Happy 2016! First Round of Follow-ups!

And to you, Mr. President.

Feliz año nuevo!

It certainly has been a while since my last update (about three months), so I figured it was time for a new post.  I think I let things slip because there haven't been a lot of thyroid-related events in my life as of late, which is probably a good thing.  But, new developments have occurred, so...might as well catch up!

I had a wonderful, relaxing break.  Thanksgiving was great, spent it with my own extended family and Emily's.  My sister was in town with her husband and my niece too, which was nice.

The office was closed the week between Christmas and New Year's Day, so it was ample opportunity to kick back and relax.  Vacation is never long enough though.

However, the Monday before Christmas I was due back at my endocrinologist's office for my 6-month blood test and checkup.  I was hoping for some good Christmas news!

The first blood test result came back the next day, for my TSH level.  If you recall from my Lesson in Blood post, this is the measure of if my thyroid hormone dosage is adequate.  This time, it was at an all-time high of 4.3.  Not a big deal, but it meant my doctor had to prescribe a new dosage of levothyroxine, going up from 125mcg to 137mcg.  My pill went from brown to blue.  Luckily, my inadequate level of thyroid hormones was simply in the bloodwork; I had not been feeling any symptoms of hypothyroidism up to that point.

Que delicioso!

The next result came in the next week, no doubt delayed due to the holidays.  This was the super important one: my Thyroglobulin (Th) level.  Th is the protein produced by thyroid tissue, whether cancerous or not; any rise in this likely means the existence of cancer, since non-cancerous thyroid tissue doesn't grow back.

Luckily, this number was at an all-time low of <0.2.  While the goal of this number is to be undetectable, my doctor was happy with this result.  From what I've read, it can take as much as a whole year after RAI to reach the final Th level, since the dying thyroid tissue caused by the RAI causes a spike in the release of Th.

It is important to note that Th levels are useful numbers, but are more useful when looked at over time.  That way, you can track changes (specifically increases) in the Th level.

Here is my timeline so far:
3.5 weeks post-surgery: 1.3 (unstimulated)
Day of RAI: 8.8 (stimulated by Thyrogen)
3 days post RAI: 12.9 (stimulated by leftover effects of Thyrogen, and release of Th by dying thyroid cells)
6 months post-surgery: <0.2 (unstimulated)

All in all, a good looking path so far.  My doctor also ordered a routine ultrasound, to see what my thyroid bed looked like post-surgery, so I had it done on January 15th.

A couple days later, I got the results via e-mail with my endocrinologist.  While not the perfect result I was hoping for, there seems to be no cause for alarm.

According to her discussion with the radiologist who examined my ultrasound imaging, the film showed "residual tissue, probably thyroid."  Most likely it was just left over from the surgery, which is common, and the radioactive iodine did not fully kill it yet.  They agreed the best course of action was to continue monitoring my blood Th levels (which look great so far) and to ultrasound again in 6 months.  At that time, they will try to confirm that the tissue is either stable in size, or better yet, shrinking and showing signs of further atrophy from the RAI.

I know that all thyroidectomies never result in 100% removal of all thyroid tissue, so while this isn't a big shocker, I guess I was hoping that I was in the camp where no residual thyroid tissue would remain at this point after the RAI treatment.  I have read in various articles that it could take up to a year after RAI for it do to its full work on killing all residual thyroid tissue, so I don't think I'm out of the norm for people 6 months post-treatment for thyroid cancer.

In any case, the better news is that the radiologist did not feel the residual tissue appeared cancerous, and there were no signs of lymph node metastasis, so all in all, I'm happy with the results and looking forward to continuing with life!  Emily and I are trying to plan trips in 2016, since we haven't been able to take our official "post-cancer" celebratory trip, so...stuff to look forward to!

Yes it does, meme frog.

A Lesson in Blood

Salutations, reader!  It has been a little while since I've posted anything of substance, so I decided to post a little update on what has been going on with me, and segue into a discussion on something I know you all want to know about: my blood.

Blood?  Not now, Charlie.

Things have been good over the last month or so. Got to see two shows at the Hollywood Bowl, went up to San Francisco to visit my sister and her family, and things have been fairly quiet at work, which is nice for a change.

On Monday (Sept 21st), I had my 3-month post-surgery blood draw.  After surgery, the start of my levothyroxine medication, the administration of Thyrogen, and the radioactive iodine treatment, this was the first time that my endocrinologist could get a clean, unadulterated read on my blood levels, since all of that stuff can temporarily tweak them.

I'll run through each of the important levels that my doctor has been monitoring, and their importance.

Thyroid Stimulating Hormone (TSH)

TSH is one of the most important factors, in terms of preventing the recurrence of thyroid cancer.  In my "LID Week 1 Post-Mortem" post from July, I went over what it was, but allow me to recap it.

TSH is part of what can be described as a negative feedback loop.  The pituitary gland is what produces TSH and releases it into the blood.  It does this when it cannot detect enough thyroid hormone in the bloodstream.  The TSH "wakes up" any thyroid cells in the body and stimulates them to begin convert iodine into thyroid hormone (T4).  TSH really serves no other purpose to the body, other than to cause thyroid cells to produce T4.

If you understand this meme, then I hate you for liking System of a Down.

I have been taking levothyroxine (synthetic T4) this whole time in order to replace the thyroid cells that I used to have that produced T4 themselves.  Therefore, the primary purpose of taking my hormone meds every morning is to ensure that I have enough thyroid hormone to regulate my metabolism and energy.  The secondary purpose however, is to ensure my pituitary gland doesn't think I need more T4 in my system, and therefore to ensure that it does not release TSH.

Why is that important?  Well, at this point, especially after taking the radioactive iodine (RAI), it is assumed that I have little to no more thyroid cells left in my body.  But what if I did have a few cells?  Well, then any TSH would stimulate them to produce T4.  Not a big deal, I could always use a little more T4.  But what if those remaining cells are cancerous?  No bueno, man.

So the second point of taking synthetic T4 is to keep TSH low, and therefore make sure that my pituitary gland is not stimulating any cancerous thyroid cells left in my body.  If a leftover cancerous cell isn't getting stimulated, it's far less likely to grow and become problem.

My blood reading this week was 0.43 mcIU/mL.  I know what you're thinking: "Solid number, Walter, I wish mine was as good."  Don't be jealous.  For those of you not in the thyroid-know, I'll explain.  "Standard range" for someone without thyroid cancer is 0.3-4.7.  Great, so I'm at least within normal range.  The norm for cancer patients is different, though.   According to current American Thyroid Association (ATA) guidelines, latest publication in 2009, the target range depends on the risk.  For high-risk or intermediate-risk patients, the target is below 0.1.  For low-risk patients like myself, regardless of whether or not RAI was administered, the target is 0.1-0.5.

