Utter bollocks - spotting the signs and symptoms

My route to finding out I had testicular cancer was probably different to most, in that to this day no symptoms have manifested in my testicles. Every test and scan has indicated that they are virtually fine, aside from the battering they are now taking from the chemo! So, how did I get from living my normal life to being a cancer patient? Well, it's not straightforward but I'm hoping that by documenting it I can encourage others to not only conduct the "normal" checks regularly but to exploit any opportunity for more thorough checks - MRI, CT ultrasound and blood tests all of which contributed to my eventual diagnosis. Ultimately, it was images like the one below that finally convinced me and my doctors that something truly was awry, and whilst the passage below is more a recounting of my adventurous activities than a detailed medical history, I hope it underlines how protracted was my realistaiton that I was unwell. It's a long story, so I won't judge you for skipping through, just do me a favour and do your checks...

So, back to the question. What was wrong? The first thing I noticed in October 2022 was an odd dead leg sensation almost every time I walked, even if for only a minute. I'd felt a slight twinge a week before during a gym session at work and assumed I'd picked up a microtear. It was slightly sore and felt knotted, I figured I'd keep stretching, rolling and massage-gunning until it stopped. It the meantime, I was due to run an intense 4-week residential training exercise for 20 new students, and whilst I wasn't able to carry out my normal training routine I was invariably on my feet for about 16-18 hours a day. Without my normal gym-based training it was less noticeable but the dead leg never disappeared. A week later I would be in Nepal, where after 10 days of meetings and disaster planning I would have a chance to put my leg to the test...

My toughest climb

I'd organised for a group of us to undertake the Ghorepani Poon Hill trek in the Annapurna range of the Himalayas. It was going to be the highlight of our trip to Nepal, and certainly an activity that at any other time I'd have loved. I expected to be that person bouncing back and forth between the front and rear of the group, annoyingly taking photos and veering us off course as I became distracted. We had a guide and 3 porters, possibly the most redundant porters to have conducted the trek at this point in the season; our group comprising 6 soldiers stubbornly refused to hand over any of our kit for the duration, at some points even buying water and bunches of bananas to give the teenage porters something to carry as they effortlessly led us along the route. I have to admit, for the first couple of hours I didn't feel any pain whatsoever. We were mostly on the flat, and truth be told I was still drunk from the night before. Not hungover. Drunk. A few of us had got back to base at 0500 ahead of a 0700 airport transfer, for a flight which we remembered nothing of. 

After a couple of hours, some lunch and a dip in an ice-cold Himalayan stream, I began to sober up, and as the incline began to ramp up I noticed that familiar dead leg begin to resurge. The sensation quickly evolved from one of numbness to painful throbbing, and this time it really was unrelenting. What exacerbated the feeling was any increase to our incline, which didn't bode well for me because the first day of the trek included a virtually non-stop ascent of a stone stairway comprising 3,767 steps. Some steps were close by, some were a stretch, but each and every one took a toll. Very early on I had to adapt my entire walking profile, climbing about two thirds of the steps with my left leg and allowing my right to trail. 

The team could tell I was in pain. Gemma gave me her emergency supply of ibuprofren, and Scotty caringly helped me to stretch and massage my aching leg every half hour or so.

 

That first day took us about 6-7 hours altogether. For the latter 4 hours, I probably had to stop every 10-15 mins. Sympathetically, the group would instigate unrequired water stops to allow me to keep within line of sight. At other times, even more humanely, they would continue without me, allowing me to catch up at the next 'long stop' and saving me the shame of being the group handbrake. You see, with no previous indication that I had any medical or mechanical problem, and with no prior warning that I may struggle, I was completely absorbed with the premise that the group and our guide would take my struggles for a lack of fitness. On several occasions I felt my blood boil as the teenage porters were sent to the back of the group to babysit me; not because I was ungrateful for the concern over my safety, but because after several years of serving alongside Gurkhas I knew enough colloquial slang to recognise some of the more derogatory words being cast in my direction, often with a chuckle or exasperated sigh at how long the climb was taking. Ah well, anger can be a powerful anaesthetic. Half a league, half a league, half a league onward.

Mercifully, we reached the first overnight stop early that evening, still ahead of schedule. A lukewarm shower, marginally warmer meal and not-at-all-warm bed awaited us, and whilst they were each a welcome relief I couldn't help but wonder how I was supposed to continue on. Thankfully, I didn't have to decide - on a guided trek in the middle of a mountain range I didn't have much choice other than to stick with the group and hope I could keep pace. The second day unfolded not unlike the first, perhaps a tad easier without the relentless series of steps. We reached Ghorepani that evening, settled in for one of the coldest nights of my life, and were up and away at 0400 the next morning to reach the summit of Poon Hill ahead of sunrise. I won't repost the photos of the stunning scenery that greeted us, you can see those plastered over my home page, but it was enough to make me forget what was happening in my legs temporarily. Unfortunately, once we'd taken our fill of the view we then had to complete the reverse of the last two days' trekking in about 6 hours. Granted it was mostly downhill, but it was heavy on the legs. The trek had taken us about 30,000 steps up, and the same again back down. By the time we landed in Kathmandu that evening we could barely climb the stairs to our rooms without trembling.

