Survivor Spotlight: Eric Forman
My Own Day of Infamy
PART I
It was like any other monotonous day on the ship. Wednesday, August 25th, 2010 to be exact. I had just finished my 14 hour shift for the day and my work out in the gym so I was more than ready for a shower. Lucky for me, the water on the George Washington was rather warm that day. Warm water is a big deal at 9pm (2100) being on an aircraft carrier of 4800 sailors. Figuring that 80% of the crew is day shift, like I was at the time, there are about 3800 sailors taking a shower at one time within a four hour window. Anyway, I digress; warm water on the floating city is always something to look forward to. So I'm taking my shower and my time doing it...then ouch. Ouch in the shower can be rare, this time was peculiarly rare solely based on the location of the pain. I carefully went over my left testicle again, more gentile than before. It was extremely painful and very sensitive. Now I realized I should compare and contrast. I softly felt my right, noting that under the skin was smooth, all around. I checked the left, not so much. It felt as though there were multiple calluses encompassing it, and quite tender. Well I did not like that of course. Like any other guy, I endured the pain for a week hoping it would go away, naturally it didn’t. On September 1st, constant pain in the left testicle began to form as though I was just kicked in that region. I went to medical at 3pm that day and was seen by the ship's Chief Medical Officer (a Captain at that) and the lieutenant surgeon. Both explained to me that the growing mass was very concerning; however they could only observe to an extent by means of exterior feeling. I was told that since we (the ship) were three days off the coast of Manila, Philippines that I would be flown from Clark AFB back to homeport in Yokosuka, Japan for an ultrasound.
On Sunday, September 5th at 0300, while five miles anchored off the coast of Manila would be the last time I would perform the duties I joined and trained for, until arriving on the USS Boxer January 16, 2013. With my sea-bag half full and backpack of electronics, I boarded the liberty boat at 0600 that would take me to the mainland. I was only on the mainland for five hours before the plane took off from Clark AFB for Japan.
The dreadful week began on Tuesday, the 7th consisting of blood tests and an ultrasound, which is cold by the way. The effects of the temperature in that area made it difficult for the technician to retrieve quality images. Once that was complete and I got warm again I headed over to my doctors office to see what she learned. No sooner than five minutes of sitting down did she tell me that I would be going in for surgery in 20 hours for a unilateral orchiectomy (removal of my left testicle) at 0800 the next morning. She didn’t know what the mass growing was, but they would remove it anyway just to be safe. Naturally I was defensive and asked if they couldn’t cut me open and take a sample. The doc said, “That may induce spreading, thus it is safer to remove it now” (Easy for you to say). According to my blood labs my hCG level was 15. The hCG is a hormone mainly produced by females during pregnancy. Male levels range on average 1-5.
I went into surgery 0830 Wednesday morning and didn't wake up until 2pm in a world of pain. Morphine via IV only does so much. Plus, I felt half the man I use to be, as though I were missing something. I was confided to bed rest in the hospital for 24hrs before I could leave. Once discharged from the hospital, I was allowed 7 days convalescent leave and a big bottle of 800mg Percocet’s (2 every 4hrs). I didn't see my doctor until Tuesday the 21st for more blood tests and a CT-scan. My hCG level had now risen to 25, while the CT-scan proved signs of spreading through my lymph node system. The lymphnotic system is what makes cancer so deadly. The system runs through all the major areas of your body, giving the cancer a highway to spread. Normal lymph nodes should be 1-2mm in diameter. Mine were 1.2 cm and 2.3cm. I was informed that day that my testicle was sent to Balboa Hospital in San Diego for a biopsy. It was then my doctor quietly broke the news to me and told me I was diagnosed with Embryonic Testicular Cancer. In a way, I was relieved to learn that it was something serious than not, for they already took my testicle as it was. It was good to know I lost it for a reason, not on a whim. So here I am in Japan, 21 years old, after only a year in the Navy, and I get stuck with the rarest of the rarest cancers, which happens to be the fastest spreading. Testicular Cancer alone is the most curable if you look on the bright side. I broke the news to my parents. My father stayed strong as he should. My mother on the other hand was a wreck. Five days later on Sept 26th at 12:07pm I landed in San Diego International and headed for home to surprise my parents. My mother broke down once I stepped foot in the door.
