On Thursday of my first appointment, I had to leave school early. I hadn’t indicated to anyone, aside from Brian, about the urgency of this appointment so no one thought any of it at the time. I told my students that I just needed to leave a little early for a doctor’s visit and they seemed ok with that explanation.

I got to the doctor’s office and had to fill out a ton of paperwork. Once in the the exam room, I summarized the first two parts of this blog to the nurse practitioner. In retrospect, I should have written this sooner and just printed her a copy. Like I’ve said, up until this point in my life, I had the world’s most boring medical history - scoliosis when I was younger, wisdom teeth out at 17, slightly above average height and weight, and no family history of testicular cancer (although other forms of cancer have appeared in my family’s history). After discussing with her the reason for my visit and my enthralling medical history, she told me to drop my pants so she could examine me.

To be completely straightforward, this was the part that I was most nervous about. There is usually a pretty involuntary reaction when someone touches me in that region, and I didn’t want to make it awkward. Obviously, she is a professional and I pretend I am a professional, so a situation like that may have been expected, but luckily nothing happened.

Initially, she had an issue with finding the lump. In my mind, I knew exactly where it was, and I was flabbergasted that it was hard to find, but I also know my body best. I kind of rearranged myself to find and isolate the lump. She did then find it and confirmed yes, there was a lump. She said that the next step was to get an ultrasound. Before going into the appointment, I knew that I wouldn’t have answers immediately that day, but it was frustrating that I had to wait even longer for a more defined picture of what I would be facing.

“It could be any number of things. A cyst, an infection, or it could be a cancerous mass.” Click To Tweet

I asked her what she thought it could be. She said, “It could be any number of things. A cyst, an infection, or it could be a cancerous mass.” Now, I obviously now know it was cancer, and I even had assumed it was cancer at that point, but it always kind of amazed me through this process that cancer was treated as an afterthought versus a definite possibility. I understand that, as a medical field, it is probably better to undersell issues like these rather than get people worked up only to find out it is not cancer. Ironically, this is kind of what I was doing with my friends by being dismissive about the situation, even though internally, I had already more or less accepted that I had cancer.

The doctor referred me for an ultrasound. I probably should have been more pushy in getting this scheduled, but I also do not deal with doctors often. She said the imaging office would call to get me scheduled the following day, and I assumed that was how things worked.

The next day, I had not received any calls by lunch time, so I called them. They said they were still processing orders and had not gotten any with my name on it yet. If I had not heard back from them by the end of school, I could call back to see if they had processed it yet. The school day ended. They hadn’t called, so I called back looking for answers. The person I spoke to said they had processed all of the orders for the day, and mine was not in there. This was my health issue and things didn’t seem to be moving as fast as I wanted. Exasperated, I sent a message to my doctor and asked if they could send another fax over. However, the office was closed by then, and they could not send one until Monday morning.

In my classroom, I have very little cell reception. To actually receive calls, you have to go outside, which does not make for easy scheduling in cases of emergencies. During morning meeting on Monday, I saw I had a missed call from what I assumed was the medical imaging office. In a totally calm and rational way, I excused myself, arranged for someone to watch my class, and politely stepped out to take the call.

Except not really. My anxiety was a little high at that moment and I was having difficulty formulating action steps. I asked the art teacher to watch them as I sprinted down the hall to make the call. I saw she was about to have a class come in, but one of my teammates offered to watch both classes. I got the ultrasound scheduled and arranged for coverage during the ultrasound time.

This was the first time I indicated to others in my school that something was wrong. I probably looked like I was running around like a chicken with his head cut off. I had been playing things pretty close to the chest up until that point, but this sort of let the cat out of the bag.

Roughly two hours after the call, I went for the ultrasound. I had not had one in recent memory so I didn’t really know what to expect. The nurse said she would step out to give me some privacy to change. I found this humorous because she was just going to come back in and see everything anyway, but professionals will be professionals.

