Cardozo Current Events: October 2009

Peter 5:7 Cast all your anxiety on him because he cares for you.

One of my friends sent me this verse this week and I am reminded to keep it close to my heart through all of the strife!

On Tuesday, October 13th(which happened to be Addi's 9mo. b-day) I was sitting in her room playing with her on the floor and something compelled me to feel around the base of my neck. To my displeasure I found a rather large lump located at the base of my throat on the right side. Jeff came home and I had him feel it just to confirm what I had found. He immediately made me call my Dr. to schedule an appointment.

The next morning I saw my Dr. and she informed me that my Thyroid was enlarged and that she was going to send me for blood work and an ultrasound. The next morning I went (with Addi in tow) to Quest to have my blood work done. My sweet baby just sat on my lap and watched them fill the 2 viles with my blood. Later that day my Mom came to the house to watch the kids while I went to have my ultrasound. The ultrasound showed that I had a rather LARGE nodule in the right side of my Thyroid.

Kimby came to visit the next day and we had a great weekend filled with Gator Growl, Football (the one and only game I'll get to attend), Dinner out with friends, shopping, and some much needed sister time! I did, however; receive a phone call from my Dr.'s office on Monday telling me that she wanted me to come in and discuss the results of my ultrasound. We scheduled it for Wednesday, October 21st (which was also 7 days earlier than the appointment we had previously scheduled for a follow-up).

I went in on that Tuesday and she told me that I would need to have Iodine uptakes and scans performed to delve further into the complex nature of the nodule. Its size was also providing her with concern as well as its complexity. I received a phone call the next day from the admitting department at NFRMC (we won't even go into the stress that phone call gave me in terms of misleading me into thinking that I was going to have to wean my sweet Addi!)

On Monday, October 26th I went to the hospital at 7:30am to receive my iodine pill(this started the 48hours in which I wasn't able to nurse Addi (and there is nothing fun about pumping and dumping people!!! Kind of like watching liquid gold slowly filter down the sink drain)). I then went and enjoyed the fellowship that I so much needed with my wonderful friends at MOPS. After the meeting it was off to the hospital again to have the scans performed. Spending over 30 minutes with a large metal machine 3 inches from my face was not how I would have chosen to spend my afternoon! The next morning I was back at the hospital at 8am to finish the testing. The Dr. said that he needed a copy of my ultrasound to compare with the scans and that I would have to wait and speak to my Dr. in the morning (and so the waiting commenced!) This morning I went in to get the reults from my Dr.(which of course hadn't been sent yet!), so they had to call for them. I think she had about 3 seconds to go over them before coming into the room to give me the news that "the nodule is cold and I would need a tissue biopsy." This is NOT what I wanted to hear, but I had prepared myself for this news. So, now I wait....AGAIN......to hear from yet another specialist to schedule the biopsy. If it proves to be cancerous I will then go for almost immediate surgery to remove it and will have to undergo radiation treatments. If it is not cancerous, I will begin taking medication to hopefully reduce the size of the nodule and help my Thyroid function better. Either way, it really is weighing heavy on my heart knowing that I will most likely have to stop nursing Addi :( It really is hard to have something thrust upon you that you never had in your life plan!

I have had so much support from my family and friends and I am encouraged every day by the power of prayer. I know that God is the ultimate healer and HE will give me the strength to overcome this battle.

Here is a little bit of what I have found through researching Thyroid Cancer and Cold Nodules:

There are about 37,000 new cases of thyroid cancer each year in the US, according to the National Cancer Institute. Females are more likely to have thyroid cancer at a ratio of three to one. Thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients. The majority of patients present with a nodule on their thyroid that typically does not cause symptoms. Remember, over 99% of thyroid nodules are not cancer. But when thyroid cancer does begin to grow within the thyroid gland, it almost always does so within a discrete nodule within the thyroid.
Cold nodule in thyroid

Symptoms of thyroid cancer
Occasionally, symptoms such as hoarseness, neck pain, and enlarged lymph nodes do occur in people with thyroid cancer. Although as much as 75% of the population will have thyroid nodules, the vast majority are benign. Young people usually don't have thyroid nodules, but as people age, they likely develop a nodule. By the time we are 80, 90% of us will have at least one nodule.

Far less than 1% of all thyroid nodules are malignant. A nodule that is cold on scan (shown in photo outlined in red and yellow) is more likely to be malignant. Nevertheless, the majority of these are benign as well.

Types of Thyroid Cancer

There are four types of thyroid cancer, and some are more common than others.

Thyroid Cancer Type and Incidence

Papillary and/or mixed papillary/follicular ~ 78%
Follicular and/or Hurthle cell ~ 17%
Medullary ~ 4%
Anaplastic ~ 1%

What's the Prognosis?
Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular) are the most curable. In younger patients, both papillary and follicular cancers have a more than 97% cure rate if treated appropriately. Both papillary and follicular cancers are typically treated with complete removal of the lobe of the thyroid that harbors the cancer, in addition to the removal of most or all of the other side.

The bottom line is that most thyroid cancers are papillary thyroid cancer, and this is one of the most curable cancers of all cancers that humans get. Treated correctly, the cure rate is extremely high.

Medullary cancer of the thyroid is significantly less common, but has a worse prognosis. Medullary cancers tend to spread to large numbers of lymph nodes very early on, and therefore require a much more aggressive operation than the more localized thyroid cancers, such as papillary and follicular. This cancer requires complete thyroid removal plus a dissection to remove the lymph nodes of the front and sides of the neck.

