Thyroid Cancer Update 12/12/2008

I’m almost through my first full week of the low-iodine diet.  All things considered, it’s not that bad, but it’s certainly not fun.  I pretty much can’t eat in restaurants.  I can’t have anything with salt, because it might be iodized salt.  I can’t have anything with seafood or sea-based products (such as sea salt, seaweed, or seaweed extracts).  I can’t have dairy products. I can’t have soy products, such as soy sauce.  No egg yolks or anything containing them.  No bread products that contain iodized salt or iodine based dough conditioners (whatever those are).  There are lots more restrictions. 

Pretty much, my diet this week has consisted of: unsalted walnuts, unsalted sunflower seeds, oranges, apples, bananas, celery, home-cooked chicken, home-cooked pot roast, veggies, a special bread from a bakery that doesn’t use iodized salt, homemade popcorn with unsalted margarine and non-iodized salt, rice, and pasta.

Unfortunately, since I’m off the thyroid medication, too, I don’t think I’ve actually lost any weight on this diet.  Being off the thyroid medication is the worst part of this by far.  I get horrendous muscle cramps for virtually no reason. For example, one day this week at work I moved my arm slightly (not rapidly, not holding anything, etc.) and suddenly the muscles under my arm and on my rib cage under my armpit absolutely throbbed in pain.  I don’t think I’ve had that much pain in years, and it took the better part of an hour to go away.

Another added “benefit” to being off the synthetic hormone is that I’m really sensitive to cold temperatures, which is just great in December in Ohio.  What makes it more fun is that I’m in a recently-renovated area of our office complex at work.  This new area has a heating system that the engineers are still working the bugs out of.  This afternoon, a co-worker measured the temperature and humidity in our area, which was 70 degrees with 24% humidity.  He said the calculations say that feels like 64-65 degrees.  Everyone in the area, none of whom are hypothyroid, is complaining about the cold.  My hands and toes have been so cold the last couple of weeks that at times I can’t even feel them.

When I got in the car, I was so cold I started shivering.  That shivering activity set the muscles in my chest off with yet-another cramping spasm.  The pain continued at a decreasing level until we got home.

While making dinner, one of our cats was lying on the floor nearby, hoping for a handout. I stepped on his tail and he let out a screech. I reacted instantly to lift my foot and get off him.  That caused my leg muscles to spasm, which made me double over in pain.  Doubling over caused my shoulder, the muscles under my arm, and muscles under my armpit to all cramp in extreme pain.  By the time the pain subsided, my dinner had pretty much gone cold.

As if the muscle cramps weren’t enough, I get short of breath often, my leg muscles feel really weak, I’ve had memory lapses, headaches, dry skin, and have to be careful not to be “short” (mean/rude/impolite) to others.

The diet will continue until 12/22, when I’ll revert to a normal diet again and start taking the replacement thyroid hormone again.  I’m looking forward to that.

On Tuesday and Wednesday next week, I’ll be taking small doses of radioactive iodine.  Thursday I’ll undergo a radiation scan to see where the iodine went.  Friday (12/19), I’ll take the “full-size” dose of radioactive iodine.  That will begin a six-day period of keeping at least 6 feet from other people and pets.  Fortunately, that period will end on 12/25, so I’ll be able to spend time with the family then, be back to a normal diet, and taking replacement thyroid hormone once again. I ought to feel a lot better then than I do right now.

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Thyroid Cancer Update 12/04/2008

I was told to stop taking my thyroid hormone the day before Thanksgiving.  It began to take a toll on me pretty early on, and it’s only gotten worse.  According to endocrineweb.com, low thyroid hormone (also called hypothyroidism) carries with it a lovely list of symptoms:

