POST OP DAY 8 - NOT MELANOMA!

HUGE sighs of relief are coming from the Howell Household.  The urologist called today to tell Dave his tumor was indeed cancerous, but it was not melanoma.  It is seminoma.  I know nothing else, other than what I've googled.  I was at a meeting when Dave got the call, so I didn't get to hear any details.  I am a little confused, as I thought seminoma was one of the cancers the blood test would have identified.  I'm sure I just didn't understand, but this was a surprise.  A good surprise.

Dave's next appointment is with his oncologist Dec. 2nd where we will hear the treatment options - or maybe there will be no treatment necessary.  I'm tired and don't want to pass on any incorrect information or assumptions, so I'll stop here for now.  We are so thankful.

AND STILL NO PATH REPORT

You read that correctly folks, no report yet on what Dave's mass was!  He had an appointment with his urologist this morning and we were told the lab was 'ordering a stain.' I asked if that meant his cells (on the slides) were something other than routine, something unusual.  I thought all they had to do was look at them under a microscope and we would know what they are.  The doctor said, "This whole adventure has been unusual," without really saying yes or no.

My interpretation of what he told us was that the lab was out of a particular stain (like Ritz dye) they needed to further examine Dave's cells, and they had to order some from the stain store.  Don't laugh too hard, those of you who know better.  What he meant was 'a stain' is a very ordinary type of procedure, and the lab was ordering that procedure.  Oh. (And I think that's right - if I understood Molly correctly.)

So we are not to read anything into the fact that a stain was ordered, or that it has taken so long.  Both Dave's urologist and oncologist were dismayed at the delay.  AND SO ARE WE.

The urologist removed the staples from Dave's incision, which has left him with discomfort this evening.  The doctor said the incision is healing well, at least it looks great.

A special thanks to Paul today, for being Dave's chauffeur and spirit lifter.  I went with Dave to the urologist, but then I went to a makeup clay class, to my podiatrist, and shopping for shoes I can wear to Libbie's wedding, and a wrap for my sleeveless dress.  The countdown is on to the wedding weekend, and there are too many places I need to be, all at the same time.  So thank you Paul for helping Dave take care of Sandy while I did my To Do List.

Tonight we celebrate - unfortunately not the results of a lab report - but with some of our great friends here in The Landings.  I'm going to dinner with The Belles to celebrate Allison and Fran's birthdays, and Allison's husband Bob is picking up Dave for their own dinner out. What in the world would we do without our fabulous friends???

STILL NO PATH REPORT

It's Post Op day 5.  The work week has come and gone, and we did not get the results of the pathology done on Dave's mass.  Just thought I'd let you know so you don't think we're celebrating or bemoaning the results without you.  Dave has an appointment with his urologist who performed the orchiectomy (otherwise known as the nutcracker) Monday morning.  In the meantime, I say no news is good news.

Dave turned a corner yesterday.  I was at a class Friday AM and he forgot to take his pain pill, which I didn't know.  He took a nap in the afternoon and got up an hour after his next scheduled pill and when I reminded him he was overdue, he decided he didn't need it.  He felt since he skipped the 10 AM pill and felt okay, he would forgo the 4 PM pill as well.  He hasn't had one since.

Of course he is nursing his incision site but he's much better at remembering to protect it when he moves by being very careful about how he moves.  I'm glad he has been taking afternoon naps, as that seems to give him relief.

He's getting cabin fever.  It spiked at 150º yesterday.  He needs a hobby or project to keep him busy that doesn't require a lot of movement.  He's bored with television, and solitaire so I gave him a stack of his unread books.  I wish I could get him to learn to knit, or work on my To Do List.

I've missed (and will miss) some of my clay classes due to all these doctor appointments.  I need to go to Michael's this morning to get a tool to use on my project at home.  I dread going on a Saturday as the shopping season has begun, but here's an idea for Dave.

ONCOLOGIST VISIT; NO PATH RESULTS YET

Let's start with some good news; Dave feels a little better.  Hooray! He is learning (and remembering) how to ease himself in and out of chairs and in and out of bed.  Those first few nights were pure agony for him and it is such a relief that he is better at managing his movements.  Speaking of movements, this is Dave's favorite new (to him) wonder drug.  Required to balance the only annoying effect of the pain medication.  Enough said.

This morning was the first day Dave wasn't watching the clock for his pain pill, and in fact I had to remind him to take it.  As soon as he swallowed it, he said he could tell he was due as the incision area was starting to throb.  It's not good to let the pain get ahead of you.

We had a late morning appointment with his oncologist.  Dr. S. had not received the pathology results, so he called Dave's urologist to see if it had become available.  It had not.  He examined Dave's incision and said considering Dave had this surgery just three days ago, both he and the incision look remarkably healthy.  We discussed options for treatment if the mass turns out to be melanoma, and set up another appointment for early December for further discussion.  In the meantime, Dave and I will be looking into the use of Yervoy (ipilimumab), as that may well be the recommendation.

