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.

Sickie

One of the things I dislike most about being an adult is getting sick. Let me count the ways…

(1) I don’t like when I’m sick enough that I need to miss work, because this means I have to use up leaves (if I do have any) or go without pay for the days I miss work when I’m not entitled to paid leaves. It also means I need to catch up with work when I get back after a sickie.

(2) As an adult, I am expected to take care of myself when I am sick. That means taking care of all my basic needs even if I am not feeling well. This includes preparing food for myself, keeping the place clean and organised, and even laundry still need to happen. It’s challenging to manage one’s energy to be able to do all necessary domestic things when you’re not feeling well.

(3) Going to the doctor or the hospital is now typically a solo activity. No one is expected to take you to the hospital. You’re lucky if you have a good friend or a family member who is available and willing to go with you. Otherwise, you drag yourself out of your house, drive yourself (if you have a car) or take the public transport to the medical centre or hospital, and do the same going back.

(4) In addition, going alone to the doctor or the hospital means that you don’t have any emotional or moral support for anything that you may find out about your health. Maybe the closest alternative is having your family or close friends reachable by message or call on your mobile, but of course it isn’t the same.

(5) Missing activities and events when you’re sick is not fun. Sometimes even if you’re able to go, you can’t enjoy it as much and you usually have to leave early because you are not feeling well. Total buzz killer.

(6) Medicine and other related stuff are expensive! Even with health insurance, some consults and treatments also cost a lot. And as a responsible adult, you are now in charge of paying for all my own expenses. Goodbye shopping money.

(7) It’s always hard to decide if I’m too sick to go to work or to go somewhere or if I am well enough to do so. But I don’t have another adult to decide that for me, I am my own adult and I have to wrestle with myself to figure it out.

But most of all, getting sick never really feels good. No matter what illness – whether the usual colds or flu, body pains, injuries, short illnesses or persistent ones, minor conditions or acute or serious conditions – it’s always bound to make you feel bad.

And if you were wondering why I write about this, I am sick right now. Nothing serious but a whole lot annoying, and I’ve been semi-stuck at home for the past week. I’m doing my very best to be well enough to get to work tomorrow. I must.

Health, above all else…

“Bawal magkasakit” is a Filipino phrase that’s pretty interesting and full of impact and sense. Roughly translated, it means “you’re not allowed to get sick”. It means so much, because there are so much bad things that one has to deal with getting sick – the actual feeling of being sick, the possible complications, side effects, and related symptoms; the hassle of not being able to work at one’s best, or not being able to work at all for some time; the costs required to get well, such as doctors’ fees, hospital fees, laboratory test fees, and the cost of medicine; the hassle of needing to go to the hospital, or not being able to go to or attend one’s typical activities. It’s hard.

I learned this the hard way about 4 years ago. I am known to be asthmatic but mostly only very mildly symptomatic before. In 2010, due to the ongoing construction on the museum I was working for, my asthma was triggered very badly. I dealt with it the usual way I knew, through oral medicine, inhalers, and nebulizer. However, although I was not feeling very well, I went on a day trip for work to Hongkong by my own. I drove myself to the airport, boarded a flight to HK, did my official business in HK, went back to the airport, flew back to Manila, then drove myself back home. That’s about 24 hours worth of travel time and active work, all the while I was terribly coughing already. When I got back home, I used my nebulizer, but my coughing could not be relieved anymore. The next day, I asked to be driven to the emergency room, and I was immediately attended to and admitted for treatment. I spent four days in the hospital, on IV, steroids, and regular nebulization. It was that bad. That was the first and only time I’ve been hospitalized thus far. Unfortunately, that was the moment I realized how much risk I’ve placed myself by not paying enough attention to my body.

Fast forward to current day. Unfortunately, I’ve been battling something similar in scale lately. I’m not quite sure what initially triggered it, but I know it started with a very mild sore throat, the kind that I know will eventually progress to a cough and/or cold. I paid attention to it immediately, gave myself enough rest, consulted with a doctor, and followed his prescriptions. However, my symptoms persisted for weeks, so I decided to see a doctor again. The second consult revealed that my persistent and increasing symptoms were due to a bacterial infection that was a little bit antibiotics-selective, I had to go through another round of antibiotics. The doctor actually almost ordered me for admission because of how bad my symptoms were, but did give me the option of just staying at home to completely rest while on medication for an entire week for my body to recover. Of course, I complied, although quite hesitantly because of all the pending tasks at the office. But this time around, I just had to prioritize my health first.