  • Fatigue
    Boy, have I noticed this one. Yesterday I walked a distance I used to walk every day without breathing hard, and wasn’t sure I would make it to the end between feeling worn out and in pain.
  • Weakness
    I’ve experienced this one as well.  I don’t have the strength or endurance I had just a few weeks ago.
  • Weight gain or increased difficulty losing weight
    This started even before the surgeon removed my thyroid, and I’ve been keeping a close eye on it. I don’t think I’ve gained anything in the last couple of weeks, and may have even lost a pound or two.
  • Coarse, dry hair
    So far, I haven’t noticed this problem.
  • Dry, rough pale skin
    The skin on my hands definitely mirrors this.  It’s much drier than it’s ever been, even to the point of almost cracking in places.
  • Hair loss
    Fortunately, I haven’t see any of this yet.
  • Cold intolerance (can’t tolerate the cold like those around you)
    Got this one in spades.  Doesn’t help that my office is in a renovated part of the building where the techs haven’t got the heating working just right yet, and that it’s now December. There was a long part of today where I couldn’t feel my feet and my hands were almost numb with the cold.  I’m the guy who could go outside in short sleeves for 10-15 minutes in the dead of winter, and now I can barely stand my indoor, heated office.
  • Muscle cramps and frequent muscle aches
    This was the first thing I noticed, and it’s been getting worse.  Tuesday, I gently set my laptop bag on the floor in the den and really irritated the muscles and joint in my shoulder.  It caused intense pain for several minutes.  Other muscles and joints got in on the act later, to the point that I took two prescription pain killers and a muscle relaxer to try to counteract it.  It helped some.  Wednesday, my back decided to flare up and cause trouble.  Most every morning I’ve woken up with cramps in my hands that are so severe I can’t hold much of anything in them.  Even sitting here typing, my shoulders and arms are hurting.  I’m looking forward to the weekend when I can relax and move a minimal amount.  It’s not an exaggeration to say that stretching, twisting, or exerting any muscle scares me.  Most of the time, those actions cause pain comparable to a “charley horse” that lingers around for a while afterward.
  • Constipation
    So far, so good on this one.
  • Depression
    How anyone could have any of the above symptoms, combined with the knowledge that they have cancer, combined with the recent death of a parent, and not have some level of depression is beyond me.
  • Irritability
    I hadn’t noticed, but apparently I do have this.  I said something I thought was slightly humorous but supportive, but dropped the jaws of everyone in the room because it was apparently “out of character” and mean.  I accidentally said something rude to a co-worker, too, in response to a comment she made… and I didn’t mean to be rude then, either. So while I may not be FEELING irritable, I must be based on the way others are reacting to me.
  • Memory loss
    Yesterday, I would have said “no” to this one.  It started to be a problem today.  I’ve forgotten several things, sometimes very basic things like words I use often, and just couldn’t recall them.  I’m starting to understand what Denny Crane (William Shatner) on Boston Legal experiences with his Alzheimer’s.
  • Abnormal menstrual cycles
    If this starts being a problem for me, it’ll be time to call the Guinness Book of World Records and maybe The National Enquirer…

  • Decreased libido
    My wife probably wishes this was true.  I don’t think my libido has changed, but my desire to act on it has certainly diminished based on the cramps, aches, pains, and weakness I feel.

In addition to the above, I’ve noticed my voice having trouble today.  It sounds very weak and crackly to me. I can only imagine what it sounds like to others.  According to Wikipedia, that’s a symptom, too.  In fact, their list is a bit longer and indicates that I’m probably in the “late symptoms” category now. Oh, goody.

Monday I start the low-iodine diet.  This will probably take care of any potential weight gain because it eliminates nearly everything I can and do eat.  Fortunately, it does allow for an occasional beer and (homemade) popcorn.  On the serious side, it eliminates dairy products, seafood and sea-based foods, anything with iodized salt, anything with red dye #3, virtually all baked goods (due to iodine based dough conditioners in use), certain beans, more than 6 ounces of meat a day, and lots of other stuff.  What’s left is mostly raw fruits and vegetables, small amounts of home cooked meats without salt, popcorn, unsalted nuts, and homemade foods that you’re positive don’t include iodized salt or red dye #3.

Later in the week, I go in for blood work.

