My Diet...Through Poetry

Today marks Day 7 of 8,429 of my low-iodine diet.  Okay, that's an exaggeration.  But it sure seems like it will never end.  I have spent the past week trying to make it seem like a fun adventure, but the truth is that I'm having a really hard time getting through it.  In fact, I have found myself feeling downright grumpy at several points this week.  I miss simple things, like butter and cheese. And it takes every ounce of willpower I have not to sneak bites from that yellow bag of Lays potato chips in the pantry.  I actually LICKED up a tiny bit of pizza sauce that fell off the pizza cutter onto the counter top last night.  It's getting real around here, people. 

The rational part of me is trying my best to stay positive about it because I know this is what's best for my health. So in an effort to keep things upbeat, I have decided to express my feelings about this diet through a series of silly poems.  Enjoy :)

Your Pizza (a haiku)
Longingly I stare
At your pizza topped with cheese
Your plate, it haunts me

What's for Dinner? (a tanka)
I can't have that dish
Far too much dairy and salt
Shall we grill some meat?
Only 6 ounces allowed
With a random piece of fruit 

My Mom (a limerick)
There once was a woman from town
Who didn't want her daughter to frown
She baked up some bread 
So her girl would be fed
Could we please give this lady a crown?

My Mom...Take 2 (another limerick)
There once was a woman named Mary
Whose daughter was banned from all dairy
In a bag she did fill
Some lavosh made with dill
Now this diet seems not quite so scary

Well, wasn't that fun?  No, but seriously.  My family has been so super supportive during all of this, which has made it not as terrible as it could be.  Here is a picture of all the yummy iodine-free things my mom cooked up for me last week (those limericks speak the truth).  It is a huge reminder that I am loved and not alone on this journey.

Back to School

I returned back to school last week, and it was great!  I have had plenty of energy and it has been so nice to get back in to a regular routine again.  Not to mention, all of the thoughtful things my students and friends did to make my return such a happy one!  I truly have the best job ever.

Adventures in Low-Iodine Shopping

In preparation for my upcoming Radioactive Iodine (RAI) treatment, I am required to be on a low-iodine diet for the next 3 weeks.  As someone who has never had to be on such a restrictive diet before, this has been a very challenging task....but man, have I learned a LOT about the foods I eat.

At first, I was really grumpy about the fact that I wouldn't be able to eat most of the foods I love for so many days.  But by researching and learning more about why this diet is necessary, I have begun to realize that this is the one thing that I have complete control over during this war with those nasty little cancer cells.  The more aware I am of the foods I am eating, the better chance I will have at destroying the things that are trying to take over my body.  Watch out, you ugly little invaders.  This girl is on a mission!

The purpose of the RAI treatment is to ablate (or kill off) any remaining thyroid cells in my body, cancerous or not.  Something you may not know is that your thyroid cells are the only cells in your body that absorb iodine.  The pill that I will take on the day of my treatment will be full of iodine...but in a radioactive form.  The "poison" iodine will seek out and be absorbed into any thyroid cells it can find, which should destroy all of the cancer cells left.  

Here's why my diet is so important to this process.  If I am vigilant about staying away from any foods or ingredients that contain iodine, then I can "starve" all of those thyroid cells so that they will be quick to absorb the iodine from the dosage they give me the day of my treatment.  The tricky thing is that a BUNCH of the foods most of us eat everyday contain iodine in one form or another.  

For us, grocery shopping on a normal week with two young children can feel a little like a circus.  Add in the wait time to stop and carefully analyze every label on every package AND the travel time to multiple stores in search of specific foods, and it was definitely an exhausting adventure.  Luckily, the Butricks are not quitters.  I'm happy to report that we prevailed and conquered the low-iodine shopping list with only minor injuries and minimal tears.  Just kidding.  There were no injuries...this time.

With the exception of the creamer that sneaked its way into the picture, here are all the foods we found that I can eat for the next 3 weeks.  I actually think I can do this!

Recipe Suggestions???

Today I got my RAI treatment scheduled, so beginning Monday, I will be on a low-iodine diet for 2 weeks.  My endo gave me a list of foods I can and can't have during this diet...but I want to do what I can to avoid eating nothing but bananas and rice cakes for 2 weeks.  

I thought I'd see if anyone out there has access to some EASY, but tasty low-iodine recipes or meal ideas that I can add to my menu before I go shopping this weekend.  If you can help, great!  If not, I guess I should look on the bright side - bananas and rice cakes will be a great way to shed a few extra lbs!

