Tag Archives: thyroidectomy

Incision, Day 4

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A little more bruising than last time, but overall, I am doing very well. Not coughing like I did after the last surgery, and my voice is better. Could it be my anesthesiologist did a better job this time?

I have a little more energy each day, but I still have to sit and rest for a while if I get up and do very much.

Also, I need to get some kind of routine down for taking my medicine early in the morning. I’m supposed to wait an hour after my Synthroid before eating, and four hours before taking supplements.

I weighed myself this morning and I have gained about 6 pounds since my first surgery. Once my meds are stabilized and I am up and running, I am going to have to give that my attention.

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At home, doing well.

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My incision, the morning after surgery. Second verse, same as the first, right? Once again, Dr. B appears to have done a great job.  I especially appreciate that he went looking for lymph nodes, even in the lateral areas of my neck. He found one on the left side, which he said he wouldn’t have thought anything about if I didn’t have cancer. I am thankful that he went to the trouble of looking carefully.

I have had no problems with my calcium levels, Praise God.  My pain at the very first was a little more than last time, but now is about the same. I am able to be up and moving about the same amount as before, which is not much yet.

Dr. B went ahead and started me on 100 mcg of Synthroid because he doesn’t think I will need RAI. (Sounds good to me!) He says he will check my TSH in 3 weeks to see if I am in the ballpark, or if I need to have my prescription adjusted. I was pleased to learn that he aims to keep his thyca patients with a TSH around 0.5.  That’s what I was hoping for.

My follow up is Thursday, when we’ll hear the final pathology report on what they removed in this surgery.

Aunt Sharon got here today in time to help Rusty get the family off to church.  She brought a car load of Krispy Kreme doughnuts, because that’s just how she rolls. :) I am so glad she’s here. Rusty has been doing a phenomenal job taking care of me and the kids, but its all a bit much, and I know it is overwhelming to him. This will ease his burden a good bit.

Follicular Variant Papillary Thyroid Carcinoma, Second Surgery Today

Just as I did when I had done research on Hurthle Cells way back when I was diagnosed with a Hurthle Cell Lesion and wanted to understand what that meant, I want to put down here some of what I have learned about the particular variety of cancer I was diagnosed with after my first surgery:  Follicular Variant Papillary Thyroid Carcinoma, FVPTC.

The very first things I read indicated that FVPTC pretty much behaves the same and is treated the same as “Classical” PTC (cPTC).  Since then I have read a good deal more, and have found that this is not always the case.  In both cPTC and FVPTC, it makes a difference if the tumor is encapsulated or diffuse (spread out with no clear margins in the tissue).  Just like you might think, diffuse tumors tend to spread more readily and are considered more “aggressive.”

There is also an “in between” type that is not encapsulated but is not diffuse–From what I have read, it tends to behave more like encapsulated tumors and is, as these authors love to say, more “indolent.” I haven’t found much about that, so cant say more.

Then there is a great deal of research published within the last two to three years that examines encapsulated FVPTC (EnFPTC) versus unencapsulated.   See this, this, and this.  The basic takeaways are two-fold.

One is that FVPTC tends to behave more like FTC (Follicular Thyroid Carcinoma) rather than PTC.  That means it is more likely to spread distantly through the blood than to reoccur locally in the neck (in lymph nodes, etc.)  It also means that a totally encapsulated FVPTC might even be considered benign.  In FTC, malignancy is determined by capsular or vascular invasion.

The other take-away is that encapsulated FVPTC is generally very non-aggressive.  It seldom spreads anywhere.  There is a good deal of debate about whether it warrants a total thyroidectomy if there is no vascular invasion.  Even with capsular invasion, some authors believe a total thyroidectomy is not worth doing.

Then there is an alternate point of view, that encapsulated FVPTC can have vascular invasion that is so microscopic as to be almost undetected, and that in such cases a tumor that looks to be harmless could end up with distant metastases years later.