During the ultrasound, she turned on this microphone feature to listen to the blood flow of each testicle. The right one (the unafflicted one) sounded like calming ocean waves. His brother, the concerning one, sounded like a pack of angry wolves chasing Liam Neeson. I took this as an indication that something was wrong, but the nurse said it wasn’t super alarming. “Easy for you to say,” I thought to myself.

After the ultrasound was done, she said she had to go consult with the radiologist to see if he was going to come talk to me or if she would share preliminary results. She came back saying that she was the one to share the news. There was indeed a solid mass in there, and that meant either inflammation or cancer. Again, to bring up my earlier point, I think they were grasping at straws for something other than cancer. She urged me to call my doctor to discuss results and said they would have analysis of the CT scan by the end of the school day.
More and more, I was gaining confirmation of the theory I had already begun to embrace: that I had cancer.I never got a chance to call my doctor because, around lunch time, she called me. Obviously, getting a call that quickly after the scan did not bode well in my mind. She again reiterated what the radiologist report said. She said it might be inflammation, but I had no other symptoms so it seemed unlikely to both of us. I was prescribed an antibiotic to rule out the slim chances of it being an infection, but I still didn’t put much leverage into that theory. She gave me statistics on incidence rates of testicular cancer in men of my age range. About half of testicular cancers occur in men between the ages of 20 and 34. She also added that the risk of testicular cancer among white men is about 4 to 5 times that of African-American men and that of Asian-American men. These numbers were significantly higher and more serious than I expected. I was told to call a local urologist to schedule an appointment for further consultation.

On Thursdays, I am chronicling my journey from discovery to the beginning of chemotherapy. To read through my story up until this point, please click here.[/vc_column_text][/vc_column][/vc_row]

December 13, 2016No Comments

TBT02: The Call

Editors Note: This post originally appeared on A Ballsy Sense of Tumor Blog

While I had strong intentions of making calls immediately when I returned to Virginia, I already had tons of commitments to attend to first. We picked up our puppy on Sunday, I had lesson plans to prepare, and my parents were coming on Thursday. I love being the center of attention when it’s my choice, but I hate being a burden to people so I will keep things in so I don’t upset other people. I didn’t want to make Mal worried when she was having her first week with her puppy, nor did I want to tell my parents about this issue quite yet. I decided to wait until they had left the following weekend to make calls. I continued closely monitoring myself and did not notice any major changes during these few days.

img_0838On top of this whole worry, we had just moved to a different area in Virginia. My primary care physician was still in Front Royal, which was about two hours from our new home. I had to find a brand new doctor and essentially ask them to fondle me on the first time. I usually don’t even kiss on the first date.

Of course, these are all excuses related to a much bigger issue. Society has such skewed visions of men talking about their health - we’re supposed to be seen as strong and able to heal ourselves. According to a 2016 study by the Cleveland Clinic, only three in five men actually go to their annual physical, and just over 40 percent go to the doctor only when they have a serious medical condition. 53% of all the men surveyed reported that their health just isn’t something they talk about, and 19 percent admitted they will only go to the doctor to stop nagging from their significant other, a point I can usually understand.

Simply put, most guys don’t like to go to the doctor. I am no different. In fact, I could probably be the poster child for not going to the doctor unless someone forces me. Towards the end of the last school year, I was unable to talk between a sore throat and feeling incredibly lethargic. I still refused to go to the doctor because I don’t like going to the doctor. Overall, I have been pretty healthy in my life, so I didn’t really see the need to waste two hours of my day filling out paperwork and answering routine questions from the doctor. Yes, I feel fine. No, I don’t have a cough. No, I’ve still never smoked. Yes, this is total waste of my time.

screenshot-2016-11-13-at-5-38-38-pm

source: health.clevelandclinic.org

However, what I was experiencing didn't feel on the same level as a sore throat. And, though I have a very healthy ego, I wasn't arrogant enough to think that something like testicular cancer could never happen to me. I started looking into statistics about testicular cancer occurrence in men of my age. What I discovered was surprising: about half of testicular cancers occur in men between the ages of 20 and 34.