Rays of Sunshine

For the past week, I have been kind of laying low.  I have spent a lot of time reading, grading, and binge watching Season 3 of Parenthood.  Oh, that reminds me - I need to add Kleenex to the grocery list this week (I mean, seriously...how do the Bravermans make me cry. Every. Single. Episode.)  It was just the perfect amount of relaxation and "me" time I needed to help heal myself body, mind, and soul. 

I can happily say that, with the exception of a couple of days, I have been feeling better and better every day.  One of the things I was worried about with losing my thyroid was feeling tired and lacking energy because that combo is no bueno when it comes to teaching 5th graders.  I have been super vigilant about how and when I take my medicine each day, so I'm hopeful that the doctor has chosen the correct dosage for me right off the bat.  

Today was the first day since surgery that I really crawled out from my hidey-hole and interacted with other human beings.  And it felt awesome!  I spent the morning with my teaching partner and our amazing students to view their animal habitat projects at the zoo.  It was so good to see them and hug them.  It made me super excited to get back into the classroom next week.  

Then, this afternoon, we decided that we couldn't let the gorgeous fall weather slip away from us, so we took the kids to the park and soaked up every drop of sunshine we could.  It refreshed my spirit and helped me to feel normal again.  It made me realize that, even when life seems gloomy, there are rays of sunshine that I have to focus on.  It's not always going to be easy, and I know I will lose my focus at times, but those rays will always be there.  Here are my rays.

Scars or scarves?

There it is.  There's no way around it.  Thyroid cancer leaves a lasting scar.  A scar that is in a very noticeable place.  As you can tell from the picture, mine is obviously a lot more noticeable right now because it is still healing, but I would be lying if I said I wasn't a little worried about what people will think when they see it.  I know that sounds incredibly shallow, but I have to keep things real here. It's a journey...right?

I especially thought about my scar today because I was scheduled to have my picture taken with the owner of Andy B's, a local bowling alley/entertainment center where we had my son's birthday party over the weekend.  They wanted to take a picture of me for their Facebook page...because I WON A TV!!!  Yep.  Sure did.  But, that's a story for another time. 

Anywho, I fretted about what I should wear for this picture because I wasn't sure if I wanted my visible scar to be seen by thousands of people on Andy B's Facebook page. I could cover it up with a scarf or try and dig up an old turtleneck from the closet archives...or I could just wear what I wanted and not give a hoot.  I opted to give zero hoots, and I've decided that's the attitude I'm going to strive to have during all of this.  

I found the following quote today that really inspired me:

I think I'm going to print it out and tape it to my mirror so I can see it as I'm getting ready everyday. 

Sure, I'm going to wear scarves from time to time because scarves are a great finishing accessory and they're awesome.  But if you see me wearing a scarf, just know that it's not because I'm trying to hide anything.  I'm going to also wear my scar as my latest accessory because it tells a story and it's my own personal reminder about my inner strength.  

Find Joy in Every New Day

This is my joy today.  What's yours?

Partial...er...Total Thyroidectomy

Surgery day was...weird.  And looooooooooooooooooong. I was told to check in at 8:30, so naturally, I was there at 8:15. I also hadn't had anything to eat or drink since 6:00 the night before. Then as luck would have it, they weren't ready to take me back to surgery until around 2:00, so I got to spend most of my day in what I called the surgery "holding cell" longing for a double cheeseburger, tots, and a milkshake from Sonic. I was hangry, people. HANGRY.  

Keep in mind, my only two previous hospital experiences were on the 5th floor maternity wing where everything was so quiet and calm...and private. There was definitely nothing private about this part of the hospital.  Loud talkers in the waiting room, people scarfing down their McDonald's IN FRONT OF other hangry people who hadn't eaten in hours, hearing Betty's entire medical history on the other side of the curtain.  It prompted me to take this selfie at about half-past-crazy:

When the surgeon finally came back to talk to me about the plan for the day, I was ready to get it all over with. He talked about the plan to only remove the right side of my thyroid, which I was prepared for. What I was NOT prepared for was for him to say that he would only be taking the right side since I had a hot nodule. SAY WHAT?!?!?! All this time I've been thinking I have this cold nodule that is more likely to be cancerous, and now the surgeon is telling me I have a hot nodule?  He could clearly see the confusion on our faces, so he pulled up the report and read it aloud: "You have a nodule on the right thyroid gland which is producing excess hormones."  So, yep.  That sounds like a hot nodule to me! I have no idea where the confusion about the type of nodule came from - If I was told incorrectly, or if I heard it wrong, or if it was just too much information for me to process at first and I was just making up my own stories.  Whatever the reason, this was the best case scenario because it is extremely rare for a hot nodule to be cancerous. Hooray! 

