Zonked!

Years ago, Monty Hall stood on a stage in front of an oh-so-live studio audience and offered hopeful contestants the opportunity to win big.  Clad in bear suits and spacealien'd tinfoil, and tutus with fairy wings, the chosen "traders" would throw chance and bravado into the air and see what stuck.  If the players were really lucky, they'd get the try their hand at selecting the correct entryway to the best prizes. "Monty," they'd say, surveying the trio of closed curtains, "show me what's behind door number three!"

The door would whoosh open and, if luck or the producers' need for better ratings were on their side, the room behind would hold a new car or an exotic trip or piles of cash.  If not, well, our trader had just been Zonked.  Congratulations, enjoy your llama!

These days, I think there's livestock in my future.

My most recent visit to the Endocrinologist yielded some frustrating results.  After playing around for some time with my Tirosint dosage, we thought we'd have one that would balance the level at a good smidge-too-high.  What we failed to consider, however, is my extreme love of chocolate. And cupcakes. And bagels. I'll explain.  Sigh.

So, I've been hitting the carbs a bit heavy.  I won't sugarcoat this...er, actually, I guess I will.  Or, I did.

Mmmmmm, sugar...

Which is how I managed to pack on an extra 5 - 8 lbs (depending on whose scale you believe and which shoes I've donned) since October.  It's winter. I'm hiding under bulky sweaters during perfectly cozy snuggle weather, and it's too cold to jog, and it's baking season, and I'm a known stress nibbler.  Matt will tell you all about my ability to "Tiffany-bite" -- That means deliciously ittybitty slivers, if you haven't experienced the phenomenon -- my way through pans of brownies, batches of cookies, pints of ice cream...  Much like a grizzly, I pad myself with an extra layer to help me hibernate the winter away.

Aside from being a poor lifestyle choice (aaah, chocolate, my friend, my vice!), apparently, this can greatly mess with one's need for thyroid horomones.  Even a weight change that doesn't require bigger pants does result in a shift to one's TSH.  Sigh.  Soooo, my TSH went from being a not-too-awful, almost-surpressed .59 to a ridiculously high 1.84. Yowza!

Hey, you over there with the normal functioning thyroid?!  Yes, YOU. You're probably rocking a 1.84.  Me?  Thyroid cancer warrior that I'm supposed to be?  NOT allowed to ride the triple digit TSHs.  Eeek! 

To counteract the rise, the Endo upped my Tirosint dose again, hoping to bring it down to closer to the .4 he'd ideally like to see it at. 

So there's that.

My Thyroglobulin paraded in at .7.  Ideally, this should be at a big, fat 0.  Since Thyroglobulin is an indicator of body-made Thyroid hormone, the presence of any in a thyroid cancer patient indicates that somewhere thyroid cells (i.e. the cancer) are active.  If you've been following along, you may recall that my last Thyroglobulin number was a .6.  On the plus side, this change is not significant enough to indicate anything.  On the less joyous side, it is still not zero.

Add all of that together with the troubling ultrasound results (hey there, lingering thyroid tissue!) and you have one cautious and slightly aggressive Endocrinologist.  He's signed me up for a neck biopsy in a couple of weeks to get a closer look at the 8x6x3 mm nuisance hanging around.  And, now that the Thyrogen shots have officially been approved, the week that follows the biospsy has me swallowing the I-123 and sliding into the Whole Body Scan.  And then?

Well, we finally talked about the "and then."

My Endocrinlogist delved into the dangers of not addressing the tissue and/or "or what" that still takes up residence in my neck.  He feels that we'll soon be making a decision to do one of three things...

Hit it, Monty...

Door #1:  Surgery again.  We could go back in attempt to rid my body of the slice of thyroid the surgeon left behind.

Door # 2: Radiation again. Another blast of the ol' I-131 to zap any cancerous cells looking to start a fight up in there.

Door #3:  Nothing.  Watch and wait.  Continue to monitor closely that 8x6x3 foe to see if it makes a move.  This is, by far, his least favorite option, as it allows our adversary a chance to attempt a sneak attack.  The benefits, however, include no more risky surgery, no more chancing IV antibiotics I may be allergic to, no more heavy exposure to radiation that can cause other cancers.


We'll wait to get through the biopsy and Whole Body Scan before we start laying out a plan of attack, however.  Until then, I glance from door to door to door, praying not to get Zonked.

Meanwhile, a recent trip to the GYN has me heading to the Women's Imaging tomorrow for a mammogram and an ultrasound.  You know what's the easiest way to take your mind off of thyroid cancer? Find a suspicious lump in your breast. Wheeeeee!

Oh, look, a cookie!

I'm starting to think I should take more vitamins. 


In other, much happier news, Matt and I are frantically finalizing plans for our wedding celebration party.  Yay!  While eloping in a giant elephant on New Year's Day was so ridiculously fun and amazing and perfect, we're excited to be able to share all of the love and warm fuzzies with our friends and family. C'mon, April!

And then, the honeymoon!    :::biggestgrinever:::

Hitched! Inside Lucy the Elephant in Margate, NJ

The next few weeks will be filled with pokes and prods and intrusive and obnoxious tests and scans.  But, I've come dressed to this gameshow in my best ninja garb, determined to dodge as many sneaky opponents as possible.   I'm not choosing a door yet, but I know a definite pull of a curtain will eventually be required.  Fingers crossed, I'll aim for the grand prize and if, in the end, I take home a camel instead...well, you're all welcome to hop on a hump and come for a ride.