I told Mallory I wanted to see a doctor, and after she was done commending me for actually agreeing to see one, she asked our neighbors for advice and they recommended a family practice close to our home. On October 18th, I made a call to schedule an appointment. Of course, being a teacher, the only time I could call was during my planning period. Calling the doctor and saying the word 'testicle' in school was a bigger concern to me than anything at that point, as sometimes students come back to grab a forgotten library book. Luckily, no one interrupted, and I made a doctor’s appointment for October 20th. It is a testament to medical practices how quickly they can get you in as soon as you say “lump in my testicle” (and also to be able to avoiding laughing while saying it).

screenshot-2016-11-13-at-5-38-29-pm

source: health.clevelandclinic.org

At this point, I knew I had to let more people in on this than just Mallory and me. Not out of desire, but mainly out of necessity. The first person I knew I had to tell was my principal, Brian. The whole reason we had relocated was because I had just started at a new school. It was not a conversation I was looking forward to, but do you blame me? I had worked there for barely a month, and I was about to go talk to boss about my balls. Again, usually I don’t even mention a kiss on the first date.

Talking about your testicles is an extremely personal matter, but it's an under-discussed issue. Men will avoid talking about it out of embarrassment, especially in a professional environment, which makes sense. It's awkward. But I've overheard women in the teacher's lounge and hallways openly talking about lumps in their breasts, thanks to a widespread awareness and acceptance of breast cancer. Why should it be different for men? Having these open conversations about testicular health, along with regular self-checks, is the key to early action.

Despite my initial fears of embarrassment and unprofessionalism, I told Brian about my medical concern and said I had made an appointment for later in the week. He was 100% supportive and has been this entire time. From the start, he has said, “Nothing is more important than your health. You take care of you, and we’ll take care of the kids.” That is truly the mark of a strong principal and further solidified my appreciation for making this choice to join this school.

As the date of my first doctor's appointment drew closer, for some reason, in my head, I already knew I had cancer.

On Thursdays, I am chronicling my journey from discovery to the beginning of chemotherapy. To read through my story up until this point, please click here.

December 5, 2016No Comments

TBT01: The Discovery

[vc_row][vc_column][vc_column_text]Editors Note: This post originally appeared on A Ballsy Sense of Tumor Blog

Field Day class selfie

Field Day class selfie

Friday, October 7th was field day. It was a fun time, and I even participated in many of the activities with my students. The glory of capture the flag and beating my principal, Brian, in a tire relay buoyed my spirits. Talk about making a good impression at my new school - by destroying Brian in front of my whole class and numerous parent volunteers. It was also a half day that day, which worked out well. After the students were released, I left school quickly. I had a flight to catch to Kentucky for my first ever shadow event for an EdTechTeam Google Educator Bootcamp. Not only would I be part of this event, but I would also be shadowing my Google for Education Certified Innovator mentor, which was the first time I would meet Donnie. Between field day, the early release, the excitement of the Bootcamp and meeting Donnie, I thought it was going to be such an incredible weekend.

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Meeting Donnie. I swear the shirts were unplanned.

Just kidding - my luck only got worse in the morning. As I was showering, I felt a suspicious lump in my left testicle. (As an aside here, the word testicle is funnier to me than ball or nut or any common vernacular, but I’m trying to be professional here). I knew the routine for self-checks.* They’re best done after a shower, when the scrotum is relaxed, and they’re pretty easy: just place your index and middle fingers under the testicle with your thumb on top. Firmly but gently, roll the testicle between your fingers. Any weird lumps or bumps should be checked out by a doctor. I knew the drill.How wrong I was. I don’t often fly, but 2016 has been the year I have traveled most. When I booked my flights for the Bootcamp, I chose what I thought was the closest airport. I was mistaken. However, I didn’t discover this until 10 minutes to departure at my gate in Dulles, the airport I was flying out from. Clearly, listening to an audiobook and chowing down on some Chipotle took precedence over verifying distances. I discovered that the airport was 25 miles from my hotel, and the hotel was 90 miles from the Bootcamp. Rightfully so, I started freaking out. Luckily, Mari (one of my friends) and Donnie helped me to settle down and get arrangements made. I knew making it to the Bootcamp would require lots of driving, but in the end, it would be worth it. The weekend started looking up.

