Wednesday, July 11, 2018

Radioactive Iodine treatment dose( RAI)- friend or foe?

there seems to be a lot of discussion going on about the use of  RAI, and at what dose. when i received my treatment dose of RAI for thyroid cancer, back in 2010, i received a large dose- 155 millicuries. that was 55 millicuries above the, i guess you could say, " average" dose of 100 millicuries. it was not so hot of a topic- excuse the pun- back in 2010 when i received my dose. yes, i knew i was getting a larger than average dose of the RAI. my endocrinologist thought that i would be receiving 100 millicuries. the radiologist who was treating me with RAI after my surgery recommended upping the dose to 155 millicuries. he based this on the facts that: although i did not have a positive lymph node, i had had several tumors which had burst open and spilled out into my lymphatic system.  i had an aggressive area of follicular thyroid cancer in addition to papillary thyroid  cancer. and finally, i also had two parathyroid glands that were cancerous as well. i might add here that to have thyroid cancer spread to the parathyroid glands is rare. sometimes the parathyroid glands are damaged in the surgery and have to be removed, but rarely are they themselves cancerous.

at the time of my surgery and subsequent treatment with the RAI, it was considered a " no brainer" decision. my endocrinologist told me that " even the most brilliant surgeon could not possibly remove all of the thyroid cancer cells." i knew a little about the risks- especially the highly debated possible connection between RAI use and breast cancer. this link has still not been proven. i will disclose here that in 2015 i did in fact have breast cancer. do i feel that the RAI was a contributing factor? i am not sure. there is no hard evidence that a treatment dose of  RAI can cause breast cancer. the general consensus  has been that one should  treat the cancer that one has, namely the thyroid cancer. just be sure to have regular mammograms, which i continued to have on a yearly basis.

one thing that i do know for sure is that RAI can cause salivary stones. about 7 months after my treatment dose, i developed salivary stones. i used the sour candy and sour lemonade as instructed when i received my RAI. i drank lots of water. when i got my first salivary stone, i went to my dentist first- hoping it was a dental issue. he told me he thought that it was a salivary stone, and made an appointment for me with an ENT ( ear, nose and throat) physician. the ENT confirmed the diagnosis and prescribed warm compresses, a little massage, sour lemonade or candy, drinking lots of water, and he told me that i could take ibuprofen occasionally for the pain and inflammation. i have had trouble with salivary stones over the past 8 years. it is not a constant issue, and when the salivary stones   occur, i use the self care issues stated above, and they usually resolve. lately, though, i have had some trouble with a little  swelling in my neck under my chin. i have the name of a very good ENT surgeon that i will probably  make an appointment with if this continues.

in some of my previous blogs, i have shared the statistic that if you have had thyroid cancer, you have about a 33% increase in risk of having another second primary  cancer. and there is an increased risk of having breast cancer if one has  had thyroid cancer. interestingly enough, if one has  had breast cancer first, the risk of having thyroid cancer is also higher . some  cancers that have been POSSIBLY associated with larger doses of RAI include leukemia, lymphoma, colon or bladder cancer.

there are so many factors to consider, when it comes to making a decision to have or not have an  RAI treatment dose. one must consider the severity of thyroid cancer, for one thing. it is not the" good cancer" that some people, even health professionals, like to say.  thyroid cancer changes your life forever. constant monitoring, searching for the perfect, ha, thyroid hormone replacement medication(s), dealing with the physical symptoms of being hypothyroid in the extreme, just to name a few issues. and people can possibly  die from thyroid cancer. there is a very  good chance of survival ( a good prognosis)   if treatment is successful and  there is an early diagnosis. the type of thyroid cancer, yes there are  more than one kind- there are about five to be precise, also plays an important part in survival. thankfully, the most deadly forms of thyroid cancer, especially anaplastic, are very rare.( only 1 to 2 % of all thyroid cancers are anaplastic )

treatment of thyroid cancer, including the RAI treatment dose, is an individual decision. i used myself as an example, but the treatment i chose might not work for anyone else. there needs to be a good relationship between a thyroid cancer patient and the radiologist, or oncologist, concerning the question of is RAI necessary, and if so, what dose ? every patient should do all of the research possible, from reputable websites and books, and along with a physician they trust, come to a decision regarding treatment.