The week after that, I go in for a small dose of radioactive iodine. The next day, a scan. The next day, more tests (I think). That Friday, the “big dose” of radioactive iodine intended to kill any remaining thyroid cells or cancer cells.  For 6 days after that, I’m supposed to keep at least a 5-6 foot distance from others to avoid exposing them to radiation.  Thanks to the two surgeries and my mother’s illness earlier this year, I have no sick time left and barely any vacation days, so I’ll have to work at least one day while I’m in this “radioactive” state.  I’ll try to find a place away from my colleagues and as far as possible from others.  In a company of 1200 people that may not be easy.

On the 22nd, the worst of it should be over, as I’ll start taking the permanent thyroid hormone replacement and eating my normal diet again.  By Christmas, I’ll no longer be (dangerously) radioactive so I won’t be excluded from the festivities.

That’s all for this round. I’ll share more once the diet starts.

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Another Step in the Papillary Carcinoma Treatment

Today, I met with an endocrinologist who will be overseeing my treatment from this point on.  He explained that based on the type of cancer I had on my thyroid (papillary carcinoma) and the fact that it didn’t appear to have spread, the prognosis is extremely good. 

The next step will be for me to meet with the nuclear medicine specialist who will eventually administer radioactive iodine to me.  That appointment has not yet been scheduled, but is expected to take place in the next couple of weeks.  After that meeting, I’ll most likely be placed on an iodine-restricted diet, designed to make any thyroid or cancer cells remaining after surgery starved for iodine.  Then, when the radioactive iodine is administered, they’ll grab up all they can get and die out. 

As I understand it, for 5 days after taking the iodine, I’m to minimize my exposure to other people to prevent the radiation from affecting them.  If you’re curious as to what those restrictions might be, there are other web sites that can tell you.

Once we’ve done that treatment, I’ll start taking synthetic thyroid hormone.  The challenge will be to determine the correct dosage for me, as each person is a little different.  Once that’s settled, I’ll have annual checks to see if the cancer has returned.

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Surgery was Successful

Yesterday, I met with the surgeon who removed my thyroid to discuss the pathology report and next steps in treatment of my cancer.  He has referred me to an endocrinologist, who will administer the radioactive iodine and start me on replacement thyroid hormone.  I’ve been feeling really run down the last few days and in a moderate amount of pain, which is probably the fibromyalgia acting up.

The pathology report showed that the cancer didn’t appear to extend beyond my thyroid, which means that the radioactive iodine should get any remaining cancer or thyroid cells.

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Thyroid Cancer Update

The surgery is only a memory now, and will be a week ago tomorrow.  I just spent my first full day back at the office, and it was a fairly busy one.

The steri-strips over my incision are starting to come loose and are expected to fall off of their own accord in the next day or two.  The little bit of the incision that’s already visible doesn’t look too bad.

I’m not feeling too bad. I got a little tired late in the day at work, but walk and some decaf coffee perked me up enough to get through the rest of it.  There is a small amount of pain left in my throat, and the incision area itself occasionally burns a little, but I haven’t had to touch the prescription painkillers for days.

There are lots of doctor visits in my immediate future… follow-up about the surgery, planning for the radioactive iodine treatment, working out a dose of synthetic thyroid hormone, and whatever else might arise in the meantime.  Still, I’m happy to have the cancer out of my system and to continue on.

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Back Home

Tuesday morning, I underwent surgery to remove my thyroid and the cancer it contained.  It took over three hours for the surgeons to do their job.  Afterward, they told me that it appears the cancer didn’t spread beyond the thyroid, which is extremely good news.  If they missed any, the radioactive iodine I’ll be drinking in a few weeks should take care of that.

I spent Tuesday night in the hospital, where they monitored my calcium levels and other vital signs to ensure that the surgery went well.  Although the hospital staff was very attentive and treated me very well, it was still a fairly unpleasant night.  Every time I tried to fall asleep, my mouth and throat would dry out and wake me up.  I’m pretty sure I saw every hour pass from 3pm when they put me in the hospital room until about noon Wednesday when they released me.  When I got home yesterday, I took a couple of pain medication pills and a nap on the couch.