I had grown rather attached to my testicles over the past 25 years (well, they were more attached to me) so, as I stood there in the shower, I knew something didn’t feel quite right.

This wasn’t the first time I had felt it either. In mid-September, in a similar showering episode, I had felt what felt to be a pea-sized hard lump. I thought back to my annual checkup (which I had neglected this year) and how the doctor always described lumps as something to take seriously. What I was feeling seemed to fit the bill.

[/vc_column_text][/vc_column][/vc_row][vc_row row_height_percent="0" override_padding="yes" h_padding="2" top_padding="1" bottom_padding="1" overlay_alpha="50" equal_height="yes" gutter_size="3" shift_y="0"][vc_column column_width_percent="100" overlay_alpha="50" gutter_size="3" align_medium="align_center_tablet" medium_width="3" align_mobile="align_center_mobile" shift_x="0" shift_y="0" z_index="0" width="1/3"][vc_single_image media="2870" media_width_percent="100" css_animation="zoom-in" animation_delay="200"][/vc_column][vc_column column_width_percent="100" overlay_alpha="50" gutter_size="3" align_medium="align_center_tablet" medium_width="3" align_mobile="align_center_mobile" shift_x="0" shift_y="0" z_index="0" width="1/3"][vc_single_image media="2871" media_width_percent="100" css_animation="zoom-in" animation_delay="400"][/vc_column][vc_column column_width_percent="100" overlay_alpha="50" gutter_size="3" align_medium="align_center_tablet" medium_width="3" align_mobile="align_center_mobile" shift_x="0" shift_y="0" z_index="0" width="1/3"][vc_single_image media="2872" media_width_percent="100" css_animation="zoom-in" animation_delay="600"][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]I told my fianceé, Mallory, about it, and she started getting a little anxious. Rightfully so, since the prior year, she had gone through a similar scare after finding a lump in her breast. It shook her to her core, but luckily it was determined to be something other than a tumor and she had it removed. I was hesitant to tell her, as I did not want to bring back bad memories, but I did anyway. I undersold the situation a little bit and told her between not being sure what it was and my old health insurance giving me very little coverage, I would continue monitoring it at least until my new insurance kicked in.

Or maybe my uneventful health history caused me to be less worried. Perhaps, because there was no "pain" associated with the lump (like many testicular cancer survivors mention), I thought it was nothing. To be perfectly honest, I felt 100% healthy and fine. Just a few weeks ago, I had completed a Spartan Sprint and was jogging in the mornings before school. I had no fatigue, headaches, swelling, fever, or anything that indicated I was sick. Either way, I didn’t feel anything at the time, so I apologized to Mal for working her up and put it out of my mind.

With over 50% of young men not knowing or being unsure about how to do an exam, consider sharing this post with the men in your life. (Source: Testicular Cancer Society)

With over 50% of young men not knowing or
being unsure about how to do an exam, consider
sharing this post with the men in your life. (Source: Testicular Cancer Society)

The following day, when I went to check myself again, I did not feel anything. Perhaps my skin had folded in a strange manner the prior day or maybe the lump had shifted in my scrotum and I couldn’t feel it anymore. Looking back, my decision to forget about my discovery for awhile could have been because I was just being a typical guy - ignoring a symptom because “guys don’t go to the doctor.”

Of course, I thought of that moment again on that fateful October morning in Kentucky. This time, as I checked myself in the shower, I definitely felt something, and it was bigger than I remembered. Whereas in September, it was one small pea-sized lump, this felt larger. There also seemed to be more areas of concern. For lack of a better way to describe it, think of a jellyfish wrapped around a rock (or, for you sci-fi fans, a face-hugger alien). Now, just a few short weeks later, that’s what it felt like around my left testicle. I knew I couldn’t put this issue off any longer. My insurance had just kicked in, and I needed to make some calls.

