Monday, August 28, 2017

Nuclear Medicine... it's no joking matter.

Nope, it's not.  They are very serious there.  I guess they have to be when dealing with turning people radioactive...  the doctor did not like my joke about making my kids do their own laundry for longer than necessary... she corrected me, twice.  Oh, well.

We checked in and filled out forms.  I met "The Scheduler" face to face.  She was very nice.  My husband reminded me later that her job is an impossible one with all that she really does have to keep track of and the logistical dance she has to do with each patient.  She took us back to an exam room and we watched an informational video.  We then met with the doctor, who pretty much went over everything that was in the video and in the notebook that they had sent me, and then asked if we had questions.  I went over stuff that wasn't in the book, like what to do with my CPAP machine, etc.

 Sounds like iodine is water soluble and the best thing to do after the first day 24 hours (or so) is keep myself isolated, but if I use something, it can just be washed off normally, although, it should be washed separately (i.e. laundry) and that I should take extra precautions when I reasonably can (using paper plates and plastic utensils).  These precautions should be practiced for the first week, after that, I am safe to be around.

You know, I say that they are very serious there, but they did end their introductory video about my radiation therapy by saying that although I would be radioactive, it wouldn't give me special powers and that I wouldn't be able to do anything fancy like turn the lights on and off from across the room... How disappointing!  I was hoping to get super hero powers to go with the awesome scar I have on my neck.  Then, I'd really have a great story to tell...

Friday, August 25, 2017

Let me tell you again how this works...

The scheduler was not my favorite person to work with.  Once we finally were able to talk on the phone, she explained all of the visits we needed to schedule (consultation, injections, blood work, scan, the procedure, and then the post scan) and then said, "Let's schedule your consultation, the earliest date for that is..."  After hearing the date, I was still in a little shock over the multiple appointments, my doctor had led me to believe it was a total of 3 appointments, the scan prior, the procedure, and the post scan.  I stopped the scheduler and asked, "Can we work backwards a little, I have a specific week that I need the actual procedure done, I would like to schedule everything else around that."  She seemed really annoyed that I would mess with their precious system... "Let me tell you AGAIN how this works, you come in for a consultation, then you come in for the injections..."  She went on and explained everything again, I listened, as patiently as possible, and calmly replied, "That all sounds great.  I need to do the ACTUAL treatment the first week of October.  It's the only week I can do it, so all of the other stuff will need to be before that, when do we need to schedule those?" She took a deep breath and I heard her grunt (almost growl) into the phone.  "I'm going to put you on hold while I see IF that works with our protocol."   She put me on hold, I thought, "Um... it does.  I just need you to put it on your calendar..."  She came back several minutes later.
   "Let's start by scheduling your consultation.  I have availability starting..."  Once I scheduled that, she told me what days I had to come in for everything else to hit my target date, I only got to pick the times.  I chose early in the day so that my husband could possibly come with me without interrupting his work day, however, some of them were 4 hour appointments.

But I'm scheduled.

This coming Monday, I have my consultation where we will get our questions answered.

Then, in 2 weeks, I start a low iodine diet.  No iodized salt (so basically no salt), no dairy (including egg yolks), no sea products, and no soy beans or similar beans.  Doesn't sound so bad, right?  Until you realize that it means NO pre-packaged foods because they all have salt in them, many have some form of dairy in them, and some are thickened with a seaweed product or made higher protein with soy products.  NONE of my protein shakes or bars are okay because they are soy or whey based.  I will have to make my own bread and buy almond or coconut milk that doesn't have any additives to put on whole grain cereal that has no salt.  Then, I will eat that and veggies.  That's it.

2 weeks after that, I go in on a Monday to do blood work and get my first injection.  Then I go back the next day to get another injection, and then back again on Wednesday to get my blood drawn and take a very low dose of the radioactive iodine.  On Thursday, I go back for 4 hours to get multiple scans, another blood draw, to review the scans and calculate the dosage of my big radiation.

On Tuesday the next week, I go in for another injection, and possibly another blood test.  On Wednesday, I go back for my final injection.  On Thursday, I go in to be admitted to the hospital, take the high dose of radioactive iodine and then remain in the hospital in total isolation until I don't register dangerous levels of radiation on their Geiger counter (not kidding, that's when they let me go home...).  This usually takes about 24 hours from when I take the pill.  Then, I will go home, spend the next few days in total isolation at home, then go back to the hospital for a follow up scan, and when I get home, I will spend the few days after that no closer than 6 ft. away from my family.  It is going to be an adventure, for sure!

