Ultrasound and Waiting

The ultrasound was on Friday morning, April 29th. It was the day we were scheduled to leave for our “spring break” trip—even homeschoolers need a spring break!—to Panama City, Florida. I arrived at the diagnostic imaging center for an 8:00 appointment. The lobby was full. I read on my kindle while I waited. Eventually, my name was called, and I was ushered into an area plastered with pictures of….babies!

As a childbirth educator, I am fairly familiar with the OBGYN practices in our area. I knew for sure that the largest practice had their own ultrasound staff and equipment; I had assumed that the smaller practice did as well. So I was surprised to learn that the smaller practice actually sent their patients over there for their ultrasounds.

So I sat on the table in the ultrasound room and gazed at adorable art pictures of newborns while the tech dimmed the lights in the room and applied her transducer to my neck. She complimented me on wearing ideal attire for a neck scan—a blouse that left the area around my neck bare to just below my collar bone.
I am normally a chatter—I like to make conversation with the people I have interactions with, from the girl at the Publix check out to the guy that comes to work on our appliances. But with an ultrasound transducer on my neck, talking wasn’t the thing. Instead I waited in silence while the tech did her job. After a few minutes, she was done, and she started wiping the goo off my neck.

“Can you tell me anything?” I asked.

“Well, you have some thyroid nodules,” she said.

Nodules? I thought. More than one? She went on to run through what I had already learned from the limited research I had allowed myself on the internet: Thyroid nodules are common, they are usually benign, if they do turn out to be cancer, I would have to have surgery and maybe other treatments. She told me that my doctor should have the results within 24 hours. Since it was Friday, I assumed that meant Dr. G would have them sometime Monday.

After I got home, we finished loading the car and took off for our vacation. During our drive to the beach, I got a call from Dr. G’s nurse about my blood work. I was unsurprised to learn that my thyroid levels were normal, though I wished for more detailed information. She asked about my ultrasound. I told her it had been that morning.

“When we get that report, we’ll give you a call,” she said. I did the mental calculation and figured I’d have a call by Monday evening if I was lucky, but surely by Tuesday. What I didn’t know was that the imaging center was not known for their quick turnaround on reports, in spite of what the tech had told me.

I was determined not to let my thyroid nodules dominate my mind or conversation while we were on vacation. I knew that Rusty was worried, and that talking about it would make it worse for him. I am also all too aware of my own obsessive tendencies—when my mind becomes occupied with a topic, I have a very hard time thinking about anything else. It’s all I can do to keep from spending large portions of my day searching for information on the subject du jour. I tried to redirect my thoughts to my new interest, essential oils. I had brought a couple of books, as well as my small supply of oils. I had fun experimenting.

Still, I couldn’t stop myself from doing a little bit of covert investigation, both via internet on my phone and through a book that I found in the kindle store. I gathered a basic outline of the likely next steps and also got a good idea of what my current odds were of a cancer diagnosis. I knew that regardless of what the ultrasound showed, I was probably at least in for a fine needle biopsy. I learned that it made a difference whether the doctor doing the biopsy was experienced in the procedure and if he or she used ultrasound to guide the placement of the needle.

I started doing a little research on endocrinologists in the Auburn-Opelika area, as well as in Birmingham. “I want you to promise me you will find a good doctor,” my friend J said when she called me on the phone during the week.

I also learned about the different types of thyroid cancer and a little about their respective treatments and outcomes. The outlook wasn’t too bad. Even if I had thyroid cancer, odds were I could be cured. Anaplastic thyroid cancer looked pretty scary, but it is also very, very rare. I decided it was so unlikely that it was safe to ignore it as a possibility. After all, only 5% of thyroid nodules were malignant, and then, of those, only 1-3% were diagnosed as anaplastic cancer.

So I thought I could see the path ahead, at least for a few steps. I would most likely have a fine needle biopsy (FNA). If the results were benign, my nodule would probably be monitored every 6 months to a year. If the results were unclear because of an inadequate sample, I would have another biopsy done in a few weeks. If the results were inconclusive because it was too hard for the pathologist to tell if the cells were normal follicular cells or not, I would probably have at least half of my thyroid removed to be on the safe side. If the surgical results showed cancer, I would have my whole thyroid out, most likely followed up by radioactive idodine treatment (RAI) to make sure there weren’t any traces of thyroid cancer left in my body. If it was anaplastic thyroid cancer….well, I wasn’t going to think about that.