So all of this was what I have waded through since my diagnosis, what I’ve struggled with as I decided whether to have the completion surgery or not. What it comes down to is that I do not believe completion surgery will change my prognosis, but it will lower my risk of recurrence and make it easier to be monitored going down the road. I put my trust in my God to continue with me down this path, wherever it leads me.

And in a few minutes, I’ll be headed over to the hospital for my surgery.  Last time I was anxious about having surgery–since I’d never really done that–and about what they would find.  This time I know what to expect and the procedure doesn’t worry me.  I don’t really expect them to find any more cancer, but know it is a possibility.  This time, I am more concerned about adjusting to life without a thyroid, life on a daily med.  Again I put my trust in the Father to take me forward one step at a time.

See you on the flip side.

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.

Weaning, Whining, and Well-Wishes

Alliterative titles: cutting edge or passe?

First weaning–it’s been rocky, people,  but I think I have found the solution: Chocolate.  A couple of mornings ago, Eleanor was crying, begging to nurse.  I almost started crying myself.  But then my wise, sweet husband rescued me by offering Eleanor a precious treasure:  A Thin Mint Girl Scout cookie.  She took it and was fine.  So now, when she is asking to nurse, I offer her a piece of chocolate instead, and it is getting us over the hump.  She is asking less.

Whining–well, we can save that for later…

Well-wishes.  I have the very, very best friends and family–including my family in Christ–in the world.  I have gotten some of the sweetest cards.  The food offerings have been amazing.  A sweet sister called me on Monday with an offer to order pizza for our family.  I told her I had “canceled” the rest of our meal list because I was doing so well and knew I would need help again after my second surgery.  She said, “Well, I’d like to help you out now and later too.”  So Monday night we had pizza.

Ok, this doesn’t fit into my neat, alliterative title, but the mom of the two boys down the street with whom Silas and Elliot play almost daily came to the door yesterday to pick up one of her sons.  We don’t meet face-to-face very often–our boys usually just run up and down the street to visit with each other, and A (the mom) and I text or talk by phone as needed.  So she hadn’t seen me since all this thyroid business started.  She saw the bandage on my neck (actually a scar-reducing patch) and asked me what was going on.  I saw she had a scar on her neck too.  Because she had thyroid cancer about a year ago.  Same process as me–lobectomy, completion thyroidectomy, then RAI (which I’m hoping will NOT be part of my process) and is now on thyroid replacement.  She sees Dr. S, whom my friend S recommended to me.  I may have to still look him up, but I am going to give Dr. G a chance as my “manager” first.  It’s just one more of those “out of the woodwork” experiences for me.  (There’s the alliteration I missed–Woodwork!)

Ok, now the whining.  As always, feel free to skip the rest of this post if you don’t want to hear me complain.  I will never know the difference! :)

I don’t want to lose my thyroid.  It freaks me out.  I don’t want to deal with the process of trying to adjust my meds so that I feel right.  I don’t want to be dependent upon a drug manufacturer for my life.  I know that this is what we need to do.  I’ve read enough stories over on the Thyca boards to know that even Papillary Carcinoma can spread and grow and make my life awful, and it’s better to get the whole thyroid out and pray no lymph nodes are affected yet.

But I do. not. want. to. depend. on. a. drug. for. my. life.

I am just going to have to get over it.  But I don’t know how.  May the Lord help me overcome my anxiety.  I just have to remember that this life is not what it’s all about.

 

Looking worse, feeling better

My bruising is pretty bad. It’s sliding down my chest. Check it out (day 4, if you were wondering):

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But on the other hand, I feel almost normal. I am having very little pain. What I’m mostly experiencing is a mild burning feeling around my incision. That sounds scary, but it doesn’t feel or look inflamed.

My energy is still not all there. If I get up and “do” for a few minutes, I will start to feel just a little bit clammy and woozy. That’s my cue to resume my station on the couch. But I am doing more today than I did yesterday. And I expect to be doing even more tomorrow. It looks to me like that one-week recovery I keep seeing quoted everywhere may be right on for me.

Third Day Post-Op

Today is Monday, three days out from surgery.

