Human food

Asparagus omelet,  side of cytomel. I'm almost in tears in anticipation.

Nuclear Monday

The executive summary : I will get my main treatment dose of I131 -- 100 mCi on Monday. Woo hoo the end is in sight!

It's been about 3 weeks since I've had any Thyroid replacement now. I've been eating a low iodine diet for about 2 weeks. I'm not having the best time of my life but I'm not exactly curled up in a ball in bed either.

I went to Dr Haugen in Denver at UCH (University Hospital) a few weeks ago after having been referred to him for a second opinion by my endocrinologist Dr Lori Book. He's a great resource to have so nearby because he's actually one of the authors of the industry standard for treatment protocols for thyroid cancer. He recommended a scan prior to treatment to guide I131 dosing. 

I got a blood test on Monday revealing a TSH of 130 which is quite sufficient for the minimum requirement of 30 in order to proceed -- very hypothyroid! Then on Wednesday I received the low dose scan pill day and this morning I got a gamma body scan to determine the amount of cancerous tissue in my body -- whatever took up the tracer. The news is good, they only found a little uptake in my thyroid area and didn't see anything in my neck. In accordance with Dr Haugen's recommendations that puts me on the low end of the I131 dosing. 100 mCi vs what I was on track to receive without the scan : 200 mCi. That's good because there's a lower chance of side effects from the treatment.

So Monday I'll go in and swallow my pill and let it work it's cancer killing magic! It also means that soon I'll be off this crappy restrictive diet and back on thyroid replacement meds... back to the land of the living!

Being off of thyroid meds is not a lot of fun. You've got low energy because thyroid hormone is what regulates your metabolism. Your thought processes slow down. I'm tired, but it really hasn't hit me as bad as the stories I've heard. I took one day off work. There have been ups and downs but nothing awful. 

I think the low iodine diet is worse. You can't eat a laundry list of things that have iodine in them. The idea is to get any cancer cells good and ready to suck up the radioactive iodine treatment. Iodine is an artificial additive to most salt. Basically it prevents you from eating out at all and from using any prepared foods. You have to cook everything from scratch because even canned foods all have salt included! So in addition to being tired you have to spend hours cooking meals from absolute scratch.

Anyway shortly after Monday I'll be able to resume thyroid replacement and iodine. I'm planning a binge dinner in celebration :)

Information Dump

I've been procrastinating on this post for a while mainly because all I had to report was ambiguous and bummer information. Let's start with that:

I went to Dr Lori Book, my endocrinologist 3 weeks ago. Before that she had an informal conversation with Dr David Book: her husband, my surgeon about my case and they realized that yet another doctor had ordered a CT scan with contrast early on in the diagnostic process. The contrast contains loads of iodine and an aggressive treatment plan calls for 6 months between such a scan and radioactive iodine treatment. So the treatment I was supposed to have last week was delayed until January. The other shocker was when she told me that I had an extensive and aggressive case and that it had probably been going on for 10 years!! The primary tumor was small but the spread to the lymph nodes in my neck was extensive which is abnormal. Usually the size of the tumor correlates with the aggressiveness of the cancer. Where I had been viewing the radioactive iodine as just a clean up procedure and the end of the road for this little chapter of my life, she made me realize how possible it was for me to have "distant metastases" in my lungs and bone due to the apparent aggressiveness of my case. We talked about the possibility of recurrence etc. So I wasn't very upbeat at the end of all that.

I have some good information now though. I just got off the phone with her medical assistant with the results of my blood labs. There's a protein called thyroglobulin that is monitored in these cases. It is produced by thyroid cells and in my case it's a direct indication of the amount of remaining cancer cells in my body. The level of thyroglobulin was so low it showed no cancer! I haven't talked with the doctor yet but I'd imagine this would affect my treatment plan going forward. It's absolutely good news though!

Major thanks to the skill of my surgeons Dr. David Book and Dr Gregory Buchalter!

Insurance

Check it out, total billed $54,360. Total they actually get $6511.00 (12%). What a health care system... what if I didn't have insurance? Could I go in and say "I'd like to pay 12% of my bill and call it good? HA!

Next Steps

I'm feeling just fine now. I've been off of all pain killers for a few days now and the staples are now medically ready to come out. They'll be extracted on Tuesday and then I'll have to rely on my scars for a conversation starter :). I'm spending the weekend with Mom in Buena Vista. I just got back from a run. The replacement thyroid hormone has actually given me more energy than before! The surgery site got a little agitated but no big issue.

I visited the Oncologist last week and now everything's scheduled for the mop up nuking operation. On October 6th I'll go take a tracer dose of I-131. The next day I'll sit under their scanner and any remaining cancerous thyroid cells will be illuminated. Based on the number and size of these hot spots they will administer an appropriate kill dose of I-131 which will kill any remaining cells. I'm told to be a little tired afterwards... not bad! I'm also to avoid contact with people, especially children after the therapeutic dose for a few days.

Dr. Book told me that the Endocrinologist would be the doctor responsible for this. Since I haven't been able to get an appointment with her (Mrs. Dr. Book) I'm happy to have Dr. Markus pushing forward. There may be some conflict and intersection of roles during the hormone replacement tuning... we'll see.

So I've got staples in my neck, a giant scar, I can't feel the skin at the surgical site (yet), I have to take a pill full of nuclear waste , I still have to get settled into a dosage of thyroid replacement, yet all I can think was : that wasn't so bad :).

Why can't it be Halloween?

I could really work with this:

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