*Regular self-checks are the main way testicular cancer is detected early in men. It may be awkward to tell a guy in your life to "Go play with yourself," but it could save their life. Please take a moment to share this post with as many men (of any age) as you know. Like I said, I felt perfectly healthy, and the only indication that something was wrong was the lump. This may help them to think about it more seriously. Leave their reactions in the comments below. 
On Thursdays, I am chronicling my testicular cancer journey from discovery to the beginning of chemotherapy. This is the first post in the series.
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October 17, 2016No Comments

Decisions, Decisions

Close your eyes and read this passage.  Ha Ha!  Seriously, though, read this passage:

You're driving down a two-lane road in an unfamiliar area at night.  The road ends in a ‘T’ with another two-lane road.  You look left, you look right.  The moon is low, the stars are few; the road is dark in all directions.  Which way do you turn?

You’ve just been diagnosed with an aggressive type of testicular cancer.  You have to decide: Chemotherapy, Surgery, Radiation, or Sit and Wait.  Which way do you turn?

This is easily the most common question new patients and their loved ones ask the online support groups: “I just found out I have testicular cancer...what kind of treatment should I have?”

We make hundreds, maybe thousands, of decisions every day.  Yesterday I had to decide what time to wake up, whether to shave, what to wear, what route to take to the doctor’s office, what kind of coffee to drink, where and what time to play golf, what to wear golfing, where to park, what to drink, which club to use, etc…

The countless daily decisions are normally pretty easy; a few well understood choices, predictable outcomes, unimportant consequences.  

Plato believed an individual's responsibility to society was a cornerstone of decision-making; thus, I probably should not wear a striped shirt with plaid golf shorts.

Adam Smith believed we make decisions based on our own self-interest and the social or macroeconomic results of those decisions are rarely considered.

John Maynard Keynes believed our decisions are the result of our ‘animal spirits’.  This is my animal spirits shirt (courtesy of NPR’s Planet Money):

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Albert Carter and Abe Bookman believed decision-making was the purview of cryptic messages in murky blue water:  Magic 8 Ball, will people still like me if I wear socks with sandals?

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Oh.

Back to the turn...do you go left or right?  

Without knowing what awaits you in either direction, even a simple decision can become difficult.  So what happens when the decision isn't so simple?  What happens when a once trusted body part turns against you, attacks from the inside, threatens to grow and grow, invade and destroy your brain and heart and lungs?  Time is a factor-what do you do?  How do you possibly make that decision?

Have you ever had this conversation?

“What do you want to do for lunch?”
“I don’t care, whatever you want.”
“Well, I’m not picky so it’s up to you.”
“I’m up for anything.”
“Fine.  Let’s get burgers.”
“I don’t want burgers.”
“Then what do you want?”
“Anything you want is fine.  Except burgers.”
“Thai?”
“Not Thai.  Anything you want is fine.  Except burgers or Thai.”

Eventually you give up and eat a stale fortune cookie from the back of your desk because you spent the entire lunch hour arguing about where to eat.  And the little scroll inside reads, “Be happy today.”  How is that even a fortune?!?!?!

If we vacillate so much for something as inconsequential as lunch, how are we expected to make an intelligent decision about cancer treatment?  Almost none of us is an oncologist or urologist or medical researcher.  When I was diagnosed with Stage II testicular cancer in December 2012 I wasn't a doctor.  I was a loadmaster in the Air Force.  What’s a loadmaster, you ask?  A uniform full of awesome.  

The Air Force has some big cargo planes.  Without question, the best and most versatile and sexiest of those cargo planes is the C-17.  You can’t argue with that; it’s science.  The loadmaster is the member of the flight crew who decides where and how cargo gets loaded onto the plane, calculates the weight and balance of the airplane,and airdrops troops and cargo onto battlefields.  Loadmasters bring joy and class and spendable per diem to Irish pubs and gin joints the world over.  Loadmasters do not treat cancer.

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Instead, we (smartly) turn to the men and women with education and experience.  Years and years of education and experience, in fact, treating hundreds of patients.  But strangely, ultimately, the decision is the patient's to make.  And therein lies the absurdity.  One person has years of schooling and experience, an intimate understanding of biology and disease and treatment options, and access to technology and tests and peer expertise.  The other person has Google.  

