Wednesday, April 30, 2008

I Am Humbled

Day 3 of chemo.

Well, this is no surprise, really, but any dim fantasy I entertained about breezing through this process has been quickly dispelled. Nothing too bad in the side effects department: just a general feeling of malaise and a sense that my insides are in a delicate balance that could go screwy any minute.

The major nastiness so far was a demoralizing and extended bout of acid reflux last night. I started taking some Prilosec (per my nurse's instruction), which seems to have knocked it down.

I am feeling pretty good just at the moment, so let's hope that that holds up through the evening.

Monday, April 28, 2008

Drip. Drip. Drip.

Wipe that smile off your face, you prick.

So, I came into the clinic today and heard some good news: all my tests from last week (bone scan, brain MRI, CT scan) came up negative -- although the brain MRI revealed a ball of snot in my sinuses. It may be time for a rinse.

It isn't pretty, but it works.

So what's it like to get chemo? Well, it depends on what mixture of drugs you're receiving and what supplemental infusions those drugs call for. In my case, chemo (at least during the first week of a cycle) is like 6 hours in a clinic -- a nice enough clinic, but a clinic nevertheless, with the attendant sterile sights, smells, and sounds of a clinic.

I sit in a recliner with an IV hooked into my port. The IV drips stuff fluid into my bloodstream slooooooooowly (not just chemo drugs, but saline and anti-nausea medications). It's important to keep track of my kidney function, so -- fie on this new wrinkle -- I have to piss into a plastic jug and note the volume before pouring it out into the turlet.

The nurses are very nice, though.

Here is some video of me at a fancy dress party last night. Enjoy!

Saturday, April 26, 2008

Ported and Ready to 'Mo

The port is in. I have been testing it at home, injecting and extracting fluids into and from my body all day.

INJECTIONS: Olive oil, mustard, dish soap, baking soda, bacon grease, angel dust.

RESULTS: Feelin' great!

EXTRACTIONS: Blood, mostly.

RESULTS: A little light-headed.

There's only today and tomorrow standing between me and chemotherapy. While I'm not looking forward to feeling like I have a nine-week hangover, I am eager to kick this fucking cancer right in the balls. (Tit for tat!) There's wireless internet in the infusion room, so I pledge to report diligently on how I'm feeling.

In the meantime, you should spend twenty minutes laughing your ass off at this superb and hilarious effort.

Thursday, April 24, 2008

In Praise of My Copious Seed

I called the cryobank this morning to inquire into their analysis of my "sample" from yesterday. (The bank analyzes your sample and, depending on your count and your motility, divides it into separate vials. Each vial represents on "shot" of viable sperm that you can withdraw later.)

Sometimes people need to make multiple deposits in order to get a sufficient number of vials, which is why I needed to check in. No worries, as from my sample they were able to successfully extract FIFTEEN VIALS OF MAN-SEED. That's with one (1) testicle. The guy said that my overall count and motility were "significantly above average."

I am the mighty Nile River, drenching the soil with my floods. Eat that, you daffy motherfuckers.

That is the best news of the day. In other news: I got several tests today, including an MRI of my brain. All I could think about in the MRI machine as it clicked and thudded away was Einsturzende Neubauten:

Tuesday, April 22, 2008

I'll Be More Machine Than Man, Twisted and Evil

Yesterday, I met with the surgeon who will be installing my port on Friday afternoon.

This is a nifty little device -- a catheter that runs into a major vein near your heart plus a little dome connected to the catheter. The dome is implanted under the taut skin around your collarbone. This allows easy access to your circulatory system for both injections and blood draws; the nurse sticks the needle right into the port and you don't feel a thing. Or you shouldn't, anyway. It's a must for chemotherapy, as I'm told you get needled approximately 12,309 times per cycle.

The port will technically make me a cyborg, or "robo-cop."

Scheduling the 20-minute surgery to get the port installed has been proven the most bureaucratically infuriating ordeal of my cancer experience thus far, involving multiple calls back and forth between different extensions at Seton Medical Center, the surgeon's office, etc. But it seems that we're on for Friday at noon.

Also! This morning I deposited some man-seed at the cryobank as insurance against the chemotherapy (maybe, potentially, possibly) leaving me infertile.

The best thing about sperm banks (in my one-time experience) is how delicately the staff tap-dances around the essential fact that you are there to jerk off into a cup. The two euphemisms used repeatedly were "produce the sample" and "take you to the back room." The former sounds like all work and no fun; the latter sounds like detention, interrogation, or torture.

I must add: though this was a very nice facility with a very helpful staff, their collection of wank material was unsatisfactory. Listen up, fertility labs/cryobanks! You cannot bring the same lackadaisical approach to your spank mags as you do to the junk in the waiting room! Stroke books are not an afterthought; they're an essential tool of your trade. A half-dozen tattered Penthouses will not do. Variety, please! Different guys, different tastes! (Also, whatever it once was, Penthouse is now a hardcore Maxim where every pictorial is cut short for a comparative review of rancid body sprays.)

