Tale of the nodule

Disclaimer: I am not a medical professional. The things I write here are just based on my own personal experience, how I understand my doctors’ explanations, and some online research I did to help me understand more about what was happening to me.


It was just a lump. One fine day in July while I was putting on moisturizer on my face and neck, I felt a firm lump at the front left part of my neck near the base. It felt as big as a cherry (or specifically I described it as like having a “sinigwelas” stuck in my neck). I knew it wasn’t there before, not that big to be felt anyway. My mom was around that time so I told her about it. She told me to have it checked by the doctor.

I never thought I would be dealing with any major medical issue anytime soon, but that’s how simply I discovered it.

I went to the GP to have it checked. He did a simple physical examination of it, then sent me for an ultrasound. The ultrasound confirmed a solitary thyroid nodule in my left thyroid about 3.3cm. I went back to the GP with the results, and he sent me for more tests, blood tests to check my thyroid hormones, and fine needle biopsy (FNB) for the nodule. This entire thing, from the first GP visit to the FNB results, went on for a few weeks. When my GP got my FNB results, he referred me to a specialist.

I went for a consult with the specialist, who then sent me for another set of tests – more blood tests, and a thyroid scan (where they give you a small amount of radioactive iodine which should be absorbed by the thyroid and shows the level of function of the thyroid). Immediately after my thyroid scan (I think my specialist was around during the scan, and came over while I was still on the scanning bed) told me that my nodule was cold (or it wasn’t absorbing the radioactive tracer, thus, was non-functioning thyroid tissue) and that he would need to refer me to a surgeon on my next visit. So I went back a week after when the rest of the test results were ready, and the specialist referred me to the surgeon, who luckily had a free slot for a consult on the same day.

I went to the surgeon who checked through my previous test results. He checked my thyroid again with an ultrasound in his own clinic, and noted that the nodule was around 3.7cm (but initially he said the size difference from the first scan may just be due to viewing variances). He also did a nasolaryngoscopy to check my throat and vocal chords. He explained to me the results of my test, and why surgery was recommended to take it out. During that first visit with the surgeon he scheduled me for an operation in less than a month (which I eventually rescheduled a little bit later to time it when my mom can come over to provide support).

During the following weeks while waiting for my surgery, I was starting to feel the lump as a mild pressure inside my throat. Perhaps it was getting a little bit bigger, or maybe it was shifting positions, but I couldn’t really tell.

I don’t think I ever stopped reading any and all online references I could get my hands on on the subject of thyroid nodules and thyroid cancers. I’ve read about the different kinds. I’ve read maybe a hundred times (a lot of times the same articles) about how they are diagnosed and treated. They were mostly saying the same things. And somehow, most were also pointing to the direction that all the characteristics of my nodule were somehow indicating higher risks for malignancy.

Just to review, here were the characteristics of my nodule:

  • Solitary – there were no other visible nodules in the scan
  • Cold – it was comprised of non-functioning thyroid tissue
  • Atypia of undetermined significance – it could not be determined if the mass was benign or malignant based on the FNB alone
  • Bigger than 3cm
  • Thyroid hormones normal
  • Family history – mom had her entire thyroid removed a few years ago and findings include microcarcinoma

I guess that’s the reason why all the doctors I consulted recommended to immediately remove the mass to get a definitive finding if it is benign or malignant. I was undergoing a hemi-thyroidectomy – removing the left lobe of my thyroid. The doctors told me that there is a possibility that they may need to do a second operation to remove the rest of my thyroid if the nodule turns out to be malignant. So I was also trying to ready myself for that possibility.

Mid-November, I finally had my surgery and it went smoothly. The only thing that got me is the horrible nausea and headache after the operation, which was probably the side effects of the anesthetics. Once I got over that, recovery went well.

A little over two weeks after the operation, I had my follow-up appointment with the surgeon and he told me the results of the biopsy. Findings was Hurthle cell adenoma – it was benign! I was relieved. I get to keep the rest of my thyroid for now. The surgeon also told me that it was a good that we have already removed the nodule because there may be a risk of it becoming malignant if it wasn’t removed.

There is a “thin line” between Hurthle cell adenoma (benign) and Hurthle cell carcinoma (malignant).