You may have heard of this guy named Hippocrates.  Something like 2,400 years ago he came up with a set of ethical rules for doctors.  Things like “Treat the sick” and “Abstain from harm” and “Don’t go chasing waterfalls.”  He also advised doctors to “conceal most things from the patient while...attending to him.  Give necessary orders with cheerfulness and sincerity, turning his attention away from what is being done to him...revealing nothing of the patient's future or present condition.”

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I completely understand that.  Thanks to the magic of WebMD and Facebook, everyone with a smartphone is suddenly a medical professional.  Most people will search the depths of the World Wide Web until they find the answer that works best for them or they crowdsource treatment opinions from their almost-certainly-not-a-doctor Facebook friends.  Too many people with Internet access want to validate their pre existing opinions or find an explanation that best fits their usually fantastical world view.  Except the Galaxy Note users.  They just want to watch the world burn.

So then, it stands to reason and logic that we should defer to the experts.  They say “chemo,” we say “which arm, doc?”  Except that’s not what happens.  

Hippocrates would have hated Informed Consent, the idea that a doctor educates the patient and provides options; the patient makes the decision.  But that makes sense, too, because the doctor doesn’t know my personal situation.  The doctor doesn’t know my family situation or economic situation or professional situation.  The doctor knows which treatments have what percentage of success, and can make great medical decisions in a vacuum.  But life doesn’t exist in a vacuum, can’t exist in a vacuum.  Except the water bear; those wacky bastards can survive anything.  

And so it was I found myself facing a decision at the end of 2012: Chemotherapy or Surgery?  What is a loadmaster to do?  Turn left or turn right?  

The answer to that, and much more in Part 2.

October 5, 2016No Comments

The Importance of Catching Testicular Cancer Early

[vc_row][vc_column][vc_column_text]Testicular Cancer is known to many as “the young man's cancer.” It can strike in the midst of some of the most carefree times of life. Take a minute and think about the day-to-day stressors you faced during your high school years. I’m willing to bet that cancer, or dying from an illness, was not likely on the top of the list.

For me, the stressors were girls, a rogue pimple, school dances, football games, friends, and excelling at my passion, cycling. Time flies at that age and the FOMO (fear of missing out) is more real than ever. Something like being grounded for getting a speeding ticket was just about as devastating as getting cancer – trust me I know; I have first hand experiences with both.

At the age of 19, testicular cancer was the last thing on my mind. When the doctor uttered those three words “You have cancer.,” my mind immediately started to race. The first question that should have raced through my teenage brain was “am I going to die?” but it wasn’t. It flashed from “Is my cycling career over?” to “Am I going to miss the USA National Championships next week?” I was more worried about what I was going to miss out on than dying and repercussions a cancer diagnosis could bring. I realize that is likely due to teenage naivety, not knowing the reality of the situation, but that was my thought process (and is likely the same for many diagnosed at a young age).

I quickly had surgery. With evidence of the cancer spreading, chemotherapy immediately followed. If you were wondering, the experience was a tad worse than that $700 speeding ticket and being grounded for the weekend. Chemo sucked. Having a bald head in the dead of winter really killed the chill. The nausea, loss of appetite, and bag of bones I became were also less than ideal. What really cut me to the core was watching all of my friends continue on with their lives, relationships, college, and cycling careers. It ate at me that if I would have caught it earlier, if I would have known to do a monthly self exam, a simply surgery could have been the only treatment needed.

My point is… that if the thought of getting sick, having radioactive poison coursing through your veins, being split open for sternum to belly button from an RPLND surgery, losing your hair, and any ounce of strength you once had cannot get you or a loved one to perform a monthly self exam, maybe the thought of losing your precious time, missing out on that football game, weekends with your friends, missing out on college, and putting your passions on hold, can.