It's important to note that TSH is not really considered a way to detect thyroid cancer.  TSH is typically normal when someone has it.  For example, before my surgery, my TSH measured between 0.5-0.7, well within the normal limits.

Great, I was within my target range!

Thyroglobulin, and Thyroglobulin Antibodies

The second vital reading is Thyroglobulin (Tg), along with Thyroglobulin Antibodies (Tg AB).  While TSH is more of a cancer preventing measurement, Tg is how you monitor recurrence of cancer.  So, it's kind of a big deal.

I'm Thyroglobulin Burgundy?

All thyroid cells produce Tg.  Therefore, prior to a thyroidectomy, measuring Tg is essentially useless.  For most, Tg won't really tell you anything about the presence of cancer, or its staging/severity.  From what I've read, the only time it may help is if a Tg reading is off the charts (above the standard rage of 3.0 - 40.0 ng/mL), which can indicate significant spread to several other organs.  However, as I said, in most cases this isn't even measured before the thyroid is removed, since all thyroid cells, cancerous or not, produce Tg.

After surgery however, this measure becomes absolutely key.  Once the thyroid is removed, it can be seen a direct measure of cancer activity in the body.  After RAI, it is assumed that one's Tg measure will be extremely low, perhaps even undetectable.  This makes sense because the RAI should have destroyed every last thyroid cell, cancerous or not.  Therefore, by monitoring this number through regular follow-up, any increase in the amount becomes immediately suspicious of cancer recurrence, which necessitates follow-up via physical inspection, ultrasound, whole body scan, or some other method.

In cases where people did not receive RAI, establishing a "zero" baseline becomes a bit harder.  Since residual thyroid tissue is always left over after a thyroidectomy, the number never becomes close to zero.  Therefore, doctors have to establish a baseline amount, and then monitor for spikes in the figure after that.  Even then, spikes may not indicate cancer.  Following up on Tg levels without RAI can be a bit more nuanced and have grey area; however, this alone is not reason enough to favor doing RAI over skipping it, according to several medical articles that I've read.

So, what were my numbers?  Well, my doctor felt that the 3-month point was too early to get a reliable Tg reading on my blood due to potential interference from the Thyrogen shots and the RAI, so we skipped it this time around.  However, here are the numbers I have seen from previous draws:

First blood draw, post-surgery: 1.3 ng/mL
- 3.5 weeks of levothyroxine
- I've seen many studies try to predict what level of post-thyroidectomy Tg can be indicative of recurrence of the cancer down the road.  I've seen as low as 1.3, but have also seen 4.2 and >50.  It's all over the place, man.  None of my doctors seemed to be alarmed by my level, so I guess it was fine.

Post-Thyrogen, pre-RAI: 8.8 ng/mL
- On the morning of my RAI treatment, after 2 days of Thyrogen injections
- Oh no, it went up!  This is fine.  Because Thyrogen increases TSH to ungodly levels, that much TSH causes any existing thyroid cells to be in overdrive.  As a result, they release way more Tg.  This was my first "stimulated Tg" reading, as opposed to my previous reading, which was "unstimulated."  Stimulated Tg becomes more important down the road if cancer recurrence is suspected, otherwise this should be the only time I get a stimulated Tg reading.

5 days post-RAI: 12.9 ng/mL
- 5 days after taking my RAI dose
- Up slightly again!  This makes sense though, because: A) my TSH is still slightly elevated from the Thyrogen in the prior week, and B) the RAI was actively destroying my thyroid cells at this point.  When thyroid cells die, they release Tg.

So, we'll see what my Tg reading is 3 months from now, to establish a true post-RAI baseline.

Tg AB, on the other hand, only means something if it is on the high side. The presence of Tg AB can interfere with Tg readings, and make them less reliable, particularly if they are found in high quantities.  Tg AB may be present as the result of the body's defense against thyroid cancer, or against other thyroid disorders like Hashimoto's disease where thyroid cells or the organ itself is malfunctioning.

In any case, if Tg AB is high, then it makes the Tg measurement less valuable, since Tg AB causes interference with lab readings of Tg.  If high Tg AB values persist after a thyroidectomy and subsequent RAI, it could suggest the presence of residual thyroid cancer, or underlying thyroid disease like Hashimotos'.

The acceptable range of Tg AB is <4.0 IU/mL.  The three times mine has been measured, I have been at 0.9.  So, all good there!

Free T4

T4, as I described earlier, is the primary thyroid hormone.  Levothyroxine pills (or their brand name equivalents) are synthetic T4 hormone.  The thyroid primarily produces T4 over T3, in about an 80/20 ratio.

As the thyroid takes in iodine and converts it into T4, it then releases it into the bloodstream, where it circulates around the entire body.  Most of the T4 molecules bind themselves to cellular receptors in specific organs, such as the liver, kidney, and muscles.  In these organs, one iodine molecule is released, effectively converting the T4 into T3.  From there, T3 circulates to the rest of the organs and tissues in the body, which regulates the body's overall metabolism of carbohyrdrates, proteins, and fats, as well as the stimulation of growth and development, both physically and mentally.  Important stuff!

When I said that most of the T4 molecules produced by the thyroid get bound to organs, I wasn't kidding.  About 99% of T4 gets bound to organs or various transport proteins, but that remaining 1% ends up floating freely in the bloodstream, essentially homeless.  This is Free T4, which can be measured in a blood draw.  It can be seen as the concentration of "available" T4 that can be taken in by any organs that need a fresh supply.  By measuring this Free T4, doctors can assess if the patient is getting an adequate supply of synthetic T4 from their pills, and adjust as needed.  Many endocrinologists believe that the measurement of free T4 is more important than free T3.

I've only had my free T4 measured twice.  The acceptable range is 0.8 - 1.6 ng/dL.  My values have been 2.1 right after my surgery, and 1.7 more recently.  Therefore, everything looks good here!

Free T3

T3 is another thyroid hormone that is created by the thyroid in smaller quantities.  As discussed above, the primary source of T3, is the body itself, which creates T3 by converting T4.  T3 is also available as a synthetic pill (generic name Cytomel), but I'm not currently on it, so I can't really speak about it with much authority.  In addition, my doctor isn't currently measuring my Free T3, so I don't have any blood readings to share with you either.

