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Testicular Cancer Survivor
|Doug Rettko, Tacoma, Washington|
Doug Rettko’s face lights up when he describes transitioning from skiing to snowboarding. “I grew up skiing and I went snowboarded one time and I was hooked!” He can’t wait to get back on the mountain. Doug is always looking forward to the next step, the next goal, the next adventure. His naturally positive attitude has helped him continue to enjoy his life despite serious health challenges.
Doug and his wife Kelly have two children, son Addison and daughter Delaney. Between snow sports and coaching soccer, Doug is the special events coordinator for a beer distributor. He works on popular public events like the “Taste of Tacoma” and is also responsible for installing big beer systems for commercial clients.
In 2006, snow sports were put on hold as Doug battled testicular cancer. For most patients, recovering from cancer is the number one goal, but for Doug, there was another challenge ahead that depended on his becoming cancer-free—a liver transplant.
Diagnosed in 1997 with autoimmune hepatitis (AIH)—a disease in which his own immune system was attacking his liver, causing scarring—Doug came to University of Washington Medical Center (UWMC), part of Seattle Cancer Care Alliance (SCCA), for treatment. In 2003, after a second flare-up, his doctors added his name to the liver transplant waiting list. But in 2006, with a new diagnosis of testicular cancer, his name was taken off the list. To be eligible for a transplant, Doug had to be cancer-free for at least one year.
In 2006, at 41 years old, Doug had symptoms of tenderness and inflammation in his left testicle. He went to see his urologist in Tacoma, who performed an orchiectomy (the surgical removal of the testicle on one side) and diagnosed him with testicular cancer. In addition to the cancer in his testicle, another nodule was found behind his left lung and one below the left kidney. Right away, Doug’s wife Kelly contacted UWMC to arrange for him to be seen in oncology.
His urologist encouraged him to return to UWMC for his cancer treatment because of his complicated medical history. With the most experienced physicians, SCCA offers specialized care to patients with complex medical issues.
At the SCCA Prostate Cancer Center, located at UWMC, Doug met with oncologist Dr. Bruce Montgomery. A review of his pathology reports and CT scans was made at UWMC, and the complete staging of his cancer was done at SCCA.
Testicular cancer is a highly curable cancer, but Doug had an advanced stage that required aggressive treatment. Dr. Montgomery discussed treatment options with Doug, and they determined that the best treatment for him would be four cycles of chemotherapy. Doug’s chemotherapy treatment began June 9, 2006.
To help keep Doug’s liver function at its highest during the chemotherapy, he was given prednisone and dexamethaxone (a higher potency steroid), which likely led to his steroid-induced diabetes. He still gives himself insulin injections in the morning and at mealtimes.
Because chemotherapy drugs have to pass through the liver, doctors needed to ensure that Doug would get the most therapeutic effect from the chemo despite his impaired liver. Doug’s platelet count was low. Before beginning chemotherapy, his doctors wanted to increase his platelet count by decreasing the blood flow through his spleen. They would accomplish this by inserting a surgical shunt. On May 18, 2006, Dr. Terry Andrews performed a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. During the TIPS procedure, with fluoroscopic guidance, Dr. Andrews guided a small plastic catheter through Doug’s heart, into his liver, and out one of the hepatic veins.
On June 9, 2006, Doug began his chemotherapy treatment. He received four cycles of chemotherapy—one week of treatment, followed by two weeks off—over a period of three months. It was tiring. He says, “On Monday and Tuesday I drove myself in and Wednesday through Friday I got a ride and my wife would pick me up.”
On treatment days he arrived at the infusion room by seven in the morning and left at three in the afternoon. First he was given two bags of IV fluid, then before the chemo treatment his blood was sent to the lab for testing; after the results came back he had the chemo, and then two more bags of fluid before going home. Keeping Doug’s blood count up was a challenge: “Every Monday I received two shots: one to increase my red blood cell count and one to increase the white blood cells.” Doug’s main side effect from the chemotherapy was fatigue. Often he fell asleep during the process.
In the past, nausea was an accepted side effect of chemotherapy. For Doug, that wasn’t a problem: “Before the chemo, and every six hours, they gave me the anti-nausea drug ondansetron by IV. I had no nausea.” However, Doug didn’t have much appetite. He recalls, “Chemo made my stomach feel blah—chemo-stomach. And, nearly everything tasted like metal. The only thing I found that tasted good was Roasted Red Pepper Tomato Soup from Trader Joe’s, so that’s what I ate.”
Doug’s chemotherapy ended in August of 2006. His results looked good—the nodule behind the lung was gone and the one below the left kidney had shrunk.
Meanwhile, Doug was still being followed for his AIH at UWMC. In November of 2006, a transplant surgeon reviewing Doug’s CT scan noticed that the nodule below the kidney had grown. At the time, Doug wasn’t yet strong enough for another surgery, so they waited. On January 10, 2007, he had a retroperitoneal lymph node dissection in which a large incision is made in the abdomen, and lymph nodes are removed from the groin and abdomen. Dr. Dan Lin, a surgical oncologist, performed the operation. The nodule was benign, and a year after his treatment ended, his name was put back on the liver transplant waiting list.
On November 19, 2007, Doug received a life-changing call from UWMC—they had a liver for him. In a surgery that began on Monday night at 7:45 and ended more than nine hours later, a highly skilled medical team gave him a new, healthy liver. A week later, he went home.
These days, Doug stays busy, exercising and playing with his children. His family looks forward to their annual snowboarding trips.