“If vascular invasion, invasion of adjacent tissues or complete capsular penetration (if the tumor is encapsulated) is demonstrated the tumor is considered malignant” (http://www.med.harvard.edu/JPNM/TF99_00/Nov23/WriteUp.html).

“Unlike many cancers, Hürthle cell cannot be definitively diagnosed with a fine needle aspiration (biopsy). While the biopsy may be suggestive of a tumor that may or may not be cancer, called a Hürthle cell neoplasm, the large majority of these will be found to be benign (called a Hürthle cell adenoma). The only way to confirm the diagnosis of cancer is by identifying capsular or vascular invasion (that is, invasive growth that is seen with cancer). This can only be determined after the nodule is surgically removed and examined by a pathologist in the laboratory… Once there is a diagnosis of a Hürthle cell neoplasm, surgery to remove the affected thyroid lobe is typically the next step to clarify the diagnosis. Only 15-30% of patients will receive a diagnosis of carcinoma after surgery, with the remainder finding the nodule was benign.” (https://www.oncolink.org/cancers/thyroid/all-about-huerthle-cell-carcinoma)

I’m super glad that its Hurthle cell adenoma and not Hurthle cell carcinoma.

“Hürthle cell cancer has the highest incidence of metastasis among the differentiated thyroid cancers… The lungs, bones, and central nervous system are the most prevalent sites of metastases.” (http://emedicine.medscape.com/article/279462-overview)

“No widely accepted paradigm exists for the pathogenesis of follicular and Hürthle cell cancer of the thyroid. Some evidence suggests that a multistep adenoma-to-carcinoma pathway may be involved; however, this concept is not universally accepted. Many of the cells probably develop from preexisting adenomas, but a follicular carcinoma in situ is not recognized pathologically.” (http://emedicine.medscape.com/article/279462-overview#a5)

During that same follow-up, I also asked the doctor about the size of the nodule they removed, since I had a feeling before the surgery that it was slowly getting bigger. He told me that it was possibly around 4cm – indeed a little bit bigger than when it was first diagnosed just four months earlier. I’m so thankful for the perfect timing of when I noticed the lump, when it was diagnosed, when the doctors decided to take it out, and when I finally had the surgery. Otherwise if I or any of my doctors have ignored it, the outcome may have been different.

I’m almost back to my normal self, although I’m still avoiding heavy physical activities and my wound is still recovering from the swelling. I can move my neck, but not yet 100% back to its normal range. I have yet to see my specialist to find out if my remaining half-thyroid is producing enough hormones or if I need to take hormone supplements. But everything is good and well. I no longer need another operation or other therapies. I can start planning my life for 2017.

Christmas came early this year

There are just so many things that should excite me in the coming days. There’s the Coldplay concert next week, the family trip pre-Christmas, and most of all, spending Christmas and New Year back home. There are even more exciting things coming early next year – Adele, travels, and so much more. But somehow I feel like I’m not as excited as I should be for all those other things.

Perhaps it’s because of the health-scare I’ve had in the second half of this year. It’s quite unsettling to be face-to-face with that big word – cancer. I had a solitary thyroid nodule which was suspicious on tests. They couldn’t determine from initial tests if it was benign or malignant, and a lot of parameters were pointing to a risk for malignancy. The only way they could find out is to take out the entire lobe and do a biopsy of the entire mass.

Hence, I headed for surgery mid-November. I’m super thankful to my mom who came over to help me out pre- and post-operation. And my brother who has always been great support. I was lucky that I got myself a good private health insurance earlier this year. I am also very happy that I have good doctors and an amazing surgeon.

Christmas came early for me this year, as two weeks after my surgery, my surgeon gives me the great news that my nodule was benign! It’s the best news for me all year. Thank God.

Let me savor this moment to realise how truly blessed I am.

 

Post script:
Being the inquisitive geek that I am, I have been reading and I continue to read about my entire thyroid nodule saga. So beyond what my doctors were telling me up front, I was also researching and reading relevant references in my own time, because I wanted to know what it was all about. My surgeon just confirmed with me the findings of the biopsy, and I am also reading more about it. I might do another post later on with the more medical side-story.

