Nervous, dizzy, and filled with anxiety, I woke up on Monday morning sweating bullets. What would a needle in my neck feel like? How much would it hurt? It was time to find out.
I drove the length of the 90 Freeway (all 10 yards of it) to the Marina, where I parked and headed up to see Dr. Sigari for the first time. Shaking in my boots, I was called in and sat down in the exam room where the nurse told me they had just received the medical supplies for the biopsy (called a Fine Needle Aspiration Biopsy, or FNAB), so they were ready to go. Another person did what I assume is the standard ENT visit checkup on my ears, nose, and throat (hence, "ENT." Mind. Blown). She said something about how my right nostril was slightly obstructed. I nodded and mumbled something resembling acknowledgment. "Lady, I'm in here to check for cancer! I don't care if I snore!" was the thought in my head.
In came Dr. Sigari. As you can tell from the fact that this blog exists, this won't be my only rodeo with this guy, so more on how awesome he is later. He came in, felt the nodule, and stated that while he could perform the FNAB purely by feel (or by palpation, for your medical folks out there), he felt the most accurate way to do it would be with ultrasound guidance. Essentially, he was happy to perform it, but to do so would have resulted in a higher likelihood of inaccurate results. The irony of this will be apparent in this and the next blog post, but I was inclined to agree with him, as the only thing that seemed more annoying than having a needle stuck in my throat was to do it twice. The doctor referred me to the radiologist on the first floor of the same building, so I left, took the elevator down, went into the imaging center/radiologist and set up the appointment for an ultrasound-guided FNAB on January 21st.
Everything had happened so quickly, and now it all had ground to an abrupt halt. The next action on this nodule/cancer scare wouldn't be for another 10 days. I had psyched myself up to get this biopsy done, only to be greeted by this:
Damn you, Yao Ming.
At this point, on the verge of a nervous breakdown, I called my parents. Important to note that up to this point, I hadn't told anyone about what was happening. Not my family, nor my girlfriend, nor my roommate. I had decided to keep it secret, because...I actually don't know why. I figured I was sparing them the anxiety? I figured it would turn out to be nothing, and then it could just be an interesting cancer-scare anecdote weeks later? Not sure what I was thinking, but a tip to anyone that may be facing this in the future: don't keep it to yourself. It'll only wear you down faster when you have no one to talk to about it. You don't have to tweet your experience to the general population, but the ability to talk about your fears and hopes with someone can go a long way.
Anyway, I decided to call my parents primarily because every doctor I had spoken to so far had asked if there was history of thyroid cancer in my family. All I could say was that I think my aunt and my grandma had their thyroids removed, but I wasn't sure why. That's all I knew; asian families don't exactly disclose medical histories very openly, as any of my asian friends can probably attest to. Am I being racist? Yes. But it's OK, because I'm asian. I'm also good at math and can't drive.
After talking with them, we figured it would be best to call my aunt in Texas to get the accurate scoop on why her thyroid was removed. So that afternoon, I called her from work and learned the truth: while my grandmother had her thyroid removed for malfunction and overgrowth (called a "goiter"), my aunt had thyroid cancer in the late 1970s in the Philippines. My heart sank. There it was. While family history of goiters was enough to increase the likelihood of thyroid cancer, an actual case of cancer made me feel even worse about my fate.
The days passed and I became increasingly worried. I started to have anxiety attacks and chest pains. I read somewhere that studies have shown that the anxiety from waiting for biopsy results can have the same effect on the human body as actually being told you have cancer. I believe it...I hadn't even had the biopsy yet!
January 21st came around, and it was time for my biopsy. My parents came by to pick me up and take me to the radiology office. After waiting for a while, I was taken into the dark ultrasound room. After taking initial scans, the ultrasound tech called in the radiologist. He came in and seemed friendly, but was obviously a man of few words. He explained what was about to take place, and began to disinfect my neck with that orange stuff that you always saw on episodes of ER.
The way these work is pretty simple: the radiologist holds the ultrasound wand in his left hand, and is watching the insides of my neck on the monitor. With his right hand, he holds a fine-gauge needle, thinner than the one typically used to draw blood, in some kind of device that makes it look like a gun, trigger and all. With one eye on the monitor and the other on my neck, he then proceeds to stick the needle in, aiming for the nodule. Once he confirms he hits paydirt on the monitor, he then starts to poke the nodule from several angles, jabbing the needle with small "punches" forward, in order to force thyroid tissue to go into the syringe. The goal is to poke as many areas of the nodule as possible, in order to get an adequate representative sample, almost like an audit (shoutout to my fellow former Deloitte auditors). Even of a nodule is cancerous, it doesn't mean it can be found throughout the nodule.