.

A snapshot of the inside.

I lay on the exam table, eyes following the wormhole paths in the pocked white ceiling tiles, trying hard not to swallow against the lump forming in the back of my throat.  The ultrasound tech waves the probe over the contours of my neck, pausing to capture still frames on her screen.  The gentle "click-click-click-click" as she traps her quarry with mouse and wand is all I can hear, save Matthew's soft breathing and the heavy beating of my own heart.  Hospitals smell like hospitals.  I have never liked the scent.

I am here for a head/neck ultrasound, an event which stresses me out more than I have cared to admit.  All of the hard work of Endocrinologists and Phlebotomists and Radiologists and Pharmacists and BillingDepartmentists have brought me to this day and this table.  It's the great Follow Up, a time to see exactly what's been happening in my neck since the radiation treatment. The hope is that her magic wand reveals exactly nothing.  No tissue, no growth, no crazy, involved lymph nodes.

She finishes up the right side - where I've already warned her she'll find residual tissue - and hops over to the left "just to be sure."  I stare at the abandoned worm colony in the plaster above, getting used to the slick smear of warm gel on my skin. On days like this, I am still not used to me.

She finishes, one final frozen view of my innerworkings on the screen.  I sit up and rub the rough towel over my gooey neck.  She tells me, even though she technically shouldn't - an untechnical tech, thank god-  no suspicious lymph nodes, nothing causing huge amounts of concern...except "there's something there" - the right side - and she "can't be sure whether if it's a lymph node or tissue or what...could just be a lymph node." Brightly. Calmly.  But, the right side is where the radioactive whole body scan told us before that the surgeon left a little behind, forgot the last scalpel scrape, and gifted me with an unwanted hive fit for hornets to take hold. "Could just be a lymph node."  But, in this small, sterile room, with these heavy ceiling tiles being held up by hopes and prayers and hospital-grade putty, we know, of course, of course, it's not a lymph node.  I ease into breathing, because this gets easier with time and, despite that it's only been nine months since the thyroid alarm was sounded, I know that, most likely, it's probably tissue, the last of my forgotten friend, and not, not, not the "or what" this lady in the scrubs cheerfully references.

I have had enough of "or what."

Three full business days later (I count them Friday-Saturday-Sunday-Monday-Tuesday on nervous fingers) the results to my ultrasound pop up in my online Penn Medicine electronic basket.  It's as the tech says: fantastic lymph nodes.  No idea what that other stuff is.  It hovers, 8 x 3 x 6  millimeters, in the bottom right of my neck, its existence just troublesome enough to add another layer of complication to a new life I felt I was finally settling into.

The Endocrinologist calls me later that night as I pull into my driveway.  I put the car in park and he explains to me what I'm pretty sure I don't want to hear:  time to bring out the big diagnostic guns.  Another Whole Body Scan is in order.  I'll spend two weeks once again on the Low Iodine Diet, receive two more Thyrogen shots to propel my TSH upward, and swallow another capsule of I-123, a low dose radioactive iodine.  Then, I'll return to the belly of the great white beast for some explicit closeups of the whateverness hovering in my throat.  And then...well, we don't get that far in the conversation.  He says his secretary will call me the next day to get the ball rolling.

I wait for his office to call, anxious to hear the timetable for this next round of upheaval, but, when no call comes by day two, I phone them.  She's still wrestling with insurance for the order for Thyrogen, she says, and will call me once the approval goes through.  I brace myself for the $500-$2000 bill that will soon follow.

I try to shake off the frustration and fear that comes with all of this.  I am working through the multiple dose changes of Tirosint, the artificial thyroid hormone that needs to be kept at precisely a high-enough level to suppress my TSH (and thus, provide personal chemo for the cancer) and a not-too-high-enough level that will negatively affect my heart, head, and various other vital systems.  This wibblywobbly balancing hits me with hosts of bothersome effects, including heart palpitations, hot flashes, wavering  jittery-ness, and bizarre episodes where I can not not not find the word I was trying to speak and I stand there, fish-mouthed, until I can pluck it from wherever my hormonal brain has hidden it.  I take a pill each day and wait four hours to eat, knowing I need to absorb as much as possible even as I worry that "as much as possible" is technically more than my body is happy with.

The anxiety about achieving that balance is enough to permeate my daily happenings with constant thoughts of my health.  I hate thinking about my health.  This is what we have doctors for, I think.  To think about our health for us.  I hate feeling so helpless in all of this.

But, this is not every day.  Many days I feel strong. Grateful. Accomplished.  Kickass, even.  Some days I know that I am fighting this better than I would have believed possible.  Most days I can not believe it has only been nine months.  I gulp that amber-hued capsule at 4:18 am each day, gratefully aware that each one takes me closer to officially cancer-free, that each one is serving to fight my battle for and with me.  I chase it with a full bottle of fresh, clear water, filling each steady swallow with a reminder that I will not always have to endure these jacked up Tirosint levels, that, one fabulous, future day, the doctor will look at me and my prescription and my by-then-improved test results, and say, "It's time to let you feel closer to you again."  I'm so excited for that day.