Come Alive

“Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.”
― Howard Thurman

I go through phases. Been through a stoic state for quite some time. Days go through like clockwork of things that need to get done and need to happen. My “adventures” were adventures of other people that I only ride along with, or serendipitous incidents, or things that I have forced myself to participate in and enjoy. A steady boring cruising through life for the past few months. But how I long to come out of it soon. I’m slowly feeling like someway somehow I’m on the way to coming alive again.

Humming music, singing songs in my head through lull moments – it may seem a simple thing, but it’s somehow a significant change for me. Music is a piece of my soul, and a piece of my soul is starting to speak to me again.

I crave for more colors, more glitter, more bling to cover myself with. I crave to garb myself in nice clothes. I want to look beautiful, to feel beautiful. It matters to me again.

I miss that feeling, that passionate aliveness. I’m not there yet, but I’m longing to be closer to it again.

“I did not know I was on a search for passionate aliveness. I only knew I was lonely and lost and that something was drawing me deeper beneath the surface of my life in search of meaning. There is a hunger in people to go to those deep depths; to know that our lives are sacred; that our hearts are truly capable of love. It is a yearning to be all the we can be. A longing for what is real.”
― Anne Hillman, The Dancing Animal Woman

Bridget Jones and my raging hormones

bjdThe trailer for ‘Bridget Jones’ Baby’, the newest Bridget Jones movie was very much appealing to me and I’m meaning to watch it soon, but I honestly haven’t seen any of the previous movies yet. That was until two nights ago, when I chanced upon their first movie, ‘Bridget Jones’s Diary’ showing on TV. Watching it for the first time, I found it to be much of a delight.

I don’t know really. Is it because she’s single and on a challenging search for that elusive love, and it is something I can pretty much relate to? In the movie though, in the craziest way, in a wonderful chance, she found a wonderful gorgeous man who was willing to take a chance on her. Mr. Darcy.

Wait, he sounds familiar. Oh yes, Pride and Prejudice. A little googling told me that Bridget Jones book and movie are actually loosely based on Pride and Prejudice, especially on the BBC series starring Colin Firth. Oh yes, Mr. Darcy. I was also in love with the Mr. Darcy from the 2005 movie version of P&P.

Okay, back to Bridget. And her Mr. Darcy.

Oh, I don’t really know if it was such a good idea to watch the movie while I am hormonal, highly emotional, and all that shiz. Somehow it has uncovered and unearthed all that subconscious longing and that unfulfilled desire for the love of my life, who somehow hasn’t shown himself yet after all these years.

I’ve enjoyed watching Colin Firth, Mr. Darcy. Where do I find myself a real life man like that? So I was pining for my own Mr. Darcy during and after the movie. Then went to bed (alone).

Lo and behold, my dreams may have revealed to me my hidden desires. Wonderful vivid dream about a guy I was in love with from long ago. It was the sweetest dream I’ve ever had for the longest time. I wish it never ended.

Honestly, I don’t really think I want him back, whoever that specific person was in my dream. But how I long for that feeling again. Why has it always been so elusive?

I had to watch the second movie too, ‘Bridget Jones – Edge of Reason’, since it won’t be long until the third movie is available in the cinemas for me to watch. I watched it tonight, and again just fell for Mr. Darcy even harder. Perhaps I did not relate with Bridget in the second movie as much as the first, since I didn’t agree with her reasons for questioning her relationship with Darcy. But Darcy has just been such a delight.

Within the next hour I shall go to sleep, but now I am already wondering what dreams will come this time around.

Good riddance

I was pining for a boy for the past few months…

I was pining. Longing, waiting, hoping that this certain someone will cast upon me his attention.

It was a boy. I no longer dare call him a man, since most recent realisations revealed that he is nothing but a boy.

It went on for a few long months. Call it madness. But mostly a waste of time.

But most of all, this statement is now in the past tense. The madness has ended. I have been set free. Good riddance.

Perhaps it’s a certain weakness of mine. Sometimes I waste my precious time not seeing the futility of certain things. I have awaken from this stupidity by some profound revelation – a truth that I spite from the deepest of my soul.

