Thursday, December 15, 2016

TBT03: The First Visit and Ultrasound

“About 1 in 250 Men Will Develop Testicular Cancer. Of Course, that Statistic is Irrelevant if You’re the One.”

Our engagement pictures were taken between the
visit and the ultrasound. On the outside, life was
looking pretty normal. 
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. This was even easier than making that initial call to the doctor.

My first doctor experience in many years

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.

Having a hard time finding my testicular lump

Initially, she had an issue with finding the lump on my testicle. 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 (and had felt it for the first time a few weeks prior). 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.

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.

My testicles need an ultrasound... But first, lots of calls and waiting...

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.

Finally, my testicles get an ultrasound

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 bloodflow 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.

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.

More and more, I was gaining confirmation of the theory I had already begun to embrace: that I had testicular cancer.

Click here to read the next part of my story, in which I visit a urologist.

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.

A self exam is how most cases of testicular cancer are detected early. Click the image for video directions or click here for a larger version

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  1. An interesting experience. For the benefit of others, I'll post my Australian experience (each countries health system is unique, after all). I visited the doctor due to swelling and pain. Had an older male doctor give it all a check. I was given antibiotics, but told to get an ultrasound as well. I booked in the ultrasound for the next day. I definitely wasn't looking forward to the experience. Of course it turns out to be a young lady conducting the ultrasound. I had the same moment of 'privacy' change. As I said to her, if my wife could go through all the tests for birth, I should be able to cope with this. Wiping off the jelly was disgusting. She was very neutral, but it seemed clear to me she knew something was up. I received the images shortly after with a letter. I didn't read that, but I could see the differences between the testicles easily. The right one was clearly stuffed. A weird mix of textures. I was certain it was cancer at that point. I went to the doctor the next day. The ultrasound letter made it pretty clear that cancer was likely. The doc faxed through a request for an appointment with a specialist to the main hospital in my city as their main phone line rang out.
    I waited a couple of days without an answer. I called and they had already made an appointment, but sent out the details in a letter that took a couple more days to arrive. Luckily they were able to tell me the time on the phone. I saw the specialist a week after the doctor appt. Again got a quick feel up (by a male). He was certain it needed to go as cancer was very likely. I had to fill out lots of paperwork and would be contacted for what to do next, except I needed a CT scan.
    I was given a place to go and called them. I told them I needed it quickly and was able to book a couple of days away. They did a chest, abdomen and pelvis scan. This was to see if there was any visible issues elsewhere. I believe especially in the lymph nodes. The result was forwarded to the hospital and I'd find this out later.
    I was called and asked to attend a preop appointment where I was weighed, urine tested and a few other things. The big bit was that I saw an anaesthesiologist who give the bare basics on the surgery and recovery. Plenty of questions re allergies. At some point I had to get a blood test done at a pathology centre, a quick in and out process. I think I was given the surgery date with the call for this appointment, but I can't remember. Surgery was three days in the future.
    So, sometimes there were gaps, but it felt like it was moving forwards. The worst bit was the hospitals method of communication. Give me emails or SMS any day! I did have some initial worries about reaction to being touched, but I think it is fair to say that situationally, it was about as unsexy as you can get.
    2 days until chemo...