Monday, February 8, 2010

How Do You Solve A Problem Like My Goiter?

The left lobe of my thyroid is coming out, because its nodule tips the ruler at 5.5 cm, and doctors recommend that a nodule comes out if it is over 4 cm. Or 5 cm. Depending on which doctor you listen to. In any case, my nodule exceeds expectations.

The Indian med student told T-Doc that she was unable to feel the nodule, at which point T-Doc stood behind me and squeezed my neck until I had a coughing fit, but just before I started hacking, he said, "There. Right between my hands. All that is nodule." After I caught my breath, I told him that made me feel better, because those other docs and each one's posse exclaimed over it like it was a football-sized goiter, and told me that surely I must be unable to swallow, and unable to sleep, and unable to breathe, and that one of them had flat-out declared, "That thing is a monster!"

T-Doc was the scale-tipper in persuading me to have surgery. He was quite calm and clean. Not that all doctors aren't clean...but when he sat down beside me to discuss my nodule, I got a gander at his hands. They were small hands, with well-trimmed fingernails, just the kind of hands you would want pawing around inside your neck once it is sliced open and the sides are pulled back to form a gaping cavity with metal pitchfork claw thingies holding it open.

T-Doc said that he had reviewed my previous ultrasounds, had looked at all the specimens from my fine-needle biopsy, and had gone over the 30-minute-old ultrasound, and that he and the radiologist both agreed that there was nothing in the biopsy or ultrasounds that would suggest cancer. He said that due to the size of the nodule, he would recommend that it be surgically removed. And wouldn't you know it...T-Doc performs that kind of surgery every day. But here's the thing: he was not pushy and not sensational about it.

I explained that I was there because an ENT had recommended surgery to remove the entire thyroid within 3 weeks of my visit back in December. Chauffeur H chimed in that it made us a bit nervous that Young Doctor Whiz-Kid was in such a hurry to get 'er done. T-Doc said that would make him nervous, too. I said that I was worried about missing work, and being able to talk after the surgery, so I wanted to wait until summer. T-Doc said that he usually likes to remove such a nodule within 3 months. He counted up the time, and said, "This is only one month more. Even if the nodule would prove to be cancerous, and there's nothing to suggest that it is, thyroid cancer is very slow-growing, and one extra month would not be a problem." He then went on to sketch on the back of a piece of paper the various risks and complications.

T-Doc said that he would do a left thyroid lobectomy, which has fewer risks and complications than a total thyroidectomy. He said that he does not put in a drain, hadn't put one in for years, actually, except for that one last week. They had a patient with a HUGE thyroid, which they didn't know until they got into the surgery, a thyroid that looked like two oranges with two bananas sticking up from them. And T-Doc had been the hero of the operating room. And with (this pronouncement being followed by a twinkle in T-Doc's eye), he had put in a drain. But normally he does not, and the only problem that could arise from no drain would be excessive bleeding, in which case they would simply (!) take me back to the OR to stop the bleeding. But that such a risk of bleeding so much that the airway is in danger is less than 1%.

Other complications would be irritation of the vocal cords, or in my case, vocal cord, which may cause a hoarseness that could possibly be permanent. Oh, crud. I suppose now I will never be cast as the lead in the remake of Sound of Music. In addition, my parathyroids could go into shock, and mess with my calcium absorption, the consequence of which could be death from cardiac arrhythmia. But since I will still have my unmolested parathyroids in the right lobe, that is unlikely. Less than a 1% chance.

All in all, I liked the fact that T-Doc did not say that I had to have this surgery right now because I might die. Nothing dramatic such as the way Young Doctor Whiz-Kid carried on. Because of T-Doc's style and experience, I took the surgery bait. I think his attitude came from operating on people who have serious, life-threatening illnesses compared to my overgrown nodule, and he put it in perspective.

I have to call his office a month before I want the surgery, to get on the schedule, and I have to go see that anesthesiologist. It is a 23-hour admission, which means that I stay in the hospital overnight, and go home the next day. I will have medicine for pain, and should feel like I could return to work within two weeks. It is a 2-hour surgery under general anesthesia. My throat will be very sore for one-and-a-half to three days, mostly due to the intubation during anesthesia. The scar will be in a neck wrinkle, and will fade.

I am SO not looking forward to this procedure.


Marshamarshamarsha said...

Glad that doc put it in perspective. Hoping that it doesn't mess with your parathyroids...I had mine out on the left side. Pretty similar surgery to what you are saying will happen to you. Very minimal scar. However, I was hoarse and unable to yell at my rambunctious children from the end of June until sometime in September...lots of fun to start the semester and not be able to go over the test directions or syllabus with little more than a whisper. But one day, my voice was just back. Scared the beejesus out of me though---could never go through life without talking! It's like oxygen to me.

Sinead O'Clobber said...

I'm so sorry to hear about your neck wrinkle.

jk. Scary stuff, HM. Don't you just love the weeks of waiting and asking questions and getting more tests done and so forth to find out whether you have the "C" word? I'm glad it's gonna be taken care of. It sounds like you'll be hurtin' for a while but I'm glad it's not going to be a bigger ordeal and that you can wait 'til it's more convenient.

Hillbilly Mom said...

Long time, no comment! One of our staff had her whole thyroid removed, and said she couldn't talk above a whisper for about 6 months. I'm hoping it doesn't come to that. Glad your voice returned.

Right now it's the thought of the cutting that bothers me more than the results.