Wednesday, March 20, 2019

PCL47: Nathan Adrian - Eight Olympic Medals, One Ball, and a New Important Goal

Olympic Swimmer Nathan Adrian Shares His Experience With Testicular Cancer and His Goals Moving Forward

Recently, Nathan Adrian, an Olympic swimmer, posted on social media that he had testicular cancer. I immediately reached out to him and he responded just as quickly! He agreed to do an interview with ABSOT to share his own testicular cancer story and his newfound mission for men’s health awareness.

ABSOT: Tell us about yourself before your shocking diagnosis of testicular cancer.

Nathan Adrian: “I am 30 years old. I have been to 3 Olympics (2008 in Beijing, 2012 in London, and 2016 in Rio) for various swimming events, winning eight medals in all. I finished up eligibility in 2011 and turned “pro” shortly after that. Life for me was eat, train, sleep, repeat for a majority of that time until after the 2016 games.

Nathan at the Rio Olympics 2016
image credit: E! Online
I don’t think I am doing a good enough job, however, to describe how much I did and still do love swimming. It almost seems like you are listening to a broken record to train all year long just for a single chance at the end of the year to go for a best time. However, it was the puzzle aspect of it all that fascinates me. How do we optimize training so we can find a way to go .01 faster at the end of the year?

Anyways, life leading up to diagnosis was going great. I was engaged in 2017 and married in 2018 so as you could imagine my life changed quite a bit, but all things for the better. We had gotten married a couple months before and moved into a new house in Oakland. We were ready to leave the craziness of San Francisco behind and I wanted to be closer to Berkeley where I train everyday.”

ABSOT: What symptoms or signs of testicular cancer led you to go to the doctor?

NA: “I actually didn’t notice anything was wrong until I accidentally hit myself and it hurt a lot more than it should have. At that point, I figured that for whatever reason my testicle was just swollen maybe from hitting it or whatever else it could have been but I needed to keep an eye on it.

So a few days go by and the pain goes away but the swelling does not. I figured, ‘Hey something is getting better I guess. I am on the right track.’ Yet, the swelling/hardness never goes away. After another week or so, I decide it is time to go in to the doctor to figure this out.”

ABSOT: How fast did things move once you got the ball rolling?

NA: “Once I was at the doctor it went pretty fast. Not quite as fast as some people that I have read about but certainly not the slowest. I was put on antibiotics in case it was an infection but my doc wanted me to get an ultrasound and an appointment with the urologist ASAP just in case. If the ultrasound went well and the antibiotics cut down on the swelling then we could cancel the urologist appointment and go on our way.

Nathan after surgery
As we all know now, the ultrasound showed a mass and the urologist appointment confirmed that it needed to get taken out but my urologist was semi retired so he didn’t do surgery anymore. He got me into another urologist he recommended and the surgery was the next week.

I think the sequence went as follows:

  • Monday - PCP appointment
  • Tuesday - Ultrasound
  • Thursday - First urologist appointment
  • Monday - Second urologist appointment
  • Thursday - Orchiectomy

After the orchiectomy, I also did a laparoscopic RPLND [retroperitoneal lymph node dissection surgery - a surgery to removed affected lymph nodes] as well just to try and cut down our chance of recurrence as much as we can surgically. The procedure took 3.5 hours instead of the 1-1.5 hours the orchiectomy took, but I have to say the recovery from the L-RPLND was easier than the orchiectomy since the incisions were only about 1-1.5 cm across, rather than the 3 inch incision from the orchiectomy. There were 4 of them, but I would take 4x1cm incisions over a 3 inch one anyday based off of this experience.”

ABSOT: How was recovery from the surgeries?

NA: “Recovery went as well as it could go. I did do the low fat diet thing which was probably the worst part of recovery from either surgery. I really thought sticking to the diet wouldn’t be a problem at all but just eating carbs and protein leave you so unsatiated! After a couple days I started feeling super cloudy in my head and needed to get MCT Oil [medium-chain triglyceride, an oil that has a variety of uses] just to get to the point where I could think straight again.

