Category Archives: Ultrasound

Water Under the Bridge

VBS and Rustic Youth Camp are done.

VBS went very well, I think.  I ended up not doing quite all that I planned, but that was ok, and a good lesson to learn in not biting off more than I can chew.  Usually, if I don’t end up achieving all that I hoped to on a project, I blame myself for not working harder.  Maybe, finally, I am coming to realize that some of the problem is that I tend to have grand ideas–bigger than I am able to pull off sometimes.  This season in my life is teaching me that I don’t have to do amazing and spectacular things to be effective.

Camp was wonderful.  It was so much fun to have Sarah and the kids there.  It was a blessing to see so many good friends and to make new ones, too.  I need to work on the way I interact with children, including mine.  I have a tendency to be more stern than I need to be–to jump to sternness instead of letting gentleness be my trademark.  I don’t think I did a bad job as a teacher, but I could have done better.  Always more to learn.

To review my last post, I was anxious because I wanted to have an ultrasound done on my neck to look for suspicious lymph nodes.  The American Thyroid Association and the National Comprehensive Cancer Network both recommend such an ultrasound prior to surgery for Papillary Thyroid Carcinoma (PTC) because it spreads to lymph nodes so frequently, and it’s better to get effected lymph nodes out in the first surgery if possible.

I was going to try to just accept that Dr. B hadn’t ordered it and it would be ok, but I couldn’t let it go, so I emailed him to ask him about it.  He said that he would be glad to do it, and I told him I would take him up on it.

Then I kept on reading–I wanted to learn more about the particular variant I was diagnosed with–Follicular Variant Papillary Thyroid Carcinoma (FVPTC) and even more specifically, encapsulated follicular variant (EnFVPTC).  What I learned was that EnFVPTC is much less likely than PTC to spread to lymph nodes. (More about that in my next post.)  So then I felt a little silly about requesting the ultrasound.  I decided that if they called and told me it was scheduled during camp week I would just cancel it rather than rescheduling.

And that’s what happened.  Dr. B’s nurse called and told me my ultrasound was set for July 3rd.  I told her that I would just cancel it, since I would be out of town. Then ADI–the place that actually does the ultrasounds–called to pre-register me.  I cancelled with them as well.  Then, while I was gone, ADI called the house REPEATEDLY to pre-register me, and Dr. B’s nurse called me again to tell me that my ultrasound was actually July 2nd, not the 3rd.  All this was kind of confusing to me, since I had told Dr. B’s nurse that I was cancelling the ultrasound, since it was at my request anyway.  I am sure that Dr. B is going to think I am a complete nut job before this is all over.  The only thing I know to do is to be as sweet as possible to them.

Also behind me is another crisis on this journey. I had to decide whether or not to have this surgery done.  I’ve already outlined my anxieties about it.  For a few days, I was seriously considering calling it off.  Ultimately, I decided that I would do it.

The main reason for me to not have the surgery was fear of an apocalyptic future event that would leave me without medicine.  What I decided was that in such an event, my survival was unlikely anyway, and I couldn’t base my decision on speculation.  If I kept half of my thyroid, my chances of recurrence would be much higher.

I have also been anxious about adjusting to life without a thyroid–again, the message boards add fuel to the fire.  There are so  many over there who have struggled to adjust to life on thyroid replacement.

And the honest truth is that I know myself, and I am a person who likes to keep my options open.  I don’t like making irreversible decisions.

Anyway, my completion thyroidectomy is scheduled for Thursday, July 11th, three days from now. After all of that, I feel that it’s the best decision I could make for my circumstances.  I’m hoping all of these anxieties can just be water under the bridge as we move forward.

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It’s the good kind….Really!

“The Good Kind” is a catch phrase/byword in the thyroid cancer world.  Thyroid cancer (thyca) in general and Papillary Thyroid Carcinoma (PTC–which makes up about 75% of thyca) specifically are known as “The good kind” of cancer or, “if you’re going to have cancer, that’s the kind of cancer to have.”  There’s a reason for that….the survival rate for PTC is better than just about any other kind of cancer out there.  Some question whether it should really even count as cancer.

I know that some people hate this generally optimistic feeling about thyroid cancer, mostly because they feel that it minimizes their fears and the difficulties that treatment involves for them personally.  Also, there are some types of thyca that are not nearly as easy to treat as PTC and whose outlooks are not nearly as favorable.

So today I found out I had Papillary Thyroid Carcinoma, not Hurthle Cell Carcinoma, as I feared. And my first reaction when I saw that lab report was relief.  Because I know that PTC actually is “the good kind.”  Because HCC was really a scary thought for me.