T3 is the primary "active ingredient" in stimulating your metabolism.  Much research suggests that T4's main reason to exist is to be converted into T3 so that the rest of the body can use it.  I have read of patients who have been diagnosed as "poor converters" of T4 to T3, and as a result experience symptoms of hypothyroidism despite being on an adequate does of T4.  In those cases, I know some people end up taking a tandem of T4 and T3 pills.  I don't appear to be in that boat so far, so all good to me.

I know.  No more medical jargon for today.

And so, in summary, all my blood tests have been pretty much on the money so far.  Hopefully everything stays that way!  I hope you all are doing well!

-W

Happy Thyroid Cancer Awareness Month!

September is upon us, and you know what that means...it's THYROID CANCER AWARENESS MONTH!!!!!

F*cking Chuck Norris.

Ok, you probably didn't know that.  I certainly wouldn't have if I hadn't had the summer that I had.

So, in celebration of Thyroid Cancer Awareness month, I thought I'd put together a list of helpful links & resources that I found during my time with ThyCa that could help the potential internet traveler that comes across my blog in search of answers.  (Note: ThyCa is what the cool people call Thyroid Cancer).

Here's my list of links, with my little blurbs or reviews on them.

Thyroid Cancer Survivors Association - http://www.thyca.org/

This is pretty much considered the official site for ThyCa.  My nuclear medicine doctor even pointed me to this site when he was prescribing the Low Iodine Diet to me.  They have an international network with local support groups, and tons of resources that you can download for free (like the Low Iodine Cookbook).  Definitely a good starting place for the basic information, laid out very simply.

Thyroid Cancer Canada - http://www.thyroidcancercanada.org/

Same as above, but if love hockey.  Lots of helpful information here though, you just need to ignore the Canadian-specific stuff and you'll be good.  I found their newsletter material to be a good place to get good information too (http://www.thyroidcancercanada.org/thry-vors-news-(seasonal-newsletter).php)

Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer - http://www.thyca.org/download/document/409/DTCguidelines.pdf
This is the big one.  Yeah, it's 48 pages written in medical journal jargon, but this is the place to go if you want the current definitive guidelines on what the accepted steps are toward finding and diagnosing thyroid nodules, how to treat them should they be cancerous, and how to treat them post-surgery.  Searching websites is fine, but ATA guides like this are pretty much the law of the land in the medical field, until newer guidelines are published.  This link is to the most recent published guidelines (2009), but word on the street is that newer guidelines are closer to being published.  Most people believe that the newer guidelines will reduce the use of radioactive iodine and say that surgery is sufficient treatment for thyroid cancer, but it is all speculation until the ATA publishes something.
Update (10/16/15): The new 2015 guidelines have been published!  The link above should take you to the latest version...all 411 pages of it.

National Institute of Health Low Iodine Diet Guidelines - http://www.cc.nih.gov/ccc/patient_education/pepubs/lo_io_diet.pdf

In addition to the ThyCa.org linka bove, this was a very good place to start if you're going on the LID.  This was the most recent version of the guidelines I could find (published January 2014); an older version gets linked to a lot, but this is the latest and greatest I could find.

Inspire ThyCa - www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/

Inspire is a message board for people with different types of cancer, where they can share stores, swap advice, etc.  I did find this pretty helpful, but it is absolutely important to take things here with a grain of salt, for two reason: 1) These are patients that are posting here, not doctors, so the more medical and scientific the advice, the more you need to be careful, and 2) Being on these boards can paint a very bleak picture of ThyCa sometimes.  You have to keep in mind that people who had simple or uneventful experiences with ThyCa are less likely to spend their post-treatment time browsing message boards.  They tend to be filled with people who are experience on-going complications with their treatment, which is why they're active on a board in the first place.

Thyroid Cancer Blog - http://thyroidcancerblog.com/

This blog was written by a guy who got diagnosed in 2009.  He hasn't posted since 2013, but his blog is very good from an informational standpoint, almost like a reporter.  He laid out the steps of his treatment very well, and I ended up writing my blog in a similar style.  Very good and detailed read.

My Experience with Thyroid Cancer - http://caaaait.blogspot.com/

This was the other blog that I read from cover to cover in the leadup to my treatment.  The girl who wrote this had more extensive spread than the blog above, and as a result still has little inoperable bits of cancer that remain to this day (but appear to be "dormant").  However, she wrote her blog from more of an internal/emotional perspective of going through multiple surgeries and her treatment, and her writing is now more focused on her post-treatment life and how she's changing her life for the better, regardless of what cancer might be left in her.  I even exchanged e-mails with her to thank her for her writing, and she was very nice!  An excellent read, I recommend even if you don't have ThyCa.

Blog for a Cure ThyCa - http://www.blogforacure.com/members.php?type=thyroid+cancer

This is a site that compiles several blogs, although many of them are not too active.

That's all the links I can think of for now...hopefully that helps you cut down on your Google use. :)

I see your true colors...shining through.

[Note: I may edit this post in the future to include other links as I think of / remember them.]

That. Just. Happened.

I thought it would be a fun exercise to write out all of the appointments I've had since this whole thing started, now that I can start to look back and reflect on everything.  For someone who is about to go through this, maybe it'll give you an example timeline of what to expect.

Here you go, my remembrance of 2015 (so far).  Every single line, except for the one that says "via phone," represents an appointment at a doctor's office or hospital:

01/07/15: Initial Primary Care Physician (PCP) visit, received diagnosis of thyroid nodules
01/08/15: Ultrasound of thyroid nodules, received diagnosis of "suspicious for thyroid cancer," referred to surgeon
01/12/15: Ear, Nose & Throat (ENT) surgeon consultation, referred to radiologist for ultrasound-guided Fine Needle Aspiration Biopsy (FNAB)
01/21/15: Radiologist performed FNAB
01/27/15: Received biopsy result of "benign," via phone
02/05/15: ENT surgeon consultation, instructions to repeat ultrasound in 3 months
04/17/15: Repeat ultrasound of thyroid nodules
04/28/15: ENT surgeon consultation, thyroid nodules diagnosed as showing "minor growth," referred to radiologist for second FNAB
05/14/15: Radiologist performs second FNAB
05/21/15: ENT surgeon consultation, received biopsy result of "Papillary Thyroid Carcinoma"
05/29/15: Endocrinologist (Endo) #1 consultation
06/01/15: ENT surgeon #2, second opinion
06/03/15: ENT surgeon, pre-operative consultation
06/03/15: Endo #2 consultation
06/04/15: Endo #3 consultation (ended up choosing this one)
06/08/15: PCP pre-operative physical exam and blood draw
06/18/15: Total Thyroidectomy
06/23/15: ENT surgeon, first post-operative exam
06/29/15: Endo, post-operative exam and blood draw, received Stage 1 diagnosis
07/01/15: ENT surgeon, second post-operative exam and bandage removal
07/02/15: Nuclear Medicine, consultation
07/14/15: Endo, blood draw to check hormone levels
07/21/15: ENT surgeon, third post-operative exam
07/29/15: Endo, first Thyrogen injection
07/30/15: Endo, second Thyrogen injection
07/31/15: Pre-treatment blood draw
07/31/15: Nuclear Medicine, received 52.1 mCi of Radioactive Iodine I-131 (RAI)
08/04/15: Post-treatment blood draw
08/05/15: Nuclear Medicine, Whole Body Scan (WBS)
08/10/15: Received WBS result of no metastasis

I'm not even upset.  I'm actually impressed.

