Mike Heasley

As mentioned the other day, I've just now gone through my second surgery in under three months. Yeah, it's been a heck of a year so far.

Wacky coincidence

The two procedures were due to unrelated conditions, though there have been some interesting coincidences in both timing and physical location of these ailments. Both were on my left side and both started showing symptoms within a few weeks of each other. But the evidence in both cases suggests no correlation whatsoever.

Back in November, I started noticing two different problems: one ultimately led to the cancer diagnosis and subsequent surgery in January; the other I attributed to possibly pulling a muscle after going bowling for the first time in a few years. I'd had similar lower back problems in the past, though this one seemed more concentrated on the left side only. Still, it was merely a bit sore and didn't really give me any trouble with daily activities.

Fast forward to late February. Just as I was feeling almost 100% recovered from the January surgery, my left lower back pain returned with a vengeance. Soon the pain began extending down my left leg, making it difficult to walk, and impossible to fully extend the leg. Just as I had stopped limping from the surgery, I started limping due to this new problem. Soon I couldn't remember what it even felt like to walk normally, and I started feeling like I was 80 years old!

More scanning

My doctor sent me in for an MRI of the lower spine. Having an MRI done is very similar to getting a CAT scan. The three main differences are: no nasty contrast dyes, the MRI takes longer (at least mine did), and the machine is full body length, rather than a foot or two deep. This means that some people I'm sure get claustrophobic during the procedure. I had no trouble with that aspect, but it was painful lying mostly flat and not being able to bend my leg as much as I wanted to relieve the pain.

Music...

They give you ear plugs to wear because the MRI machine is loud. That's a fourth difference, I suppose. Actually, as I was laying there during the scan, I wished I had a microphone to record all the sounds it was making. Long and drawn out buzzes from low to high pitches; short, staccato bursts; all kinds of different repeating patterns; and everything in between. I could put together a pretty cool little musical piece using a recording of all those different sounds.

...And pictures

I didn't get a fancy CDROM of the MRI images, but I did use my camera to sneak a few pictures of the films, using a computer LCD screen as a rudimentary backlight. Here's one of the discs in the middle of my spine. The disc itself is a nice shape in the center of the image, and you can see the spinal cord and the vertebra structure below it.


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And here's the lowest disc in my spine. Notice anything wrong?


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Getting on my nerves

That's right, this disc has apparently ruptured, sending a good bit of its gelatinous material into the spinal cavity, where it happens to be pressing on the nerves going down my left leg. So while my leg was in pain, there was really nothing wrong with it; the problem was with the nerve in my lower back. This condition is otherwise known as a herniated disc.

Apparently the bulge here is about twice as big as most people get when they start to experience pain. And so by all accounts, I should have been in far more pain than I was. My orthopedic surgeon thinks I just have a higher tolerance for pain than most people. I think I'll take his word for it, as that doesn't sound like a pleasant thing to test for.

Since I was in some pain but not totally incapacitated, we tried physical therapy for a few weeks. This often helps people with smaller bulges to avoid surgery if the disc begins to heal on its own. But mine wasn't getting any better, so soon it was time to go for surgery #2 of the year. Tuesday I went in for a microdiscectomy.

Going under

I'm not sure if general anesthesia is something I could ever get used to. Both surgeries, I can recall being wheeled into the operating room and given anesthesia by IV. I can remember looking around and being generally alert, and then it all suddenly jumps to waking up in the recovery room. There's not the usual sense of passage of time that you'd get when taking a nap, but it's not exactly instantaneous either. It's a very strange feeling.

Immediate results

But like the last time, soon I was drifting back to wakefulness, the procedure all finished. Dr. Mayo came to my room sometime later and had me get up and walk around. The difference was amazing! No more left leg pain at all. Aside from the soreness in my back from the surgery, I was already walking better that I had been earlier that morning. I realized that I had to unlearn the limp because I was still expecting the pain when it was no longer there.

The gory details

Dr. Mayo also gave me a souvenir to take home: a photo of my back, opened up, with the excess disc material pulled out. He said if he'd known I was going to blog about it, he would have video taped the surgery so I could put it up on Youtube. Oh well! All you get instead is this gruesome picture:

WARNING: do not click if you are the slightest bit squeamish!

Fun with pain meds

So now I'm at home recovering. It's kind of funny. I'm already walking better than I ever have in the last 2-3 months, but I have this new soreness in my back from the surgery, so I'm still far from 100% healed. The most important thing is to make sure I have good posture during the healing process. Standing, walking, and lying down are ok, but no sitting for very long at all.

Should be a fun couple of weeks!

It's been over 2 months since I last posted about my cancer so it's about time for an update.