    I am super lucky that my mom is coming to take care of my family.  I will not be allowed to touch anyone else's food or laundry, and since I can't be closer than 6ft. I can't ride in the car with them, so she is coming to take care of them.  Once that week is over, we will all be very happy to start to get back to normal.  I am hoping to spend my birthday (exactly 1 week after my treatment) with my family and not in total isolation, even if I am 6ft away from everyone.

  Shortly after all of this is over, and well after the time has passed when I am radioactive, I will be getting in the car with my family to drive to Orlando, Florida.  It will be a much needed vacation after not being able to spend the time with them and not being able to hug them and after putting toxic radiation into my body.

For anyone that lost count, that means I get to drive to the hospital 9 times in the next 6 weeks.  The hospital is 1hr. 15 min. from my house each way (if there is minimum traffic) so basically, we are talking a 3 hour commitment, minimum, each time... The 4 hour day is going to quite the day!

Fun times, fun times...

Wednesday, August 23, 2017

Fun to say, not to do...

I am learning that there are a lot of things that more easily said than done... or in some cases, more fun to say than to have.

   Take, for instance, the word, "metastasize."  That is a super fun word to say, in all of it's forms... metastasis, metastases, metastasized... so fun to say.  Oh, go ahead, you know you are dying to say it aloud, just do it, no one is listening (even if they are, they don't care).  However, saying it might be fun, but having your cancer do it is not as fun... in fact, it's scary.  Quite scary.
   At my follow up visit with the surgeon, she told us that she took out 6 lymph nodes.  This was more than she was planning, but she didn't say how many more.  The pathology report came back from my thyroid showing... cancer (no surprise) and that 2 of my 6 lymph nodes also had cancer (Surprise! Metastasized! Hmmm... I tried to make it sound fun... Nope, still scary.)  I would definitely need radioactive iodine treatment.  This was something I was truly hoping to avoid, even though I have been planning on it all along.  At my follow up with the endocrinologist, she confirmed that I would need the treatment.  Both doctors gave me great advice on what to look for in places to get it done, however, neither gave me an exact name or phone number or instructions.  They also both had suggested getting questions answered about specific insurance coverage before proceeding.  I felt like this was good advice.  I had my questions set.  I had reviewed my calendar with my endocrinologist during my visit with her to determine the best time for me, then, I had spoken to my mom about it and reviewed her availability within the correct time period... my window of opportunity was quite small... 1 week, to be exact.  I had an exact week that my treatment had to occur.  We were now only about 6 weeks out from that particular week and I felt like I needed to get it scheduled as soon as possible so that we could get my mom's plane ticket purchased.  I had my date set.  I just needed to know exactly who to call.
 
   Researching a nuclear medicine doctor to administer the radioactive iodine was overwhelming.  Add to that a sudden fluctuation in mood levels from my thyroid being gone.  Add to that PMS.  I could not function.  I burst into tears and felt like there had to be someone out there that could help me... there wasn't.  I needed to make a decision and make a phone call.  After a full afternoon of crying, I calmed down enough to call the next morning.  We decided on the same hospital where I had my surgery, mostly because they came recommended by my endocrinologist as knowing what they were doing, and their website seemed to really show that.  They also promised someone to walk us through the process, step by step, which with feeling this overwhelmed, was something I NEEDED.  Right now, I just wanted to walk away, not deal with it.  The website promised help... I bought into it, hook - line - and sinker.

   Scheduling radioactive iodine treatment is another thing that is easier said than done.