If it all sounds awful, it is, but only in theory. In practice, it honestly didn't feel like much. The doctor had numbed my skin with the first injection, so the actual needle pricks felt like nothing. The rest of the procedure just felt like he was poking down on my neck multiple times, and no pain was felt really. His first offensive was against my liquid cyst, which he tried to drain as much as possible, although he explained it might or might not come back. However, cysts are considered to have little-to-no risk of cancer. The solid nodule was in a deeper, more awkward position on my thyroid, so that took a little more work and a little more discomfort for me before he was able to attack it. About 30-45 minutes after starting, we were done. He thanked me for not squirming too much, and left to do other work, so I sat there while the nurse applied pressure to my neck (which was more out of procedure, as there was no bleeding), and we talked a bit. She actually told me she was going to have a biopsy for a lump on her breast in a few weeks, so we wished each other luck on our respective biopsies. She was really sweet. I hope her results ended up better than mine did. The ultrasound tech was a big LA Kings fan, so we talked about that too.
I went to grab lunch with my parents at the local pho spot, and then they dropped me off and headed home. After replacing the band-aid on my neck with a less conspicuous one, and putting on a high-necked sweater, I drove off to work and finished up a half-day, my neck just slightly stiff from being in an awkward position during the procedure.
Imagine my face on this cat, and you get the idea.
My parents were about to embark on a five-week vacation to the Philippines on January 29th, their first time home since 1995, so the clock was ticking on these results. Even though I was told the results would be in by early next week, I called Dr. Sigari's office on the 27th in panic mode when I hadn't heard back, explaining that my parents were about to leave the country for more than a month, and if anything was going to happen, we needed to know ASAP. After some digging and investigation on their part with the radiologist and pathologist, on Wednesday, January 28th, I finally received a voicemail from Jen, one of Dr. Sigari's friendly nurses:
"Just wanted to let you know that we just received the final pathology report, and it came back negative. No malignancy, no cancer. We thought you'd want to know ASAP, so please call us back when you have a chance so we can schedule an appointment for you to follow up with Dr. Sigari, so that we can establish a plan to monitor you going forward."
Well, those weren't her exact words, so perhaps my use of quotation marks was a bit disingenuous. But that was the basic gist of it. So stop treating my like I'm Brian Williams.
I don't remember seeing you there, Brian.
So that was it, just like that my month of panic was over. I called my parents to tell them the good news, about 36 hours before they were set to take of from LAX. I then told my boss Peggy, who had noticed the band-aid on my neck the day of my biopsy. With all the doctor's appointments I was going to, she put two and two together and had told me she hoped that I was OK, but that I didn't need to tell her anything more if I didn't want to. I had ended up filling her in on what was going on with me, just because I preferred she not be worrying about me while completely in the dark.
Meeting with Dr. Sigari on February 5th, and got a copy of my pathology report. More beautiful words have never been seen on paper:
DIAGNOSIS:
1) Benign follicular nodule, consistent with colloid nodule, FNA of left thyroid cystic lesion
2) Benign follicular nodule, FNA of left thyroid solid lesion
He then told me that because of the suspicious nature of my solid nodule on ultrasound (the microcalcifications), because I was male, and because of my family history, he wanted to follow up with another ultrasound in 6 months. He then doubled back, saying "no, no...let's do 3 months, and then 6 months". I told him we could ultrasound every month if he wanted to, so I took his order for a 3-month follow up down to the imaging center and set my follow-up ultrasound appointment for April 17th.
With everything now settled, I felt like I had a new outlook on life. I told my girlfriend Emily what I had been through, which was a bit more awkward then I had imagined in my head. "Oh, BTWs, I just had a month-long cancer scare, but it's benign, so yeah, that was pretty crazy. Is the new episode of The Americans on the DVR yet?" was what I had imagined, but as I got ready to tell her, I realized it made me sad that I hadn't told her about what was going on. I already gave you the tip about not keeping stuff like this completely secret. This is why, suckah. But I had that conversation, as challenging as it was, and she was very understanding and glad that everything turned out OK. I then told my sister and brother-in-law and a few other close friends, who were all also relieved. I didn't really see the need to tell a lot of people though. I mean, it all ended up being nothing. So, I decided to just go on with my newly renewed love of life...
...because ultrasound-guided FNABs have only a 5% chance of false negative readings. You are sure about that, right Google?
-W
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