Category Archives: nodules

Macrophages

Ok, so I couldn’t leave well enough alone.  I HAD to keep on researching.

Let me back up.  Here is the word-for-word write up of FNA of the the larger nodule on the isthmus of my thyroid:

Hurthle cell lesion–see comment

COMMENT:

The specimen consists of numerous Hurthle cells and fragments of Hurthle cell epithelium, with a population of macrophages.  The differential diagnosis includes Hurthle cell change in a background of thyroiditis or a hyperplastic colloid nodule versus a Hurthle cell neoplasm.  Clinical correlation recommended and follow up as indicated.

So that actually didn’t sound too bad, especially the idea that it could be “Hurthle cell change in a background of thyroiditis.”

But I couldn’t leave well enough alone.  I wanted to know what, if any, meaning the macrophages had.  I had some vague memory that macrophages were immune cells, maybe a type of white blood cell?  I knew that certain cell types like lymphocytes tended to point towards a benign nodule.  So I went looking, using “macrophage” as a term in combination with “Hurthle cell lesion,” “Hurthle cell adenoma,” “Hurthle cell FNA,” etc. ad nauseum.

I found one case study in which two different patients had similar FNA samples that included Hurthle Cells and macrophages.  One ended up being a Hurthle Cell Adenoma (benign) and the other a Hurthle Cell Carcinoma (malignant).  So I know that macrophages could be present in either.

Then, for whatever reason, I searched for “macrophage thyroid cancer.”  From that I learned that macrophages are generally present in tumors (benign or malignant) and that a certain type of macrophage, known as a Tumor-Associated-Macrophages can sometimes make up up to 50% of a tumor, and that their actions tends to help the tumor grow and spread.

I found this article.  The title alone almost sent me into a panic attack.

I had a little freak out moment, feeling SURE that the “population of macrophages” meant my nodule is FOR SURE cancer. I have reeled it in a bit, and I’m now back to the recognition that “tumor-associated” doesn’t have to mean “cancer-associated,” and that, once again, I cannot find out if my nodule is cancer or not by doing research.  Still, I am not comforted.

I’ve also learned that “hemosiderin-laden” macrophages are usually associated with benign tumors; they “digest” red blood cells when a colloid nodule (always or almost always benign, from what I understand) undergoes “hemorrhagic decay”.  My FNA report didn’t say whether the macrophages were “hemosiderin-laden” or not.  So I really have no idea where I stand.

Before I made my macrophage discovery, I sent Dr. B an email to ask how long surgery should take (45 minutes to an hour)  and where pathology would be done (right here in our local hospital).  I have now looked up the pathologists on staff and am considering sending them gift baskets the day before my surgery, to make sure they do top-notch work for me.

Also, my sweet, sweet Aunt Sharon has said that if I need her, she can come for a few days.  We are going to play it by ear to see how things go.  And UK is in Uganda, preaching.  Love it.

Ok, I REALLY, REALLY need to forget all about this until maybe a few days before June 7th!  Although, I think it would be good to work on some things that would be helpful to accomplish before surgery. I am going to put my “folder” (containing my lab reports, surgery instructions, etc.)  somewhere out-of-the-way.

Should I Google “Hashimoto’s macrophage,” just to make myself feel better?  You see how sick I am?

ETA:  I did Google some more.  I am back to the realization–full realization, not just what I’m telling myself to think–that macrophages don’t mean I have cancer, and very well could point to a Hurthle Cell Lesion associated with Hashimoto’s.    Must.  Stop.  Googling.

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Surgery Scheduled

Rusty went with me to my follow-up appointment with Dr. B on Tuesday.

Dr. B is going to take out the right side of my thyroid on June 7th. That’s a FRIDAY! Which means that Rusty might only have to take off the day of surgery, and maybe no one will have to come and help me.

My friend, A, has been telling me how easy her surgery was (she had the same surgery I am scheduled for), how little pain she had, and how quickly she was able to do her normal activities. Praying for a similar experience.

