Thyroid Fever (Part 2)

Continuation of http://therealgoodgirl.blogspot.com/2016/11/thyroid-fever-part-1.html

Sometimes all you need is a splash of color. You can't have a rainbow without a little rain.

SURGERY.

Whoa. Dr. Lo said it wasn’t that super urgent (but it had to be done at least within 3 months for the lab results to be still valid), and after that, ibi-biopsy whatever was removed from me. The next steps will be determined after that, once they find out if it’s malignant or not. But after thyroidectomy, I will have to have hormone replacement therapy from then on. Doing my research, I later found out that the thyroids produce hormones that controls or regulates metabolism. So that’s why HRT is required. And that's why those with hyperthyroidism lose weight, and those with hypo gain weight. But good news though, Dr. Lo said that thyroid cancers are the kindest. They are manageable, cureable and are not deadly or death-dealing like the others. A thyroid cancer patient does not usually die from it. “10 years, 20 years, they live long enough,” he said.

So after that visit, I was preparing for surgery already. I will just have to fix my workload and finish pending projects so we can schedule it after Christmas. I already informed my boss, my co-department heads, our HR, and my staff. I already told the same to my children and household staff. I will be gone for two weeks or so. I would miss a lot of post-Christmas events. And it was sad to think that I would be welcoming the New Year in the hospital.

I consulted a radiologist-friend (Ate Bugs), showing her the u/s results. And she said, based on what she read, surgery might be the way to go. But when I discussed this with my pedia-kumare Dra. Joy, she was insistent. No, huwag muna mare, she said. She gave me the name of another endocrinologist at Asian Hospital whom her fellow pedia referred to her. “Magaling yan,” she said. Her secretary was able to talk to this doctor’s secretary and advised me to go to her clinic on Monday. I called up the secretary the following day (Saturday, during my son's school program) to confirm my appointment and she said, singit lang ako talaga because there’s already a list, and usually, patients were on a first come-first served basis. 

So off we went that Monday. If somebody told me I would be meeting or talking to more than five doctors within only one week, I would have told you you’re crazy. But it was what I was doing!

Turned out that my 2nd endo, Dr. Lantion-Ang, is the professor of my first endo at the UP-PGH. At first, I thought she was masungit. She had many questions about my health and my lifestyle and she was very thorough. Metikulosa kasi ako, she told us. I was about to show the ultrasound report to her but she didn’t want to see it until she was finished with her questions. And she hated that I was holding my cellphone. Too much radiation, she said.

She was surprised that Dr. Lo recommended surgery right away. She was trying to rule it out, because she said, “Surgery is still surgery.” And the only way to determine malignancy of my thyroid nodules is biopsy. She was upset over the ultrasound report/conclusion. “Tinakot ka pa,” she said. She asked me to see Dr. Abelardo of Manila Doctors for the fine needle aspiration biopsy (FNAB), and to come back to her with the results.

So here we are again, I told Alex. We were already decided to undergo surgery. But what if I shouldn’t have to? What were the odds? What would we lose? If the biopsy results were “malignant”, what would it mean - additional expense? Another validation of the earlier recommendation to remove the masses and my thyroid glands?

But what if the results are benign? We saved money, time, and of course, my body organ. But what did Dr. Lo say after still taking it out, even if it’s benign? He said that the masses may still grow and may obstruct some blood vessels, or my breathing or my voice. Naku, hindi pwede. Raket ko yun! I was scared – the results were beyond our control and we could only pray that it will be in my favor. But what do you do? When you hear biopsy, hindi ka ba matatakot? What if it’s goiter, like Mama? I would still need surgery.

In the end, I followed my heart. Deep inside all of us, we wanted a miracle. And what if that was it, the biopsy? I consulted our HR and yes, the procedure was covered under our hospitalization insurance. When I called before Undas, the lab staff said the pathologist was out of the country and will be back Nov. 2 onwards. Before my appointment, again, in the meantime, we were trying to lead normal lives, as if my condition was normal and I didn’t have health issues.

So, with another LOA, we went to Manila Doctors last Nov. 4, two weeks after. We waited for an hour and a half, then my name was called. Dr. Abelardo explained what she was going to do, and that it was just like a blood extraction procedure, taking around 10 seconds. Do not swallow during the time the needle is inside, she told me. She checked my neck and remarked that it seemed small, I assumed maybe she compared it to the size indicated on the ultrasound results. She asked if I was given meds and I said no. She said she might do the puncture twice if needed, but otherwise once would be enough for four smear slides. I closed my eyes when she asked me to swallow for the last time and then, the needle went in. I counted and it wasn’t even 10 seconds, maybe less. It was not painful but of course I was scared. After that, she asked me to hold that portion of my neck for 10 minutes. I was waiting for her to tell me she was going to do it again, but no, she said she didn’t need to, as she was able to get enough smears. Ok ka lang? Dr. Abelardo asked. I felt weak for a while. But that was all. We were to come back after an hour for the results.