The restrictions on lifting were annoying but obviously they serve a really important purpose. I also have a great physical therapist at Cal that I have worked with for years so I had access to the weight room and all the recovery modalities available to a Division 1 football team so that helped keep my mind where it needed to be.

On the walk
Just so we are clear ‘working out’ over the past couple months would mean anything from taking a quarter mile walk with my mom through my neighborhood (and feeling exhausted afterwards) a couple days after surgery to lifting/swimming for 3 hours after all restrictions were lifted. No matter what the actual workout was, the fact that I was doing what I could to get back to normal life was what was important.

I think some of the most important lessons I learned from this is that there are going to be good moments and bad moments. When I had a bad moment I knew how to fix it and that was by getting back into my regular routine and working out. Figuring a way to progress towards my next goal. It made me feel better physically and emotionally.”

ABSOT: What is the outlook and treatment plan going forward?

NA: “I am now on the active surveillance protocol. One of the hardest things about ‘real life’ vs the training we all receive in school as children/young adults is that a lot of times there are decisions that must be made that don’t have always have a clear right or wrong answer. In this case, the choice between active surveillance or adjuvant chemo was one of those decisions.

Fortunately, I remembered my old days as a public health major struggling in one of my population statistics classes. Given my staging and pathology, the ‘right choice’ regarding treatment options is to opt for active surveillance. If you had 10,000 people that were exactly where I was at regarding testicular cancer, the vast majority of them would be over treating themselves if they were to do adjuvant chemo.

Knowing this I decided to opt for what I feel is my “right decision” to try and avoid chemo if at all possible. Please keep in mind this is all knowing that ultimately my disease free survival rate. My next scans/bloodwork are in April.”

ABSOT: As someone who has been there, I know that facing testicular cancer can be very overwhelming. How have you been coping with all of these sudden changes?

NA: “I feel like my wife and I did a great job. To walk in to a doctors appointment together and hear the words “You have cancer” is some very real adversity that a lot of people are going to have to deal with in their lives. I am proud of the way we got through it and are continuing to go through it together.

As I had mentioned before there were good days and bad days for both of us and fortunately not too many of them overlapped. We could be each other’s strength when the other wasn’t feeling too hot.

He's clearly a Uniballer... selfie game strong
I would be remiss not to mention that my mom flew down to help with recovery and attend doctor appointments with me so she was an incredible source of support and help through the whole thing!”

ABSOT: Shifting gears here a bit, how important was taking care of your health before this testicular cancer diagnosis (aside from the obvious being a world-class athlete)?

NA: “Taking care of my health was/is my job! Being a pro athlete means that you need your body to function optimally at all times. I was having three green smoothies a day, making sure I was eating enough protein before, during, and after practices. I would eat a different type of protein at night that was a little slower digesting since I wasn’t going to eat for 8+ hours. I blew the daily recommended fruits and veggies out of the water! So I guess I never really separated the two because in the world of swimming, performance and health are so interconnected that you can’t have one without the other.”

ABSOT: Why did you choose to go public with your testicular cancer experience?

NA: “I decided to go public with my story after every single doctor told me it was a good thing that I decided to get checked out as quickly as I did. All of them had stories about people waiting six months - or even longer - until the symptoms were too serious to ignore.

I was also a Public Health major at Cal so it really spoke to me that if we could get guys to go get checked out sooner we could have a higher cure rate at Stage I on a population level and less people would have to go through chemo and deal with the side effects.”

ABSOT: That’s very admirable and what really spoke to me when I started reaching out to you. What do you plan to do to keep this momentum about men’s health awareness?

The 'Gram seen round the world
NA: “I plan on speaking about it to anyone and everyone that will listen. Men’s health is a topic that is almost criminally underrepresented in our society. I recently read a paper forwarded on to me from a Public Health friend that discussed the idea that men don’t seek treatment soon enough because they correlate properly functioning genitals with masculinity.

If something isn’t functioning properly then going to the doctor is only going to help! Why bury your head in the sand when it comes to medical information? It is a human fallacy that needs to be changed!”

ABSOT: What advice would you give to someone newly diagnosed with testicular cancer?