I was wheeled back and prepped for surgery...and took a good 2-3 hour nap.

When I woke up, they took me to my semi-private room where I would be staying the night (my roomie affectionately called it our suite at the Hilton). Curtis was there to meet me and fill me in on what the surgeon had told him.  During surgery, the doctor removed the right half as we had discussed. After removing it, it was sent to pathology to be examined further. Because the doctor was so confident that there were no malignancies in my nodule, especially with it being hot, he was preparing to stitch me back up and get me ready for recovery.  It was at that time that the lab called back with the surprising results that they had found cancer. The folks in pathology were even so surprised that they got a 2nd opinion on it to make sure. So, the doctor went back in to remove the rest of my thyroid. 

I am so, SO thankful that they found the cancer right away while I was still there in that operating room. I am thankful for the surgeon, the nurses, and those beautiful people in the lab who caught it immediately so that I could get it taken care of right then and there.

The Long and Winding Road

Here are a few things I have learned about thyroid cancer throughout this process:

• The diagnosis rate has increased over the past several years.
• Approximately 62,000 people will be diagnosed this year alone
• Women (especially those in my age bracket) are more likely than men to have it
• The type I have (papillary) accounts for about 80% of thyroid cancers

Diagnosing thyroid cancer can be a very tricky thing, and I consider myself extremely fortunate for it to have been discovered at all.  Here is the timeline of my long and winding road.

Spring of 2013:

I went in for a routine physical with my primary care physician.  Everything looked great at the appointment, however I mentioned to her that I had been having some heart palpitations, but I didn't know if they should be cause for concern or not.  She thought it might be a good idea to check further to make sure I didn't have any kind of heart condition, so she ordered for me to wear a heart monitor for a few weeks to see what might be going on.

Summer of 2013:

I wore the heart monitor for about 3 weeks, which entailed calling in the recordings on a landline phone every day...which meant I had to make several trips either to my parents' house or my husband's office.  Because, seriously - who has a landline phone these days? The monitor showed that I was having premature ventricular contractions, but that it was benign and would normally just be treated with a beta blocker.  I opted not to be put on the beta blocker though because we were hoping to have another baby in the near future.  

September 2013-May 2014:

This was happening...

...so my focus was completely elsewhere for a while and I didn't really think any more about my heart.

March 2015:

I went back for my first routine physical since the 2013 appointment because my ObGyn had been my primary care doctor during and immediately following my pregnancy.  My doctor asked about my heart palpitations, and I told her I was still having them daily but that I hadn't been concerned about them.  She decided to order a blood test just to check my TSH (Thyroid Stimulating Hormone) levels and make sure there wasn't anything going on with my thyroid.  I thought nothing of having this blood test done because I felt healthy, just completed a healthy pregnancy, and wasn't having any other symptoms to lead me to believe there was a problem.

Later that week, I received an email from my physician that my TSH levels were suppressed.  Because of that and the fact that I was having heart palpitations, she was concerned about hyperthyroidism.  I was then referred to Dr. Thomas, my endocrinologist.

April 2015:

I went in for my first visit with Dr. Thomas.  We reviewed my medical history, the results of the lab work, and any other symptoms I might be having.  Through our discussion, he was pretty confident that it was a classic case of hyperthyroidism, or Graves' Disease.  Basically, my thyroid was overproducing the hormone, which was causing my metabolism, heart rate, etc. to speed up.  

Towards the end of the appointment, he decided to do a quick "neck check" to feel my thyroid.  It was at that point that he discovered that I had a nodule on the right side of my thyroid.  When he had me feel it, I couldn't believe there was this lump on my neck that I had NO CLUE was there!  At that point, he wanted to do an ultrasound on it right away, so he took me back to another room to look at it further.  

During the ultrasound, he explained to me that there are two types of thyroid nodules: hot and cold.  Hot nodules act as a working part of the thyroid, so there is activity in them.  It is extremely rare for hot nodules to be cancerous. Cold nodules produce no activity at all...so basically just a lump serving no purpose.  It is more common to find cancer in a cold nodule, but most still turn up benign. The only way to tell what type of nodule I had was to do a 3 part thyroid uptake test, so he got me on the schedule for the following week.