Dr. B does the “minimally invasive” version of the surgery, which should mean a smaller scar. They will also do initial pathology while I am in surgery, with full pathology completed afterwards. What this means is, there is a possibility they could catch a cancer before they close me up, enabling them to do a complete thyroidectomy without a second surgery. What I have read is that this pathology procedure catches about half of the cancers. The other half would have to come back for a second operation.

I was pleased that Dr. B didn’t think I needed the left lobe out at this point. He said that it looks “almost” normal. I just REALLY don’t want to be thyroid-free if it isn’t necessary.

He said that he didn’t think I will need an endocrinologist going forward, but if he thinks I am going to go around with less than half a thyroid in my neck and NOT see an endo, he has another think coming. :) I talked to S at Bible study last night, and she likes her endo a lot. She suggested I might want to see an endo before having half my thyroid out, but I’m pretty sure that no matter who I see, this is the path in front of me.

Ok, so I feel like we are doing the right thing–taking the best next step.

However, is it ok to say that I am still a little disappointed in my care? Here’s the part where I get whiny. If you would like to skip the rest of this entry, I promise I won’t get my feelings hurt. :)

Whine #1–The pathologist who looked at my FNA samples only made two slides per sample. At some labs, six slides is considered a minimum. Maybe that won’t make a difference, but two just doesn’t seem very thorough.

Whine #2–When Dr. B sent my FNA samples off, he didn’t include ANY clinical history (i.e., sample is from a mixed solid/cystic nodule measuring 2.8x 1.3x 2.9 cm), which is supposed to help the pathologist make a more accurate assessment of what he or she is looking at.

Why I am not going to make a fuss about this: Both nodules are coming OUT in less than a month. So if they’re baddies, they’ll be gone and they can find out for sure after they are out. A Hurthle Cell Lesion has to come out anyway.

A couple more interesting factoids about Hurthle Cell Lesions:

I have read conflicting reports that their malignancy rate is somewhere between 13% and 35%. That’s a pretty big range. I am banking on being under 40, having a lump smaller than 4 cm, and having (possible) Hashimoto’s thyroiditis. (Dr. B says it can’t be diagnosed by biopsy–but that’s not what I’ve read. Yet another reason to go see an Endo. Dr. S, here I come! After all this surgery hullabaloo is over.)

Interestingly, lumps diagnosed as Hurthle Cell Lesions that turn out to be malignant often are not Hurthle Cell Carcinoma. They can be any of the other kinds of Thyroid cancer–Papillary, Follicular, etc.

Enough for now. I am going to try REALLY HARD to quit thinking about this whole thing until my surgery gets here.

Giving Thanks

I heard from M a little while ago.  Her melanoma surgery this morning was a complete success!  She said it was a “very superficial cancer.  No treatments or lymph node biopsies.”  Praise the Lord!

I am ready for my appointment tomorrow.  Questions printed and emailed.  (Dr. B’s quick response was, “Lots and lots of good questions,” maybe with the emphasis on “lots and lots?”)  Childcare lined up.

And here, for your amusement, are pictures of my neck!

Now you see it (swallowing):

Lump visible when swallowing 5-5-13

Now you don’t! (not swallowing):

Lump invisible 5-5-13

Everything you’ve always wanted to know about Hurthle Cells

T minus 2 days until my follow-up appointment with Dr. B. I wanted to compile a summary of what I’ve learned about Hurthle Cells and “Hurthle Cell Lesions,” because I know from experience that although all of this info is really fresh in my mind right now, I will forget it.  And it will be convenient to have it all here in one stash.  I’d like to make a disclaimer ahead of time, just in case this blog ever goes live:  I am not a doctor, or a scientist.  What follows is my understanding based on the research I have done over the past two weeks.  (If two weeks isn’t long enough to make me an expert on Abnormal Cells of the Thyroid, what would be?)