In the meantime, we had lunch and coffee/tea afterwards. Then it was verdict time. Alex went to claim the results and  as he handed the envelope to me, I thought to myself: This is it, Lord. Please be with me. And there it was, in bold letters: Thyroid Bethesda System Category II – BENIGN.

I wanted to hug someone at that moment. Alex was just laughing at me. Of course, I couldn’t understand the other medical terms, but BENIGN all caps was enough to feel a quick win. I don’t have goiter. Because the report would have said so otherwise. I was holding back my relief and happiness until I see Dr. Lantion-Ang that following Monday. What if I don’t need surgery after all? What if we are able to save my thyroid glands after all? I updated my family and dearest friends and requested for more prayers. Please, Lord, let this be good news for all of us.

Monday came and this time, I would see Dr. Lantion-Ang on my own as Alex couldn’t make it. When I sat down, she noticed my neck right away. Lumiit ba yan, she asked. And I said that was the same thing Dr. Abelardo said. When she saw the cytology report, it was as if she knew it all the time. She explained that the thyroid nodules are common in adults, especially females, and that when T3 / T4 are produced, they serve as storage for such. But they are harmless. “I’m overruling Tom,” she said. Surgery is ruled out.

What if they grow big again, I asked. She asked me to monitor it and to go back to her if I feel there’s a problem. Otherwise, my next visit is after six months. Walang bawal! Walang meds! Praise God.

I told her, “Doc, wini-withhold ko po yung saya ko, hanggang makausap ko kayo. Pwede na po ba ako magsaya?” She was amused, “Oo, pwede na.”

And that was the moment when I experienced the realness, the existence of miracles. This doctor was the instrument. She was a blessing. And I couldn’t thank my kumareng Dra. Joy enough for the referral. Imagine if we just stopped at that, and we were just waiting for my surgery schedule. I would have lost my thyroids just like that, and be forever dependent on therapy. I was trying to recall what they said about the biopsy procedure. Sabi nila, surgery na lang than biopsy. Para isang sakit na lang. Para isang gastos na lang. But it turned out that the pain was not comparable to actual surgery after all, and of course it was not really that expensive. What if we didn’t go to Dr. Lantion-Ang? What if. What if.

All the heartaches and hurts in the past 3 weeks have been replaced by happiness and humility. During those dreadful weeks, I always felt tired. I felt so ugly. And miserable. I got sick. I had these two huge zits on my face. Pangit na pangit ako sa sarili ko, and it affected my self-confidence. My period was late. And life seemed...unfair.

My consolation then when I was down and out were my children, and the love that surrounds me, amid my beautiful colorful Christmas trees and decors. The ugly scars left by the (bwi)zits will be constant reminders of the ordeal that I went through, and that you can't have a rainbow without a little rain.

My takeaway from all these: Enjoy life. Tell people dear to you that you love them - you may not have the time to do so one day. Always take care of yourself. Take it easy. Yes, sometimes do take the time to smell the flowers. It's not always about your job or work. Go take those annual physical check-ups, don’t take them for granted. Don’t be embarrassed to tell people about your plight. Who knows, the best help is just out there and you might never get it if you don’t ask around. What if I didn’t tell my kumare about it right away? I wouldn't have gone to another doctor. Seek 2^nd, 3^rd or even 4^th opinion. So what if they cost you an arm and leg? The peace of mind it will bring you is simply priceless. The enlightenment. The joy. The bliss of knowing you are ok. That God loves you no matter what. That prayers indeed work. That miracles happen. 

Thank you to my family, friends and loved ones who included me in their prayers when I asked for it. And even if I didn’t ask for it. You know who you are. Deeply appreciated and I will forever be grateful. I would do the same for you. Of course, this may not be the end. I will still go to Dr. Lantion-Ang regularly. But I will continue to hope and pray that I will stay long enough in this world for my children who need me the most. Hope is a good thing. Maybe the best of things, and good things never die.

My two CAEs

God loves us - even if we don't always deserve it. God bless us all.

~TheGoodGirl

Thyroid Fever (Part 1)

“Death is what gives life meaning. To know your days are numbered and your time is short.“
- Doctor Strange (2016)

Now it can be told (better yet, written).

My post-biopsy procedure selfie

Last October 12, I had my regular annual physical check-up. For me, since I undergo APE every year, it was a routinary activity, just like in the past years.  Imagine my surprise when during the physical exam, our company doctor asked me to swallow a lot of times as she palpated my neck. She said she would see a movement in the left side of my neck each time I swallow. I wasn’t really paying attention because I wasn’t feeling anything, and I wasn’t alarmed – yet. She wanted me to have a neck and thyroid ultrasound and she also asked if she didn’t advise me about it the previous year. I said no, because otherwise I would remember it, and I would have heeded her advice.

So after getting my LOA from our HR (thank you, Fred for all the assistance), I spent the day
going to Asian Hospital to have that ultrasound and sadly yes, I took a VL (which I rarely do), missed our event at the office, and instead of resting and spending it with my son who just turned 11, it was spent somewhere else.