I know what I want. At the same time, I know what I don’t want – my non-negotiables. I have decided to tolerate most things that I can for the sake of someone I desire or love, unless non-negotiables present.

If there is something that makes your gut twist with disgust, something that makes you fear for your safety or for your life, or something that you know will bring out the worst in you, then you know those things are non-negotiable. No amount of love or care or desire can compensate for any of that.

Aside from the fact that I now know that he does not like me in a way that I wish he did, I have realised how immature he views love and relationships. Though not really a non-negotiable, that in itself ended it. Add to that a non-negotiable that goes against my sense of morality.

The best thing about all of this is I have been set free, and my attention shall no longer be captivated by an undeserving boy. I have regained my entire energy to spend on someone who so deserves it.

My personal data has been compromised – now what?

The Philippines’ Commission on Election (Comelec) hacking has created one massive data leak that affected almost, or perhaps all of the registered Filipino voters. A few days ago, there was a website that provided access to the available information by using one’s name as search term, and it shows all available information under that name. I just had to check which part of my personal information have been leaked, so that I know my personal risk factors connected to the leak. Indeed, my name was there, including some Personally identifiable information (PII).

Personally identifiable information (PII) is any data that could potentially identify a specific individual. Any information that can be used to distinguish one person from another and can be used for de-anonymizing anonymous data can be considered PII.(http://searchfinancialsecurity.techtarget.com/definition/personally-identifiable-information)

I won’t enumerate what my leaked data contained to retain a sense of security. But let’s just say if someone was determined to do something about it, there may be bits of information that can be useful to them, if I am not careful of my transactions both online and offline. And my information is already out there somewhere in the internet and most probably in the dark web, it will probably be there forever.

Blame it on the government’s incompetence in digital security. However, no amount of blaming can reverse what has already been released to the world. Somehow I’m also a bit thankful of the government’s general incompetence in data management because there were some typos in my data that might make a difference. And I’m thankful that there is essentially no data consolidation across the different government agencies, so the leak in PII from one government entity did not connect to all other available personal information in other government agencies.

So now that my (any everyone else’s) personal data has been compromised, what can we do to protect ourselves from any harm that it can cause?

  1. Secure all your accounts. This is very important for all financial accounts, digital and online accounts, as well as any other accounts that may be accessed using your PII.
    • A lot financial institutions verify transactions using PIIs (e.g. mother’s maiden name, home address, etc.), but there are additional security features which may be available from some institutions such as mobile notifications or email notifications. This will alert your if there are any dubious transactions under your accounts.
    • Ensure that your passwords online are very secure, including your password recover options. Change all your passwords if you think your password may also have been compromised. For password recovery options, avoid using PII. Use strong passwords as much as possible. See tips here: https://support.google.com/accounts/answer/32040?hl=en. If possible, also utilise extra layers of security available such as the 2-step verification.
  2. Monitor your transactions. Online banking is a pretty good way to monitor all activities in your account to ensure that nothing goes wrong, or if something goes wrong, you’ll be able to do something about it immediately. This also goes for your other accounts.
  3. Avoid phishing attempts.
    • Phone call phishing. In the past, I’ve already experienced receiving a call from someone who was posing to be from my bank and attempting to “verify” my personal information. I’m quite wary about those since I was not expecting that call, and there were other means to verify and update my information, so I did not give any information. I can imagine that possibly happening with the available information, with phishing attempts to get more information that may be used in identity theft.
    • Email phishing. Be careful when you open emails, especially those that you are not expecting, or those from senders that you are not familiar with. Make sure you don’t click on unnecessary links that may send your computer viruses, or hack your accounts, or steal your information.
  4. Keep a low profile. Remember that there the leaked information is comprised of millions of individuals, and you are only one of them. Since the information is mostly searchable by name, it may be the more popular and known one’s to be first targeted by criminals or what-nots. Remember BIR? It was the people who show up on the news (no matter how un-connected to taxes) who get their income tax closely reviewed and scrutinized. I would think it may be the same for this massive data leak. If you’re relatively unknown and do not seem to have a lot to offer, hopefully you’ll just go unnoticed.
  5. Use an alias online. Or at the very least, do not display your full legal name (with your middle and last names) on your social media and other online accounts. It may give you one thin layer of protection since the leaked information has your full name.