A final note: last night I made a very stupid pledge that on the first evening of every chemo cycle I will watch National Treasure to boost my spirits. I say "stupid" because I'm not sure that even my all-consuming affection for the movie will survive an eternal association with chemotherapy.

So, while my love for it is still strong, let me (for the 27th time) explain why National Treasure is awesome:

1) The word "treasure." The word is used an average of once per minute in the movie. By grown men. And it's one of those magic words that takes on its own comic force the more it's repeated. TRAY-ZURE.

2) The treasure itself. The treasure they are looking for in National Treasure is a storehouse of every lost and valuable artifact of every human civilization ever. It is the treasure, a maximization of the very concept of treasure.

3) Nicolas Cage. Seriously, who the fuck is this guy? I once knew the answer to that question: an off-beat actor who fit nicely into quirky movies like Raising Arizona. Now I guess he's the leading man you call on to sleepwalk through your movie when no one else will do it.

But how the hell did a guy who looks like a wax dummy with a bad toupee become leading-man material in the first place? Isn't the basic guideline for a leading man "men want to be him, women want to be with him," not "neither men and women would be shocked to see him rummaging through a dumpster"?

I mean, Jesus Christ, look at this ghoul!

4) Watching Nicolas Cage act and narrate "thought." There is immense pleasure in watching Hollywood's laziest furrow his brow and mumble his way through the solution to one inane puzzle after another. "'Seeing twice' ... 'seeing twice' ... to see ... focus ... focusing twice ... look again? ... no no ... twice ... BI ... bi ... focus ... bi-focals ... Ben Frankl -- IT'S IN THE LIBERTY TOWER!"

5) Him:

I have no idea who this actor is. To my knowledge, I have never seen him in another movie. But he is the sidekick in National Treasure. And his anti-triumph is that he is the lamest sidekick ever. He is so bland that he could be an art-terrorist exploding the notion of Comic Sidekick. He responds to every situation with sarcasm so canned that it wouldn't pass muster in an old Head and Shoulders commercial. He is the human Alf.

6) The movie re-contextualizes every important event in American history as an attempt to either conceal or find treasure.

I could go on. Jesus, could I go on.

Monday, April 21, 2008

The Course Becomes Clear

Let it be known: I meant no serious disrespect of Mr. Bon Jovi in my last post. It would be rank hypocrisy from me to dismiss JBJ entirely, as I have been known to throw the fuck down on the dancefloor when "You Give Love a Bad Name" makes its always-predictable-and-always-welcome appearance on someone's nostalgic mix CD. BUT. JBJ is associated with the creation of precisely 2.5 good songs, all of which appear on one album. ("Wanted Dead or Alive" is fun, but only counts as half-good because rock and roll was technically not illegal in 1986. The song is misleading.) On the other hand, Bruce Springsteen, no matter what you think of his music, is a Big Deal.

A middling late-career effort.

Also, JBJ's first professional appearance on a record was on Christmas in The Stars: A Star Wars Christmas Album. And that album actually wasn't good!

OK, on to the cancer stuff.

Met with my oncologist today (Dr. Beth Hellerstedt of Texas Oncology -- she's awesome), and the news is mostly pretty good. Not great, but good. The CT scan showed some swelling in a few lymph nodes ... the biggest one swollen to 3 cm. That means that my cancer can be staged as clinical Stage II B testicular cancer. (There's some nice info on TC staging here, if you've a mind to peruse it.)

So Dr. H laid out the options: surgery or chemotherapy. Neither of these are particularly pleasant, so the thing to do is see if you can't avoid one or the other. If I got the lymph node dissection surgery, there would be a 30-35% chance I'd need chemo afterward (2 cycles). If I got the chemo (3 cycles), there would be a 10-15% chance I'd need surgery afterward. On that basis, Dr. H said she'd be more inclined to recommend the latter option. Considering that I can take the chemo as an outpatient right here in Austin, that I am young and can probably get through three cycles without being hit too hard, and that I am more wary about getting cut open and spending 3-5 days in a hospital with tubes up my nose and my dick, I have decided to move forward with chemotherapy. BOO YAH.

And that means I will be a busy boy this week:

TUESDAY -- Meet with the surgeon that will be installing my nifty port so that I don't have to have my limbs poked all to hell over the next 9 weeks. (We'll have to figure out when to schedule the surgery itself; it's a fifteen-minute-or-so procedure but they still have to put you out for it.)

WEDNESDAY -- Drop by the cryobank to deposit my manseed. A lot of guys regain their fertility after chemo; a lot of guys don't. This is my insurance policy in case I decide one day to bless a new life with my prone-to-testicular-cancer DNA.