PART II
The doctor appointments at Balboa Hospital began the very next day discussing my case to the Urologist and Oncologist. The busy day ended with a blood test and checking into Med-Hold. My hCG level jumped to 37. The following week was filled with check-in paper work, other small appointments and three visits to the Fertility Center of California of San Diego. It was at that time the seriousness of my condition set in. I was only 21 at the time but I knew then someday I would want to be a father. Having cancer was jeopardizing my opportunity to do so. My doctor explained to me that chemotherapy would possibly cause me to be infertile for one year, with a 50% chance of being infertile forever. She recommended that it would be a good idea to make a "deposit" at the "bank". The interest rate was low but oh well. Let me tell you, never have I done anything so embarrassing before in my life. The first time I went was in my service uniform. I was definitely not dressed for the occasion. Of course, only females worked there except one male doctor. They know what you are doing behind that door, in the leather seat with the sanitation cover, flat screen TV with a DVD or choice of magazines. In the back of my head I think, “Do I rush or take my time? Come out in 5 minutes they may think I'm quick on the draw. Take too long and they may start to worry.” Anyway, I did not enjoy those three visits. However on the plus side, after my last "deposit" a doctor spoke to me about my samples and was pleased to tell me that average sperm count is 20 million parts/ml for the avg. male. However based on my condition I was cranking out 16 million parts/ml. I got me some Navy SEALS. My doctor urged me to quit smoking during chemo. I said "Why? I don't have lung cancer. I have Testicular Cancer. You should tell me to quit sex with that logic." She did not find my logic amusing as I did.
The first cycle of chemo did not begin until October 18, 2010- Oct 22, 2010 (hCG level = about 61). Each cycle was five days in a row, four hours long each day. The morning of the 18th began at 0800 as I went into surgery for the placement of what is called a Power Injection Port. It's a device that sits under the skin just below my right collar bone. It's about the size of a penny with a gel like top and cord that run to my neck and into my jugular vein. This is so that the chemo may be administered easier and less painful rather than a daily prick of an IV. Once I took my anti-nausea medications (worth over $500) they hooked me up with a 2mm needle that the nurses taped over and I kept it in for the week of the cycle. At the end of the needle is a tube just like a normal IV would be with an end to screw in another line for either 1000/ml saline w/ 0.9% potassium for pre-hydration, 1000/ml of chemo, and another 1000/ml saline with 0.9% potassium for post-hydration. The chemo I was administered was called BEP (bleomycin, etoposide, and cisplatin). All three drugs have different side effects however only bleomycin, etoposide cause infertility. Chemo is a drug that kills fast growing cells. This includes the cancer itself, but also hair and blood cells. The red cells carry oxygen throughout the body, which made me more tired. White blood cells are my immune system, the lesser the easier it is to get sick. The platelets help make scabs and prevent bruising. By the end of the day of chemo I went straight to bed and usually didn’t wake up until midnight or so. I’d make a fast-food run to Jack-in-the-Box and order 10 tacos then head over to 7-Eleven for a double gulp. I still had my appetite God bless me and managed to gain 60 pounds during the course of my year in Med-Hold. Something I am still working to get off. It mother found it hard once my hair began falling out after only the first week of chemo and on her birthday too. Cycle 2 was suppose to begin on November 1st, however my hands broke out and formed hard, painful calluses and blemishes on my wrist that look like scars. Cycle 2 was postponed one week. I also had another blood test to check my hCG level and the results showed that in one cycle I dropped all the way down to level 3. I finished chemotherapy on December 31, 2010.
PART III
The January 2011 CT-scans reviled two lymph-nodes 6mm wide in my aorta track and a 5mm one in my lung. Normally lymph-nodes should be 1-2mm and when I still had the tumor back in September they were 1.2cm. So, they were not big enough to create a scare however something had to be done with them. For those who do not know, (I didn't at first) the aorta is by Wikipedia definition (at times, a credible source) the largest artery in the body, originating from the left ventricle of the heart and extending down to the abdomen, where it branches off into two smaller arteries. After reviewing my CT-scans, my Oncologist said that she was fine with "the observation stage" meaning CT-scans every 2-3 months to track if there was any growth of the swollen lymph-nodes. She would present my case to the Tumor Board for their opinion as well. In the meantime, she recommended I get a second opinion from the Head Urologist and learn what he thinks.
