July 6, 2008
One Man’s Cancer Journey: A Survivor is Silent No More
By George B. Sanchez, The Arizona Daily Star, Tucson
Jul. 6--It was my first summer in Tucson, July 2007.
My friend Will looked up, said he'd heard I was sick and wondered how I was.
"I'm doing all right," I said, looking him in the eyes. "Thanks for asking."
One of his buddies chimed in about picking up a cold in Mexico that took about 10 days to shake. But something inside of me didn't feel right, as if I was hiding from the truth.
So I coughed and said: "I don't have a cold. I have cancer."
It was in that moment that I decided never to shy away from talking about my cancer.
Ever since I discovered the tumor in my right testicle in April 2007, I've noticed how men don't speak, or don't know how to speak, about testicular cancer.
But not talking about cancer doesn't make it go away. Not wanting to get tested, or not wanting to know the results, doesn't change anything.
A clarity arrived with my cancer. The infinity of time and life that cradles youth slipped away. I discovered my boundaries. The fragility of the body I had once pushed with reckless abandon became obvious. This is my story of cancer: just mine. Every one is different. Every body is different. I don't speak for anyone but myself.
I am lucky. Testicular cancer is the most common form of cancer for males between their teenage years and mid-30s. But in the pantheon of cancers, it's highly curable. In my 29 years, the mortality rates have reversed: The chance of surviving testicular cancer, just 10 percent in the past, is now 95 percent.
When my disease was diagnosed, I started on a very specific path. There were options, each with its own risk, but every decision had a very precise aim: surviving the growth inside my body.
People always ask, "How did you know?" or "How did you find it?"
Well, I touched myself.
To be specific, I touched my right testicle. How do I explain? To be honest, I must have been getting ready to masturbate. I don't know. Picture me shrugging my shoulders.
When I tell my male friends, I can see the gears cranking behind their eyeballs.
"What did it feel like?"
"I found a hardened spot, like a sharp edge, on my right testicle."
This usually prompts them to check themselves -- and inform me later that they did so.
The drummer in my old band actually checked himself while we were on the phone. My brother got so concerned that I think he checked himself too often.
My sister asked me what it was like to get stitches in my scrotum. I asked her where she got that idea from. My sister, like most of my friends and family, thought my testicle was removed through my sack.
You can hear the surprise -- and relief -- when I explain that the surgeon didn't cut through my scrotum, but removed my testicle through a small incision in my lower abdomen, at the root.
A ton of other questions pop out.
"Can you have sex?" Yes. Oh, yes. A friend from high school, Adrian, went through the same thing -- testicular cancer -- when he was 18. It was our senior year. He said he was back in the saddle within two weeks. So I vowed to beat his record.
During chemotherapy, the nurses warned me that if I had sex, I had to be careful, because the toxins were in my semen. My oncologist told me that, because of this, survivors generally shouldn't try to conceive for six months after chemotherapy.
My best friend jokingly snarled later: "You have radio- active sperm." I suppose I do, er, did.
At the same time, the questions are telling.
More than a few adults -- fathers -- had trouble asking if I was going to bank my sperm. One asked me if I was "going to save some of my man juice."
Men asked if I considered getting a prosthetic testicle.
While back home in Los Angeles for Christmas, my family ate at an Italian restaurant we've patronized for more than 15 years. My mom told everyone I was a survivor. Our waiter, whom we've known for 15 years, too, asked what I survived.
When I said testicular cancer, he was confused. I said it was in my right testicle.
"What's that?" he asked.
"My balls," I responded.
"I'll be right back with your garlic bread," he said as he stepped away from the table.
When I met my urologist, Dr. Jennifer Peters, she explained that my testicle had to be removed. A biopsy would follow to see if it was cancerous.
With some forms of testicular cancer, removal of the testicle is all that's necessary. But because of what I had -- my tumor was actually composed of two types of cancers: embryonal carcinoma and teratoma -- this wouldn't be the case.
Life was no longer this seemingly endless highway, but a series of small roads. I wouldn't wake up cured. There wasn't a magic pill, or treatment, to make it all go away in an afternoon.
Instead of looking at this as a single, massive journey, I recognized it as small steps: test to test, appointment to appointment, day by day, one day at a time.
After my testicle was removed, I had three choices:
A) Undergo a second, invasive surgery to remove the lymph nodes in my lower abdomen, where the cancer was likely to spread.
In plain language, this surgery entailed cutting me open from my belly button to my pelvis, moving my organs on one side and, one by one, removing about 200 grape-size lymph nodes. The surgery would last at least four hours.
Complications could include infection, blood loss and a 5 percent chance that my ejaculatory muscle could be damaged, causing my penis to inject, rather than eject, semen.
B) Begin chemotherapy.
C) Monitor what are called cancer markers through weekly blood tests.
My urologist recommended I have my lymph nodes removed.
I sought second, third, fourth and fifth opinions.
