chemo /// prep

From the highest of highs, to the lowest of lows. Many people report a massive post-wedding blues come-down, but I think ours might take the cake.

We arrived back to Nuremberg a few days after the wedding, still probably a little hungover and feeling extremely disorientated by the complete inversion of our world compared to the weekend prior, the best few days of our lives in Portugal. During the first few days back home, I needed to go through a few additional tests and a minor surgery before I could start the chemo program. The strange sense of dread and anticipation during those days was very strange. I remember at various points being randomly overcome with overwhelming emotions and the feeling of needing to cry, without really knowing what those emotions were.

The prep during this period consisted of:

• Another blood test

• A pulmonary lung function test

• A CT scan

• A minor operation to implant a port catheter

BLOOD TEST

A blood test to measure the tumor markers again. They had risen during the weeks we had been away for the wedding, but at least hadn't rocketed through the roof. AFP was now 249 ng/ml and β-HCG was 69 mU/ml. Both were way above the normal level of course, but neither was even close to the levels pre-surgery when I still had a lime sized tumor in my scrotum.

The blood test was also checking that I was healthy enough to start chemotherapy and establishing a baseline for various levels in my blood. And while my body took partying in Portugal, I was indeed healthy enough.

LUNG FUNCTION TEST

The chemotherapy program I was about to start is very hard on the lungs. This test established a baseline of how my lungs were functioning, which could be used as a reference point later once I started the chemo. It involved blowing hard into tubes at various intervals in a pressure controlled chamber, and was over in a few minutes.

CT SCAN

This second CT scan of my thorax and abdomen should have actually happened a few weeks prior, after the upward trend in my tumor marker levels had been established. However, as we had agreed with the doctor to defer chemo for a few weeks until after my wedding, he suggested to also push the CT scan because the results would just add another worry to my mind and wouldn't change the course of action anyways.

The CT scan this time established what the first scan immediately after surgery did not: imaging of the metastasis (no longer micro-metastasis). The scan showed lymph nodes slightly enlarged to 2.6 cm and a tiny 4 mm legion on my lung. Picture proof together with my blood that the cancer had spread. But, at least the lymph nodes weren't huge, and my lungs weren't riddled with it. The oncologist said the chemo would take care of the cancer with a very high probability of success.

PORT CATHETER IMPLANTATION

A very important decision to be made ahead of chemotherapy is the election (or not) to have a port catheter ("port" for short) implanted. The port basically consists of a thin needle inserted into a large vein near the heart, which is connected to a port just below the skin implanted under the clavicle on the left side of the chest.

Source: Cleveland Clinic

The port allows secure and convenient access to an internal vein - this secure access is important because of the toxicity of the chemotherapy drugs being infused. They cannot use the usual veins with a normal needle, for fear of it dislodging and leaking into surrounding tissue.

The major benefit of the port is the convenience factor, in some ways. The alternative is to have a catheter needle inserted up the arm (again for secure access to a vein), with a tube then hanging out of your arm for the whole of the chemotherapy program. Whereas the port is internal and more discrete - and importantly for my decision, would make any exercise my body might allow over the next months, much easier.

There are definitely benefits to having the port, but there also drawbacks, which in my experience include:

• Needing an operation (see below), both before & after the chemotherapy program

• Discomfort and some pain even weeks after, especially if the port is caught on something (e.g. seatbelt, this happens all the time) or hit (e.g. while playing ice hockey)

• No one really warned me of this upfront or maybe it was lost in translation, but it's advised to keep the port impanted for up to a year after chemotherapy ends, as there are still regular blood & CT tests (the port can be used for these too), and recurrence probabilities are highest in the first year (i.e. in case more chemotherapy is needed, avoiding another operation)

The operation itself took about an hour, and was performed under local anesthesia only. This was probably the weirdest part, feeling the pressure of the surgeon working away in my chest, trying to look away as he assembles and embeds the port system (it really felt like he was putting together IKEA furniture inside me). At the end, I was stitched up and sent on my way with the usual after-care instructions for such situations - no getting the stitches wet until they came out a week late. It wasn't overly painful after the local anesthesia wore off, but was definitely sore and I couldn't sleep on that side for a week or two. The other weird part is simply looking in the mirror with this thing in my chest - I feel like a cyborg!

Cyborg status achieved, prep completed, it was chemo time.