I thought the list would be long...but not that long.

Granted, it's a little bit longer because I decided to "audition" 3 different endocrinologists, and get a second opinion with another ENT, even though I was already very happy with my primary ENT surgeon.  And the fact that I got an initial false negative diagnosis also lengthens things a bit.  But yeah, that is a glimpse as to how my 2015 has been so far.  I hope yours has had less doctors' appointments! :)

-W

All Clear

It's been a while since I've posted.  It's because I've been waiting for the results of my whole body scan.  I'll get to that in a second, but first I'll try to catch up on what's been going on.

On Tuesday, I had my post-RAI blood draw, and then on Wednesday, I had my big Whole Body Scan (WBS).  I got to UCLA Santa Monica at around 7:30am, and waited a bit before getting in.

The whole scan took 35 minutes.  I just lied there, trying not to fall asleep, as the machine did its thing.  The scanner pretty much came within about an inch of my face.  I don't tend to get claustrophobic, but it definitely took a few minutes to get used to it.

"I'm not touching you!  I'm not touching you!"

The scanner spent about 10 minutes at the positive you see above, and then it slowly, millimeter by millimeter, started moving down toward my toes, with robotic whizzing and whirring sounds going on the whole time.  I could hear the nurses moving around while the scanner was going, and could see them in the corner of my eye sometimes, but I wasn't allowed to move, so I just had to sit there in awkward silence.

It finished up, the nurse shook my hand, and I went home.  That was it.  They didn't share the results with me, even though I had heard that some people get the results immediately.  Oh well, no one was expecting any surprises, so I thought nothing of it and went on with my life.

On Thursday morning, my quarantine was lifted!  While I had been eating meals with my parents, I had been limiting my total time with them each day to about an hour, for their safety.  But Thursday morning was the end of it all.  I went to see Ant-Man with my mom, which was fun.  The next day I took her to see Mission Impossible: Rogue Nation, which was pretty solid.

I heard Tom Cruise filmed this stunt without any wires.

I spent the weekend with family, celebrating my cousin's birthday.  One of my cousins even gave me this pin:

Mini Thyroid!

It was from a company named I Heart Guts, which makes cute little merchandise based on body organs.  It's pretty hilarious, I highly recommend it (iheartguts.com)!

I returned to work yesterday (Monday), getting caught up on the work that I missed.  However, the biggest news came in the afternoon, when I got a message from my endocrinologist:

"The result was as expected - residual tissue in the thyroid bed which always remains after surgery, and no distant metastases."

Woohoo!  But wait, what does it all mean?  Well, allow me to explain.

The whole body scan works to detect where any remaining radioactive iodine is in the body after taking the RAI.  It produces an image, showing the location of any remaining radioactive iodine.

The one place you would expect to see light up would be the "thyroid bed," which is the location of where the thyroid used to sit.  This is because it is impossible for a surgeon to remove 100% of all thyroid tissue.  It would be too difficult to do so without compromising the other structures in the neck (vocal chord nerves, parathyroid glands, muscle, etc.).  Therefore, the RAI goes straight to any remaining tissue there and works over several months to kill off what is left.

Other places that can light up during this scan are areas of the digestive tract, the salivary glands, and the bladder.  The digestive tract takes a hit (although hopefully minimal) since this is where the RAI pill first went when you take the dose.  The salivary glands are also obviously affected, since I've mentioned before that they can take up some of the RAI.  The bladder is also expected to show some traces, since as I've mentioned in previous posts, almost all of the excess RAI that is not taken up by thyroid cells is excreted through urine.

A clean RAI scan could look something like this:

Note: Sample from internet, NOT my scan.

What you're hoping not to see from these scans is metastasis to other organs.  The most common locations for metastasis are lymph nodes, lungs, and bones.

Sample scan shows lymph nodes and lungs "lighting up," which is no bueno.

However, while you don't want metastasis, it's not necessarily the worst thing in the world in many cases.  This is where the whole "thyroid cancer is the most forgiving" phrase can be a good thing.

If thyroid cancer metastasizes to a distance location, like the lungs for example, it does NOT become lung cancer; it is simply metastatic thyroid cancer in the lungs.  They are cancerous thyroid cells that moved into the lungs, and the treatment would still be radioactive iodine.  And if the lungs light up during the scan, then it means that the RAI found the thyroid cells, and are now actively working to kill them.

Obviously, metastasis is scary, and there are exceptions when the RAI isn't able to attack them, but for most people, the RAI is sufficient.  Maybe a second dose is needed down the line, but had my lungs or other distant organs shown signs of metastasis, the treatment plan would have been to wait 6 months for the RAI to do its job, and then re-scan.

However, I got the ALL CLEAR!  

Thanks, Captain Solo.

To be honest, the news is almost a bit anti-climactic.  As arduous and challenging as this journey has been so far, I guess I thought getting this message would make me break out into song and dance.

J. C. V. D.

But I guess I just feel more...content?  Relieved?  Not sure what the word is.

Perhaps it's because thyroid cancer is one of the peskiest cancers around, with an overall recurrence rate between 20-30%.  However, statistics that I've seen online for Stage 1 has a recurrence rate more like 2-5%, so I'm probably in the clear.  So maybe I'm trying to prepare myself for the long haul?

I guess I've started to reflect on everything that's happened to me, all of the ups and downs, all of the support that I've gotten from family, friends, co-workers, and even strangers.  Maybe this is the proverbial shock that comes after experiencing something crazy, and everything will start to hit me later on.  In any case, I believe a celebration is in order.

I'm sorry, Charlie Murphy.

Going forward, I'll have blood tests and ultrasounds to monitor everything and make sure that it doesn't come back.  For the first year, the tests will be every 3 months.  I think the standard is about 5 years of monitoring before a doctor is willing to say the word "cured."  

