The Dr. Joe Quatrochi Story

Hi Folks. My name is Joe Quatrochi. Like you, I am on the mailing list for Dr. Len Kravitz’ e-newsletter. Since Len and I were both attending UMN at the same time, we remain friends and correspond via e-mail periodically. I’m writing now at Len’s invitation. He thought some of you might be interested in my story.

Many of you do not know me. I’m a UNM alumnus who graduated with a doctorate in in H.P.E.R. with an emphasis in Health Promotion/Exercise Science in 1991. During my graduate studies, I served in various positions within the Exercise Science department (graduate teaching assistant, lab assistant, etc.). Since leaving UNM, I’ve been teaching at Metropolitan State College in Denver.

Until the spring of last year, my health was excellent. I’m sure I take care of myself the way most of you do – healthful eating, plenty of exercise, striving for balance in my life. However, in April of 2000, I was confronted with the biggest challenge of my life. I was diagnosed with testicular cancer (TC). I had less than one week to come to grips with the fact that my cancer would require surgery. This was an incredible shock to me because of my (apparent) good health. I was in excellent physical condition with no hint of any problems.

After Surgery
After surgery to remove the cancerous testicle, my oncologist assured me that everything went well. The cancer seemed to be “encapsulated” – very good news with this type of cancer. He explained that I’d need a second surgery to remove my lymph nodes (supplying the cancerous testicle) to reduce my risk of recurrence (to less than 5 percent). The lymph node dissection was going to be very traumatic, but it was a “no-brainer” in terms of risk reduction. I felt that I didn’t really have much of a choice. So, the surgery was scheduled to occur about 3 weeks after my initial surgery.

Woops! Another Surprise
The call came from my doctor approximately one week in advance of my lymph-node surgery. “Joe, I need to see you right away. Your blood work revealed that “tumor markers” are significantly elevated. This needs to be confirmed. If it isn’t an erroneous result, we will not be able to do the surgery next week.” What I learned was that (surprisingly) the cancer had spread to my abdominal cavity. Lymph node surgery would have been futile without eradicating the microscopic cancer cells within my abdominal cavity. This would necessitate chemotherapy.

Chemo
I didn’t know anything about chemo. I learned quickly that it was nothing to look forward to. I learned the chemo regimen for TC was particularly difficult. Besides the nausea and other side effects that you might have heard about, I learned that it would decimate my immune system and make me susceptible to infections (that would normally be routine) that would be potentially life threatening. Other lovely effects included hearing loss, loss of sensation in the fingertips, sterility and increased risk for other cancers later in life.

Despite these sobering facts, I was determined to embrace this therapy with all that I had in me, knowing that it was going to rid me of my cancer. One day, as I was sitting in the recliner in the cancer center while connected to the IV pump, I was reading Lance Armstrong’s book called It’s not about the Bike (I’m an avid cyclist and several friends gave me copies of this book for inspiration from another famous TC survivor!). To make a long story shorter, I was concerned about something I had read in Lance’s book. Apparently, his initial chemo “cocktail” was the same as mine until he went to see Dr. Lawrence Einhorn at the University of Indiana. Dr. Einhorn is the foremost authority worldwide regarding TC. He pioneered the chemo treatment used across the world that changed the survival probability for TC victims from about 15% to 95%! He changed Lance’s therapy to avoid lung toxicity from one of the drugs he was using (bleomycin). Lance wrote about this in his book. He said the doctors were worried that his lung function and aerobic capacity would be severely compromised if he continued on bleo. When I asked my physician about the potential for lung toxicity in my case, he seemed unconcerned. His rationale was that I was fighting a life-threatening illness and loss of lung function might be a necessary consequence.

I was not satisfied with the answer I received from my doctor. I started to research the effects of bleo. Eventually, I stumbled upon a web page that listed the e-mail address of Lance Armstrong’s doctor – Dr. Einhorn. I sent him a lengthy e-mail regarding my treatment and condition and asked for sources of information so that I could learn more about whether I should request a change in my treatment. I ended my letter by stating that I assumed that Dr. Einhorn would never actually read my memo, but I’d appreciate a reply from his assistant/mail-reader. Much to my surprise, Dr. Einhorn actually answered my memo and invited me to call him. I was shocked! I called and we talked for several minutes about my case as well as Lance’s. The best news was that he said I would need only 3 (3-week) courses of chemo. He assured me that this would not only cure me, but it would not affect my lung function at all. The effects I was afraid of occur when you’re exposed to 4 courses of this chemo cocktail. When I told him that I was already scheduled for 4 courses, he offered to speak to my doctor for me. I was incredibly relieved after speaking to Dr. Einhorn

