Baby Update

Tomorrow is Kristen's "official" due date, but we've understood for a while that first time moms are very likely to go past 40 weeks and while things are accelerating, it certainly looks like we will be in that group. Last week we were considering inducing so we could jump start my treatment, but it looks like we are just going to let nature take its course. We still haven't decided what sort of treatment I should have, or when it should start, so waiting and letting the baby come on his own terms feels like the right decision.

After having a number of contractions Saturday, Sunday and Monday were both pretty quiet. She had some contractions and it seems like he has dropped a little (his butt seems lower to me), but we probably still have a little ways to go (but who knows).

We'll keep you updated. We sure are looking forward to meeting him.

Decisions, Decisions

If you had asked me last week what I was going to do for followup treatment, the answer would have been pretty clear cut: 2 cycles of chemotherapy, 3 weeks apart. Now the answer is less clear. Should I have radiation therapy? 1 cycle of chemotherapy? 2 cycles of chemotherapy? Do nothing but watch and wait? All of these suddenly seem possible.

Today we met with an oncologist team at MGH. This appointment was a little bit different than my last oncology appointment. First off, we met with a team instead of an individual medical oncologist. The team was a medical oncologist and a radiation oncologist, both who have treated testicular cancer before. I appreciated the multi-faceted approach: we got lots of detailed information about both possible treatments, from doctors who specialized in each area. Secondly, the office an environment was more welcoming and friendly. Finally, both doctors have treated testicular cancer before. Since testicular cancer is so rare (about 8000 cases / year in the US) it is not uncommon to find urologists or oncologists who have only rarely encountered the disease. It was comforting to know that this team has treated at least 10 cases over the last year or so -- not a lot of cases, but certainly more than you might expect given the statistics.

The doctors did not make a recommendation for treatment today, they are waiting on some additional imaging and blood work and I'll have a followup appointment on the 6th, but my impression was they are leaning towards radiation therapy. They did not rule out waiting or chemotherapy, but they have treated more people with testicular cancer using radiation. There is more data about the long term effects of radiation -- less so with Carboplatin (the chemotherapy drug). There are no long term studies of the effects of Carboplatin on 31 year old men so they can't say with any certainty how my quality of life will change. Hopefully, I'll learn more on the 6th.

Right now, I think I'm still leaning toward chemotherapy. Radiation treatment scares me because the radiation, while targeted, still reaches the stomach and pancreas. I don't know if I should be just as scared of chemotherapy or what is the quantifiable risk associated with radiation.

Anyways, things are up in the air and we have a lot of decisions to make.

Thanks for your love and support.

Busy day, Lazy day

We had a busy Saturday and a lazy Sunday this weekend. Saturday we got up early and went to breakfast at Ball Square Cafe in what is quickly becoming a weekend tradition. I think this is the third weekend in a row we've gone there for breakfast -- we've enjoyed getting out of the house and it helps us make the most of the day.

After breakfast, we went to the EcoFest at the Arlington Town Hall. We went mainly to pick up a composting bin, but enjoyed the displays and booths. Along with the composting bin, we came home with a badly needed recycling bin and some new baby books.

After the Eco-Fest we went to a baby clothing and equipment sale put on by the Massachusetts Mother of Twins Association. This is a twice yearly sale of gently used clothing, toys, furniture geared towards mothers of twins (they get in early). We arrived right when the doors opened to the general public and got one of the last parking spots and waited patiently for the 100 people in front of us to file in. While it was busy and packed, there were tons and clothes, toys, equipment, books and furniture. We ended up with three books, and about 10 great toys for under $30.

After the tag sale, we went to a first birthday party for our friends Josh & Courtney's son, Mack. It was a lot of fun and nice to sit after a busy morning. Mack seem to have a good time. He got a big yellow dump truck, a big wheeled pelican and a number of other great toys. We left a little early and went home for a nice long nap.

Later Saturday, we went to a surprise birthday/green card party downtown. We were told to arrive either before 8:15 or after 8:45 and since the train was running late, we ended up vigoursly walking from the Charles/MGH Station down to the common through Charles Street and killed some time at Starbucks. We got to the party around 8:50, but the birthday boy didn't arrive until later (surprise party recipients aren't required to keep schedules). We stayed at the party until about midnight.

Sunday was considerably more relaxed and lazy. We slept in until 10:00, had a nice french toast breakfast, then did some chores and work around the house as well as watched a few movies and took a nap. It was a good change from Saturday.

This week doesn't hold a whole lot in store, unless we have the baby. I'm taking 1/2 day Monday and Wednesday to deal with doctors, recommendations and treatments. Kristen had a number of practice contractions this weekend so the baby could be coming soon; of course, it could still be a while.