Take a look inside

About a week after that post, I had my first CAT Scan to look for possible spread of tumors to other parts of the body. It's kind of an interesting experience if you've never done anything like it before.

First, you spend an hour before your appointment drinking this white, milky barium contrast drink. It's not something I'd consume for fun, but it is tolerable. Kind of like an a diluted, unsweetened milk shake.

Once you get in the room, you lay down on this movable table that's positioned to go through the large tube in the scanner. The scanner's only a foot or two deep, so there's no real problem even if you're a little claustrophobic.

Over an intercom from the next room, the technician tells you to hold your breath; then the table moves you through the scanner and back, all in about 10-15 seconds. Then you breathe again. This repeats a few times for several different scans.

In my case, I also had to get iodine contrast injected for some of the scans. As soon as the technician starts the IV, you suddenly feel a strong heating sensation around your neck and in the groin. Very strange feeling. This lasts about 25-30 seconds as they do the next couple of scans.

After that, you're done. The radiologist looks over the scans for any problems and sends the report to your doctor in a few days.

The good news

After my first CAT scan, the results showed no evidence of any cancer remaining in my body. It was confirmed that the tumor was Stage I Seminoma, just about the best type of cancer to have. Success rates are overwhelmingly high, and my urologist said I probably have an 85% chance that I won't need any further treatment. But there was a huge decision to be made.

The big game

At this stage, every testicular cancer patient must make a big decision: go through radiation treatment to kill any possible microscopic cancer cells that may still be there, or simply watch and wait. With the radiation therapy, your chances of relapse go from 15-20% down to 3-4%. Most patients opt to do this, even if there's an 80% chance that they don't need it.

Should I reduce my chances of relapse by going for radiation, or should I take my chances and hope I'll never need it?

This was a very difficult question. I like the idea of reducing the chance of relapse as much as absolutely possible. And judging by the fact that the majority of patients opt for this treatment, so do most other people. But I was also concerned about the side effects of radiation therapy.

The near term side effects I can deal with if necessary. Nausea, skin rashes, and other potential side effects are temporary and livable. But what about long term side effects? And what if I don't even really need the treatment?

Most cancers strike towards the end of life. If your choice is between maybe succumbing to cancer at age 65 or possible side effects at age 95 (if you're so lucky to make it that long), the choice is easy. But in my case, I certainly plan to be alive and kicking in 30 years, at age 62. I don't want a potentially unnecessary treatment causing me problems in 20-30 years from now.

The thing about cancer treatment is that it's poison. Whether you get radiation or chemotherapy, you're poisoning your body, knowing that the fast-growing cancer cells will be the first to die. As soon as they die, you cut off the poison and hope it didn't ravage the rest of your body too badly. People recover from this process, but there can be lasting effects, manifesting decades later. In the case of radiation therapy, this can include increased risk of secondary cancers and heart disease, among other complications.

Playing the odds

So it comes down to the percentages. What are the chances of relapse and subsequently unsuccessful treatment versus long term effects in a few decades? I spent a few weeks researching this, combing through dozens of medical journal articles I found. It was actually kind of fun, and made me feel smart again, like when I had to research journal articles in college.

Numerous studies have been done over the years, applying all sorts of statistical analyses to the available data on patients over the last few decades, their treatment choices, and ultimate outcomes. Unfortunately you can't just take statistics from patients who were treated 20 years ago and apply them to your situation now. Treatment methods have changed, hopefully improving, but we won't have long term data on today's treatments until decades from now. In short, it's impossible to know for sure.

Still, I collected the numbers from numerous studies until I felt like I had a good handle on the problem myself. And it was about time for me to make my decision. Either start radiation therapy or begin scanning for relapsed cancer every 2-3 months.

Placing the bet

I chose surveillance. I felt uncomfortable enough the increased odds of long term complications from radiation that I decided not to risk poisoning myself for possibly no reason. I'm pretty comfortable with the 85% chance that I'll need no further treatment, especially given the fact that treating relapse is still well over 95% effective. If it happens, it'll require chemotherapy, but I'll get through it. At that point, the poison is necessary to save your life in the near term, so you have to do it. I'll cross that bridge if I get there, but hopefully I won't.

I realized that I'd feel really horrible if I got a secondary cancer in 20-30 years because of the radiation, cutting my life short. Especially given the fact that at that point, I wouldn't even know if I really needed the radiation to begin with! Either it would have worked and we'd never know, or there wasn't anything there to begin with. Now I know I'll never be in that situation, and I'm happy about that.

So far, so good

I had my second CAT scan the other week. This time I got to keep the CDROM with the images on it. Pretty cool stuff. The machine basically does x-rays of various slices through your body, both horizontally and vertically. From just a couple of images, I can identify several major organs, including: lungs, heart, stomach, pancreas, liver, intestines, bladder, kidneys, bone structures, and more.