Something interesting to know about thyroid cells that might help you understand how the uptake test works:  They are the only cells in the body that absorb iodine.  So, for this test I had to go in to radiology one afternoon to take a radioactive iodine tracer, then report back early the next morning for my first scan.  The purpose of the scan is to measure how much of the tracer was taken up by my thyroid.  They check it at certain time intervals after you take the pill, so I had to go back for the 2nd scan later that afternoon.  Painless process, but just more of a hassle to go back and forth to radiology for those two days.

This is the part of the journey that has gotten a little confusing for me.  I met with Dr. Thomas after the uptake test, and he wanted to put me on a beta blocker to regulate my symptoms of the heart palpitations.  He shared with me that my most recent blood test came back with even lower TSH levels than the previous one.  He also discussed the results of the uptake test with me.  For whatever reason, I left that appointment thinking that I had a cold nodule.  As I go further in to the story, you'll see why I am now unsure of what I understood.  Anyway, he wanted to see me back in a couple of months to do another blood test as well as a biopsy of the nodule.

August 26, 2015:

Biopsy day.  A biopsy of a thyroid nodule is also called a Fine Needle Aspiration (FNA). During the procedure, Dr. Thomas used a thin needle to collect 5 samples from the nodule. He numbed the area first with some extremely cold spray, so it was fairly painless. Just uncomfortable as I was able to feel the pressure from the needles.  

To ensure he was collecting from the right spot, he also used the ultrasound machine to locate the nodule during the procedure. It was when he showed the nodule to Curtis on the screen that I had pretty much confirmed in my mind that I had cancer. I remember his exact words: "Here, you can see the nodule and you can see how it is encapsulated on this side here.  Usually they are encapsulated on all sides, but you can see how this one appears to be growing out on this side."   Yeah.  That didn't sound good at all.  

I was told that, regardless of what the results happened to be, Dr. Thomas would want to discuss them with me over the phone and that I should expect to hear from him within the week. Let the nervous waiting begin...

August 28, 2015:

My phone rang and I immediately felt my heart drop.  The biopsy results were back and it was considered "atypia of undetermined significance".  In other words, the biopsy was abnormal, but they weren't able to conclude 100% that it was cancer.  Dr. Thomas wanted to speak to me in person that afternoon.  It's a good thing I work with the most amazing people ever who will drop everything to help because I literally hung up the phone, grabbed my purse, and walked out of my classroom.  

During the visit with Dr. Thomas, he explained that with what he saw on the ultrasound, the results from the biopsy, and the type of nodule I had, he wanted to remove it. Basically, there were three possible outcomes:  

1. Best case scenario: I could plan on having only the right side removed.  They would immediately send it to pathology, and if it came back as benign then I would still have the left side of my thyroid. 

2. Plan on having only the right side removed, but if malignancies are found while I'm in the operating room, they will do a full removal right then.

3. OR, there is a possibility that any malignancies might not turn up until the full report comes back in a week.  If that happens, you'll come back in for a 2nd surgery to remove the rest. (Which sounded like the WORST possible scenario to me!!)

4. Plan on a total thyroidectomy, then undergo the Radioactive Iodine treatment to kill all remaining thyroid cells, cancerous or not. 

I asked Dr. Thomas point blank what he thought I should do.  He told me that if he was giving this news to his sister or his wife, he would tell them to have the entire thyroid removed.  That was the moment I knew how serious he thought my situation was.  I could tell that he felt pretty confident that I had cancer.  I spent the rest of that weekend feeling absolutely sick to my stomach.

September 3, 2015:

I met with the surgeon (actually his nurse) to discuss the plan for my operation and schedule my surgery date.  At that appointment, I learned that the surgeon wanted to take the least aggressive route possible.  The plan was to remove the right side only and then have it checked out by pathology.  I wasn't sure how I felt about this plan because I had already spent the past week preparing myself to have a full thyroidectomy.  I explained my feelings to the nurse, but she went into further detail about some of the risks involved with rushing right in and removing the whole thing.  There is a higher risk of damaging the vocal cords, as well as these tiny little things called the parathyroid glands.  Apparently, these little guys are pretty important as they help the body regulate calcium.  There are two parathyroid glands on each side of the thyroid, so a partial removal ensures that there will be two working ones left while a full removal increases the risk of damaging all of them. I appreciated that information and put my trust in the fact that this surgeon is highly regarded and is an expert at what he does. Surgery was scheduled for September 25th.