Two weeks later, mid-February, I met with the urologist and his recommendation was to perform a Retroperitoneal Lymph Node Dissection (RPLND) to remove the two lymph-nodes in my aortic track and leave the one in my lung only due to the fact that the surgery to do that is more of a risk than the actual lymph-node itself. His reasoning behind the surgery was that, one, could possibly turn into a teratoma cyst later in life (A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers). Or 2, be benign, or 3 could just be scar tissue. I thanked him for looking at my case and went on my way; right back to my Oncologist. I told her he recommended the surgery and she was quite surprised. She said it's up to me now, obverse or surgery. I asked her when is the soonest I may have a second CT-scan to see any possible growth and she said two months from the last one. So I had a second CT-scan in mid-March and the results turned out to be the same as the last one. Neither growth nor shrinkage. I took the next weeks researching the surgery, learning the risks involved, talking with friends and family members for their insight on what I should do. I came to the conclusion of going through with the surgery for numerous reasons. One being that it would be a greater toll on my body if I was to wait until age 30 or 40. Being 22 I would heal faster and quicker. Secondly, so that I may end this chapter of my life and press forward with my career which has been on hold since September 5th. So I called it preventative maintenance.
The original surgery date was May 27 at 0600. However do to hungry issues and not eating for 18 hours per doctors orders. I indulged in a Slim-Fast the morning of, thinking liquid was ok. The surgery was postponed until June 9th. This worked out well because my advancement ceremony to E5 was on the 2nd and attending it would have been a painful challenge 6 days after surgery. The morning of the 9th began with checking in a 0900 however not going into the OR until 1pm. It took the doctors a good hour just to get my epidural set up, which also took them two tries. The surgery lasted five hours and I was placed in ICU. It was a complete success. I didn't fully wake up until about 9:45pm with my girlfriend Nicole at the time (Married November 11, 2011) by my side in the room. Turns out the epidural worked on only the right half of the incision. The incision began one inch below my sternum and extends two inches past my waist totaling 10.5 inches long and 66 staples holding me together. The next day, Friday, the doctors wanted me out of bed and sitting up in a chair for half the day. Then once they moved me to the wardrooms, they insist I walk around as well. Using a walker, my IV machine and catheter bag behind me, two orderlies and Nikki, I made one lap around the desk area at about 2mph. Back in my bed they finally left me a alone for awhile. The worse part of it was the pain meds weren't working one bit and I was on a "no nothing" diet for the first 2 days. Saturday I was finally allowed 30ml of water/hr, the same as those plastic cups on the top of NyQuil bottles.
According to the doctors I was making great progress and they were very surprised how fast I was healing. I made it to 3 laps around the desk that day. Sunday morning came with a treat, liquid diet stage. Never has Jell-o tasted so good. Everything else was questionable. They removed my catheter around 1pm and told me I must pee 300cc in 6 hours on my own or they would put the catheter back in. So I guess you could say I had some motivation. By 715pm I was only at 250cc and finally by 8pm got up to 500cc. I went another 1400cc in 4 hours. Sunday night I was able to eat "real" hospital food again. Monday I was discharged from the hospital with the doctors pleased to see how quickly I was recovering. For pain, I was given 325mg Tylenol, 5mg and 10mg Oxycontin. None of it worked effectively the first week and a half. I had my staples removed the following Monday and continued to recover in Huntington Beach, CA until July 14, when I had to report back to Active Duty. Five month later after recovering from this major surgery, I received my first PFA failure due to BCA. The doctor claimed that even though I had a rare extensive surgery that required cutting open my abdominal muscles 10.5 inches long and removing my intestines to reach the lymph nodes that needed to be taken out, I should “Just lower my calorie intake.”
PART IV
After a year had passed since I completed chemotherapy, the fertility clinic wanted me to begin coming in again to test samples and view the affects it had on me. I went in February 2012 for a check-up. Just as my doctor told me before I began chemotherapy 16 months prior, my count was less than 100,000 per/ml. The doctor at the clinic said this was normal. The real test is once two years have passed since my last day of chemotherapy. From there, what every my count is in two years is most likely what my count will be for the rest of my life. A few months later I went back for another check up on July 17, 2012. My count only rose to 2.4 million per/ml. It was not looking hopeful. My fears came true on March 6, 2013, two years and three months since my last chemotherapy treatment. My count was only at a measly 3.2 million per/ml. In the matter of 25 months, my count dropped from 16 million to 3.2 million. My odds of having children have greatly decreased. To further worsen those odds, my wife is currently on dialysis due to kidney failure. There have been no known cases of any woman on dialysis to carry a child to full term. My wife and I now play the waiting game for the next 3-5 years until she can receive a kidney and before we can start a family of our own.
Every day for the rest of my life, if I think I'm having a crappy day, I think of where I came from and what I have to be thankful for. No day is worst than a day of chemo thinking you will never get better. But I did get better. I was given a second chance. I survived and was able to continue my Naval career. This is why I always live on the positive side of life. I am overjoyed and proud to say that 10 months, 2 surgeries, and 20 days of chemotherapy later I have beaten Testicular Cancer.
