By Andy Stover, ATC & Scott Murayama, ATC
As athletic trainers we are constantly learning. We have a passion for our profession and we are looking to hone our skills, learn new techniques, and review the latest research to be able to take care of the athletes to the best of our ability. We believe that some of our greatest learning opportunities are when we are challenged with those cases that are atypical especially when they are not baseball or orthopedic related.
One of the Colorado Rockies pitchers, Chad Bettis, went through such a health issue this past off-season and continues his treatment now. He has a platform and a desire to bring more awareness about his case and he has granted us permission to present it.
In early November, Chad Bettis was no different than any of his teammates working out in Arizona. They reported to Salt River Fields at Talking Stick to work out, play some catch, do some shoulder maintenance, and prepare for the 2017 season. On the morning of November 13th, Chad would begin to prepare for something completely different. The night before, during a routine self-exam, he noticed a small lump on his right testicle. “It was no bigger than a grain of rice” he said at the time; he didn’t think much about it, but at the same time he knew it shouldn’t have been there. He did some research on his own and decided to re-check himself the following morning. When he arrived at the field the next day, he came into the training room and notified us of his discovery. We discussed all the different scenarios of what it could be, and decided together, that it was best to get it checked out. We contacted our local physician, Dr. Destin Hill, and he was seen that afternoon. The exam was inconclusive, other than a swollen vein, and Dr. Hill determined that an Ultrasound would be the next logical step. The ultrasound results indicated “2 separate masses representing malignancy until proven otherwise,” and a follow-up CT of his abdomen was ordered.
The CT results in November indicated a “questionable fullness” of a lymph node in the high retroperitoneum in the anterior aortocaval region, which is the area of the abdominal aorta and the inferior vena cava. The blood tests indicated a high tumor marker: Beta hCG 22, (normal range = 0-3). The other tumor markers (AFP and LDH) were in the normal range. With this information, Dr. Hill believed that testicular cancer was possible and referred Chad to a Urologist to discuss his options further.
The Urologist sat down with Chad and his family and gave them the news that no one wants to hear. Testicular cancer was the new battle Chad was preparing for, pure Seminoma to be specific. The Urologist recommended removing the testicle and also discussed that in these cases, surgical removal of the mass typically heals the patient at a 70% cure rate, but going through a round of radiation or chemo increases the cure rate to 99%. Chad and his family took a few minutes to sit together and process the news they had been given. Shortly after, Chad’s response was, “OK, let’s get this out of me, how soon can we do it?” As luck would have it, there was a last minute cancellation on the surgery schedule for the next day.
The following day, Chad and his family arrived at the hospital for the procedure, a radical orchiectomy. Everything went according to plan and there were no complications. Chad would go home and recover for 2 weeks before he could do much physical activity. The procedure involved going through his abdominal wall, so we had to make sure that he healed from that procedure to prevent developing a hernia or other complications. After 2 weeks of “rest and recovery,” Chad returned to the field to begin some light body weight exercises and start getting back into shape. During this 2 week period, we waited for the pathology report to come in from the surgery, and he was scheduled to follow-up with an
Oncologist to discuss the next steps. Chad was informed by his Oncologist that, if he wanted to be proactive and have regular CT scans, bloodwork and follow-up exams, he could avoid going through any radiation or chemotherapy at this time.
Over the next several weeks, Chad went through blood tests that showed his tumor markers decreasing. On December 22nd, he got the call from the Oncologist. His tumor markers were “non-detectable,” meaning that as of that point in time Chad was “Cancer Free.” Chad would still have follow-up blood tests every six weeks, CT scans, and a check-up with the Oncologist. It was a Merry Christmas for the Bettis family.
All that changed again in late February, after one of his routine check-ups. The tumor markers were still in the “non-detectable” range, but the CT showed growth in some of his lymph nodes, with one of them actually doubling in size. Due to the change, a biopsy was ordered in early March, which revealed malignant cells in the lymph nodes. This raised all sorts of questions. Why was it not showing up in the blood? What is the next step? “I was cancer free and now I’m not.” At this time, it was determined that the original cancer was not pure Seminoma but in fact mixed germ cell seminoma, which led to the spread of the disease.
At the time of year when pitchers are deciding how to approach a certain hitter, or win a battle for a spot on the big league roster, Chad was facing a different opponent and fighting a different battle.
He was informed that it was the same cancer that was found in his testes and that chemo was now indicated. He had a chemo port placed in his chest and started chemotherapy on March 20th. Considering that he is a right handed pitcher, and wanting to avoid any complications with his right shoulder and arm, he requested that the port be placed on the left side of his chest. Chemotherapy drugs and their side effects were discussed with the Oncologist. BEP (Bleomycin, Etoposide, Cisplatin) is a common drug combination used to treat testicular cancer. The possible side effects of each drug are: bleomycin can damage the lungs causing shortness of breath and trouble with physical activity; cisplatin and etoposide can cause neuropathy but primarily if given in high doses. Chad’s dosage of cisplatin is low enough to treat the cancer but without running a high risk of neuropathy. His dosage of bleomycin has caused side effects such as high fever and a lowered lung capacity including shortness of breath. These side effects are typically short term and can subside shortly after treatment ends but may be long term.
Three cycles of chemo will last for 9 weeks, scheduled to be completed on May 16th. Once that is done, he will have more follow-up blood tests to check his tumor markers and a follow-up CT scan in mid-June.
During the course of chemotherapy, Chad has had his good days and not-so-good days. When he feels up to it, he comes to the field and plays catch. He goes through an easy body weight program to keep his lower body in shape and does his shoulder maintenance. Until he is done with his chemotherapy and the port is removed, we are moving slow and easy with him, keeping things simple and doing what he can without pushing the envelope. He will continue to play catch and progress with his bodyweight workouts to dumbbells and finally into the weight room. The medications used in his chemotherapy were changed slightly to alter some of the side effects. Neuropathy has not been an issue, but his lung function has been somewhat impacted. His workouts have been aimed at seeing what his level of conditioning is each day and what he can handle. As he increases his conditioning and stamina, things will progress naturally.
Throughout this entire process, Chad has faced everything with grace and dignity, and the attitude that he WILL beat this and come out stronger on the other side. As an organization, we stand behind Chad and have faith that he will win the battle. His return has no time table right now, but rest assured, you will see him pitching at Coors Field again.
When Chad returns, the scoreboard won’t matter, he will have already recorded the biggest win of his life. Stay tuned to the Rockies for the conclusion.