In terms of recuperation, I’ve been asked to sleep with my head raised up so that any swelling caused by the surgery will be carried down to my chest rather than remaining in my neck.  That makes sleeping comfortably a little difficult, but not impossible.

Today, I was allowed to shower as long as I didn’t get the surgery area on my neck too wet and didn’t attempt to scrub or dry it.  That probably did as much to help me feel better as the pain medication.

All things considered, I actually don’t feel too bad.  The surgery site looks like something from one of Dr. Frankenstein’s experiments.  It’s stitched up and covered with “steri strips” (tape-like stuff).  The steri strips are a bit bloody-looking, which contributes to the Frankenstein look.

My throat is still a bit raw and sore from having a tube stuck down it during the surgery.  That’s probably the majority of the pain I’m feeling right now.  The surgery site doesn’t hurt much, unless I put stress on it by moving my neck too much in any one direction.

All that prevents me from returning to work at this point is all the paperwork.  Unfortunately, it looks like I may have left that on my desk Monday.  Hopefully, my wife will be able to get that sorted out for me tomorrow.

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Papillary Carcinoma and Me

(This blog entry contains medical information which is based on what I’ve read and what I’ve understood from my doctor’s words.  It should not be construed as medical advice or in any way be used by anyone to make medical decisions  I am not a doctor.  I share this information both to help myself process what is happening to me and to give others who might receive the same diagnosis comfort from knowing they’re not alone in the world.  Please consult a licensed medical professional rather than rely on anything you read in this blog.)

A few months back, I noticed that it seemed like the medications I took in the morning were getting stuck in my throat.  I’d go most of the morning feeling like I had a capsule in there that just wouldn’t go down.  Then I noticed on mornings I forgot to take my medications that it still felt that way.  I thought I’d massage my throat and see if it helped with the sensation any.  In doing so, I found a rather large lump. It felt like about half the size of a golf ball.

While in a doctor’s office about another issue, I asked him to examine the lump to see if it was anything I should worry about. He estimated its size and 2.4 centimeters in diameter.  He ordered an ultrasound examination to get some idea what it was.  The ultrasound showed that where he’d expected to find only fluid, there appeared to be some solid components.  He said this wasn’t unusual, and that sometimes when a lump like that (which he told me was on my thyroid) grows quickly it can choke off healthy tissue, which then floats around inside it. To be safe, he ordered a “needle biopsy” or “fine needle aspiration” of the lump.
This morning, my wife and I got the results of the lab examination.  It was thyroid cancer, more specifically “papillary carcinoma“.  He said it was unusual to find actual cancerous cells in the biopsy. More often, they’re “unusual” cells that indicate the possible presence of cancer, but not actual cancerous cells.
Apparently, this particular type of thyroid cancer is very slow growing.  He says I’ve probably had this lump in my throat for years and didn’t know it until it got large enough to interfere with my swallowing.  Generally speaking, the prognosis for people who contract this particular variety of cancer is good.  According to one web site I read, over 95% of the people diagnosed with papillary carcinoma are successfully treated and go on to live for many years.  The success rate goes down depending on the size of the tumor, whether the cancer has spread, and other factors.
This news comes almost two weeks to the day that my mother passed away, and one week exactly after she was laid to rest after a long battle with melanoma.  My doctor said that if you had to contract cancer and could choose which cancer you got, this would be one of the best choices because it’s relatively easily treated and treatment has a high success rate.
What’s in store for me from this point on begins with a pre-surgery certification by my primary doctor.  That happens tomorrow.  On October 7, the surgeon will remove my thyroid and any surrounding tissue that looks abnormal. There are risks to the surgery, including changes to my voice or possible damage to calcium-processing glands near the thyroid, along with all the usual surgery risks.  I’ll spend one night in the hospital, unless there are complications, which aren’t likely.  After that, I’ll spend 3-5 days at home recovering.  At some point I’ll be given radioactive iodine.  They do this because the cells in this particular cancer respond like normal thyroid cells, which absorb iodine readily.  Any cancerous cells missed by the surgeon should, at least in theory, gobble up this radioactive iodine and die off.  After that, I should be cancer free and continue to live a normal life span, I’m told.
Somewhere in all this process, I’ll begin taking synthetic thyroid hormone to replace what I would have gotten from the now-missing thyroid.  It will take some time to adjust the dosage to the right level for me, after which I’ll take that medication for the rest of my days.
As I understand this, the only way the prognosis could get “bad” is if this cancer has spread beyond the thyroid, into the bones or other organs.  At this point, there’s no evidence that is the case, and I should be fine.  I’ll know for sure (hopefully) within a couple of weeks.
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Recipe: Blackberry Cobbler