What else? I really don’t know, I’m not a data security expert. These are just some ways I can think about on how to protect myself, and how you can protect yourself in the midst of this massive mess that is the Comelec data breach.

What If…

Lately I’ve been wondering, what if I was never meant to find the love of my life in this lifetime? What if he does not exist, and I continue to drag my feet all my days still waiting for him to magically appear out of nowhere? 

What if my soulmate has passed on, murdered or died heroically, or died too young because of a disease, before I even got the chance to meet him? Perhaps we’ll see each other again in the next lifetime, but I am left to toil for the rest of this life alone and lonely. Is it time to start buying cats? But I hate cats. I should just get myself dogs, rabbits, and capybaras…

But seriously, it is a possibility. Same way that finding the love of my life is simply a possibility and is not certain. That’s why I enjoy imagining how my my funeral will be more than imagining how I want my wedding to be. At least I’m sure my death is certain, but love? I don’t really know. 

I should start working on my Plan B, since Plan A doesn’t seem to work at all. What can I do with this beautiful life if I end up living it all alone? I want to be completely rational and at peace with my Plan B. I don’t want to feel horrible and alone and defeated even if I never find the love of my life in this lifetime. 

Finding Abii – Half-a-year in Straya

Today marks the completion of the first six months of my new life here in Australia, and indeed it’s something worth celebrating.

Let me explain the title for this post. Finding Abii… perhaps it refers to both discovering and rediscovering myself here in my new world. A fresh new start have given me a great opportunity to rediscover things about myself, my love for music, dance, and the learning endeavours I’ve put on hold or semi-abandoned in the past. Finding the time and opportunity here, there is a chance to find more of myself again.

Music, Dance, and the Arts
On my first month, I bought new guitar and have been fiddling with it during free time. My my dad also brought over my violin when he came over in December. That’s one more thing that I want to spend more time on, practicing how to make beautiful music on stringed instruments. I’ll be going for dance classes soon too. People who know me most know how much I love dancing. I want to spend more time on it in the coming months.

The city also abounds with so many different opportunities to enjoy and appreciate different kinds of arts. I enjoyed watching the Symphony at the Domain a few weeks back, just having a picnic on the grass and watching an orchestra under the stars. I would’ve enjoyed watching the Opera at the Domain the week after, but I’m sure I’ll have other chances for that soon. I might find time to visit the art galleries in the city too.

Health and Wellness
I am also lucky to have also rediscovered a healthier me here in Sydney. I no longer need my asthma or allergy medicines to survive the world. Just a little bit, and I’ll be off all maintenance medicine soonest. I’m also starting to rediscover a more fit Abii. With a gym downstairs from our apartment, there is no reason not to go or not to make time to go. Eating relatively healthier has been helping too. I’m starting to find a skinnier version of myself which was kept somewhere deep inside. So far, I’m down almost six kilograms since I arrived. I know I still have a long way to go to get to my target, but it’s a good and promising start.

Work and Learning
I was lucky to have found contract work with the Federal Government of Australia on my first two months in Sydney, and even luckier to have received a 3-month extension on top of my original 4-month contract. I must be doing something right, they must be satisfied with how I work to consider me for such. I still continue to search for a permanent job though, but what I’ve had so far is a good start.

I’ve also started on some studying and learning towards something I should have done a long time ago. It’s mostly self-study for now, maybe take some formal classes in the near future, and eventually take a certification exam. It’s a personal commitment I have to make good on.

Finding the lost self
Unfortunately, not everything about this new life is about finding or rediscovering things. I’ve also lost a little part of me somehow when I moved, and it’s something intangible and difficult to explain or put into words. As such, I am truly in the process of “finding Abii”, looking for a part of my sense of self, confidence, and independence that gave me the power to overcome all kinds of adversity in the past. It took some time for me to realise what was lost or missing in my self, but as they say, knowing is already half the battle. Now I can actively remind myself of “myself”, I should be back to my old self shortly.