NA: “Find a way to not go through this alone, whether it is support from a family member or maybe one of the resources available online. Doctors call this a “rare” cancer which from a purely numbers standpoint is true. However, you would be surprised how many other guys are dealing with the same thing. Even in something like the swimming world I have had tons of people reach out to me saying they had Testicular Cancer, or someone they knew did and were happy to share their experience. It is not weakness to take them up on that offer.

I actually really enjoyed reading ‘A Ballsy Sense of Tumor’ as I was in the early stages of this because it was the full story (disease wise). Other blogs were the same thing. Beginning, middle, and end. The end usually consisted of clean scans and smiling faces and that is something that was really important for me to see for my own mental health.”

ABSOT: Thank you for the kind words and to the readers, I promise I didn’t pay him to say that. What do you want all men to know about men’s health?

NA: “It doesn’t make you any less of a man to have a health issue or a problem. I really believe this is one of the top reasons why so many men are reluctant to seek treatment. It could be physical or it could be mental but as I had mentioned, our society has this archaic idea that in order to be masculine you don’t need help and that needs to change!”

ABSOT: One final question, and possibly the most important one of this interview. Do you feel like losing a testicle will improve your swimming and odds in Tokyo 2020?

NA: “Now we are on to the hard hitting questions I like it! I don’t necessarily think it will improve my swimming as I was forced to take the longest break from training I have taken since I was probably 5 years old.

However, I do think it’s important to note that it shouldn’t hurt it! I still have a healthy testicle and my MCB32 Intro to Human Physiology class at Berkeley taught me, testosterone production is a negative feedback loop what I lost in one testicle, the other should make up for just fine.”

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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ABSOT is endorsed by the Laughter Arts and Sciences Foundation, a registered 501.c.3 charity. To make a tax-deductible contribution to help help continue ABSOT's work with testicular cancer awareness and men's health, click the image below.

Wednesday, March 6, 2019

BOB13: Alun Pepper - Britain's Manliest Man

Britain's Manliest Man, Alun Pepper, Works to Raise Awareness of What It Means to Live After Testicular Cancer

Welcome to the Band of Ballers! In this series on ABSOT, I’m turning over control to some other ballsy testicular cancer survivors and patients who have inspired me with their work in advocacy and awareness during and after their diagnosis. This month’s feature is all about Alun Pepper, who is Britain’s Manliest Men. Enjoy!

My story starts in July 2006, when I was 35. I was watching sport on TV with a beer in one hand. The other came to rest where we men like to place it when we relax and that’s when I felt a lump.

My first thought was ‘Oh F*#k’, not because of what it might, and turned out to, be but because I was not in the regular practice of checking myself and so did not know how long it had been there.

You see, I had quite good testicular cancer awareness due to the Lance Armstrong story

I also knew testicular cancer had good survivability if caught early, but at that time I was not in the habit of regularly checking myself once a month.

Alun and his jet
I felt the lump on a Friday and on the Monday I was at the doctor. At the time I was getting ready to deploy to Iraq (as I am a fast jet aviator in the Royal Air Force), and maybe due to this I was sent for an ultrasound really quickly. All along, I tried to be well informed from good sources on the internet. Due to this research, I was not shocked that once the ultrasound had ruled out a cyst, a biopsy was required and that required an orchiectomy.

What followed was a routine operation - well, as routine as having your right ball cut off can be. At that stage, the scan showed no spread, which then made me a little surprised to receive a letter with regard to chemotherapy. Once I understood that it was a voluntary process, as a preventative measure against re-occurrence, and after consulting with my aviation doctor about the potential ramifications to my flying, I went ahead with once dose of carboplatin. The side effects from this were minimal - no matter how hard I tried to milk them to get my girlfriend to make me drinks.

All told, from first detection to being back in the cockpit, it was about 3 months with no ill effects. Although, maybe my jet now had to fly a little more left wing low to compensate for the change in the center of gravity.