I am extremely grateful to be healthy and living a full life post treatment. My cancer experience taught me more about myself, my capabilities, and what it means to suffer. Above all else, it has taught me how precious life truly is. I want young men to understand how simple a testicular cancer diagnosis can be. I can’t get that time back, but I have since dedicated my time to insure other young males know what I didn’t. Take 60 seconds and perform a monthly self exam. [/vc_column_text][/vc_column][/vc_row][vc_row row_height_percent="0" override_padding="yes" h_padding="2" top_padding="1" bottom_padding="2" overlay_alpha="50" gutter_size="3" shift_y="0"][vc_column column_width_percent="100" align_horizontal="align_center" overlay_alpha="50" gutter_size="3" medium_width="0" shift_x="0" shift_y="0" z_index="0" width="1/1"][vc_button button_color="accent" size="btn-lg" link="url:http%3A%2F%2Ftcfsemplice.wpengine.com%2Ftesticular-self-exam%2F||target:%20_blank|"]Learn How[/vc_button][/vc_column][/vc_row]

September 19, 2016No Comments

From Now On…

From now on we live in a world where man has walked on the moon. A simple yet profound quote by astronaut Jim Lovell after Neil Armstrong’s famed first steps on the lunar surface. Lovell understood the world had fundamentally changed, as had the path of humankind. I’d like to say I know the quote because I have extensive knowledge of the US space program but the fact is Tom Hanks repeated the line in Apollo 13; movie quotes are easier than real life.

I was in high school when that film came out, but the line stuck with me and I found it particularly appropriate after my February 2013 RPLND, though slightly paraphrased: From now on, I live in a world where I had cancer. This is what I was thinking when I returned home after 8 days in the hospital. My world had fundamentally changed, my path altered to a new paradigm I’m still trying to figure out.

See, this is what they don’t tell you. Doctors are great talking about statistics and treatment options and referrals. They will explain in detail how they are going to slice you open, move your organs, cut through layers of muscle and fascia tissue (while you’re in there, can you deflate some of those love handles? No? Seems like a reasonable request...), and cut out parts of your lymphatic system. They are great at telling you that you should consider freezing sperm and that you may be more susceptible to catching colds and you may have side effects like retrograde ejaculation and pain. Lots of pain. But they don’t tell you that your life will never be the same. In other words, “you’re not the same, you’ve changed” (am I the only one who saw Mallrats?)

I was so very naïve about the impact this disease would have on my world. I was an Air Force aircrew member when I was diagnosed; I figured 6-12 months and I’d be back flying missions. That’s one main reason I opted for surgery instead of chemotherapy: fewer barriers to getting back on flying status (something to do with potential pulmonary complications from the Bleomycin, I think). Because I never for a minute thought I was done flying. And it wasn’t as if the doctor was saying, “hey man, you should know you may never fly again, and you may have trouble sleeping for the next, well, lots of years...you know, life's going to change. A lot."  They don't tell you that. But of course, that’s what happens

Doctors are great about getting you through treatment, and your friends are great about bringing you fried ravioli and Golden Girls on DVD (the complete set!). But what about the rest?  Here is an abridged list of my experiences:

#1 - explaining this 18-inch skin zipper every time I take my shirt off (hot tubs, saunas, the DMV...). Being naturally hairless in the abdominal region ensures the scar remains conspicuous and glaring.

#2 - asking a bewildered hotel desk clerk if they have a sharps container because I'm about to make it rain syringes of testosterone!

#3 - inability to perfect a golf swing because my abdominal muscles have been severed three times. This is, perhaps, the hardest thing to deal with.

#4 - a conversation with a surgeon following a post-RPLND operation in which I was told, "it was harder than we expected because none of your organs are where they are supposed to be (RPLNDs displace your internal junk, to the apparent consternation of non-cancer surgeons).

#5 - assuring friends that one testicle does not make me more aerodynamic. It is, oddly, easier to accidentally sit on your junk when you're a single and not a duo, though.

#6 - a slight annoyance that breast cancer is talked about openly but some people think my testicles aren't appropriate for polite dinner conversation.

#7 - awkward exchanges with acquaintances. Them: "hey, I heard you had some health stuff..." Me: " I had a touch of the cancer in my right testicle. Want to see the ultrasound?"