I'll write more about blood tests and what to look for in results down the road.  But for now, "remission "is the word, I guess.  

-W

I can't wait for Paul Blart 3: Rogue Nation.

Shower, Pee, & Sour Candy

The end of my most radioactive period approaches.  So, seems like a good time to check in with an update.

CAUTION: DO NOT APPROACH!

There are essentially two phases to the period after taking the RAI dose.  The length of time can vary depending on the dosage rate, but my plan of attack is specifically for the 50 mCi that I received.

Immediately after coming home, there are things that need to be done for the first 24-48 hours, according to most literature.  I decided to carry these things on until Sunday night, which would put me more at 72 hours.  They include:

- Constant drinking of water

While the point of RAI is for the iodine to latch on to all thyroid tissue, it goes without saying that not all of it will be needed.  In fact, a majority of it won't be needed.  So, what does the body do with all of that excess RAI?  It excretes it through the kidneys, of course.  Therefore, the first thing you've got to do after taking the dose is pound water.  And pee it out.  ASAP.

Of all the excess radioactivity that is expelled out of the body, urine is the one that harbors the most radioactivity, by far.  Therefore, keeping the body hydrated so it can pee out the radioactivity is key.  As soon as you gotta go, then go.  No use keeping all that radioactivity swimming around in your bladder, which is a risky play to say the least.  And you need to keep any of that urine from splashing around.  For guys, that means peeing sitting down.

It's too bad, I really enjoy using the bottom right method.

Having your own bathroom that you don't share with someone else is key during the post-RAI isolation, which I luckily have at my parents house.

- Suck on sour candies

After urine, saliva is the next place that radioactivity can collect, putting the salivary glands at an elevated risk.  Therefore, the best thing you can do is to keep the glands producing saliva, and continuously pumping the saliva out.  If not, besides the obvious risk of radioactivity sitting idly in your salivary glands, you risk salivary gland swelling/tenderness, salivary gland stones/blockages, etc.  So, I purchased some sugar-free lemon candies from the Dollar Tree, as well as some Ice Breakers Sours (important to avoid Red Dye #3, as I am still on the LID), also sugar-free.  Figured if I was going to be tearing up my mouth with sour candies, might as well not be bombarding my body with sugar too.

Sadly, I could not find these at the supermarket.

My doctor advised me to start eating sour candies 2 hours after the RAI (I wasn't allowed to eat anything until 2 hours after the RAI, so that made sense), and to do it every few hours after that for the next 48 hours.  While most doctors recommend this, there have been a few studies showing that the use of sour candies should be delayed, not starting until 24 hours after the RAI, since they found it actually increased radioactive uptake into the salivary glands.  Here is a link to one such study: http://jnm.snmjournals.org/content/46/12/2119.full.pdf.  However, according to the research that I did, there is no conclusive evidence either way, so generally the consensus is to do it right away.  And that's what I did.

I've started to get a bit of tenderness/swelling under the left side of my tongue, but other than that, I think I've been OK on the salivary gland front so far.

- Shower...a lot

The next place radioactivity can be expelled is through sweat and body oils.  It is because of this that my doctor recommended washing my clothes for the first few days separately, and then sequestering them for 2 weeks to allow all of the radioactivity to die off.  Instead, I just wore old worn out clothes with the intent of throwing them away.

But, because of the trace radioactivity from sweat/oil, it is recommended that you shower at least 2x a day.  So I did that, and felt fresh and clean.  Although, with California in a draught, I felt a bit wasteful.

The struggle is real.

In addition, I have been eating off of paper plates with plastic utensils, and throwing them away afterward.  I figured that was safer than spreading radioactivity all up on my parents' kitchen sink.

- Isolation

That's my soundtrack for the next week.  While I've been talking about radioactivity as some kind of residue that exists in bodily fluids, there is also the simple danger of proximity.  For the weekend, I've had to keep at least 3 feet away from everybody, other than quick, fleeting moments.  So, while I've kept my bedroom door open to speak with my parents occasionally, I have definitely not been hanging out with them.

Starting tomorrow morning, I can be spend about an hour with people as long as they are at least 6 feet away from me, with Thursday morning being the official lifting of all proximity restrictions.  Except for when pregnant women or children are involved.  Literature varies as far as the safety time for that, but I'm going to go with the most that I've seen for my dosage level, which is 14 days.

So, it's been a weekend of web surfing, reading, eating and drinking water by myself in the room I grew up in.  I thought it'd be a nice reset, a chance to just take it easy.  But I'm getting kind of stir crazy, to be honest.

However, in addition to all the milestones that I am going to reach this week above, there is a big restriction that ends tonight.  Starting tomorrow morning, I am no longer on the low iodine diet!  Woohoo!

You said it, big guy.

That's pretty much it, my gameplan for the week.  All restrictions (other than staying away from children and pregnant women) lift starting Thursday morning.  Until then, it's just more hanging out by myself.

Next big thing is my post-RAI full body scan on Wednesday morning.  It's actually potentially the last big thing.  By scanning my body to see where the radioactive iodine has collected, that's where you can pretty accurately check if the cancer had metastasized anywhere else, like the lymph nodes, lungs, bone, etc.  While all pathology and indications so far has concluded that such spread hasn't occurred, this will provide final conclusiveness.  I'm pretty calm about it, since like I said, all the signs look pretty good, but I'll probably be nervous that morning.  

Wish me luck!

-W

Welcome to the New Age

Before you begin reading, I offer you a soundtrack for this blog entry:



I actually really like that song, and Imagine Dragons in general.  The video itself though...very interesting.

So that's where you've been hiding, Lou Diamond Philipps.

Today is the day of my radioactive iodine treatment, almost exactly 6 weeks after my total thyroidectomy.  I've already taken the RAI and am coming to you live from my isolation room (aka my bedroom at my parents' house).  But first, I'll bring you back to a few days ago.

On Wednesday morning, my first day off of work, I woke up and headed to my endocrinologists office to receive my first of two Thyrogen injections.  In a small minority of patients, side effects can include headache and nausea.  While I was super worried that I might experience that, all I got was some arm muscle soreness, akin to a flu shot.

That's right, I said arm muscle soreness.  For some reason, despite online documentation saying that the injections were to occur in the buttocks, UCLA Endocrinology just injects into the arms.  Woohoo!  So I got my Wednesday shot in my right arm, and went home, packing and prepping for my isolation at home.  Emily came over and cooked me a ton of low iodine pasta, since I have to stay on the LID through Sunday night.

