Decision

Nine days after my operation I went into hospital to get the results of my biopsy. My oncologist was Dr Laurence Krieger, henceforth known as Dr Laurence. He’s a nice guy, well-dressed – not elaborately exactly but certainly with an eye for detail. He’s quite earnest, softly-spoken, with a wry smile that says: “Isn’t the world a funny place? Oh well, let’s get on with things as best we can.”

With him was Kathryn Elwis, my nurse practitioner – the person assigned to me to be my point of contact with the hospital should I have any questions or issues to raise outside of my appointment times. She’s a tall Scottish woman with a friendly face and practically-cut short hair. She struck me as unflappable, someone who could face down any stroppy or temperamental customer just by continuing to be incredibly nice.

I liked them both.

Dr Laurence checked my wound and told me it looked fine, healing nicely. Then he sat me down and started doling out the news. First he asked me if I’d done much reading. I hadn’t. I’d decided not to delve too deep into the information available, especially into the panic-mongering that I thought I might find on the internet. I didn’t want to wallow in this experience. I wanted to be pragmatic and get it over with as quickly as possible. To me this meant just listening to the doctors and nurses and taking on board their advice and information, nothing more.

My tumour was a seminoma – the classic testicular cancer tumour that they enthusiastically told me is easily curable. It was roughly four centimetres in diameter. While the x-ray and scan had revealed that I was clear of cancer in the rest of my body, and there were no what they call tumour markers in my bloodstream, there was evidence of ‘lymphatic vessel invasion’.

This means they found that cancer cells had moved around in the vessels of the testicle. It followed therefore that cancer cells could have moved on to other parts of my body. The emphasis was on ‘could’. It was unlikely given all the other evidence, but it was still a possibility. Therefore they wanted to give me one dose of chemotherapy, to be on the safe side.

They were adamant it was my decision whether I had chemo or not, but made it quite clear that it was sensible to do so. I was given odds of 40/50% of it coming back if I didn’t have chemo, 5% if I did. They were hard odds to ignore. I made the decision to have it then and there, but played along with their game that I had time to think about it. What was there to think about, really?

They gave me something else to think about: sperm banking. Chemotherapy works by breaking down the fast-producing cells in your body, as that is how cancer grows. But this also includes things like white blood cells (which form your immune system), hair, and sperm. As such there is a risk of infertility from having chemotherapy. Given that I was only having one dose this was unlikely, but the risk was still there and they advised sperm banking if I thought I would ever consider having children in the future.

I’m given a week to think about it, though I don’t need to do much thinking. My own opinion and that of everyone I speak to is that the sensible option would be to have it. As Maz put it: “Of course you should have it. What’s to think about?”

When I went back, this time with Mark, Dr Laurence - flustered and tired-looking this time as he juggled three doctors’ work due to illness - once again went over the side effects of chemotherapy so I was aware of the possibilities of what I was letting myself in for. He didn’t paint a pretty picture.

I’ve already mentioned the possible effects on the various bits of my body that are made up of fast-producing cells, although Dr Laurence was happy to admit that I was very unlikely to lose any hair given that I was only having one dose of chemo.

The main side effect would be nausea, but this would be treated with anti-nausea pills given before the treatment and for some period after. The effects on my gut may also cause diarrhoea or constipation or, most importantly to me, loss of appetite. If I can’t eat to make myself feel better then I was in for a rough ride.

I was warned I could bruise easily and that my gums may bleed, particularly after I clean my teeth. I may get mouth sores, dry skin, or flaky nails. I was told there would be an increased risk of blood clots, both from having had cancer and then chemotherapy as well.

I may find myself overly tired, lethargic, even breathless. This is due to anaemia caused by the red blood cell count being diminished: less red blood cells means less haemoglobin which means less ability to carry oxygen around the body. This may also cause dizziness or aching muscles or joints.

A more unexpected one was the possibility of getting the pins and needles feeling or numbness in my fingers and toes. They call it peripheral neuropathy. Other symptoms included headaches, changes in how well my kidney works, effects on my hearing; it didn’t sound like much fun at all.

The other main effect though was to my immune system. As my white blood cell count would be dramatically diminished by the chemotherapy I would be at increased risk of infection. If I was to get sick in the recovery period after having chemotherapy it would be a matter of heading into hospital to recover, not just heading to bed.

But it was inevitable. Despite this onslaught of gently discussed possible side effects I never really wavered in my decision to have the chemotherapy. It was just a matter of when.

Mark and I had organised some time away to Cornwall. It was an important holiday. Mark would finally meet my parents for the first time. I would spend some quality time with them and my godchildren for the first time in some three years, having been away for so long. Mark and I would travel around Cornwall as tourists as well, me getting to see my homeland through his fresh eyes. But the week we were heading down was the week Dr Laurence wanted me to have the chemotherapy.

There was a certain period after the operation that needed to be left so that I could heal properly, before exposing my body to chemotherapy. But there was only a certain period after the operation where they knew chemotherapy would have some effect on any remaining cancer. If we delayed the treatment until after our holiday, Dr Lawrence said regretfully, there was no scientific evidence to say it would have the desired result.

It was yet another inconvenience. That’s how I saw it: an irritating thing that was causing much inconvenience and bloody well ruining my summer. I’d already had to give up weeks of kickboxing training so as not to risk a hernia after the operation, now I was going to have to give up my holiday.

Again Dr Laurence gave me time to go off and think about it, but again I felt I didn’t really have much choice. It was either treat this sensibly and go with the doctor’s advice, or carry on living my life how I want to regardless of the risks to my health.

This week I went in for more blood tests. This time I found myself in the Nuclear Medicine Department. Dr Laurence wanted me to have what he called ‘EDTA creatinine clearance’. My understanding of it is that it’s an injection of a small amount of radioactivity in your arm, followed by a series of blood tests every hour for a few hours. With the results they can assess how well my kidneys will respond to the chemotherapy. I may have that wrong, but that’s the general idea. I did well anyway so I’m good to go for chemo in that respect.

I tracked down Dr Laurence and gave him the go ahead to arrange a session of chemotherapy. I need to get this sorted, get it out of the way. Only then can I go back to doing the things I want to do and living my life properly.