     I called the number on the website, I nice woman answered who took careful notes on on what I needed (I could hear her typing into the computer), and asked all sorts of questions.  She finally said, "Okay, Honey, I am going to transfer you to the main number for the hospital, from there, you ask for Nuclear Medicine.  Here's the main number in case you get disconnected... xxx-xxx-xxxx.  Have a great day, and good luck!"  The phone rang for the hospital, it went to some hold music for about a minute while I waited for an operator, who then transferred me to Nuclear Medicine.  Nuclear Medicine has a menu, I pushed 2 for scheduling.  That got me to another woman in the nuclear medicine scheduling department, to whom I explained what I needed... she transferred me to the voicemail of... THE SCHEDULER.
      Oh, the scheduler.  She has 1 job to do - schedule people for this particular treatment.  Literally.  When I said what I needed, they transferred me to her desk because she is the only one that does this at the hospital.  I had to leave a message because at 9:30AM, when I called, she wasn't at her desk.           At 10am, she called me back and asked, "Do you have the order from your doctor?"  I told her I would check through the paperwork I had and see if she had given me one because she had given me orders for some blood work and I wasn't sure if the order was with that or not... it wasn't.  "I can have her office send it over to you when we get off the phone.  Uh -"  I was interrupted when I took this breath.  "I can't schedule you without the order from your doctor.  Have them fax that, along with your patient demographics sheet, and a copy of your insurance card - front and back.  Here is my fax number...  xxx-xxx-xxxx.  I will call you once I have received all of that information.  Good-bye."  Um, okay... what about finding out if my date was even a possibility so we could buy plane tickets, and checking my insurance and all of the other questions I had?  No?  Nothing?  Okay.
     I called my doctor's office and pushed the buttons on the menu - make an appointment? No?  Okay, then push this other button to go to the nurse's line to leave a message and we will get back to you as soon as we can.  I left a message, explaining, in detail, what I needed and asked them to call me as soon as they had done it or if they had questions, and then I hung up.  I then logged on to the electronic chart service for the doctor and emailed her office requesting the information and explained that I had also called and left a message.  I then waited 2 hours, but still no call from either office, nor an email reply.  So, I called the endo's office again.  This time I pushed the menu to make an appointment.  I was sent to a real person who took careful notes of what I needed and said, "Okay, I will send this message over to them right now so they can get that information sent out for you."  Okay... so the schedulers have to send a message to the office people to send the information.  Great... What could go wrong?  By 4pm, I still hadn't heard from either office.  I was having a hard time believing that the endo's office hadn't sent that information over by then so just after 4, I called the hospital.  Wait... how do I get in contact with the scheduler?  Okay, hospital main number, ask for nuclear medicine, push 2 for scheduling, then, this time, I asked for her by name... "Um, I can transfer you to her voicemail, but she's gone home for the day."  The voice sounded a mix of "matter-of-fact", disbelief, and annoyance, that I would call at this particular time... you know, within NORMAL business hours.  Okay, transfer me.  I will leave a message, it isn't like I've been waiting ALL day for her to call me!  Tears started to well up in my eyes and the more I spoke the more emotional I got.  My message once again stated who I was, what I needed to schedule, and that I had a very specific date I needed to schedule it for.  I then said that I was running out of time to get plane tickets (fare sale ended the next day) and that my mom wasn't going to be available the whole next day.  I had appointments scheduled both of the next 2 days, right in the middle of the day and would not have much time to talk to her.  I asked her to please call me before 10am the next day.  UGH!
    That night, I got an email message back from my doctor saying the information would all be faxed over.  The next morning she emailed me again saying it had all been sent.  At 10am, I was in the garage, walking out the door to an appointment when my son came running out the door with the phone... it was the scheduler.  I was very short with her because I had asked her to call before 10am, not at 10am.  "I don't really have time to talk, I am on my way out the door to an appointment."  She was annoyed with me.  "I know.   I just wanted you to know that I never did receive anything from your doctor yet, so I can't schedule you."  Now, I was really annoyed.  "Well, my doctor emailed me this morning confirming that she sent everything yesterday afternoon.  This is the fax number I gave them...  xxx..."  She was very short with me.  "That's my fax number.  I don't know why I didn't get it, you can call them and ask them to send it again."   At this point, I wanted to scream.  No, I can't call them and ask them again...  there is no one to ask.  No one.  When I call, I talk to people who give messages to the people, but I can't actually talk to anyone in the office.  Then there is the fact that you are purposely calling me as I am walking out the door.  Seriously.  After hanging up with her, I ran out the door and called the other office from my car.  I gave them all of the same information again, and this time expressed that they had not received the information, even though the doctor had it had been sent and that we were waiting for it.  Just before getting home from my appointment, I got a call from the scheduler, she finally had all the information she needed.  This time, she would need to wait for me to call her back... and you will need to wait until the next post to find out what happens next.

Friday, August 11, 2017

A lot of catching up to do...

In the days leading up to surgery, I had a lot of feelings that I hadn't really let myself have before.  I was starting to feel apprehensive about the future, I was thinking about the "what ifs."  I planned things out... to take care of some of those "what ifs."  I even recorded myself telling my husband and kids that I loved them, just in case my voice was damaged and I couldn't ever say it again.  Maybe it was a little silly, but I knew that if my voice was damaged, I'd be happy that I had it.  I also knew that if something went terribly wrong and I never woke up from surgery, that perhaps they would find it on my phone and have one last message from me.  Again, not a likely scenario, but I felt like it was good to record the message, just in case.  I dealt with the feelings, as they came, pretty much hid them from everyone.  It helped that I had a lot of real life happening to hide behind.  On top of coming home from vacation and going to an escape room for the first time, we had 2 kids with ear infections that needed attention and one of those lost a toe nail.  After caring for them all weekend, I took my oldest to the DMV to get his learner's permit and then took both boys to get hair cuts, then my oldest to 2 hours of Taekwondo.  It was sort of a crazy few days taking care of others and running around.  It helped to not think about myself, though... it always does.