On Thursday morning, I set out to get my second shot.  I arrived at the office to see a fire drill taking place; I ended up getting the shot 30 minutes later than my appointment time.  Oh well.

An alarming site at the UCLA medical building, especially for a drill.

After that, I got a dental cleaning done (some online literature suggested getting a dental cleaning done before RAI, for reasons that will be evident later), and went to my parents house, had dinner, and rested up for my big date with destiny.

My appointment had somehow been moved to 10am (formerly 11am), and the only reason I even realized this was because UCLA left me a voicemail appointment reminder.  Yikes, good thing they called.  And prior to the appointment with nuclear medicine, I had to get my blood drawn at the walk-in UCLA lab.  So, I woke up around 5am and had breakfast around 5:30am.  Why so early?  The doctor had told me not to eat anything for about 4 hours before the appointment.

Finishing breakfast at 6am, I got ready and left.  I couldn't eat anything for about 4 hours before taking the RAI, hence the early start to my day.  After a quick detour to my apartment to pick up a few things I had forgotten, I got to the UCLA lab at around 8:30am.  I ended up waiting almost 45 minutes, but finally got my blood drawn and walked across the street to the main UCLA Santa Monica hospital, where the nuclear medicine department was located.

The initial blood draw was ordered by the nuclear medicine doctor to get a baseline measurement on two things: TSH and Thyroglobulin.  TSH, which I explained in my previous post, was at this point undoubtedly elevated due to the Thyrogen shots, so this test just acted as a double-check of that.  Thyroglobulin is something I haven't explained before, but it's pretty simple.

Thyroglobulin is an easily detectable protein that any active thyroid cells produce and release into the blood.  My reading a few weeks ago was 1.3, which is quite low, but after RAI, that number is expected to decrease even more, perhaps to an undetectable level.  Thyroglobulin serves as a very easy cancer marker to test for; if any thyroid cancer cells return, then they too (like healthy thyroid cells) will release thyroglobulin, so any significant spike in that number will indicate a recurrence.

I walked into the reception area for nuclear medicine about 40 minutes early, got checked in, and started to wait.  I guess they were ready for me, because by about 9:30am, they called me in.

From stories I've heard, the next steps would involve people in hazmat suits handing me a pill and running away from me while I swallow the pill.  I guess safety standards have relaxed in recent years, because two nurses met with me in the hallway of the nuclear medicine area, with the lead container already sitting on tray.  I had a seat, talked to Dr. Gupta about some last-minute safety questions that I had, signed a form, and then it was go time.

This is where I keep my medicine.  Excessive?

I swallowed the pill with a whole glass of water and left.  Seriously.  It was that anti-climactic.

I jumped into my car while chugging water and headed home.  Luckily, my sister had given me this nifty gift to store maximum water:

Say hello to my Bubba.

Seriously, the brand name is Bubba.  Why did I drink so much water?  I'll post more later this weekend about the joys of nuclear isolation, and the safety precautions I have to take to get all the unneeded radioactivity out of me ASAP.

Why couldn't the pill have come in this form???

Until then...

-W

LID Week 1 Post-Mortem, brought to you by Thyrogen

Well, I'm half-way through my LID, and things are going well!  While I do miss cheese and seafood and the like, I can't say that I've been suffering through this at all.  I haven't lost weight yet like I hoped I would, but hey, you can't win them all.

I've gotten by in large part due to Emily's cooking.  She studied up on the LID and made some great meals for us, like:

- Spaghetti with tomatoes and lentils
- Homemade hummus
- Whole roasted chicken with rice
- Chicken noodle soup
- Sweet and sour chicken wings

I also have a newly discovered love of oatmeal, which I've been having every morning at work with frozen berries, agave nectar, and coconut milk (free of sea salt or carrageenan).

And contrary to my belief, it's possible to have a social life while on the LID!  On Saturday, Emily and I went to Rosenthal Wine in Malibu to celebrate her cousin's birthday.  And then, after that, we went to the Hollywood Bowl for the Tchaikovsky Fireworks Spectacular, with conductor Gustavo Dudamel, the LA Philharmonic, and special guest the USC Trojan Marching band!  If you look closely at the photo below, you can see the marching band lined up around the front of the stage.

The fireworks rise to wake up those who fell asleep to the classic music.

So now, in week 2 of the LID, I have to start getting ready for the 50 mCi radioactive iodine dosage, which I'll be receiving on Friday, July 31st.  And fortunately, because it is the standard within the UCLA Health system (which my endocrinologist is a part of), I will be receiving Thyrogen injections in preparation for the dose.

What is Thyrogen?  Allow me to explain...

My blog is not sponsored, I swear.

For decades, the standard RAI (Radioactive Iodine) treatment went like this: for about 6 weeks prior to receiving the RAI dose, a person would have to completely stop taking their synthetic thyroid medication.  In some cases, people would be prescribed a different medication (Cytomel - T3), which would help soften the blow of withdrawing from the hormones, but even then, they'd have to fully withdraw for that right before the RAI.

As the weeks progressed, patients would experience the symptoms of hypothyroidism, which would get worse and worse over time.  The thyroid controls the body's metabolism.  Without its hormones, a person's metabolism basically shuts down.  The bottom line is that food no longer gets converted into energy; it just gets stored as fat.

The symptoms of hypothyroidism include: fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol level, irregular menstrual periods, muscle aches, joint pain, thinning hair, slowed heart rate, and depression.

Jackie, please don't even try to fathom hypothyroidism.

But what was the point of all this suffering?  Did endocrinologists just like making thyroid cancer patients squirm?  

Well I can't speak for all endocrinologists, but I'm sure for most the answer is no.  The reason is simple(ish).  Withdrawing from thyroid hormones causes Thyroid Stimulating Hormone (TSH) levels in your blood to increase.

Wait, what is TSH you ask?  Well I'm about to get biological on yo' ass.

That sounded weird.  But I'm still going to do it.

It all starts with your pituitary gland, aka "The Master Gland," according to nerdy medical types.  The pituitary gland releases TSH within a sort of negative feedback loop.  If it can't detect enough thyroid hormone in the blood, then it releases TSH as a sort of call to action to all thyroid cells in the body, as a signal to take whatever iodine it has and convert it into thyroid hormone (T4).  TSH does nothing for the body in and of itself, other than "wake up" thyroid cells.

Because I've been taking levothyroxine this whole time, that means my pituitary gland has been tricked into thinking my non-existent thyroid is producing enough thyroid hormone to keep my body going.