The point is this: cancer changes your life. It can be hard to admit that. It was tough to admit my flying career was over, and it was tough to admit my body wasn't producing testosterone and I would have to get over my fear of needles because guess who gets to inject himself every week!?!?

But cancer did not stop me. Cancer took my career. I’ve accepted that fact and am moving on. I'm starting a new job soon that I'm pretty excited about. Cancer took my testosterone. Ok. But I have syringes and alcohol pads and every week it gets a little easier to shove a needle in my leg. Cancer took my sense of immortality. In return, I gained a stronger love of experiences and, ironically, a desire to live a fuller and sometimes riskier life. And cancer saddled me with a 36-golf handicap. At least, I tell my friends it's cancer's fault

Naïveté wasn’t my only sin. Hubris, ego, and an inflated sense of immortality (even at the ripe old age of 34) kept me from seeing the most basic truth: cancer is what happens when you’re busy making other plans. Rather than being a detour, cancer can be a "road closed" sign. That's the reality of it. The paths you are on personally, emotionally, financially, professionally...they are about to get very, very bumpy. And some may fall apart altogether. Do you try to recover a lost path? Or do you forge ahead and blaze a trail you hadn't seen before?

I have a scar. Admittedly it looks kind of cool. More importantly, it's a great segue to start a conversation about TC with someone and remind them to always check their junk.

September 19, 2016No Comments

Zak Pendleton’s Story

There I was on May 10, 2016 in a routine physical exam. My real intention behind the appointment was just to get it out of the way so I could keep a discount on my monthly health insurance premium.

During the appointment, I wondered why we even had to go through the interrogation about my health. “I’m healthy” I thought to myself. I was preparing to do a 100-mile cycling ride in four days and for the most part felt ready to go. “Anyone who can ride 100 miles on their bike doesn’t have to worry about a medical exam.” I told myself.

Then, the physician assistant asked me if I did self-exams. “Um, well, yeah, I do. I mean I’ve looked at myself and felt down there.” I bumbled. No problems here, I reassured myself in my mind. Nonetheless, we proceeded to do an exam. For as long as I remember, I've had one testicle smaller than the other. The physician assistant mentioned there could be reasons for the size difference. They might have to do a minor surgery and the testicle may even grow back to the same size as the other one. So, we scheduled to have an ultrasound done to see what the issues could be.

Three days later, I had an ultrasound. Nearly an hour after, a call came. It was my physician assistant telling me that the ultrasound staff had called him quickly after I left. He explained they had noticed a mass. A mass? I thought. What kind of a mass? Then, he said that word. Cancer. “This could be cancer”. He scheduled an appointment with the urology clinic to confirm things.

The thoughts came racing in. Am I going to lose my hair? Will I have kids? What does testicular cancer even mean? And, what does it mean for me?

The urology appointment included a blood test for elevated tumor markers and a chest x-ray. Both came back negative. Surgery was the next step to remove the testicle.

On July 7, 2016 an inguinal orchiectomy was performed and that smaller traitor of a right testicle was removed. After a couple of weeks I was back doing things I enjoyed doing to stay fit.

I was and am lucky and blessed. The cancer does not appear to have spread to anywhere else in my body. I’m in Surveillance. This involves blood tests, chest x-rays, and CT scans on a prescribed schedule to monitor if any cancer shows up. A benefit for me was the support around me. Family, especially my Mom, friends, church leaders, and co-workers have all been supportive and have helped me. Having this support and the understanding that I’ve been blessed with catching things early, I’ve felt a need and desire to be an advocate for those with cancer and to be an advocate for awareness of about cancer, especially types of cancer that can affect males. I was fortunate to discover the issue before it became anything worse and that is why I will be supporting educational efforts to help others do the same. I plan to utilize the resources of the Testicular Cancer Foundation to educate others. My hope is to help others catch things early like I have.

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12600 Hill Country Blvd, Suite R-270 Austin, TX 78738 • info@tcancer.org • 855-390-8231

© 2017 Testicular Cancer Foundation, a 501(c)(3) registered nonprofit | Privacy Policy