Wednesday, December 30, 2009

Decisions, Decisions

I'm psychic, you know. Just as I predicted, Dr. WhizKid recommended surgery on my massive thyroid nodule. What's up with that? Surgery as a first alternative?

Here's the deal. Dr. WhizKid is an ENT. That means Ear/Nose/Throat specialist. He knows where everything is, and can dig around in there with confidence during surgery. So the thought of him being the one to do the surgery is not what concerns me. Dr. WhizKid drew a little picture of his proposed surgery, and said he'd give me a copy, but he didn't. I blame that girl in there with him, whoever she was, who had the papers in her hand when we left. Without scheduling surgery.

When Gyno first felt my goiter and exclaimed that he did not like the feel of that nodule, way back in early November, he said it would need testing. He elaborated with the mention of a radioactive iodine test, and a fine-needle biopsy. After going off my meds for three weeks (that strikes fear into your heart, huh, the thought of HM off her meds), I partook of his radioactive iodine test, and also an ultrasound of my thyroid.

Gyno called me with the results of that radioactive test. His exact words were, "It's most likely cancer." That's not something I would have told someone over the phone, myself. So I asked why, and he said because it was a 'cold' nodule, and that it was solid, not cystic. But that he, himself, is not a doctor that deals with this, and that he would refer me to Dr. WhizKid, the new ENT in town. The only ENT in town. And a DO to boot, which rubs my mom the wrong way. She has no love for osteopaths. When I called Gyno's office back to inquire about scheduling a fine-needle biopsy, Gyno said, "Uh, who said anything about a fine-needle biopsy? We're looking at a course-needle biopsy." After my interrogation, he said that yes, they do knock you out for one of those, and that it could be done right here in town. Pardon my persnicketyness, but GYNO is the one who brought up the fine-needle biopsy originally. I did not remind him. In all fairness, he did say that this is not the kind of thing he does, and that I should see Dr. WhizKid, and upon further questioning, revealed that he has sent Dr. WhizKid three patients.

Since it was taking six weeks from my first appointment with Gyno to even see Dr. WhizKid for the initial consultation, my regular primary care GP, an old Army doc, hooked me up with a fine-needle biopsy. As he said at the time, "They do these for me all the time down in the hospital lab." The results of that fine-needle biopsy came back 'benign pattern' on Monday. Doc is on vacation this week, but had instructed his nurse who called with the results to tell me to keep my appointment with Dr. WhizKid. Which I had planned on doing all along, because the appointment had been made for four weeks already.

NOW, Dr. WhizKid only mentions surgery as an option, after reading my fine-needle results right there in the exam room with me. To hear him tell it, (after all the possible complications he listed), they will slice up the nodule and send it to the pathologist. That's after they have removed the nodule and half my thyroid. And put a drain into my neck so I won't die from a hematoma blocking my airway, after dancing around my vocal cord nerves that could render me songless or breathless, and tiptoeing around my parathyroid glands, which could upset my calcium balance in 30% of patients who have this surgery, meaning they have to take expensive meds for the rest of their life. Oh, and the results of the nodule sections won't be known for about a week. Which to me, sounds like this whole hemithyroidectomy is just an extremely dangerous diagnostic test.

When I've already gotten back the results of a much less invasive diagnostic test. If that fine-needle biopsy is not good enough, why do they do them at all?

So I asked Dr. WhizKid the odds of this nodule being cancerous (because he did not volunteer that trivial bit of information), and he said, "Well, it's a cold nodule, which is more likely to be cancerous, and your age in not in the right category...and the odds of it being cancerous are about 16 percent." Loyal H, who went in the exam room with me, asked how soon this surgery needed to be done. Dr. WhizKid said, "In the next few wee---in the next few months." He asked if I would be more comfortable having it done in the city, and I said I would be more comfortable not having it done at all. I said I needed a week or two to think it over.

You can plainly read that I am dragging my feet on this surgery recommendation. Do the odds of my thyroid nodule being cancerous outweigh the risks of the surgery? I think not. I don't want to be some kind of two-insurance cash cow for Dr. WhizKid and Gyno.

I am setting up an appointment with Doc when he returns from vacation. I plan to ask him what he recommends to HIS patients after getting fine-needle biopsy results such as mine. And I want to get an appointment with the endocrinologist Doc refers his patients to at Barnes Hospital.

Because what if the surgery to cut out my thyroid kills me, and then they find out that it wasn't even a cancerous nodule? According to my aunt, "Then the family could get a big settlement." Yeah. That's my gambling aunt.

I don't want to be like the model who died after butt-implant surgery.


Integrator said...

As far as literature goes, if calcified nodule with blood flow is found it has 22% chance to harbor a cancer; only 17% of neoplastic nodules removed are actually cancerous.
However the nodules of 3 cm and larger can yield false negative results, therefore the AACE conference of 2009 make decision to recommend removal of these regardless of biopsy results.
Thanks for reading that academic stuff!

Kathy's Klothesline said...

Like you, I think a second opinion is needed.... maybe a third and fourth also. Thinking of you!

Hillbilly Mom said...

Thanks for your input. The ultrasound report said my nodule was a freakin' 5.7 cm, but also said that the entire left side of the thyroid was 6.1 cm. That's hard for me to believe, that almost the entire section is nodule. The pathologist's report said the nodule was 3 cm by 2 cm.

I saw some literature that said less than 5 percent of 'benign' nodules upon fine-needle biopsy with ultrasound turn out to be cancerous after removal. This is not that site, but says kind of the same thing:

I just know that I am looking into a second opinion, this time with an endocrinologist instead of an ENT. I'm sure Dr. WhizKid is very good at what he does. But is what he does right for ME?

I am looking into it. Of course my Doc's office is closed for New Years, so it will take a while. The girl on the phone today said that they didn't have an appointment until the beginning of February. That is unacceptable. I told her that I wanted to discuss a biopsy result, since another doctor had recommended surgery in the near future, and she said the nurse would call me next week about an appointment.

It's ridiculous that you can only make an appointment a month away. Maybe that's why so many people use the ER for primary care! That, and IT DON'T COST NOTHIN' for those with the Medicaid card. My students tell me how they go there if they need an excuse for too many absences. "If you say you have a headache, they'll give a note that says you had a sinus infection. If you say you have a cough, they'll give you a note that says you had bronchitis."

Integrator said...

Well, if the these reports are having such a huge mismatch, the second opinion is warranted. When my relative (for whom I am doing all these researches), received the ultrasound report, saying at the first line that she has heterogeneous (sp) thyroid echotexture without distinct nodules, and the last line of that SAME report contained the statement that she has multinodular goiter.
After that she finally switched the doctors!
Best of luck and have a happy New year!

Hillbilly Mom said...

Happy New Year to you, too.

I don't feel comfortable with the surgery recommendation from Dr. WhizKid, who didn't even read any of my test results until he sat down next to me. 15 minutes is not enough time for me to make this kind of decision.

I had the multinodular goiter diagnosis four years ago. I don't know if this main nodule was that size then or not. The Stabber seemed to think it was not any bigger now, and he had looked at both ultrasounds. So I want a more discerning opinion from my primary care Doc.

DeadpanAnn said...

I'd get a few opinions if possible. Keep us posted.

Hillbilly Mom said...

Miss Ann,
I am investigating my options.