Friday, October 23, 2009

Radical Orchiectomy....huh?!

The morning went pretty smooth. We all met at the hospital and spent time with Casey before they wheeled him back to surgery. In total, I believe the surgery was about 2 hours with an hour or so post surgery. Casey was home by late afternoon and watching "The Office" reruns by dinner! He had plenty of helpers which was both great, and overwhelming. In hindsight, doing "shifts" may have been more practical, but in the moment everyone just wanted to be with him. He had very little pain and was able to get up and down pretty easy. He took pain pills for the first 2 days but changed to extra strength Tylenol on day 3. The worst part of the first 2 days for him was trying to poop. Bowel movements were painful due to the pressure on the incision. It didn't help that the pain meds made him constipated. On a side note, constipation is a common side effect of pain meds so ask your doc about this if you have any questions. My Dad picked up an over the counter stool softener and that seemed to help a little bit. Eventually it happened and the world kept spinning, but for Casey time was moving very slow until then!
One thing Casey was diligent about was ice. He did a great job keeping ice packs on the incision and his groin area and I do think that helped a ton in reducing swelling, and his overall recovery time.
The next 3-5 days were the worst. Not because Casey was in pain, he was actually feeling good. They were agonizing because all we could do was wait. Waiting for the doctor to call with news on what the stage of the cancer was. Waiting for news about what type of cancer we were dealing with. Waiting for news about what the next step would be as far as treatment, Casey's school, his future, his ability to have children- everything! All we could do was wait, and we were truly at the mercy of the labs, and the Urologist. I will say this; if you are not your own advocate, and you do not stay on top of the doctor and his staff, there is a good chance your case will get pushed to the side. Not forgotten about, but bumped down the importance ladder. Since my brother is over 18 my parents had no rights to his personal medical info. They could not call the doctor and ask questions, they could not call and badger the receptionist to check on results. This was hard. If possible, speak to the nurses and/or front office staff before you leave the surgery. Find out what their typical follow up protocol is. Do they have one designated person that checks on results and reports to the doctor? Does the doctor make important calls like these at the end of the week, or is there a specific day you can expect to hear from him? In our case, the doctor said he would call in a few days and by a few he meant 4. Yeah. He called us on Friday at 4:30- right before he left for the weekend. Nice.
From what he could tell, Casey had stage 1 testicular cancer. His tumor was 90% seminoma (the better kind to have) and 10% yolk sac. Our Oncologist has since explained to us that even though the tumor is largely seminoma, they treat all tumors that have any type of non-seminoma the way they would if the whole thing was non-seminoma. If that didn't make sense, all I am saying is that even though Casey's tumor was mostly seminoma, it would be treated as if it was 100% non-seminoma due to the 10% yolk sac. If you have not already looked at the different types of TC, take some time and read through the definitions. I found great info on the TCRC page, and also the American Cancer Society website. Both links can be found above, in the left column.
Casey was really hoping this phone call would explain exactly what his treatment would entail and what he should prepare for in the coming weeks. He was disappointed to find out he would have to wait 2 weeks to get his blood drawn, at which point the Oncologist we were being referred to would meet with Casey to go over the findings. The idea behind waiting 2 weeks is that hopefully your AFP (Alpha Fetoprotein) and HCG levels have dropped drastically. These two "tumor markers" are a convenient way to determine whether or not all of the cancer is gone. A normal AFP level is 0-8, Casey's was 657 before surgery. After his radical orchiectomy (testicle removal) his number had dropped to 58. This is great, but not low enough. The oncologist was vaguely hesitant about this and asked Casey to get another blood draw in a few days so he could see if the numbers were continuing to fall. Before I get to where we are today, I should go over Casey's treatment options as they were presented to the next post!

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