The least common type of thyroid cancer is anaplastic which has a very poor prognosis. Anaplastic thyroid cancer tends to be found after it has spread and is incurable in most cases. It is very uncommon to survive anaplastic thyroid cancer, as often the operation cannot remove all the tumor. These patients often require a tracheostomy during the treatment, and treatment is much more aggressive than for other types of thyroid cancer--because this cancer is much more aggressive.

What About Chemotherapy?
Thyroid cancer is unique among cancers. In fact, thyroid cells are unique among all cells of the human body. They are the only cells that have the ability to absorb iodine. Iodine is required for thyroid cells to produce thyroid hormone, so they absorb it out of the bloodstream and concentrate it inside the cell.

Most thyroid cancer cells retain this ability to absorb and concentrate iodine. This provides a perfect "chemotherapy" strategy. Radioactive Iodine is given to the patient with thyroid cancer after their cancer has been removed. If there are any normal thyroid cells or thyroid cancer cells remain in the patient's body (and any thyroid cancer cells retaining this ability to absorb iodine), then these cells will absorb and concentrate the radioactive "poisonous" iodine. Since all other cells of our bodies cannot absorb the toxic iodine, they are unharmed. The thyroid cancer cells, however, will concentrate the poison within themselves and the radioactivity destroys the cell from within. No sickness. No hair loss. No nausea. No diarrhea. No pain.

Most, but not all, patients with thyroid cancer need radioactive iodine treatments after their surgery. This is important to know. Almost all, however, should have the iodine treatment if a cure is to be expected.

Patients with medullary cancer of the thyroid usually do not need iodine therapy because medullary cancers almost never absorb the radioactive iodine. Some small papillary cancers treated with a total thyroidectomy may not need iodine therapy as well, but for a different reason.

These cancers (medullary and some small papillary cancers) are often cured with simple (complete) surgical therapy alone. This varies from patient to patient and from cancer to cancer. This decision will be made between the surgeon, the patient, and the referring endocrinologist or internist. Remember, radioactive iodine therapy is extremely safe. If you need it, take it.

Overview of Typical Thyroid Cancer Treatment

Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.
The removed thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign (95-99% of all nodules that are biopsied) or malignant (less than 1% of all nodules, and about 1-5% of nodules that are biopsied).
The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papilofollicuar, medullary, or anaplastic.
The entire thyroid is surgically removed; sometimes this is done during the same operation where the biopsy takes place. He/she will assess the lymph nodes in the neck to see if they also need to be removed. In the case of anaplastic thyroid cancer, your doctor will help you decide about the possibility of a tracheostomy.
About 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment. This is very simple and consists of taking a single pill in a dose that has been calculated for the patient. The patient goes home and avoids contact with other people for a couple of days (so they are not exposed to the radioactive materials).
A week or two after the radioactive iodine treatment the patient begins taking a thyroid hormone pill. No one can live without thyroid hormone, and if the patient doesn't have a thyroid anymore, he or she will take one pill per day for the rest of their life. This is a very common medication (examples of branded drug names include Synthroid, Levoxyl, and Armour Thyroid).
Every 6-12 months the patient returns to his endocrinologist for blood tests to determine if the dose of daily thyroid hormone is correct and to make sure that the thyroid tumor is not coming back. The frequency of these follow up tests will vary greatly from patient to patient. Endocrinologists are typically quite good at this and will typically be the type of doctor that follows this patient long-term.

So, basically in the past two weeks I have seen my PCP 3 times, had blood work done, had an ultrasound performed, and spent 2 morning in the Radiology wing of NFRMC undergoing scans and uptakes. Going through this has definitely been an emotional rollercoaster for me (although I have yet to let myself break down because I am trying to stay strong, but I am CRYING on the inside). I know that statistics are on my side, but being faced with the possibility of having any type of Cancer at the age of 31 with 3 children under the age of 5 is my worst nightmare! I will continue to keep my faith strong and know that God is wrapping HIS almighty arms around me to help me through this difficult time.

What I can add is that I am completely EXHAUSTED and OVERWHELMED by this whole process. Being in and out of Dr.'s appointments, tests, and hospital visits while trying to raise a family and continue on with my normal daily operations has completely wiped me out! I can only hope things start to look up soon.

We had such a great time during Kimby's visit. The kids truly LOVED having her around, as did I because she really pitched in and helped me out tremendously with them. She put them to bed every night after reading them a story(they get to share a room when she stays with us which is a real treat for them) and I even caught her up and getting them breakfast one morning while I was still in my room nursing Addi. Holy Moly........this was a new and improved version of Aunt Kimby because if you truly know her then you know she likes her sleep and there is NEVER any sleep to be had at the Cardozo household (even though she tries!) It was such a blessing to have her around for the 4 days. On Sunday we went to Micanopy to the Coon Hollo Corn Maze with the Wagner's(minus Phil) and had a true blast. We let the kids lead us through the maze, which at first we thought was a terrible idea to follow a 4 year old, but in the end they got us out pretty fast.....most likely because we only went through 1/4 of it, but hey......at least we didn't get LOST! We enjoyed a hay ride through the beautiful property and there was a train ride, piles of hay, HUGE bins full of corn, fake bulls, etc, etc for us to enjoy. It was so worth the admission price and I hope we can take the kids again next year. Took some fabulous pics!

Oh, they even had fake cows that you could simulate milking them and I of course I had to take the opportunity to capture Kimby in all of her "Cow Glory!"

Austin got in on the action too

Here are a few of the pics....some of my favorite from the fall season

Couldn't believe it when we saw this truck.....I <3 Vermont!

LOL! Seeing Jeffrey crammed into this LITTLE train was priceless!!!

See our van?!? Jeffrey made us wait in it while he ran ALL the way to the top of the hill to get a picture of the ENTIRE corn maze.