Blackberry Cobbler

In less than an hour you can serve this very simple yet excellent dessert. (Serves 6)

4 – 6 cups fresh blackberries
Juice of one Lemon
1 large fresh egg
1 cup white all-purpose flour
1 cup white sugar
6 tablespoons butter

Preheat oven to 375F.

Place the fresh blackberries in a lightly greased 8 inch x 8 inch square baking pan. Sprinkle the lemon juice over top of the berries. In a separate bowl, stir together one large egg, one cup of sugar and one cup of flour, blend and stir mixture until the ingredients resemble coarse meal. Sprinkle the sugar/flour mix over the berries. Drizzle 6 tablespoons melted butter over the topping. Bake at 375F for about 35 minutes or until lightly browned and bubbly. Remove, and let stand 10 minutes. Serve hot with ice cream or whipped cream.

Garnish with fresh mint.

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Recursive Dreaming

Those of you who are computer geeks may be familiar with the concept of recursion already. Those of you who don’t recognize the term may need some background. Recursion, in computer programming terms, is a concept where a program repeatedly calls itself to complete a task. Imagine that you were programming a robot to open up one of those little Russian nested dolls. Using recursion, your program might look like this:

Function OpenTheDoll()
Remove the lid from the doll
Remove the smaller doll from inside the larger doll
Put the lid back on the larger doll.
If the smaller doll can be opened, OpenTheDoll(smaller doll)
Otherwise, stop.

Thus, on the first time through, our imaginary program will open up the outermost doll, remove the smaller doll from it, put the lid back on the larger doll, then call itself to open the smaller doll. When it calls itself, it opens the smaller doll, removes the “even smaller” doll, closes up the original doll, and tries to open the “even smaller doll” and so on until all the dolls are opened.

A function like the one above could open a nested doll whether it had only one smaller doll inside it or a million, since it will keep calling itself as many times as it has to in order to get to the point where the doll can no longer be opened.

Now that you hopefully understand the concept, let’s apply that idea to dreaming, with a real-world example. Last night I had a dream that my wife woke me up to tell me it was time to get ready for work. In that dream, I fell asleep and had a dream. Thus, this last dream was “recursive” in that I was “dreaming that I was dreaming”… I can’t begin to tell you how confused my brain was when I woke up from two levels of dreams. It took several seconds for “reality” (whatever that is) to sink in.

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Create a Desktop Shortcut with VBScript

If you’re trying to sort out how to create a Windows Shortcut on the desktop from within VBScript (or VB6) the following code should do the trick for you.  It creates a shortcut on your desktop that launches the Notepad application.  With some modification, it should allow you to create any desktop shortcut you need.

Set WSHShell = WScript.CreateObject(“WScript.Shell”)

‘ Use WshSpecialFolders object to get to the Desktop
DesktopPath = WSHShell.SpecialFolders(“Desktop”)

‘ Use the Shell to create a shortcut to Notepad on the desktop
Set theShortcut = WSHShell.CreateShortcut(DesktopPath & “\Shortcut to notepad.lnk”)

‘ Set shortcut object properties and save it
theShortcut.TargetPath = WSHShell.ExpandEnvironmentStrings(“%windir%\notepad.exe”)
theShortcut.WorkingDirectory = WSHShell.ExpandEnvironmentStrings(“%windir%”)
theShortcut.WindowStyle = 4
theShortcut.IconLocation = WSHShell.ExpandEnvironmentStrings(“%windir%\notepad.exe, 0″)
theShortcut.Save

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