Not so fast!
Unfortunately, my doctor was unconvinced that I would only need 3 courses of chemo. He assured me that he would contact Dr. Einhorn to discuss it with him, but he was sure there were conditions about my health that I had not discussed with Dr. E. that would necessitate 4 courses. This put me in a difficult position. I didn’t want to insult my physician, but I was unwilling to forsake my lung function (and the recreational activities that I’d have to give up!) if it was unnecessary.

The chemo treatments were very difficult, but I progressed faster that anyone had expected. My tumor markers were declining rapidly and my CT scans showed no sign of increasing disease. I arrived at the doctor’s office on the last day of course #3 to discuss my fate with my doctor. He had agreed to discuss my treatment with Dr. Einhorn. I was sure he was going to tell me that I was officially done with chemo – lung function intact! What he said was that he was unable to contact Dr. Einhorn so I’d need to begin course #4 on Monday. He emphasized that timing was critical with this type of chemotherapy, so we could not afford a delay in treatment. I was speechless! I wasn’t ready to hear that response. I composed myself and respectfully told the doctor that I will not begin a 4th course until he and Dr. Einhorn collectively agree that I need it. My doctor told me that I was being a fool and that “ it would do you no good to have healthy lungs if you are not alive to use them!” I politely told him I’d see him again in 2 weeks so that he’d have time to speak to Dr. Einhorn. I left his office, called Dr. Einhorn’s assistant and asked when he would be available by phone. There was only a 2-hour window of availability during the subsequent 2 weeks. I then called the head oncology nurse at the cancer center and pleaded with her to promise me that she would have my doctor call on the right day at the right time. She agreed.

Good News
After many anxious days, I called the cancer center and spoke to my doctor. He had finally spoken to Dr. Einhorn and after much convincing he decided that I no longer needed the (dreaded) 4th course! What a relief.

It has now been 19 months since my last chemo treatment. By all appearances, I’m cancer free. There is a small probability of recurrence, but I firmly believe my cancer will not return . I feel as good as I’ve ever felt in my life. I’m training the same way that I’ve always done. During my most recent stress test, my VO2max was measured at 53 ml. Not great, but not bad!

Lessons
I learned many lessons during my treatment and recovery from TC. I learned how many people really love me and care about me. People were incredible with their kind words and prayers. There were times when I felt like I had more people praying for me than for mother Theresa! I learned the importance of my family. My dad (now 85 years old) was my primary caregiver, along with my sister Mary, throughout my ordeal. He accompanied me to nearly every chemo treatment. He followed me up the 3 flights of stairs to the cancer center each day (because I refused to use the elevator!). He humored me and comforted me. He laughed and cried with me. In many ways, I’m sure it was more difficult for him than it was for me.

One critical lesson that I want to share relates to the need to be your own “patient advocate.” My entire life would be far different (physically) from now on had I not researched my illness, contacted Dr. Einhorn and taken control of my treatment. I learned that medical professionals, who have your best interest in mind, are still imperfect. My graduate education and my professional career have both focused on “prevention” and “self-responsibility.” Choosing healthful behaviors to improve quality of life, enhance wellness and prevent disease is what we all preach. However, I now know, first hand, that self-responsibility is definitely not something unique to prevention. My experience with “treatment” now has proven to me the importance of self-responsibility as one deals with a health problem – not just when one is trying to prevent a health problem. This topic is the focus of my professional presentations now. I’ve had the opportunity to present on this topic to several groups of allied health professionals over the past 6 months. I plan to continue to share my experiences with whomever I can so that others may think twice about accepting medical advice at face value. If you know of a group who might be appropriate for this type of message, please let me know.

Finally, let me encourage all of you to engage in gender appropriate self-exams. TC affects young men – most often between the ages of 15 and 35. Much attention is paid to breast self-exams, too little to testicular exams. Encourage those you know to do self-exams each month.

Thanks for reading my story. Best of luck to all of my UNM friends. In the words of the late Jim Valvano, former head basketball coach at North Carolina University (and cancer victim), “Don’t give up. Don’t ever, ever give up!”

All the best to you.

jq

Here is Joe’s email if you wish to contact him:

quatrocj@mscd.edu

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