So back to what started this whole conversation: why elevate TSH?  Well, when you take the radioactive iodine dose, you want any remaining thyroid cells in your body to take it in ASAP.  Having starved them of iodine for 2 weeks on the LID, having increased TSH in your blood is yet another (and the most important) thing that will signal to your thyroid cells that they need to start working overtime.

Following this logic, the best way to raise TSH in your blood is take the blindfold off your pituitary gland, make it realize that you are severely deficient in thyroid hormone, and therefore cause it to desperately release TSH into the blood.

Going hypothyroid, or going through "Hypo Hell," as many people call it, was the way to do this.  Until Thyrogen came out.

The sweet, sweet nectar (brought to you by the Genzyme Corporation)

Although it had been used in Europe for years prior, the US FDA approved Thyrogen for use domestically in late 2007.  Once it was in use, there were shortage problems as recently as 2011, but it now appears to be in adequate supply for mainstream use.  Thyrogen synthetically raises TSH to levels necessary prior to RAI treatment, meaning the patient does not have to withdraw from thyroid hormones.  HOLLAH!!!

Captain Jean-Luc Picard loves thyrotrpin alfa.

Thyrogen is administered through a series of injections on consecutive days.  On Day 1, you get your first injection.  On Day 2, you get your second injection.  And then on Day 3, you receive your RAI dosage.  All of this has to happen consecutively.  In the butt.  Yes, you heard me right; the injection occurs on your buttocks.

That's all I have to say about that.

You know what, if getting shot in the buttocks means I don't have to withdraw from my medication, then I'll take it!

That's more like it, Oprah.

So that's what I have to look forward to.  I'll be off of work again starting this Wednesday, the first day of Thyrogen injections.  That'll give me time to get ready for my week of isolation.  Since I have to continue the LID for 2 days after my RAI treatment, I have to make sure I go to my parents' house stocked with low-iodine food to last me through the weekend.  Plus, I just have to take care of stuff logistically, since I'll be locked away in my room for a week and away from real life.

Excelsior!

-W

The Low Iodine Diet, aka 16 Days of Hell

Ok, I'm being dramatic.  It probaly isn't "Hell."

After binging on seafood and meat this week, the day has come for me to start the Low Iodine Diet (LID).  A dark, dark day indeed.

In order to explain the Low Iodine Diet, I will start with a biology lesson.

Not what I meant, Sweet Brown.

The thyroid gland is pretty much the only gland in the body that makes use of iodine.  Iodine is the raw material for what thyroid tissue converts into thyroid hormones, which the body needs for purposes surrounding metabolism, among other things.  I'll probably discuss thyroid hormones specifically in another post down the road.

In any case, in preparation for my dose of radioactive iodine on July 31st, my doctors have asked me to begin the LID exactly two weeks before receiving the dose.  The rationalization behind this is simple: if you starve the remaining thyroid cells in your body of iodine, the one thing that they need to do their job, then the moment I take the radioactive iodine dosage, the thyroid cells will desperately cling on to the first sign of iodine that it can find.  Even if the iodine has radioactivity that is trojan-horsed inside of it.  Once those thyroid cells cling on to the radioactive iodine and try to break it down, the radioactivity will go to work and destroy the cell.

However, if I continue to consume iodine in the lead-up to the radioactive dosage, then it is possible that some of the radioactive iodine will pass over any thyroid cells that already have iodine in them.  And we don't want that, now do we?

Grumpy Cat doesn't like cancer.

Hence, you have the LID.

In all of my research leading up to this, the LID is pretty confusing.  First of all, there are many cases of doctors who don't believe in it and don't have their patients do it.  A few studies even seem to try to prove that it isn't effective (http://press.endocrine.org/doi/abs/10.1210/jc.2009-1624).  However, the rationale behind it is logical, and going on a 2-week diet seems like a small sacrifice to destroy cancer, so I won't even go there.

Then, there's the length of time.  My doctors have prescribed a 2-week LID, but other people have done 3 or more weeks.  I'm no doctor, so I'm going to stick to my orders and do 2 weeks.  Well actually, 2 weeks and 2 days.  They want me to stay on it 2 days after the radioactive dosage, just to give my thyroid cells more time to absorb.

Then, there is the diet itself.  There are tons of resources online devoted to the LID, but many of them seem to conflict with each other, which makes it hard to perform any research.  I've done my best to sort through the noise...while there are tons of intricacies to the LID, I'll do my best to spell out the major rules.  In the end, it is a LOW iodine diet, and not a NO iodine diet.  Little errors here or there won't necessarily hurt.  In fact, since there are doctors that don't even prescribe the LID and still have success stories under their belt, it's hard to even say if ANY errors will hurt.  But oh well, ahead I shall charge.

- No IODIZED salt

This is the biggest and baddest rule, but it's important to note the word IODIZED.  That's why I put it in caps.  Most kosher salt is not iodized, so it is fair game in the LID.  So is any salt specifically designated as non-iodized.  Many people mistake the LID for a low-sodium diet.  Not the case at all.  However, this is the rule that pretty much prevents me from eating out.  There's no way to know what kind of salt gets used in a restaurant, or in processed foods in general.  Therefore, all self-prepared foods from here to the end.

Interesting side note: most table salt is iodized in the US as a result of the observation of severe iodine deficiencies in the past.  There was a movement in the US in the 1920s to iodize salt as a result of a problem with goiters, which are enlarged thyroid glands due to iodine deficiency.  Ever since this was done, the incidence of goiters has been significantly reduced.

- All seafood, and anything from or derived from the sea (e.g. seaweed, sea salt)

Oh, this one hurts.  Anyone who knows me knows how much I love seafood.  On most days, I prefer it to any land-based proteins (I'm looking at you, beef).

All I see is iodine.

Iodine occurs naturally in the ocean/sea, so as a result, I cannot consume any of the creatures depicted in the picture above.

Seaweed-based ingredients can sneak into a lot of things, which makes the LID tricky.  For example, did you know that most almond milks contain an ingredient named carrageenan, which is derived from seaweed?  So no almond milk for me, which brings me to my next no-no...

- Dairy

That's right.  Milk, cheese, etc.  None of that.  I thought about replacing milk with almond milk, but it seems like all almond milks contain either carrageenan or sea salt.  Milk chocolate?  Get out of here.  My yogurt that I have every morning for breakfast?  Say goodbye.  Milk and cereal?  Hold the milk.  Butter?  You better believe it's not butter.  Anything and everything dairy goes out the window.  I have to act like I'm lactose intolerant.

- Egg yolks

Eggs contain iodine, almost entirely in the yolk.  Anyone who knows me also knows that I also love the living crap out of eggs.  This one sucks.  However, I'll get by with my good friend Costco.  Gotta avoid any foods with egg listed as an ingredient, too.