Hurthle Cells are, by definition, abnormal.  From what I have read, there are some theories about why they form, but no one knows for sure. One of the main theories is that they are follicular cells that have transformed due to stress.   They are frequently (some say always) seen in Hashimoto’s thyroiditis, a condition in which the body’s immune system starts attacking the thyroid gland for unknown reasons. They are extra large and full of lots more than normal mitochondria, which gives them a grainy appearance under the microscope.  The mechanism for apoptosis–the process by which abnormal cells know they are abnormal and cause themselves to self-destruct, doesn’t seem to work for Hurthle cells.  Also, unlike most other cells in the thyroid, most Hurthle cells (most sources say around 90%) have lost their ability to take up iodine, which means that RAI isn’t usually effective against Hurthle cell cancers.  On the other hand, theydo produce Thyroglobulin, which makes this a useful marker for recurrence in Hurthle cell cancers, but only if the thyroid is completely removed by surgery and completely nuked by RAI.  Ok, that’s it!

Actually, there is some information about biochemical processes and genetic mutations that I haven’t absorbed yet.  I’m not convinced I need to know all that stuff, since I don’t plan on doing any clinical research on Hurthle Cells.

A “Hurthle Cell Lesion,” what I have, is a group of Hurthle Cells that have all decided to hang out together in one part of the thyroid gland.  If the lesion is composed of more than 75% Hurthle cells, and it’s encapsulated with a distinct border separating it from the rest of the gland, it’s called a “neoplasm,” or tumor.

So here’s the thing.  They can tell from FNA (Fine Needle Aspiration) if the lump/nodule/lesion is composed of mostly Hurthle Cells.  I think they can tell from ultrasound if it’s encapsulated (this is one thing I want to ask about at my appointment on Tuesday).  But they can’t tell if it’s cancer (carcinoma) or not (adenoma) without taking it out.  That’s because most Hurthle cell tumors and lesions just sit there, doing mostly nothing. They aren’t aggressive, they don’t try to proselytize or set up colonies in other parts of the body.  The only way to tell the difference between a benign Hurthle Cell tumor (adenoma) and a malignant one (carcinoma) is to take it out and dissect it, to see if it’s trying to invade the rest of the thyroid through the capsule wall (capsular invasion) or if it’s trying to invade the blood stream (vascular invasion).  If it is doing either (or both) of those things, it’s classified as cancer, or “Hurthle Cell Carcinoma.”  (HCC)

Hurthle Cell Carcinomas tend to occur in people over 50 (not me) with nodules larger than 4 cm (also not me) who do not have inflammation–like Hashimoto’s thyroiditis (also not me, since I DO have inflammation).  So all of those things are WAY in my favor. Yay!  Their prognosis is not as good as for people who have Papillary Thyroid Carcinoma (PTC, also known as “the good cancer,” because of its amazingly high cure rate) or Follicular Thyroid Carcinoma (FTC, only slightly less “good” than PTC), but some people feel that this has more to do with the fact that it usually occurs in an older population than with the actual characteristics of HCC.

Here’s something else.  Hurthle Cell Carcinomas are really, really rare.  So rare that when you go looking for info about Hurthle Cell cancers, because your doctor did a biopsy on your thyroid and found Hurthle Cells, and you are freaking out, trying to figure out what on earth a Hurthle cell is and if you should be worried or not, what you will mostly find is scholarly journal articles.  Maybe a few posts on message boards.

The books about thyroid problems and even about thyroid cancers might have a sentence or two about friendly Hurthle Cells and their malicious carcinoma counterparts.  Maybe even up to a paragraph.  What they will mostly say is that Hurthle Cell Carcinomas are like Follicular Carcinomas, except that they don’t usually take up RAI, and they tend to metastasize more aggressively.

Those bloggers and memoirists (is that even a word?) who write about their thyroid cancer journeys almost all have Papillary Carcinoma (PTC), because 75-80% of thyroid cancers are Papillary.  I might have found one person with a thyroid cancer story whose thyroid cancer was of a Hurthle cell variety.  I’m actually about to go see if I can find that blog again… ETA:  I did find that blog by the guy I thought had HCC, but he didn’t; he had PTC.  But I also found this guy, who has written a very nice blog about his HCC journey.

