Tuesday, May 19, 2009

Hearing Exam Leads to Thyroid Biopsy

My hearing isn't great. Down about 20 db in one ear, which is the bottom of "acceptable," and down much more in the other. So I visited an audiologist who recommended hearing aids, but who first scheduled me with an ear-nose-and-throat (ENT) specialist because she thought the big difference between the two ears could indicate a medical problem. I've had this difference for decades, but I went anyway.

Dr D, the specialist, did an examination of the ears and of course found nothing. Then, because he is an ENT, he looked in my nose and checked my throat. "Did you know about this nodule on your thyroid?," he asked. "News to me!," said I. He explained that he always does the cursory examination (he may not have used the word "cursory") without expecting to find anything, but this time he did. He said it was about a centimeter and a half in size, and recommended an ultrasound exam to check it further.

So today I expected an ultrasound examination of a nodule on the thyroid. But it turned out to be ultrasound imaging immediately followed by a fine-needle biopsy - both had been scheduled because the nodule was large. I believe that the biopsy is indicated for nodules exceeding 1 cm in size, and K, the technician, said this one was 2.6 cm in the largest dimension. As she pointed out, that's just over an inch. I'm a little surprised that I didn't know about it.

They removed my shirt so that it would not get Betadine on it, then swabbed the area abundantly with the Betadine, and finally applied a hypo of lidocaine. Almost immediately, Dr M, the radiologist, started taking samples of the nodule with very small gauge (#25) needles. I felt the first two needles, because the lidocaine hadn't quite taken effect, but the pain was really quite minor so I didn't complain. Anyway, complaining would mean talking, which is not a good thing with a needle in the neck. The nodule was close to the carotid artery, which they refer to as "Big Red" and avoid at all costs.

Dr M explained that the nodule was not homogeneous, and he was taking samples from different areas. I couldn't see the ultrasound screen, so I watched him. Once he had the needle in my neck his eyes never left the screen until he withdrew the needle again. Totally guided by the imaging. He took four samples, then stopped, explaining that they would send these to the pathologist who would tell him in a few minutes whether he had enough cells.

Meanwhile K asked about my myeloma and shared that she herself was a 2 1/2 year survivor of an allogenic umbilical-cord stem-cell transplant for leukemia, done at the University of Minnesota. Her doctors had said that her acute leukemia was not treatable with chemotherapy, but she had a 50/50 chance of survival with a stem cell transplant. She chose allogenic, despite the lifelong issue of graft-versus-host disease, because she believed that the result, if she survived the transplant, would more likely be a cure. So far so good! No trace of the leukemia. After two years they call it "remission," and she's there. She looks great. Perhaps 25 - 30 years old, I hope she has a long life ahead of her.

Back on the biopsy table, Dr M informed me that the pathologist was not satisfied with the sample. Thus more lidocaine, and this time a larger-bore biopsy needle, a #22. Apparently, needle sizes are like wire sizes, smaller numbers indicate larger needles. But I didn't feel any of these needles, and I think he used six more. He actually ran out and had to use one of the smaller ones.

We waited another 20 minutes and were told that they probably had enough. Dr M did mention that the pathologist had not seen cancer cells in his cursory examination of the samples, and that's a good sign. It can change, of course. In addition, there is always the chance that the pathologist will change his mind about the size of the sample, but if that happens we'll schedule another biopsy and this time they'll use a needle that can cut off a chunk. They don't like to do that on the neck, said Dr M, but he didn't explain why. Of course there's always the risk of hitting Big Red, and I suppose there's also a risk of hitting nerves or something. There's a lot of stuff crammed into the neck. Come to think of it, they made me sign something after the initial ultrasound and just before the biopsy. Perhaps it was the "informed consent" sheet, which of course I didn't read. Who reads a clipboard when they're already flat on the table?

It takes the pathologist 48 hours to crank out the final report, according to K. So I guess I won't know until Friday at best. In the meantime I'm not too worried. My thyroid function tests have been normal, and what the hell, I already have cancer.

Breakfast: Organic oatmeal with dried cranberries, blueberries, organic apple, organic pear, organic strawberries, orgnic walnuts, and organic nonfat milk. Not shown: Two organic eggs cooked in good organic oils.

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