It’s been a week since I finished my second round of antibiotics. I do feel better, but not yet back to tip-top shape. Some symptoms still have not gone away after the many weeks that I’ve been battling this. It’s starting to get frustrating. I may need to get the advise of my doctor again.

I learned four years ago never to take my health for granted. When one’s health is at risk, it’s best to prioritize it above all others. I’m not taking any chances anymore.

Zen

My guess is that it started with the rabbits. They evoke something so amazingly calm about them, the way they almost never make a sound, and the very gentle way they move. There is almost nothing stressful with watching a bunny go about its way, hopping around, munching on greens, cleaning themselves, or just snuggling. It’s been a month and I have been watching my rabbits every evening. They are a stress reliever, and somehow a good way to quiet the soul.

Another factor would be doing yoga regularly. I can’t say that its already a habit, but doing it once a week for one month without falter is an achievement for me already. So many reasons why I’ve decided to invest my time and effort into yoga. It does a lot of good things for me. First, it’s teaching me more discipline just to make sure I attend a session on the same day every week. Second, it’s helping me improve flexibility, balance, and core strength. Third, it is a good way to relax the mind, a way to ease internal tensions.

I’m trying to learn and get used to meditation too. I’ve been cleaning my room of clutter. I’ve been doing more quiet alone time.

Well, people who personally know me can attest to how high-strung I usually am, and I have been like that forever. A more relaxed, more zen way of living is very new to me. Not that I am completely shifting from my high-energy life to a zen life. I still love my crazy life. But finding out the quiet and relaxed state is amazing and possibly doing me a lot of good. It needed a space in my life for the longest time.

Doctors and Hospitals

I have never been really really sick my whole life, although I’m almost always a little bit sick with all kinds of things. Am not sure if I’m hypochondriac or just very sensitive, but seems like there’s always a little bit of something wrong here and there.

I won’t do an enumeration of my medical problems right now. I just found hospitals an interesting topic to write about because I am in one now, waiting for my turn at the doctor’s clinic. There’s maybe more than an hour’s wait left, but I guess that’s typical.

I was never afraid of doctors, probably because two of my close relatives are doctors, namely my Aunt (my mom’s sister) an her husband. I was always around them growing up. My pediatrician was nice too. When I was in college, I started going to doctor’s appointments by my own when I feel something wrong. I’d go to my diagnostic procedures alone. I didn’t mind. There was also one time last year that I went to the Emergency Room alone (although I was driven there by the driver) and was admitted as soon as they saw me come in the door of the ER. It was such a bore though, to be confined in the hospital for 4 days.

Do you think it odd that I am always at ease in hospitals, or at doctors’ clinics even on my own. I am actually not sure. I do wonder how other people view hospitals and doctors.

Out of the cave, into the light

I may have mentioned it so many times before – I was eaten alive by my work last year, and only recently did it spit me out. Oh yes, I almost had no personal time for months just to make sure that the museum actually happens. But now, after giving birth to a 12,000 square meter baby, I finally have time for myself again.

I am out into the light again. But what do i do now?

First answer: travel, travel, travel. This summer is probably the first in many years that I am able to soak up some sun and feel sand and sea at my feet a number of times for the entire season. I’m loving the tan I’m slowly developing. Aside from that, I’m also planning to explore more of the world later this year. There’s one scheduled trip with the entire family, and another trip that I intend to take just by myself.

Second on my list: back to learning. I have accumulated a number of books and modules that I am slowly returning to. I’m back to self-studying on different topics that interest me. I’ve started with it slowly and taking it in bit by bit. I want to get into the habit of feeding my mind something valuable every single day.

Third: getting physical. I must admit that it is partly my fault why I have had a falling out with my exercise habit. But I am having some physical difficulties too, which hinders me from exerting much effort with sports or exercise. I am now trying to solve that and also slowly trying to get mor physically active. I want to live healthy.

Also, I now have time to plan the next big things that I want in my life. One should never settle with what one has in the present, and should always aim for something bigger and better in the future.