Yesterday Dave had an appointment with his dermatologist, and she found nothing on his skin to warrant further examination.

Now to the fun part -- what made us laugh today?  A LOT?  Kim Kardashian's nude photos and the flurry of photoshop activity that it started.

POST OP - DAY 1

Dave is better today thank goodness!!!  He slept fairly well as long as he stayed on his back, but habits are hard to break.  Every time he tried to roll over, there would be a very sudden reminder that all was not well down south.

A little background ... Dave avoids medication at all costs, or almost all. He was on pain meds for only about 24 hours after his lympadenectomy in Houston a year ago.  He is on no prescription meds, and won't take daily vitamins or an aspirin.  BEFORE his surgery yesterday, he considered not filling the prescription for the pain meds we knew he would get, as after all, he has some left over from last year, and really he won't need them.  ahem  cough cough

He can take a pain pill once every six hours and he had one at 4 AM.  When he woke up at 7:30 (still drowsy) he asked if it was time to take a pill.  I think those 2.5 hours until 10 AM were some of the longest he's endured.  I don't want to exaggerate, he was not in terrible pain, but there was enough that I caught him checking the clock, or asking what time it is, quite often.

Molly knows how Dave is, and she called this morning to emphasize that he needs to take the medication on schedule so the pain doesn't get ahead of him.  For once, this was not a problem!

Dave got up, made his oatmeal, and feels pretty good when he's standing up.  He shaved, and he got dressed, needing help only to get things over his feet (pants and socks) as that requires a lot of bending and stretching. He was advised by the doctor's office to get and wear tightly fitting underwear for the next two weeks, so he has some new underwear.  I managed to talk him into letting me take a picture.  Of course that was about an hour after he took his happy pill.  I thought if I'm going to blab about all his intimate experiences, I may as well post a picture, too.

You can see the walker on the left side of the picture.  It's been in the attic for 4 years, except for when I had my toe surgery a month ago.  Back it went after about a week, but I pulled it out for Dave this morning.  He doesn't need it to walk, but he's learning how to use it to get in and out of chairs.  Mr. Mechanical Engineer likes to figure out how things work, including the human body.  Or at least his.  He was trying different turns, using different muscle groups, etc. etc. and has hit on what works - for now.  His incision is on his right side, and if he keeps his right foot off the ground (when getting in and out of chairs) then he is forced to use his left side, and that causes the least amount of pain.  Eureka!

There's not much else to report.  I imagine we'll have a quiet week.  I'm going out to do some yard work, as I haven't been able to do any since my toe surgery.  Today is the first time in almost 5 weeks I've been able to wear a shoe!  Dave is resting comfortably in his fairly new recliner.  I had started looking for one last year when Dave's chemo started, and it took me until April to find one I could live with.  It's had a lot of good use in the last 6 months.

I will update on Thursday, after Dave's appointment with his oncologist.  Until then, please assume Dave is getting better every day.  He's eating healthy delicious meals made by loving hands and getting all your good wishes, prayers and jokes.  And oh by the way, it hurts him to laugh, so he specifically asked that PH not come over.  You know who you are.

SURGERY DONE

Oh poor Dave.  He is in so much pain.  His meds have finally started kicking in (after 40 minutes) but he's still miserable.  His bandage is about 6 inches long - of course I haven't seen the incision and staples (yes staples!) yet.  The bandage will come off in two days and I am already preparing myself.

The incision is on the right side of his lower abdomen.  For those who want details: the testes and cord are essentially pulled out through this incision.  The scrotum remains.

Dave was all checked in by 10:45, prepped (gown, gripper socks, warm blanket, IV) by 11:30, and it was off to the OR before noon.  I was finally called back to Recovery at 1:30. They had been trying to get Dave to be awake enough to sit or stand and pee, but he was having none of it.  In fact, he was still in that barely-conscious state, and moaning with pain.  It was all I could do to not collapse and weep.  

It's one thing to have pain yourself, it's another to see someone you love in pain.

The nurse couldn't give him more relief via the IV until he was awake enough to be able to take deep breaths.  When she felt he could, she gave him more pain medication, but his heart rate and oxygen started falling so we were trying to keep him awake and breathing. God bless medical personnel.  How you do you watch someone go through this and not melt into a crying mess?  I DID hold it together, though.  I thought I was going to faint at one point, but I sat down, ate some peanut butter crackers, and kept reminding myself my job is to keep Dave awake.

This was pretty terrifying for me, but you medical people reading this may think this is pretty routine (?).  Nursing is not my calling.