Not long afterward, I met Dr. Fredrick Ahmann, my oncologist.
Dr. Ahmann dresses for work like my dad used to: slacks and a short-sleeve collared shirt with a tie. In some strange way, his '70s detective style was comforting.
He also puts up with my many, many questions.
The surgery would be intense, he said. Following the removal of my lymph nodes, doctors would perform biopsies of the little glands. If they turned out to be cancerous, after recovering from surgery I would still have to undergo chemotherapy.
That being the case, Dr. Ahmann said, chemotherapy would be no cakewalk.
Uncomfortable with the idea of having a Frankenstein-like torso, I opted for weekly blood tests to monitor the cancer markers. After a confusing two months in which the markers went up and down, the cancer levels rose and it became clear that I needed to undergo chemotherapy.
Months later, Dr. Ahmann would tell me if any of the treatment doses were doubled, it could kill me.
There are certain things no parents should have to endure. Watching their child endure cancer treatment is one.
Family and friends expressed helplessness as they watched me undergo chemotherapy.
It took my father, Bernard, a while to get used to watching me, his young, otherwise healthy son, get connected to a machine, injected with chemicals and see my eyes go from nervous and tense to drugged and dopey.
During the first week of chemotherapy, as I sat in the recliner at the clinic and intravenously received my treatment, I turned to my father and saw anxiety in his eyes, concerned by not knowing and not being able to protect, his fear and confusion apparent.
"What's up?" I asked.
He grunted something. We grunt.
Then a few minutes later he got up and said he was going to find my mom. He didn't come back until it was time to go.
I couldn't blame him.
No father I know likes to show fear. Not to their wives or children, not to their friends or community. That's not how they were raised.
My dad grew up in a two-room shack in Echo Park, north of downtown Los Angeles. Four generations of Sanchezes had been raised in New Mexico. My father was the first not born on the dusty rancho.
Two days before I began chemotherapy, for the first time in both our lives he'd cried in my arms. It was a shock to both of us, and my mother, who was the only other soul present.
My father and I were arguing. I was about to head out for my last night on the town.
My dad is a scientist. He has a degree in chemistry and criminology and at one point headed the Los Angeles Police Department's Hazardous Materials Division. More than most, he knows what scientific research says about the effects of drugs and alcohol on the body.
He told me alcohol can spread cancer. I laughed at first and told him he should have told me that a few months earlier.
He begged me not to go out. He asked me to promise that I wouldn't drink anything. He kept telling me I would only do my body more harm.
Then he burst into tears, sobbing like a child, vulnerable like I'd never seen.
I didn't know what to do. So I did what he did when I, his first-born son, was a child. I put my arms around him and held him close. I felt his tears soak my T-shirt and told him it would be all right.
"Doing really well"
It has been more than six months since I completed chemotherapy. But thoughts of cancer and chemotherapy don't seem to fade.
On Memorial Day I was swimming at the Downtown YMCA. I stood up to take a breath and looked out onto the empty pool. The surface was calm and still. Suddenly, the image of shunts and tubes connected to my wrist appeared in my head. Just as quickly as it appeared, the image was gone.
While the scar from my surgery is somewhat hidden under the hair that has returned, when I shower I notice my pubic hair is still thin. It reminds me of being hairless during chemotherapy. I just want the hair to grow back like it was.
A few weeks ago, I went to a barbecue for my friend Paul's 30th birthday party. Five years ago, he was diagnosed with thyroid cancer. Though he still smokes and eats more chili cheeseburgers than he probably should, Paul's otherwise in fine health.
When I arrived, his father greeted me, asked how I was.
"I'm doing really well. All my tests are clean and I've got my hair back," I said. That's my typical post-chemo response.
"I'm really glad to hear that," he said.
Questions continue from friends and family: How are you? Are you done? Are you cured?
A disease was diagnosed and, for the most part, there was a treatment and cure. But for the rest of my life, there will be regular blood tests and CT scans.
I find encouragement in fellow survivors, like Paul. Not the ones with best-selling books, like Lance Armstrong, another survivor of testicular cancer, but those in my daily life.
In every walk of my life, there are survivors. Sources are survivors. Co-workers are survivors. Yoga classmates are survivors. College and high school classmates are survivors.
We're everywhere, I've discovered. So we might as well be honest and talk about it.
Note to readers:
This story is an honest and frank discussion of George Sanchez's testicular cancer. As such, it includes mature subject matter, and the accompanying illustration depicts the male anatomy and a testicular self-examination.
This is Sanchez's last story for the Star -- he has returned to his hometown of Los Angeles.
--April 29, 2007: Discovered something hard on my right testicle.
--May 3, 2007: Had my first doctor visit about it.
--May 9, 2007: Had an ultrasound that revealed what looked like a tumor.
--May 15, 2007: Underwent an orchiectomy -- my right testicle was removed during outpatient surgery.