Wanna know the crazy part?  The PTC was in that ugly looking nodule with the calcifications, the one that I originally “knew” had to be cancer.  The one that tested benign on FNA and frozen section.  The Hurthle cell lesion was just a big lump in a lumpy gland.

I guess that’s my only real whine at this point.  Why couldn’t we have just found it on the first biopsy and gotten all the surgery over to begin with?

Possible reasons:

  • I needed, for some reason, to not go around knowing I had cancer in my body for that period of time from FNA to first surgery–It was better to find out after it was out.
  • I needed time to work on a gentle weaning process for Eleanor.  More on that later…
  • I needed to be really afraid of having HCC so that PTC wouldn’t seem bad at all to me.
  • Something I haven’t even thought of yet.

Whatever the reason, I am going to trust my journey because I trust my Guide.  He knows what I need and what I can handle.

He answered my prayer to be spared HCC. He let me have a big benign lump in a visible place so that I could find the cancer that was hidden farther back in the gland.

I embrace the label “The Good Kind,” because this is NOT my mother’s cancer.

Ok, so here are the details:

  • PTC Nodule was 1.2 cm.
  • It was completely encapsulated.
  • It had no vascular invasion.
  • It was widely invasive of the capsule. (So glad it is O-U-T!)
  • It looks to be unifocal and confined to the thyroid. (That would make it stage I. This could change after the findings of the 2nd surgery.)
  • Also, I have Hashimoto’s Thyroiditis (or at least I do for the next few weeks.  I think surgery will “cure” me!)

Here’s the plan:

  • Have a great VBS.
  • Go to camp and have a GREAT time!
  • 7/11, have the rest of my thyroid removed.
  • recover
  • meet with the nuclear medicine doctor and talk about whether or not I need RAI.

Somewhere in that plan I need to include finishing Eleanor’s weaning.  Rusty got up with her this morning (bright and early) and fed her some breakfast before I made an appearance.  She has asked me to nurse a couple of times, but I have been able to put her off so far.  We’re going to see how far we can go with this.  I may go get my nail polish in a minute and work on my own toenails, and see if she wants me to do hers.

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.”

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.

Waiting for a Biopsy

I couldn’t quit wondering what the ultrasound report said. I knew that certain characteristics were more indicative of malignancy. I called Dr. G’s office back and asked if they could print out a copy of my blood work results and the ultrasound report. I went by and picked it up.

While I was there, I asked if it was ever possible to talk to Dr. G without making an appointment. I explained that waiting so long for my results had caused me a lot of anxiety—that I felt like I didn’t matter—and that I just wanted to talk to him about it. I was trying really hard not to embarrass myself by crying. As always, the women at the desk were extremely kind, and said they would leave a note for him to call me when he had a chance.

The lab work truly did look “normal.” Most of my levels were close to the middle of the normal range. My FT4 was at the low end of normal, but my TSH–which is what they use to determine if you are hyper- or hypo-thyroid–was right on target. The ultrasound report was very short. What I learned was that I had a lot of nodules, including three larger ones—one in the left lobe, one in the right lobe, and one on the isthmus in the center. That, I figured out, must be the one I had discovered. It sounded like the one in the right lobe was the most concerning—it had “areas of calcification.” The radiologist who had written the report recommended a biopsy.

“Areas of calcification” didn’t help me out much. I had read that microcalcifications strongly suggested papillary cancer, but “coarse” calcifications didn’t necessarily, and a calcified “halo,” or “eggshell,” as it was called, actually pointed to the lump’s being benign. The report didn’t even mention the size of the more worrisome lump, though it offered measurements on two others. I would just have to wait on more details.

The woman who had given me the call had said that I would probably hear from Dr. B’s office on Thursday. I didn’t.

I did get to meet with my ladies’ Bible study group though, and I shared with them about my thyroid nodules and upcoming biopsy. As always, it was a huge comfort to know those women would be added to the number of people who were praying for me. Y also told me that I was the third person in a short period of time who had been concerned about suspicious thyroid nodules. That was comforting too.

Thursday also brought a call from Dr. G. To be honest, I was a little embarrassed when I actually had him on the phone. I told him simply about the anxiety I had experienced while I had waited for my call-back on the ultrasound. He was very kind. He also told me about being gone for a long weekend right after the report got to his office, and about some of the nightmare issues they had been having at the new office. He had come back from his vacation to an office that smelled like a latrine because the sewer line was backed up—it was filled with concrete. And he’d been battling other problems related to the new building. It sounded like a nightmare of a week.

“I don’t want to make excuses, because I hate it when someone makes excuses to me,” he said. But it helped me a lot to know that there had been extenuating circumstances. I really felt for him, and I told him so. I also told him that I really didn’t want to be a complainer or a “problem patient.” I hope I’m not on the “bad” list for him and his staff now.