While the radiology staff was doing the procedure, she asked me, “Ma’am, wala kayong nakakapa?” I said, none. Two things were going inside my head at that time. Why did she ask that? One, she wasn’t seeing anything and it might help if I would tell her kung meron nga ako nakakapa, and kung saan, para dun sya magfocus. Or two, she’s indeed seeing something but was wondering why I wasn’t. Dear Lord, that was when I started to freak out. I couldn’t understand what was being shown on the screen, and what she was measuring. What if I indeed have a mass on my neck? What will happen and what does it mean? I felt so alone then, and scared out of my wits.

After an hour and a half, I went back to the radiology center to get the results. I sat down and braced myself. Reading the report, heavens fell as soon as I saw this:

Cystic, complex and solid thyroid masses. Complex mass in the left lower pole is worrisome for malignancy. Biopsy is suggested.

I felt more alone than ever. I started to text and send viber messages to my husband, siblings, and close friends. I was crying in the waiting lounge and I just wanted to stay there until God knows when.

I went back to the office to show the report to our company doctor. She consulted our Medical Director, who advised me to see a neck surgeon in Makati Med. She said surgery was the better option than biopsy. (To) surgically remove the masses because they might not be able to get sufficient smears for the latter. “Tanggalin na, yun na ang ipa-biopsy. Para isang procedure na lang if they turn out to be malignant.”

I felt it was too drastic as an option, surgery agad? Wala bang iba muna? I asked for other options and they asked me to see an endocrinologist. Which I said I would.

I didn’t realize it was difficult to see one at need. Each endo seems to be “by appointment only”. Available slots were already in November at that time, and I felt they were already too late. Parang ang dami nang pwedeng mangyari between then and the available dates, at wala pa kong kamalay-malay sa totoong condition ko.

Ms. Joh, a colleague, referred me to her co-parent who is an endo at Asian. I said I would check her out and call her clinic for appointment. In the meantime, I was looking for other doctors in a hospital near us. I found one who accommodates patients on a “first come, first served” basis, and has a Saturday clinic. When we came to see her, it was only then when we realized that doctors under the “Department of Endocrinology” were not necessarily endocrinologists. She was a diabetologist. But she checked my sonogram results and asked me to have additional blood tests – FT3, FT4, and TSH (thyroid function tests). She referred me to an endo also from the same hospital and she said those tests were the same ones he will ask me to have.

I was thinking if the blood tests were covered under our hospitalization insurance. But my husband decided that regardless if they were covered or not, the waiting period was too long, we might as well proceed that Saturday. Results were to be available after two days, the lab staff said the earliest was Monday. We managed somehow to suspend fears and other possible related emotions, and made it through that weekend. I wasn't telling my kids yet about it because I did not have anything concrete to tell them anyway. In the meantime, I tried to follow the diabetologist’s advice to avoid food giving me bad cholesterol, like fried stuff (eggs once a week only), and soya (there goes my weekly taho supply), dairy (milk, cheese), gata and the like. I tried to take it easy on myself, waking up later than the usual, and rest whenever I felt like it. My husband also brought up alternative medicine, which was recommended by a former officemate of his. We'll see, I said.

To the uninitiated like us, like me, the word “malignancy” is enough to kill you. If the cyst or mass or nodules are not malignant, the fear caused by it itself is enough to knock you dead. Believe me. The thought that something inside you is a killer would kill you. The thought that your days might be numbered. The thought that you might die. My God, I was praying. My children need me. Don’t let me die just yet. You may find this dramatic, but it’s true.  In the movie Doctor Strange, the Ancient One said, “No one is ever ready. We don't get to choose our time.”

“Death is what gives life meaning. To know your days are numbered and your time is short.“

To be reminded of your mortality, and that life is too short, time is not enough for the things you want to do and achieve, to be with the people you love.

Why thyroid? I was asking myself. All my life, I thought I was ok. I just had a most wonderful 45th birthday. How can I be sick? What a cruel joke. If there’s one thing that we dealt with, it’s myoma for my sisters, and hormonal imbalance. And kidney problems. Bladder stones. My daughter has scoliosis, Caehl has strabismus or lazy eye. But wait, my mom had goiter when she was younger. Eto pa yata ang magiging problema ko, I feared.

Alex came home with the thyroid function test results Monday evening, and reading them, I was again wondering, my FT3, FT4 and TSH were within normal range. So what was wrong with me then? By Wednesday, we went to the endocrinologist. I don’t have hyperthyroidism or hypothyroidism. Seeing the ultrasound results and again, after palpating my neck, the verdict was: surgery. And it wasn’t just to remove the masses on the left, but also the ones on the right, and…tada! Thyroidectomy or removal of my entire thyroid glands.

To be continued...
http://therealgoodgirl.blogspot.com/2016/11/thyroid-fever-part-2.html