Monday passed without a call. Then Tuesday. On Wednesday, I left a message for Dr. G’s nurse, asking if my results were back. My anxiety to know what the ultrasound looked like was building. I knew enough now to be aware that some nodule characteristics, like irregular margins, microcalcifications, and centralized vascularity, were more indicative of cancer.

Wednesday also brought Rusty’s mom, and brother to join us at the beach cabin, along with their two small dogs and our nephew. My boys were thrilled their cousin was coming to play; Rusty and I were happy that his brother and mom were getting out of the house to do something recreational. His brother had come far enough with physical therapy to be walking some now.

It was a very pleasant week. The temps at the beach were a little on the cool side, but my boys at least did not find the cold water a deterrent from cruising on their boogie boards and exploring the sand bar that appeared towards the end of the week. Rusty and I read, listened to the waves, and watched the dolphins and pelicans pass by while Eleanor played in the sand. In the evenings, we went to our favorite local restaurants, hitting Boon Docks twice. Then we would shop, play mini golf, or head for the rides at the Miracle Strip.

One night, while poking around in Target, I almost bought a new nursing bra. I was still nursing Eleanor, at two-and-a-half, and my bras were a little worse for wear. I picked up a bra that looked comfortable, but quickly put it back on the rack. What if I have cancer? I thought. I’ll have to wean her for radioactive iodine treatment, and this will be a waste of money. I know some people would say I was long past the time to wean, but we had both enjoyed our extended nursing time. I had nursed each of my children longer than the one before, finally coming to the full realization that the way our culture does breastfeeding is WAY outside the norm for all cultures and all times.

On Thursday I still hadn’t heard anything, so late in the afternoon I called the front desk at Dr. G’s office to see if they could tell me anything.

The very friendly staff person took a peek in my file on the computer. “Well, it looks like we got the results in yesterday, but the doctor hasn’t reviewed the results yet.” It relieved my feelings a little to know that the report hadn’t just been sitting in Dr. G’s inbox all week. What she didn’t tell me was that Dr. G had just left for a long weekend with his family. He wouldn’t be reviewing that report until sometime next week. I thought, surely I’ll get a call before the end of tomorrow. I had no idea I still had almost a week before I would learn what the ultrasound said.

By this time, I was starting to get phone calls and texts from friends and family. Have you heard anything yet? When will you hear something? Why is it taking so long? I was glad to know that my friends cared for me, but it also ramped up my anxiety over not hearing from Dr. G. They think I should have heard by now, too, I thought.

Friday came and went. When we went out for dinner Friday night, I realized my chance to learn something was over until Monday. On Saturday, our extended family headed home. Rusty’s brother, still dealing with his neurological problems, was finding it hard to get comfortable on any of the family cast-offs that supplied the beach cabin’s furniture, and was ready to get back to his recliner.

We packed up and left for home on Sunday. Monday we worked on getting back into our regular routines—but there was still no call from my doctor’s office. My family and friends, however, kept calling. I hated not having any answers for them. I knew that a biopsy was almost certainly my next step, and I was eager to get it over with. I was on and off the internet, reading bits about nodules, ultrasounds, and biopsies. I even found out that there has been a fair amount of research done on the anxiety caused by waiting for medical test results!

I was spending increasing amounts of mental energy trying not to stress about what my ultrasound looked like and when I would hear about it. I carried my phone with me as I moved from room to room in the house, so that I wouldn’t miss a call.

On Wednesday I got to talk with my dear friend, A. A few years ago she’d had surgery to remove half her thyroid for a nodule that was causing the gland to be overactive. I asked her what she had thought of her endocrinologist. I was determined to find someone good to go see, and wanted to be ready with a name when I got a call from Dr. G.

Later that day—one week after the office had received the ultrasound report—I finally got a call from one of Dr. G’s staff. She was very kind. She informed me that Dr. G thought I needed a biopsy (Duh!) and wanted me to see Dr. B, a local ear, nose and throat specialist. I was kind of surprised—I had expected to be referred to an endocrinologist. She reassured me that Dr. G had a really high opinion of Dr. B and sent people to him all the time. I asked if she could give me any details about what the ultrasound report actually said. “I don’t have those details. You’ll be able to talk to Dr. B about it when you see him.” So my assignment was to wait on a call from Dr. B’s office to schedule an appointment.

When I got off the phone with her, I looked Dr. B up online. He was in practice with two other doctors. I saw that “thyroid nodule” and “thyroid cancer” were both listed in the conditions they treated. One thing I really liked was that I would be able to email questions to Dr. B once I was officially his patient.  In his picture on the website he looked kind of like an ex high-school quarterback, and maybe not suitably nerdy.  I decided not to hold that against him.

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