THURSDAY -- Tests galore! All to make sure that the cancer is, in fact, confined to my lymphs for the moment. CT scan of my chest, MRI of my brain, and a "bone scan." And then, at 4:00 PM -- Chemo Class! I can only hope this will involve an instructional videotape with an anthropomorphic narrator, like Carl the Chemo Crab.

FRIDAY -- Another meeting with my Urologist, the estimable Dr. Brett Baker, just to make sure I am on the right course.

And then the following MONDAY -- Chemo begins at 8:30 in the morning.

So you may be curious ... how does this thing they call chemo work?

Well, chemo is, as my friend and cancer-boy-in-remission Tom W. (well-known to some of you) puts it, "straight-up poison." It's toxic stuff they put into you that just happens to be much better at killing rapidly dividing cells (like cancer, but also innocent victims like hair and stomach lining) than it is at killing normal cells. I.e., taking chemo is badass and makes you like the kid in elementary school who drank Formula 409 to prove himself king of the playground. (I do not know that this kid actually exists, but let us posit his existence.)

The chemo regimen for testicular cancer is pretty light, comparatively speaking. 3 cycles of BEP (Bleomycin, Etoposide, and Cisplatin). Here's how a cycle works:

In the first week, you receive chemo for about 6 hours a day, Monday through Friday.

In the second week, you go in two days a week (as I recall) for a one-hour infusion. The second week tends to be the one when you feel the crappiest.

In the third week, you rest up for the next cycle.

So so so. That's enough cancer talk for now.

Now, watch this video:

My thesis was on Beckett. This video is better than my thesis.

Also: Forgetting Sarah Marhall? Really good!

Wednesday, April 16, 2008

Inaugural Post, In Which Our Hero Receives a CT Scan, Contemplates the Near Future, and Turns to The Boss for Comfort

Yesterday was my CT scan, the first concrete thing to happen to me since receiving the results of my pathology report. No big deal. "Iodine-based contrast" now goes on the list of things I have taken through an IV, a list that was pretty short two weeks ago and is rapidly expanding.

The results of the CT scan are the last piece of the puzzle necessary for me to meet with an oncologist (I already have an appointment scheduled for Monday) and settle on a course of action.

Let me back up for a second. The pathology report on my cancerous left testicle revealed several things, some of them good and some of them not-great.

(I like to say "not-great" signs rather than "bad" signs, because it's important to keep in mind that even in its more dire forms, testicular cancer is extremely curable. These "not-great" signs don't mean I'm screwed, not by a long shot; they just mean I may not be one of the lucky bastards that need no further treatment after the testicle is removed.)

To wit:

The tumor was confined to my testicle; it had not begun to spread up the spermatic cord. GOOD SIGN.

There was lymphovascular invasion; i.e. the tumor had access to my bloodstream and, thus, a way of accessing the rest of my body. NOT-GREAT SIGN.

The tumor was pretty small. GOOD SIGN.

Part of the tumor was embryonal carcinoma, a cancer that tends to spread pretty aggressively. NOT-GREAT SIGN.

... but only 40% of the tumor was embryonal carcinoma. Not too bad. GOOD SIGN.

(Not technically part of my pathology report, but relevant:) The tumor markers in my blood were not elevated before the removal of the testicle. GOOD SIGN.

So: I'll be meeting with an oncologist on Monday. I know that it's going to come down to three options:

1) If the results of the CT scan are good, I could go on surveillance. This means that for a year, I get a cancer screening every month to see if anything is recurring. Screenings can become less frequent as the years go by. However, the oncologist may decide that, given the specific types and proportions of cancer cells located in my testicle, more aggressive treatment is needed.

2) RPLND surgery. This is a common but pretty intense procedure (it puts you in the hospital for a few days) where your "retroperitoneal" lymph nodes are removed. This allows the doctor to more accurately gauge the progress of the cancer and is, in itself, frequently sufficient to cure it.

3) If the cancer is deemed (or suspected of being) sufficiently advanced, chemotherapy.

For now, it's just more waiting.

Last Sunday in Dallas, I saw Bruce Springsteen, a show I had had tickets for well in advance of any of this nonsense. Energetic! As ever, I was struck by his ability to push (so, so far) toward the precipice of schlock and then charge back and wallop you with moments that make you lose your breath. Ultimately, that's what I love about the guy: he understands people's need to have epically oversized emotion in their lives and sets about satisfying it as honorably as he can.

Ain't no sin to be glad you're alive!

Oh yes. Jon Bon Jovi showed up for some damn reason:

(Well, he was playing a gig in Dallas the next day ... still, Bon Jovi? Jersey camaraderie must supersede all other considerations.)