Of course Dave eventually came around enough to get dressed - with help - and into the wheelchair to be discharged.  Unfortunately, every little movement that affects the muscles on the right side of his body hurts him.  We stopped by the pharmacy to pick up his pain pills and antibiotic then came home.  He ate a peanut butter sandwich, took his meds, and gingerly, and with a few struggles, finally got settled in his recliner.  He didn't even take off his jacket, though I suggested a sweater might be more comfortable.

I asked the doctor how long it would be before we get the pathology results.  The lab they use is in SC, but he said he'd try to rush it and hopefully it will be 3 or 4 days.  He will call as soon as he gets the report.  And now we wait.

The doc had a last piece of wisdom to impart->

Dave has an appointment with his Savannah oncologist Thursday, which was originally set up as his normal 3-month checkup.  He will keep that appointment although we realize we may not yet know what Dave's latest mass was.  His followup with the urologist is next Monday.

Thanks for all the calls, emails, texts and prayers.  We get them and we feel that we're in good hands.

SURGERY SCHEDULED

Dave had an appointment at Urological Associates today, getting his pre-surgical work done.  He had blood drawn, a chest x-ray, an EKG, a urine sample (really?  his third one in a week) and a thorough review of his medical history.  All this was done in preparation for his radical inguinal orchiectomy (I think I'm ready for my debut on ER).  It is called "radical" because the entire spermatic cord is removed as well as the testicle itself, and "inguinal" because the testicle is removed through a small cut (incision) made in the lower abdomen (groin).

We will be checking in at 11 AM this coming Monday, 11/10/14.  The surgery will be in the Urological Associates' outpatient clinic.  He is scheduled to go under the knife at 12 PM  and should be finished in less than an hour.  We'll go home that afternoon, as soon as Dave is awake and coherent.

I know the tumor will be sent for a pathological analysis, but I don't know how long that will take.  Dave will probably be on pain medication for a short while.  He should have a full recovery in 2-4 weeks.

\I certainly hope he will be up and ready to dance in 12 days, as we are looking forward to attending Libbie's wedding and reception.  And, Dave bought three, yes three! pairs of shoes today.  An historic day.  We were at the outlets in Bluffton, SC, and there were scads of Veteran's Day sales.  Who knew that's how we celebrate Veteran's Day (weekend)?  Oh well.  Dave, who hates to shop, found three pairs of Cole Haan shoes, so now he is ready for dancing as soon as he heals.

I will get back to this blog next week to let you know how the surgery goes.  In the meantime, please remember to be thankful Dave is looking forward to being well heeled at Libbie and Steve's wedding, and we could use some help in our wishes that this is just a FREAK cancer and not metastatic melanoma.  Thanks.

THE HIGHS AND LOWS OF A MYSTERY

We've had some highs and lows in the last two weeks.  Dave had his annual checkup with our internist on Monday 10/20, and all his standard vitals looked great.  Five days later, Dave felt some discomfort in his groin and at first considered his pants were too tight.  By the next day, Saturday, he had some swelling and pain radiating up toward his hip.  He resolved to call the internist first thing Monday.  Sunday I told Molly about this turn of events; Chad talked to Dave then immediately spoke to a urologist on call who promised to get him in to see a doctor asap.  Dave got in Monday morning.

By then, one of Dave's testicles was swollen to 3 times its normal size, and all he could think about was some old National Geographic pictures of guys with elephantiasis of the testicles carrying their 'private parts' around in wheelbarrows.  Not so private.

The antibiotic Dave was given provided almost instant relief, but with Dave's history, the urologist scheduled an ultrasound just to be sure there was nothing going on besides the infection and ordered a blood test to check for markers that would indicate a couple of types of testicular cancer.  Much to our dismay, the next day's ultrasound showed a small mass "suspicious for malignancy."  This low was followed by a high when the blood test was negative for the markers they were looking for.  So what is this mass?

Dave had a PET scan yesterday 11/4.  We have the preliminary results - the bad news was the mass showed activity consistent with cancer, the good news was that there were no other signs of cancer in his body.  We were very concerned that if this were metastatic melanoma, and traveled to his testicle, where else had it traveled?  So we are relieved, but know this is the preliminary review and the radiologist will be going over the results with a fine tooth comb.

Next steps - Dave has been in touch with his MD Anderson surgeon who agrees surgery is necessary.  He just spoke with his urologist this morning;  the surgery will occur early next week to get rid of the offending testicle (no worries, we've been told one testicle provides more than enough testosterone so he still gets to be Mr. Howell).  We need to find out what kind of cancer it is, as it may or may not be related to his melanoma.  It's a small chance of not being related, but however small, we'll take it.

And I'm back to blogging to keep you informed.  I'll post again when Dave's surgery is scheduled, and in the meantime, we would appreciate you joining us in our gratitude for the fabulous support we've received, our smart and proactive doctors (especially Chad) and we'd also appreciate your prayers if you pray and your positive energy otherwise.  And now, I need to find one of these t-shirts for Dave.  I wonder if they could drop the last 's'.  Joke.