Click on either image to see an animation of of the slices through that axis:


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Neat stuff. This scan came back clean, so now I'm two for two. Next scan in June.

New problem!

Are you still reading this? Well, tomorrow I go back under the knife for more surgery. What, you say? Didn't I just get a clean bill of health from the CAT scan? Well, yeah. It turns out I had a completely unrelated problem come up after recovering from January's surgery, and this one requires another operation. Rather than bore you any more, I'll tell you all about it in a few days as I recover from that.

This surgery thing is starting to become old hat!

I have (or hopefully, had) Lance Armstrong cancer.

Not that it was a big surprise. I've known for some time that this was likely coming. After initial symptoms showed up in November, several weeks of doctor's visits and tests all culminated in the surgery two days ago. There were definitely tumors, and the urologist told me before the surgery that it showed a 95% likelihood of being cancer. The only way to tell for sure was to perform a radical inguinal orchiectomy, removal of the affected part, and send it to pathology for analysis.

As I was waking up from the operation on Thursday, the doctor came by and told me that it definitely looked like cancer, giving it about 99% odds. Close enough. We'll know 100% when the pathology results come back on Tuesday, but I'm pretty sure that 1% is going down to zero.

For now, the incision hurts like heck if I try to do anything besides lie in bed. Vicodin helps somewhat but I don't want to rely on it too much. Hopefully in the next few days I'll be able to move around a little bit better. I'll probably be back at work in another week or so.

On Tuesday I'll learn the results of the pathology tests, which will tell us a number of things. It turns out there are several different types of cancerous tumors that can show up here, and treatment strategy sometimes depends on what types are present. I'll probably also have a CT-scan done to see if it has spread to anywhere else in the body. If it has, then further treatment will be necessary. If not, then we can probably get away with just the surgery + close surveillance for the next couple of years to make sure nothing pops up.


At any rate, I'm not writing this for sympathy. While the word cancer often sounds like a death sentence (and unfortunately for some types, it essentially is), my case is not bleak at all. When caught early, testicular cancer has a nearly 100% cure rate. 70 to 80% of patients don't need any treatment beyond the initial surgery (fingers crossed). And even when caught in advanced stages (when it has already spread), the cure rates can be up to 80-90% or better, depending on the type of tumors found. I'm pretty darn optimistic.

The real reason I'm writing about such a personal issue on this blog is that the prime demographic for this form of cancer also happens to overlap with BYOND's prime demographic: males aged 15 to 35 years old. You have a 1 in 250 chance of getting this disease in your lifetime; if you're in the aforementioned age range, your chances go up. If you're white, they go up even more. Given these odds, it's overwhelmingly likely that someone else in BYOND's community either has it or will have it in the future.

I'll probably use this blog to write some more about the diagnosis and treatment process, but the most important message to take away is this: perform a self-examination monthly. Early diagnosis is absolutely the most important factor in treating this cancer! I know it's embarrassing (hey, I'm writing about it publicly), but it's better to be embarrassed than sick. And I know that men in particular often wait too long before seeing a doctor, hoping it will go away on its own (thanks to my wife for a little prodding on that).

Lance Armstrong waited until the cancer had spread to his lungs and brain. He had to have extensive chemotherapy and brain surgery. Even with modern success rates, he was still given less than a 50% chance of surviving. It would have been much easier if he hadn't waited!


I'm looking forward to a full recovery, after which I will follow in Lance's footsteps and win the Tour de France 7 straight times. Or at the very least, I should become a BIKE GOD again after all of this is done.

And for those who were wondering, I still have one remaining, and it is fully functional. (sorry if that was too much information!)

In less than twelve hours I will be lying unconscious on the operating table, getting a defective part removed. Should be fun!

Set One: We headed to the dog beach with visiting family (including one extra dog) on the day after Christmas. I brought my new Canon D60, another hand-me-down gift from my Dad. Fanatical readers of this blog will no doubt recall that I received his old D30 about 2 years ago; this one doubles the number of pixels and brings a few other small improvements.

Unfortunately, in my excitement to try out the new camera, I hadn't checked all of the settings before shooting. It turns out the camera was set to aperture priority mode for most of the afternoon, forcing it to often choose rather long exposure times to accommodate the small aperture size that had been set. So, plenty of motion blur in the action shots, and a ton of unusable "stills" with too much camera shake showing. Live and learn.

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Set Two: Back to the beach yesterday (or maybe "today" since I haven't gone to sleep yet), determined to get better photos of the dogs. These ones came out pretty well.

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See also: A day at the beach