Ok, so there are probably a few more details that I could cram in here (PTC variants, etc.), but I am not sure I could do them justice.  If you want to read a scholarly article that covers all of this and more in some detail, try this one.  I have found it to be pretty comprehensive, and I’ve actually printed it out to put in my file with my test results and other paperwork.  You can also get lots of useful articles by googling terms like “Hurthle Cell Adenoma,” “Hurthle Cell Lesion,” and “Hurthle Cell Neoplasm.”

“Either way, you will be fine.”

11:45 am
They’re cutting down the Toomer’s Corner Oaks today. One of them (the one on the left) looks like it’s already down. Watching on and off on the webcam. Wondering if there will be something else to mark this day as significant for me.

I am fighting edginess today. Have yelled at the kids several times. Thank you Lord for Clary Sage. I am really, really, really trying to Remain Calm. I also need to get my head around the possibility that I may not hear anything today, even though today is when the news is “due.” I will not die from waiting.

6:30 pm
Biopsy results are back.   I sent Dr. B an email this morning, and he answered me this afternoon.

One of the nodules tested as benign with inflammatory cells, which Dr. B says is consistent with Hashimoto’s thyroiditis.

The other nodule was a  “Hurthle Cell Lesion.” This can be because of Hashimoto’s. It is probably not cancer but since there is still a small chance it is, they usually recommend “surgical excision.”  He says we need to talk about whether to remove part or all of the gland.

“Either way, you will be fine,” he said.  I appreciate his reassuring words.  He laid out the facts, but isn’t lacking the human factor to go along with them.

Pretty Hi-larious how far off I was in my latest theory! Should teach me not to speculate. But of course I have already started looking at Hashimoto’s and Hurthle Cells on the internet. Really haven’t found much to tell me any more than Dr. B’s email. And I still have to WAIT! :) It’s probably good for me.

So I still don’t have a yes/no answer on cancer, and I will probably need surgery this summer. Some good news, for me, is that Rusty can go to Utah on his business trip this weekend without the stress of leaving behind a cancer-diagnosed wife at home.

So should I go ahead and start to wean Eleanor anyway, knowing that I will probably at least need surgery? I think I will.

Questions, Confessions, Speculations

8:10 am
Question: How can I keep myself from being on edge ALL DAY, waiting for a call, even though I know I probably won’t hear until tomorrow? (or later?)

Question: Why didn’t he biopsy the lump in my left lobe?

Question: If I get a call from his office while Rusty is at work, and they tell me I have cancer, should I call Rusty at work to tell him that?

6:10 pm
I hate waiting.

Question: Since the local hospital appears to not have a nuclear medicine department, where would I go for RAI if I needed it? I could call and ask S, a friend who has had RAI for an over-active thyroid, but I haven’t talked with her about my thyroid issues yet, and I don’t want to be a self-indulgent, attention-grabbing drama queen.

I even braved the patient website, to see if my test results showed up there, even though I told myself I do NOT want to find out I have cancer that way.

Time to go make some supper. Quiche, anyone? The hens are really laying right now.

8:27 pm
Confession: I have been scouring the internet for images of thyroid nodules that “match” what I remember. I’m back to thinking I have cancer. Current theory is that the lump in the front is actually a (pretracheal?) lymph node with metastasis from the “unfriendly” nodule. Except that I can’t seem to find whether pretracheal lymph nodes move when you swallow. I will be SO glad when all my speculating can be over with.

Dr. B for Biopsy

The waiting room at the ENT office was packed. I heard the receptionist say to someone that the wait had been running about an hour. I read some on the kindle app on my phone, having forgotten to bring the actual device. I had found a memoir called Dirty Bombshell: From Thyroid Cancer Back To Fabulous! by Lorna J Brunelle. Am I obsessed? Yes. But it’s helping me cope with my anxiety to read about people who had been through thyroid cancer and come out fine.