My new best friend.

- Soy

Yup, you heard me right.  The incognito building block of the typical American diet is out of the picture.  You always read about how soy gets used as fillers in various processed foods.  Well, I'm about to learn the hard way.  It's OK, I guess.  I've heard having excess soy isn't good for guys due to what it does to estrogen production.  I don't really want to have breasts anyway.

So how am I going to survive?  Well, luckily for me, in the past I've tended not to have a problem with eating repetitively, especially when trying to lose weight.  In addition, in a huge clutch move, Trader Joe's has asserted that any time salt is listed as an ingredient in its self-branded food, it is non-iodized salt, with the only exception being if they list "sea salt" specifically.  I used to really like TJ's, but I have a feeling I'm about to fall in love with them now.

So, the following meals are going to become staples to my diet.

- Oatmeal, with honey and fruit
- Egg white omelettes, with fresh veggies
- Whole wheat pasta, with marinara/pesto sauces from TJ's
- PB&J sandwiches (Low-sodium Ezekiel brand bread, unsalted almond butter, blackberry preserves)
- Unsalted Kettle chips (I may Kosher-salt them myself)
- TJ's unsalted corn tortilla chips, with TJ's hummus
- Unsalted nut mix from Costco
- Eating my own hands (I may Kosher-salt them myself)

That's that.  LID commences today.  Wish me luck.  Next time you see me, I may not have my hands anymore.

-W

For anyone interested in more information, here's some literature I found online about the LID that seems to be from a reputable source:

Thyroid Cancer Surviver's Association (ThyCa) LID Page:
http://www.thyca.org/pap-fol/lowiodinediet/
This site has a low-iodine cookbook with recipes, as well as LID guidelines.

National Institute of Health Clinical Center LID Guidelines:
http://www.cc.nih.gov/ccc/patient_education/pepubs/lo_io_diet.pdf
The NIH is a reputable source of info in my book.  This has LID guidelines, as well as a list of brands and foods that they have verified do not contain iodized salt.  This is dated 2012 though, but that's the latest version I could find, so hopefully this info isn't outdated.

The Low Iodine Diet Blog:
http://thelowiodinediet.blogspot.com/
A popular site that I've seen many people link to as a source of info.

Thyroid Cancer Canada (Thry'vors) Winter 2011 Newsletter
http://www.thyroidcancercanada.org/userfiles/files/Winter_2011_English_final_web.pdf
An interesting article where the investigate and compare the various LID rules out there, and try to debunk some as myths.  An interesting read, despite its Canadian-ness.  Keep in mind that a lot of the food manufacturing rules and regulations they discuss are Canada-specific.

Calm Before the Annoying Storm

It's been pretty quiet ever since I went public on Facebook with the blog, in terms of life events.  I've gotten tons of positive and supportive messages, which has been really nice.  Another side effect (which has been very nice and encouraging) is finding out about friends/family of people I know that have had PTC or other thyroid issues as well.  People are nice.

Adjusting to the new hormones has been OK.  Entering the fourth week after surgery, this is about the time you'd expect all of your natural thyroid hormone (from before the thyroid was removed) to fade away.  I went back to work on Monday, July 6th and started to feel a bit drowsy.  It was probably attributable to the fact that I was back at my desk job as an accountant, but it's also possible I might be slightly under on my thyroid medications.

In addition, I started to develop a problem with acid reflux.  I've never had a problem with this before, and is was resulting in chest pains, which were a bit scary for a thirty-year-old male like myself that had never had any heart/chest problems in the past.  An EKG test showed my heart was in good working order, so after a Prilosec prescription, things seem to start getting back to normal on that front.  I'm getting old.

I also started becoming aware of my own heartbeat when lying or sitting down.  Like I could feel and hear my own heartbeat more.  I suppose this qualifies as "palpitations," which can be a side-effect of an incorrect dosage level of thyroid hormone.  Or I could just be getting old.

I want to be just like Gran Torino Clint Eastwood when I grow up.

When a person's thyroid is removed, doctors have to make an estimate in terms of what dosage of synthetic thyroid hormone to give you.  Since it takes time for the body to adjust, you need to be on the same dosage level for about 4-6 weeks before you can draw blood, test the hormone levels, and adjust the prescription as necessary.  After contacting my endocrinologist, she asked me to come in this week to do an initial blood draw.  It's a little early, but she wants to start checking my blood to see if there are signs of a need for adjustment.

Thanks, Dr. Fry.

Other than that minor medical stuff, everything else has been good.  I spent much of the past weekend with Emily, having a nice brunch on the coast.

Catalina Island in the background.  Swordfish melt and lobster roll in the foreground.  Foreground wins.

Once Sunday hit, it was time for me to go grocery shopping.  But not just any kind of grocery shopping...I went went LOW IODINE grocery shopping.

I'll probably devote a whole entry to the Low Iodine Diet (LID) later on, most likely once I start it, but in summary, in anticipation of the radioactive iodine treatment I'll be receiving on July 31st, I have to spend two weeks on the LID.  The rationalization is this: if you starve the remaining thyroid cells in your body of iodine, then once you take the radioactive iodine it'll be more effective, and the chance that the remaining thyroid cells absorb it increases.

Stupid cells.  Stupid, gullible cells.

So, I went to Costco and Trader Joe's, buying various groceries that were low-iodine friendly.  Since it can be difficult to discern what processed foods or restaurant-prepared meals contain iodine, cooking for yourself becomes the norm on the LID...as does neurotically examining the nutrition and ingredients label on everything you buy.  As you can imagine, the LID can be pretty annoying.

I don't start the LID until Friday, July 17th, but I didn't really want to bother going to the grocery store this week.  Especially since I had BIG PLANS.   Before going on the LID, I decided it would be prudent to go on an HID.  HIGH Iodine Diet.  Hollah.

On Monday night, I will be going to the Boiling Crab with several of my friends.  Seafood is my favorite.  It is also strictly verboten on the LID.

F U, LID.

Then, this coming Wednesday, I will have my final (temporary) farewell to dining out with a visit to the friendly neighborhood meat factory, aka all you can eat Brazilian BBQ, aka Fogo de Chao.

When you play the Game of Meats, you win.  That's it.

Most people lose weight on the LID.  I figure all this eating will give me incentive to do that :)

Oh, also, the incision has healed quite nicely!  The incision is actually below my typical shirt collar, so it's not even visible unless I pull my collar down.

Graphic content ahead, viewer discretion is advised.

My second mouth.

-W