Investigating the leg

By the time I was back in the UK I realised I was in need of seeing a physio. My right thigh was regularly swollen, often to the point where my trousers would be so tight I could scarcely pinch any slack material. I managed to get a short notice appointment and was put through a quick series of mobility tests, but within seconds of seeing my leg my physio became concerned there may be a more underlying medical issue. He went nextdoor and arranged for one of the GPs to see me. The GP was concerned I might be suffering a deep vein thrombosis (DVT), and after some measurements and a questionnaire she referred me to attend a DVT clinic at Watford General Hospital. The clinic was straightforward: lots of waiting, some measurements, some blood tests and an ultrasound scan. The scan only considered my leg, groin to ankle, which accounts for how my DVT and the guilty tumour went unnoticed in my pelvis for another month. Without any diagnosis I returned home for Christmas break and prepared myself to restart the cycle of trying to figure out what might be wrong. The boredom and frustration didn't last for too long however. Within a few days of being home, I began to experience a pain in my lower back that I'd never felt before. It felt like a hybrid of a sharp shooting pains and dull aches, stretching from my lower back, through my hip and down my thigh. As the days progressed, the pain worsened. Without access to my GP and physio I resorted to a lot of online research and became convinced I was experiencing sciatica, however what had caused it was unknown to me. I'd already asked several times to be referred for an MRI and became convinced that this was what I needed most to identify any nerve damage. During that foggy period between Christmas and New Year I had a few friends over to stay, and it wasn't lost on them how much pain I was in. A simple walk to the pub or bust stop was an ordeal, and much as I was intent on hosting I could scarcely get up to put the kettle on without an audible 

Upon my return to work getting an MRI scan became my main focus. The back pain was now becoming unbearable, with me occasionally being physically sick in work, collapsing in corridors and breaking into tears at night. I begged with my GP to understand how much pain I was in, but was unable to get anything stronger than some ibuprofen. Eventually, my physio went in to bat on my behalf, primarily concerned by how little sleep I was getting. The GP finally relented and prescribed me cocodamol and naproxen, and whilst there was no positive change to my sleep I was at least able to get through the days without tears or vomit.

Busted leg? Just ski it off...

So, I appreciate this next part sounds a little wreckless. I had an upcoming skiing trip with work that I'd already paid for, and one I stood to lose money on if I didn't attend. I spoke with my GP and physio to seek their consent to go. I reassured them that I'd apply caution and if I felt any pain I'd simply chill out in the hotel spa and work from my laptop. As it turned out, my leg was actually in less pain when I was on skis than when walking. However after a couple of days I began to notice a recurrence of the swelling that I had noticed on my return from Nepal. First in my leg, and then extending to my calf and ankle. By the third morning I was completely unable to insert my leg into my ski boot, and was forced to spend the next two days resting until the swelling had subsided enough to get the leg back into a boot. This whole time I was struggling to get more than a couple hours' sleep a night which certainly wasn't helping, and by the time I was back in the UK I was feeling desperate. Luckily a referral had been made for me to attend the Army's Multi Injury Assessment Clinic in Aldershot, and though normally I'd have been looking at a wait in excess of a month a slot became available at a day's notice. Finally, I felt like progress mightn't be far off.

"Oh my"

I arrived in Aldershot the morning of 1st Feb 2023. Scotty and I were due to attend some meetings in Pirbright so the timing worked well. After a quick McDonald's breakfast I reported to the MIAC where I was met by a doctor (consultant in sport and exercise medicine), nurse and military physical training instructor. It was a little nerve-wracking having 3 professionals look on as I undertook a series of odd movement exercises in my underwear, but eventually I was placed on the table and the doctor proceeded to conduct an ultrasound scan. I mentioned that I'd had a scan barely a month earlier, and her first question had been how extensive the scan had been. She seemed concerned when I mentioned "groin to ankle", and suggested that it should have been routine to scan above the hip to check for any occlusions leading into my leg, rather than expecting to find one in it. After a quick scan of the leg she proceeded to scan my tummy region as explained. Within seconds, I knew something was up as she murmured "Oh my", and began quietly discussing what was on the screen with Eimear, the nurse. After they'd concluded chatting, things reverted to normal as though everything was normal. It was explained that the MIAC would be referring me for some further imaging, both MRI and CT, and that these would be arranged privately within the coming week. Although a little disconcerted about the scan I couldn't help but feel as though things were starting to move.

Scotty and I left the MIAC and conducted our business in Pirbright for the next few hours. Just as we were getting ready to head back to base I received a phone call from the doctor at the MIAC. She informed me that during the ultrasound she'd spotted something to cause sufficient concern that she wanted me to report to Watford General A&E for an urgent CT scan. The rest of the story (and much of the above!) is covered in my "The story in my nutshell!" post so I won't duplicate, but there we have it. The point I wanted to make with this post was that over the course of about four months the only symptoms I'd experienced were a swollen leg and a painful back. Even beyond the point where a tumour had been identified, the concept of testicular cancer hadn't featured on my radar. Not even tangentially. It was probably the most surprising disclosure during my diagnosis phone call, and there were several unexpected revelations during that call. All I can hope is that this story and others like it highlight the need for more conclusive methods of screening for cancers beyond the "obvious" symptoms, of course ensuring we are all conducting our own due diligence in the meantime.