Since then, I have wanted to share my experience to educate others about testicular cancer

Like a lot of survivors, I now talk bollocks whenever I get the opportunity. This initially took the form of school visits, including the famous Eton College, and has included professional soccer teams. It was in 2014, whilst reading a Men's fitness magazine I saw an advertisement for a competition to find ‘Britain's Manliest Man’. After initially scoffing at a seemingly stupid competition (a view I still hold) and turning several pages, something in my mind changed. Wouldn’t it be good if the manliest man in Britain could be a testicular cancer survivor? It could have the two-fold effect of raising awareness and showing that having a ball removed in no way affected masculinity,

The name's Pepper... Alun Pepper
So I applied and luckily my story resonated with a lot of people. With the help of an appearance on TV, I was lucky enough to win. The competition led to me becoming an ambassador for Orchid (probably the largest male cancer charity in the UK) and has given me a great platform to share my message.

However, it has also been a bit of a burden. I do feel a bit of a fraud as not only have I met many military veterans but also other survivors of testicular cancer whose experience was far more challenging than mine. In no way do I take the title of Britain’s Manliest Man seriously, however some people seem to think I have done it for personal gain or to become a ‘celebrity’.

But my aim is to have Britain’s Manliest man almost as an alter ego to try and get the message across to ‘stupid’ young men that testicular cancer in no way affects masculinity

I do challenges to emphasize what is achievable after cancer which include: one half marathon, three 100-mile bike rides (sometimes sporting the amazing naked cycle suits from the Male Cancer Awareness Campaign), climbed Mt Kilimanjaro, and obstacle course racing and martial arts training in both Japan and Thailand. All these are done on top of my job going on operations in the RAF.

During the talks many of the same questions come up. As a single guy, I often get asked if I am self conscious if I’m with a new partner. In truth, I don’t think I have met one who could tell unless I pointed it out. Besides, by the time they are close enough to count they have usually committed. I chose not to have a prosthetic testicle put in. Once my girlfriend and I had asked about ones that glow in the dark or vibrate. The surgeon thought were weren't taking the question seriously (he was right) and left.

The question most people are thinking, if not brave enough to ask is about performance in the bedroom. Here I steal a line from the wonderful Wendy Gaugh, and say it’s a lot like a double barrel shotgun... one barrel is all you need. But again I am keen to stress the lack of side effects, post treatment, for me I attribute wholey to early detection and treatment and I know others have different experiences.

I think I was lucky in that my personality and sense of humour helped get me through my testicular cancer experience with no mental health issues

This picture made me do a double take
My friends also share this sense of humour which lead to my new nicknames on the squadron being iPod (roman numeral for 1 being I) and Uncle Bulgaria (a children's cartoon character called a womble, which sounds like ‘one ball’). This banter, for me, was far more cathartic than any sympathy. I was determined to laugh at the situation, I had already bought many comedy CDs in case I needed long doses of chemo but again I was lucky.

This approach lead my Commanding Officer to write that my approach was the bravest thing he had seen outside of combat. Whilst this statement was flattering, it was also ludicrous. Bravery to me is when you are scared and have a choice not to do something but do it anyway. When we are ill, there is no choice.

I still use a lot of humour in my awareness work, which isn’t to devalue people who have had more difficult experiences but to make the talks hopefully more memorable. After all - knob jokes are a staple of British humour.

I still do talks whenever I can, brief all RAF graduating officers, and am reaching out to professional sports teams as through them I can reach many more people to share the importance of testicular cancer awareness. I have given a talk to English Premier League winners Leicester City and hope one day to talk to Manchester United and the Oakland Raiders when they visit London. I usually try and get a signed ball, to replace the one I lost, for a feature on social media I call #newballsplease.

Finally, be careful what you wish for - I remember one day saying I would give my right bollock to fly jets.

Be sure to connect with Alun by visiting him at @alunpepper or Al Pepper or Uncle Bulgaria – Britain's Manliest Man.

Know someone (or even yourself!) who is supporting TC awareness and would be willing to share their story? Drop their name, contact, and why they should be featured into this Google Form and I’ll reach out to them and/or you!

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

Click the ABSOT logo below to subscribe to the mailing list for the new blog posts, latest testicular cancer information, and self exam reminders!

Don't forget to follow and share ABSOT on social media by clicking the icons below!

ABSOT is endorsed by the Laughter Arts and Sciences Foundation, a registered 501.c.3 charity. To make a tax-deductible contribution to help help continue ABSOT's work with testicular cancer awareness and men's health, click the image below.