Finally, I was called back and seated in a patient room. I started to read a little more, but then put my phone away. If Dr. B or his nurse asked what I was reading, I didn’t want to reveal I was neck-deep in thyroid cancer obsession. Instead I checked my email. I started to read from my friend T that she was having to see a rheumatologist to find out the cause of her autoimmune symptoms. And she had gotten laid off from her job unexpectedly that day! I was clearly not the only one in the world with things to worry about! My heart was racing for her and the anxiety she must be going through.

At that moment a very friendly nurse came in—I wish I had gotten her name. I need to make sure I do on a future visit. She had me sit in the exam chair and said, “Let’s check your blood pressure.” She strapped on the cuff and said, “So we’re set up to do a biopsy today, right?” and gestured to a small counter that I hadn’t noticed was laid out with paper drapes, syringes, and…an emesis basin. Great!

I imagine myself in that moment with my eyeballs popping out of my head like a cartoon character. “I was expecting this to just be a consultation,” I said, trying to keep the panic out of my voice.

Then my brain caught up to me. A biopsy today would mean less waiting to find out if I had cancer or not. “But that will be fine, if we do that. The lady who called me had just said it would be a consultation appointment. But I don’t want to wait if I don’t have to.”

I was babbling. “I bet my blood pressure just went…” I pointed up.

She looked at the meter and laughed. “Yep!” She left me alone for a moment. I looked again at the biopsy equipment, and saw an ultrasound machine right beside the chair. That made me feel better. I had decided earlier that I would only let Dr. B do my biopsy if he used ultrasound guidance.

I found myself facing a window that looked out onto the parking lot and the road beyond it. I don’t want people to see me getting a needle stuck in my neck! I thought.

Even though my rational brain was glad to have the process moving along, my emotions were in a tizzy. Why didn’t I make Rusty come with me? my brain screamed. I tried to call him, just to let SOMEONE know that something very important was happening! They were going to stick a needle in my neck TODAY! But he didn’t answer. I wasn’t surprised. In the spring, if the weather permitted, he is usually out in our yard, making it beautiful.

I have GOT to calm down, I thought. I said a quick prayer for the Lord’s help. Then I remembered that I had put a vial of “Peaceful Child” in my purse. I gave that to J this morning! But I still had the rest of my oils. Balance. I opened the little lime green zippered case that holds my travel oils and found the bottle of Balance. I tapped some out onto my hands, and then rubbed it on the back of my neck and my wrists. I took deep breaths, inhaling the scent each time. I felt myself start to calm.

As my pulse slowed to a more normal pace, I felt inclined to laugh. Since I discovered the lump on my neck, I had wanted to speed things along. Now that they were speeding, I felt hysterical! I was chuckling over this when Dr. B came in.

“What’s got you laughing?” he asked good naturedly. I told him that I hadn’t been expecting a biopsy, but that I was fine with it—glad to move the process along. He took a look at my file, and gave me a chance to take a look at him.

He was wearing a leather band around his head with one of those reflector discs like you see cartoon doctors wearing. He also had reading glasses with a magnet in the nose bridge to make it easier to get them on and off quickly. I was comforted by the nerdiness of that reflector and those glasses. Not so much the image of the ex-quarterback I had in my mind from his online picture.  (No offense, Dr. B!  I think you’re awesome!)

“So the ultrasound report says that one of the nodules has calcifications and posterior shadowing. We’ll take a look at it, but it sounds like it does need to be biopsied.” He stood up and started talking me through the flowchart of possibilities, all the while tucking a drape into the top of my shirt, looking in both of my ears, peering up my nose, and feeling for what I presumed were the lymph nodes on my neck.  I looked up at him to respond and saw that he had the reflector flipped down over one eye to assist him in his examination.

The nurse came back in. Dr. B asked me, “Did you get to see your nodules on ultrasound?”