First, a couple of details from my surgery that I haven’t recorded yet.  My parathyroid glands on that side did great, according to Dr. B.  So that’s a definite positive. Also, the “other” nodule, the one that initially was more scary on ultrasound but came back with a benign FNA still looked benign on frozen section.  Of course, I still want to see the report on it, but I am not worried about it at all.

We are still nursing in the morning.  I’m kind of glad I can provide that kind of continuity for Eleanor during this time.  Bless her heart, it’s hard when Mommy has a big boo boo on her neck and can’t pick you up.  We’ll get that last feeding gone sometime.

One thing I didn’t think through before surgery was making sure I had enough scoop-neck and v-neck t-shirts to wear for the first little while.  Down the road, I am going to be glad my scar is low enough for a regular t-shirt to cover it, but right now having something against it doesn’t feel great.

My incision is looking a little more gnarly today–more bruising etc.  But still not bad. Check it out:

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Also, I am not having much pain at all today. Really, my pain has not been bad from the beginning.  But I have still been feeling sort of crummy and tired.  Ever since I got home, I’ve felt like I might have a little fever.  Today I finally checked it, and it was 99.3.  Not too high, but enough to make me feel punk.  My discharge instructions say to call if I have fever over 100.4.  So I’m not too worried about it, but will keep an eye on it.

I’m also faithfully taking my antibiotic, even though I wasn’t originally sure that I would.  Dr. B, when he saw me the morning after surgery, said that it was mostly precautionary since they wouldn’t be watching me in the hospital. But that first day home, when I first started feeling a little hot, I decided to go ahead and take it.

I have been coughing some (not super comfortable, but normal, from what I’ve read), and my throat feels a bit more “gunky” on the inside today.  So I’m now sucking on On Guard throat drops.

One question I’ve had is whether I will be up to teaching my childbirth class tomorrow night.  Part of me says that I don’t feel that bad and not to be a wimp, but my rational brain is telling me that I’m still mostly affixed to the couch and don’t need to push it.  I just dread trying to make the class up.  Maybe by Friday I will be feeling better?

My follow up appointment is scheduled for Friday morning.  The old me, pre-surgery, would not have been content to just wait until my appointment to find out what my pathology report said if there was any way to know earlier.  The new, just-trying-to-get-over-this-surgery-and-a-little-scared-I-might-need-another-one me, is going to wait.  If I need to know before Friday, say, because we need to schedule a completion thyroidectomy, I am confident that Dr. B will contact me.

About that.  I am ashamed to say that I am having a hard time praying right now.  Is my faith really that wimpy?  I think I am a  scared to pray very hard that my lump is not cancer because I don’t know if God will spare me this, and it’s hard to be disappointed that way.  I  KNOW he knows what’s best and what will work out for my ultimate good.  I know he can use whatever Satan throws at me to refine and shape me into the person he wants me to be.  I just really don’t want to have Hurthle cell cancer!  “Let this cup pass from me!” I want to say.  I should say it.  I’m just afraid His answer might not be what I want it to be.

That’s not to say that I haven’t been praying at all.  I just haven’t been doing the kind of serious intervention type prayers I normally do when there is something big going on.  May He have mercy on me in my weakness and give me the strength to turn to Him the way I need to.

The really, really good news is that I know there are a lot of people praying for me right now.  Obviously, that doesn’t mean that I don’t need to pray too, but it’s very wonderful and comforting to know.  Also amazing and comforting is the meal list that Mrs. D put together for us…we will be getting meals EVERY NIGHT for the next 10 days.  I think it’s way more than we will need, but I am SOOOO thankful.  It will make things so much easier on Rusty.

My dear friend R is coming in tonight on her whirlwind visit from Brazil.  She and her kiddos will only be here in the evenings, so we decided not to cancel her stay after my surgery was scheduled right before her visit.  She generally uses us as a hotel while she visits with her in-laws in a nearby city, getting in two visits at once.  She called me to let me know that her husband’s grandmother, who has been sick for a long time, passed away this morning.  So she will likely be here another day or two beyond what she originally thought.  I am sad that they have this loss to face, but glad that I will get a little more time with her.