Torpe is an excuse

Very lightly translated, “torpe” is a Filipino word that usually refers to a guy who is too shy to make the move to pursue a girl that he likes. Interestingly, the translation of the same word from Spanish means clumsy, slow or awkward (which perfectly describes the Filipino translation, actually).

I have lately realised that calling a guy torpe is just an excuse, especially for those beyond or way beyond their teenage years. If you think a guy is torpe, it probably means one of three things:

He’s undecided. Maybe he’s attracted to you, but he’s completely undecided about it. He may be exerting a little effort trying to test the waters. Maybe you’re one of his options. He may be flirting for days, weeks, months, years… or it can go on forever (seriously, I’m not kidding), but it does not give you the assurance that he will eventually pursue.

He has ego issues. He’s afraid of making a fool out of himself. He probably loves himself more than anything else. He does not want to put himself in a position where he can be rejected.

He’s just not that into you. He probably just likes you, but he doesn’t like you “like” you. Maybe he’s just one of the guys who’s sweet and nice to everyone. Or he’s one big flirt. There is a chance that this is just the “friendzone”. Remember: flirting = attention without the intention.

Bottom line, if a guy likes you enough, he’ll take the chance. A bunch of flowers, a box of chocolates, an invitation to go out for coffee or dinner, or even the simple effort of keeping in touch. Trust me, it’s worth sticking out for men who make an effort to let you know that you matter.

Ma-basted man, at least they tried, diba?

2015 – The Year That Was

With just a day left for the year 2015, I could truly say that this year has been one of the most memorable year of my life, and no year as significant since 2007. Here are five highlights of my life in 2015:

1. It has been such a blessed year, and far too blessed because I was able to see the Pope with my own two eyes not just once or twice, but (more than) three times! During his visit in Manila this January, I was fortunate to be residing pretty near where he stayed, and most of his routes were a short walk from where I lived. Of course I seized every opportunity to catch a glimpse of him. I believe that the graces overflowed and I received it somehow. It was a great start to the year.

2. The start of the year also led to one of the biggest blessings of my life so far. It was on the last few days of January that I received a “reminder” on email, and I completed and lodged my Expression of Interest (EOI) to be a Skilled Immigrant to Australia. Just less than a week after I lodged the EOI, I got my invitation to apply for a visa. Three months after, in May, I got my visa grant as a Permanent Resident for Australia. In August, I moved here to Sydney and began a new chapter in my life.

3. I am truly happy to have spent more than half of this year working for USAID. It was an amazing opportunity, and I am thankful that I was able to work with them for an entire year (starting mid-2014). It was a great learning experience and have met a lot of interesting people, and hopefully was able to contribute something significant to the team. I would have loved to stay with the team and the organisation, but my new life in Australia was calling.

4. The year also had its challenges and sorrows, especially when my beloved grandmother got very sick and was hospitalized for a few months, and passed away later this year. I miss her terribly, and I still feel bad that I was not able to go to her funeral because she died two weeks after I left the country. But I am still thankful that I was able to spend a lot of time with her while she was still alive, and was able to tell her and show her that I loved her very much. I know that she knows that I will always be Lola’s girl, and she will always be one of my biggest inspiration. I continually seek comfort in the thought that she is now with Jesus Christ resurrected, the one thing that we’ve always believed in.

5. I have found a beautiful new chapter of my life here in Australia. I have been granted small and big blessings: I arrived with a vacant bed waiting for me; I’ve met new friends (mostly through my brother) and rediscovered old friends; I’ve been very warmly welcomed by (extended) family; I found a job 1.5 months after I arrived, and it was somehow related to the type of job I was aiming for; and I’ve had tons of opportunities to explore many different things and adventures that this new land has in store. After just five months, I am happy to be almost completely settled in. My family (mom, dad, and sister) all came over to spend Christmas and New Year.

With so much blessings in 2015, how can I ask for more?

And as always, no New Year’s resolution for me this time. Long ago, my New Year’s resolution was to never make any New Year’s resolution in the future, and that is probably the only one I was able to keep.

The year 2015 is already written and today concludes this year, but tomorrow begins a new 2016. And in 2016, I continue to pray, to hope, to dream, and to wish. Isa na lang ang kulang. Ikaw na lang ang kulang.