Friday brought no call from Dr. B’s office. Is there a pattern here? I thought. I decided to resign myself to the fact that this was going to be a long, drawn-out process.

Over the weekend I found a blog by a thyroid cancer patient. I have always been someone who can face things better if I know what to expect. I fully realized that my odds of having thyroid cancer were small, but I needed to keep reassuring myself that if I did, the path forward was doable.

In this blog, the writer, a young man in his twenties, outlined his entire cancer journey from discovery of a lump during an MRI for something else through his post-cancer recovery years later. One thing I found interesting was that the doctor who handled his surgery was an ENT. That made me feel better about going to Dr. B. It seems like even though the steps taken on this journey are pretty standardized, they can be carried out by doctors in several different specialties.

On Sunday we gathered with our brothers and sisters in Christ to worship. B, a long time friend, lead a prayer in which he asked for God to help those who were undergoing diagnostic tests, and for the results they received to be accurate. He doesn’t know it, but he’s praying for me, I thought.

On Monday, I decided to call Dr. G’s office just to make sure that I was supposed to be waiting for Dr. B’s office to call me, and that I was not supposed to call them. The receptionist told me that the referral had been sent, and that I should hear something soon. I did. Later that morning, someone from Dr. B’s office called and apologized for it taking so long for them to call me. She was training someone new and had gotten backed up. I had the feeling that Dr. G’s office had checked in with her to prompt the call.

I told her that I was being sent to Dr. B because I needed a biopsy of some thyroid nodules. She said that I would have to do a consultation appointment first. I wasn’t thrilled with the delay, but decided not to worry about what I couldn’t change. She told me where I could fill out my patient info online, and I told her I had already printed off the new patient information packet from their website and filled it out.

“Well, Dr. B is in surgery today, but he has an opening tomorrow at 3:30.”

So he’s a surgeon, I thought. I wondered if he did thyroidectomies. I took the appointment and called Rusty to let him know about my plans. He again arranged to take a few hours off work so that Eleanor could nap undisturbed. I was thankful he had time off available and that he was willing to use it to help me out that way.

I noticed that I had already received two emails from Dr. B’s office—one to remind me of my appointment and one with a link to a their patient information site. There I could enter all my patient info directly into their system. It was basically all the same information I had already filled out on paper, but I went ahead and did it. Anything that would get me in faster.

I got a shipment of some new oils that afternoon. I used some of them to mix up the popular “Peaceful Child” calming blend for my kids. Is there a “Peaceful Mommy” blend? I wondered.

Tuesday morning I went to visit with my good friend J–the one who had ordered me to find a good doctor. It had been a long time since we’d had a chance to sit and talk together. We talked of many things, but conversation did eventually come around to my thyroid nodules. I confided to her that the thing I was most afraid of, if one of my nodules was cancerous, was radioactive iodine therapy. I felt like in order to keep my children safe while I was radioactive, I really would need to be in a separate house. In her usual way, she said she would come and take care of me if I went alone somewhere like the house in Florida.

“Isn’t Rusty going to go with you?” she asked, when I told her about my consultation that afternoon. “I could come over so that Eleanor could still have her nap.”

“I kind of feel like that would make it too big a deal,” I said. “Things may get to that point, where I’ll want him with me for appointments, but I don’t think we’re there yet. But I’ll tell him you offered.”

Tuesday I also got Rustic Youth Camp applications for my boys. We’ve been to RYC the past two years—it’ss something that we all look forward to. I immediately called Sarah, my sister-in-law to see if she had gotten her applications yet, or if she had heard whether she was accepted to work the camp or not. I had found out the week before that I was in as a teacher for Elliot’s class. Last year we had tried to get Sarah in to work camp so that she could bring my nieces and nephews with her. My idea of camp Nirvana was for all of us to be there—Rusty and me, my brother, Nathan, and SIL, Sarah, with all of our children. Barring the presence of our husbands, having Sarah and her kiddos join me and mine there was a close second.  I was hoping this thyroid thing wouldn’t interfere with camp.

Sarah still didn’t know if she was accepted. I went ahead and filled my kids’ applications out and got them ready to return.

At about 2:45 Rusty came in from work. I told him about J’s offer to keep the kids if he wanted to come.

“I just assumed you would tell me if you wanted me there,” he said.

“I assumed you would ask if you wanted to come,” I replied, smiling. “I just don’t want to make it into a big deal yet.” I took off to my appointment, calling J on the way to let her know I was going alone, and that I was fine.

“Well, call me when you’re done,” she said.

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.