--May 17, 2007: Learned the tumor was a mix of two types of cancer: embryonal carcinoma and teratoma.
--July 31, 2007: Decided to undergo chemotherapy, after more than two months of weekly blood tests and two CT scans.
--Aug. 10, 2007: Worked my last day at the Star before I took sick leave to undergo chemotherapy.
--Aug. 13, 2007: Began chemotherapy at the Arizona Cancer Center, 3838 N. Campbell Ave., at Allen Road.
--Oct. 9, 2007: Finished my third and final round of chemotherapy. To celebrate, the nurses blew soap bubbles over me.
--Oct. 11, 2007: Returned to work at the Star.
--June 11, 2008: Marked eight months of being cancer-free.
Music is a key component of my life. When chemotherapy began, my fingers became very swollen and I found myself unable to play my stringed instruments or my accordion. For a short time, I also lost the ability to tune my instruments by ear.
During chemotherapy, I came up with the idea of a Top 10 list of songs to accompany my cancer treatment. I excluded songs with any reference of cancer and specifically looked for upbeat, lyrically positive songs.
Here are a few, in no particular order:
--"El Pajaro Cu," from "Viejas Canciones para Viejos Amigos" by Francisco Gonzalez.
This is one of my favorite Son Jarocho songs, and this recording, by a beloved friend and musical maestro, makes me smile every time I hear it.
--"Attitude," from 1983's "Rock for Light" by Bad Brains.
These are all the words in the song: "Don't care what they may say/we got that attitude/don't care what they may do/we got that attitude/Hey/we got the PMA."
PMA stands for Positive Mental Attitude. The song is barely a minute long.
--"There Is a Light That Never Goes Out," from 1986's "The Queen Is Dead" by The Smiths.
Singer Morrissey makes any musical list of mine. Despite a chorus that ponders a horrific automobile accident (or two), this song has always inspired me. The final coda, from which the title is taken, is as upbeat as any pop lyric.
--"The Black and the Red," from 2003's "All Rivers Run South, All Roads Lead Home" by One Reason.
I don't know much about this band, but a friend included this song on a mix CD he sent me during chemotherapy. The first verse, about a half-drunk phone call to a friend in the middle of the night, just about sums up our friendship. The fierce determinism in the simple, bellowed phrase, "This life is what you make it," is infectious.
--"Search and Destroy," from 1973's "Raw Power" by Iggy and the Stooges.
Repeat the first line -- "I'm a street-walking cheetah with a heart full of napalm" -- and try not to feel fierce. The second (and third) verse opens, "Look out honey 'cause I'm using technology." I thought that was a good warning to my cancer. Besides, I think the phrase "search and destroy" pretty much sums up the scorched-earth technique that is chemotherapy.
Five questions with Dr. Fredrick Ahmann
1. What is testicular cancer?
Cancer is an uncontrolled growth that usually has the ability to grow into surrounding tissue (invasion) and ultimately spread to other locations in the body (metastasize). Cancers are named based on the normal tissue in the body from which they arise. For testicular cancer, that tissue is the germ cells whose normal function is to produce sperm.
2. How do you get testicular cancer? Who gets it?
We don't know for certain what the cause of testicular cancer is, but the best interpretation is that some men are born with abnormal testicles and that some of these men can and will develop testicular cancer.
Medical science has identified a few recognized factors associated with a significant risk of developing testicular cancer: being born with an "undescended testicle," having Klinefelter's Syndrome (a genetic abnormality), having had a testicular cancer in one testicle, and a family in which multiple males have had the disease (truly rare). Most men who develop testicular cancer do not have one of these recognized risk factors.
3. How is it treated?
(A) surgery, (B) radiotherapy or (C) chemotherapy. Almost all men have their testicle surgically removed even if the cancer already has spread.
4. What are the long-term effects of testicular cancer?
There are long-term effects both from having testicular cancer and from the treatments for the disease.
For example, men with testicular cancer are inherently more likely to have difficulty fathering children. Undergoing surgical treatment also may interfere with a man's fertility and may cause a lower testosterone level. Similarly, chemotherapy may interfere with a man's fertility as well as his male hormone level.
In addition, chemotherapy may cause long-term damage to nerves, blood vessels, blood production, hearing, the lungs and the kidneys. Radiation therapy can cause scarring and damage to whatever structures are close to the areas receiving radiation.
5. What can men do to lessen the risk of testicular cancer?
Medical science knows of no way to reduce a man's risk of developing testicular cancer. The key is to find it as early as possible and informing/educating men that any hard area that appears in their testicles, particularly if it gets larger, should be checked out by a physician.
Dr. Ahmann is a professor of medicine, surgery, hematology/oncology and urology at the UA College of Medicine. An active medical and cancer researcher, he has been named one of the best doctors in America for prostate and genitourinary malignancies by Best Doctors Inc.
--Contact reporter George B. Sanchez at [email protected]
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