Cat Lessons

Cats lead very simple lives and yet I feel I've learned a lot of important lessons from our furry friends:

• Divide your life into only those things that are important. Sleeping, eating, and causing trouble.

• If things don't go your way, have a coping mechanism. For example, chew on a cardboard box or paper.

• It's worth finding the things you love to do and doing them over and over again. For example, it never gets old to pull a water glass over or to chase your ball down the stairs.

• Figure out the strengths of those around you and appreciate the strengths in your loved ones. John is an excellent play and food animal and Kristen is a good cuddle animal. However, it's also important to keep in mind that sometimes you can ask someone to do something they aren't typically good at.

• Learn to express your feelings in a way that can be understood by others. Purring means I'm happy and loved, meowing that I'm hungry or want to play and squeaking (well, we're still trying to understand what that means).

• Appreciate all good things that come into your life. Spots of sunshine and crinkly bags are just a couple of examples.

• Grandmas will do anything for you, Mom's and Dad's won't. You lost your ball under the oven, that's tough luck (Mom). Let's find that yardstick and get your ball out from under the oven (Grandma).

• It's important to always keep your sense of adventure. Dare to go new places and eat new things.

• Trust those people who your loved ones trust but be cautious around strangers.

• Change your perspective once in a while. Things from the top of the china hutch look very different than from the couch.

• Know where to turn when you are scared.

Baby's staying put

After my 39 week checkup it was quite clear that baby's not ready for this world yet. He hasn't dropped completely yet and there's no progress on the dilation/effacement front. We'll check in next week and see if I meet the minimum dilation/effacement amount then we can talk to the hospital about a 'social induction'. These types of inductions have less priority than a medical induction, which I would be considered at 42 weeks. If the hospital doesn't have many medical inductions and it's a slow day, then it's quite possible we'll be rolling to the hospital at the end of next week to bring this baby into the world!!

A lot can happen in a week as well, so maybe he'll decide to come out on his own to meet his Dad before he has to start chemo. Let's hope he decides to quit turning...he was heading into a posterior position today (back labor), so keep your fingers crossed he quits doing that. At least we know now he's going to be an Aries, just like Grandma!

Oncologist Appointment

Wednesday, Kristen and I met with an oncologist at Mount Auburn to go over my treatment options. As I mentioned before, there are basically three options: monitoring, radiation and chemotherapy. This doctor recommended two doses of chemotherapy with three weeks in between treatments starting 1 week after the baby arrives.

There are a number of reasons for his recommendation, both in treatment and timing. First, given the size and staging of the tumor, monitoring is generally not recommended. My tumor was about 4.2 cm and monitoring is only recommended for tumors under 4 cm. Second, he recommended chemotherapy instead of radiation due to risk of developing secondary cancers with radiation therapy. Third, Two doses of chemotherapy were recommended instead of one due to lower toxicity, fewer acute symptoms and the belief that the effectiveness is the same - though, he admitted that no specific studies had been done comparing one does with two doses. Finally, he recommended waiting until one week after the baby arrives to give us time with the baby before I feel tired and nauseous from the treatment.

I agree with the oncologist's recommendations. I think waiting is really not my best option - I would really like to reduce my recurrence risk from 20% to 1% and between radiation and chemotherapy, chemotherapy seems like the less risky long term option. The side affects to this treatment, which is relatively mild as far as chemotherapy goes, is mainly fatigue and nausea; there is a good chance I won't loose any hair or suffer nerve damage or hearing loss which are other common side affects. After both doses, I'll have to do following CT scans every 6 months, for about 3-5 years (I didn't write this down). These will taper off over time, but it might not be something that I ever stop doing.

While I do agree with this doctor's recommendations, we are seeking a second point of view and I've started the process of getting my medical records from Mount Auburn to Mass General. Kristen's primary care physician recommended an oncologist there. However he is no longer taking testicular cancer patients, but they did make an additional recommendation. I think he will make the same, or similar recommendation, and it will ultimately come down to location and personality for where we are treated.

Ideally, the baby would come on time and treatment would start in about two weeks, but we may go over the due date, in which case I would not be starting treatment for about four weeks. This carries some additional risks as earlier treatment is always better and the longer it goes untreated, the more likely it is to resist therapy. Given that seminoas are slow growing and respond very well to treatment, this may be an acceptable risk. We have an appointment with the midwives tomorrow and we'll see if there is any thing we can do to have an on-time or slightly early delivery.

Adjusting Expectations

Kristen and I have been focused on birth, perhaps a little too much. We've got a very good idea of how we would like to experience birth and bring our son into the world, but as we have learned over the last few weeks life does always go as planned. As I was doing dishes tonight, I was thinking about how birth is like a wedding - its important, but not as important as what comes after and a birth/wedding in no way prepares you for a child/marriage. Just my two cents, Kristen may have other opinions.