“No, but I’d love to,” I said.

“Let’s take a look.” He turned the machine on and put some gel on the transducer. He ran it across my neck and looked for a minute himself.

“Ok, turn you head a little this way,” he said, moving the machine more into my field of vision. “Here are the two lumps that we’re really looking at.” He moved the device around to show me the large nodule in the front of my neck, and the hidden one farther back, which had the calcifications.

“See, this one doesn’t look too bad,” he said, pointing out the nice smooth border and bland, solid gray appearance. “But this one,” he slid the transducer over, “See those calcifications? And that’s a blood vessel, so it’s vascular. It just looks a little more worrisome. Not as friendly as the other one.”

I wondered if the specks I was seeing would be considered “microcalcifications,” but I was afraid to ask. And it’s vascular. Not a great sign, I thought. From that point on, I expected that the biopsy would show malignancy. I knew that it might still be benign, but felt like the odds were against it.

“Isn’t it weird that if it hadn’t been for the friendly one,” I pointed to the bulge in my neck, “We wouldn’t have known about the ‘worrisome’ one?” I said.

“It’s serendipity,” he said.

I think I actually huffed. “It’s the Lord,” I said.

He started getting everything set up for the biopsy. “We’re going to get samples from both of them,” he said.

“How long before I hear something?” I asked—my new favorite question!

“About a week. We send them to Atlanta.” He pulled out a card and stuck it in the top of my purse. “If you don’t hear something by then, shoot me an email.” He told me that if the nodules turned out benign, it was still likely that I would have to have thyroid surgery sometime, just because I had so many lumps at such a young age.

“If I need a thyroidectomy, will you be the one to do it?” I asked.

“Yes.”

“Do you do a lot of those surgeries?”

“There’s only one guy in Alabama who does more of them than I do,” he said, not in a boasting way, just matter-of-fact. “He’s at UAB.” That sealed it for me. This was my guy.

They started to prep for the biopsy. I looked ahead, through the window, again. “Can we close the blinds?” I asked. The nurse pulled them shut without hesitation.

Dr. B injected some numbing medicine into the skin on my neck. It stung. “You’re very red-headed,” he said, “So this is really going to make your neck look splotchy for a few hours.” That was the least of my worries at that moment. But I really loved how calm and straightforward he was. I am going to have to thank Dr. G for sending me here, I thought.

“Ok, we’re going to get about three samples from each one. When I put this in, I need you to be very still. Don’t swallow, don’t talk.” He held the ultrasound wand in one hand and a syringe in the other. He was watching the screen. “Here we go. BE STILL.” The needle went in. It didn’t hurt, exactly, but it was the strangest sensation I had ever experienced. I could feel it inside my neck. It was all I could do to stay calm and hold myself still.

He took the needle out and squirted his sample into a vial. The he repeated the procedure. At one point he nodded to his nurse, “Hard drive that.” She went over and clicked a button on the ultrasound machine.

“Do you have any children?” he asked, right as he was inserting the needle for the third time. “Don’t answer that, hang on.” He withdrew the needle in a moment and I could answer.

“Three,” I said. “A ten-year-old, a seven-year-old, and a two-and-a-half year old.”

He nodded, then continued with the biopsy. “Ok, don’t talk don’t move,” he commanded, inserting the needle, now into the front nodule. I looked up at the ceiling vent and counted the louvers.

“I can tell you’re nervous,” he said. “I can see your carotid and jugular right here on the ultrasound.” I told him about counting the slats on the vent. He and the nurse chuckled. “You’re doing fine, almost done.”

After a couple more passes with the needle, he was finished. The whole thing probably hadn’t taken ten minutes.

The nurse pressed a piece of cotton to my neck. “Hold this.” I obeyed.

Dr. B was back in his seat, filling out the lab work instruction forms for the pathologist. “I want you back for a follow up in three weeks.” I remember him saying this, but at the time I was too foggy for me to process the meaning of his words.