On August 1, we woke up early and left to drive to DC.  Traffic was almost non-existent so we made it to the hospital an almost hour early!!  We decided to go ahead and check in, thinking maybe they would just have us wait a while in the waiting room, but they didn't.  We checked in quickly and I got taken back to my pre-op waiting area.  They had me change into my gown and got me settled on a bed.  They asked me tons of questions and I was then told that I would have to answer all of those same questions for just about everyone else that came through there and that I should expect to see: the anesthesiologist, an OR nurse, my surgeon's nurse, and (eventually) surgeon.  They did say my surgeon was in the clinic that morning and wouldn't be able to come in until right before surgery.  I did, eventually, see all of those people (and then some!).  When my surgeon came in, she was happy and seemed glad to be there... which is always very comforting.  She commented that it had been awhile she had last seen me and asked if anything had changed since we last met.  I got a very serious look on my face, took a deep breath, and said, "Yes, the cancer has spread throughout my body and is masquerading as fat and excess skin here and here (pointing to my flabby arms and stomach).  You have to remove it all."  She looked shocked and then just started laughing.  I think she was happy to see that I was in good spirits.  Within minutes, a huge crowd had gathered at my pre-op area and began introducing themselves as my surgical team.  I was wheeled back to the OR, where I was introduced to a few more people and as I came in and met them I said, "so many to help with my surgery, and not a single one of you is a plastic surgeon?  That is so disappointing."  They all laughed, I got settled on the operating table and that is the last thing I remember.  They didn't have me count backwards from 100, none of that.  I don't even remember them saying they were putting me under.  I just remember voices next, my doctor and my husband talking about the surgery, and then drifting back to sleep, off and on, hearing the voices around me in the recovery room.  Eventually, I heard someone talking about finding me a room for the night.  I opened my eyes and looked around.  The nurse asked me how my throat felt.  Someone came in to draw blood.    I was told I needed to drink some pink liquid (liquid tums) then I told them I needed anti-nausea medicine.  They gave me something in my IV.  My husband came in and said, "It's good to see you awake, I've been in to see you every hour or so, but you've been asleep a long time... it's 7pm."  I smiled at him and closed my eyes, feeling like I just wanted to go back to sleep again... It took quite awhile to find me a room.  By the time I got settled and sent my husband home and finally asked for pain meds for my throat, it was late, like 9pm.  I don't know when I had pain meds last.  It seemed to take forever for them to get them to me.  They brought me these HUGE pills to swallow with my sore throat.  ??  Why?  Who knows.  Liquids, people, liquids... or my IV...  either would have been fine.  I hadn't had anything to eat since the night before (24 hours+ since solids) and was starting to feel the effects of that.  I asked for a drink of water and maybe some juice.  The juice burned in my throat.  I started to cry.  The nurse brought me a lozenge just so I could numb my throat enough to take my pills.  It helped a lot, should be standard issue.  Took me a few hours to make it through a little bit of juice and my cup of water.  My nurse then brought me a bigger cup of water and an even bigger cup of ice!  Yay!  I slept off and on through the night, getting woken up by people needing to take vital signs, draw blood, and give shots (PS - still had an IV in, would have been nice to get those in there...)  Before 7am, my entire surgical team, minus the doctor, showed up in my room.  I know it was them because they announced it, "It's just us, your entire surgical team!"  They said I could go home when I was ready and told me how to care for my incision.  That was it from them, no update on how the surgery went.  Nothing.  I'm sure if I had asked more questions, they would have answered, but I was still sort of out of it.  I could have a conversation, but it took days for the full effects of the anesthesia to wear off where I trusted myself to be able to fully concentrate. Long story short... I left the hospital that day just after lunch time.  I was so happy to be home!  

I am healing nicely.  It has been a week and 3 days since surgery and I don't have much information.  I will know more after my follow up visits next week with both Dr. R and Dr. V.  I don't know yet if the medication is at the right dose and I just had one day (on Tuesday, one week after surgery) where I had tremors in my hands and wasn't sure if it was a blood sugar issue or synthroid issue.  I ate lunch and it went away, so for now, it looks like it was blood sugar.  Below is a picture of my incision.  The first is the morning after surgery, the 2nd is the day after that (about a week ago), and the third is today.  The human body amazes me.


I have had phone calls from long lost friends (okay not lost, just been a while since we got to chat), emails and cards from extended family members, and countless texts and FaceBook messages from family and friends checking in on me.  I am feeling so blessed and well taken care of.  Things really couldn't be going better right now.