“You should hear something by the end of the week,” he said. That, I understood.

“By the end of the week, or within a week?” I asked. I did NOT want to find myself expecting information when there was no chance of having it yet. He looked up at the ceiling, doing the calculation.

“Well, it’s late in the afternoon. If we had done it this morning…No, probably not until the first of next week.”

I mentally noted Tuesday as the day expect results. The nurse gently pulled my hand with the cotton away to check the bleeding. It must have been fine, because she held up a band aid—a miniscule circle.
I laughed. “So I get a tiny band aid?” I felt like I was going to need a huge gauze patch.

“Yes,” she said kindly, sticking on one and then another.

Dr. B handed me my discharge slip. “Come around here and look,” he said. He led me behind the exam chair and gently pointed me towards a mirror on the wall. “See how the medicine made your neck blanch? When you pull off your band aids, you’re going to have bull’s eyes.” I was thankful I didn’t have anywhere else to go that evening.

When I walked out of the room, the nurse pointed me towards the checkout desk. As I sat down in the chair, I saw the slip of paper shaking in my hand. Yes, I was glad to have the biopsy over with, but it had rattled me. Surprise! I thought. A biopsy!

“Looks like he wants you to come back in three weeks.” That was the first time it registered that I wouldn’t be back for three weeks, even though I should hear something within one. That’s how it’s going to go, I thought. I reminded myself what I had read several places, that thyroid cancer had to be dealt with, but it wasn’t an emergency. Later I realized that she actually scheduled me for one month later—the 16th of May. At the time, I was too much in a fog to notice. I paid my copay and went home.

Sure enough, when I got there, Rusty was watering some flowers he had just put in. I got out of the car.

“Guess who had a biopsy today?” I said in the most cheerful voice I could muster.

“Well, I wondered, since it was taking so long.” He gave me a hug. I followed him around the yard for a few minutes, chatting. Then I went inside. There was a message from S saying that she had gotten RYC applications for her kids. I thought that was a good sign—that she was probably in. But just to make sure I sent a quick email to the director of the camp, begging for information. Then I started calling the people I knew would want news.

I called J. “WHAAT?!!!!” She said when I told her about my surprise biopsy. But she was glad, too, that I wouldn’t have to wait any longer than necessary.

Then I called Nathan and Sarah. I filled them in, and then told Sarah that I had emailed the Rustic Youth Camp director for some answers. “I’ll go ahead and send our applications in, just in case,” she said.

I called my Dad. It was good to hear that he was now walking some without a cane, and that he thought he might be done with his IV antibiotics.

I called my Uncle Ken. I told him that I really wasn’t that scared of it being cancer, since it had such a good cure rate, but I was apprehensive about all the medical mayhem between diagnosis and cure—surgery, medication, radioactive iodine. He understood.

I tried to call Y. I didn’t get an answer from her, so I started my text message to everyone else who was following my case, putting her at the top. A few minutes after I sent the text, I got a call from her.
“I’m sorry I missed your call,” she said. “I assume it was about what your text message said. Did you want to tell me anything else?”

I am so thankful for you! I thought. I filled her in on what the ultrasound looked like, and basically repeated to her what I had said to my Uncle Ken. It was reassuring to hear the words, “I’m not really that scared of it being cancer,” coming out of my mouth. And it was true.

Eleanor woke up. I went up to get her out of her bed. “I like your band aids, Mommy,” she said, pointing to my neck. “I have a band aid on my foot. I don’t have one on my neck.” I had to smile. At least I was stylish.

I replied to T’s email, trying to keep my own update light by adding in the bit about Eleanor’s admiration of my bandages.

Band aids are always big with the toddler set, she replied.

We picked up Chinese for supper—comfort food to Rusty and me. But I knew I couldn’t keep indulging in needless expenses just because I was feeling vulnerable. I really needed to make myself stick to the same old routine until I couldn’t do it any more. All evening I got encouraging replies to the text I had sent out to my friends.  Once again, so many reasons to be thankful.