i have been asked several times if i would have done anything different regarding the RAI. my answer is somewhat mixed. i can honestly say that i WOULD have the RAI treatment again. my thyroglobulin and thyroglobulin antibodies remained high for three and a half years after my surgery and treatment with the RAI. i honestly believe that i might have had a recurrence  had i  not chosen to have  the RAI as recommended by my radiologist and endocrinologist. what i might have done, perhaps, was to lobby  for a lower dose- a little closer to the 100 millicuries. it might  have been enough for me, but i try not to dwell on this. everyone makes their best informed decision, and then you just have to move on, so to speak.

Saturday, June 30, 2018

" i recall when i was young, my papa said, " don't cry, life is full of ups and downs like a roller coaster ride. there'll be times you'll get so scared rollin' down these hills. but you hold on tight with all your might... you go up, down, all around on a cycle that is never ending." rollercoaster, by blood, sweat, and tears.

there are times when song lyrics sum up just the way one is feeling. this happens to be the case for me. i feel like i have been on a roller coaster ride  for eight long years. oh sure, there have been plenty of wonderful times over the past few years.  but just when i think that i have made it to the crest of the hill, my coaster
 car seems to plummet over the edge again.

i remember riding the ultimate, at the time, roller coaster. that scream machine was called " space mountain" and it was at disney. my husband and i took a short trip to disney about a year after we were married. after much trepidation, i got into the coaster  car with my husband. he assured me that it would not be that bad! there were no seat belts, and the only lights were little twinkling lights that looked like stars. i can almost still hear the grinding of metal on metal as we went on our journey upward on the roller coaster track. at the top, the car stopped for a few seconds that felt like hours, then went hurling over the edge into a dimly lit abyss. i thought i was going to die. or at least get thrown out of the car. i promised God, that if i lived to get out of that coaster, i would never be foolish enough to try it again.

the image of my one time space mountain ride, a promise is a promise after all, is how i feel about having had cancer twice. it also pretty much sums up every six month checkup that i have to endure. the anxiety, the ups and downs, the feeling of being out of control. and speaking of, what has conjured up the roller coaster again, is the fact that i will be having a skin biopsy in a couple of weeks. now, i have had skin cancer twice- squamous and basal, but i do not even count those on my cancer scoreboard. no disrespect to anyone who has had to deal with aggressive squamous, basal, or heaven forbid, melanoma. there is no good cancer!

when i left the dermatologist's office yesterday, the nurse told me to try not to worry. unfortunately, when it comes to me, that would do about  as much good as telling a sailor to not worry about the weather when a hurricane is brewing nearby. i am a worrier by nature, and having had  cancer sure has played into those feelings. i feel like i am on that roller coaster again, and it is getting ready to go off of the edge. of course, everything will probably turn out o.k. i am a Pollyanna person at heart. but my track record may beg to differ with that assumption.

so many people have difficult issues to deal with. i saw that when i was working in the pharmacy. just when i thought i would feel sorry for myself, here comes this really sweet, or cranky, person who had it WAY worse than i did. that has been very helpful to me- working with people and realizing that just because someone looks fine, does not mean that they actually are doing well. one time, i was talking to another pharmacist on the phone ( we were trading prescriptions) and she asked me how i was doing. i said the usual stuff along the lines of "oh, i am doing fine,etc, how are you?" then she said, i know you have had cancer, so how are you REALLY feeling? my coworkers knew of my health issues, but i generally did not discuss it with customers or others, so it sort of caught me off guard. i also would feel  emotionally drained whenever i discussed something that i was trying, if just for a few hours, to forget. but i appreciated the other pharmacists concern, and i told her that, really- i was fine.

we never know what issues, health or other , that people are dealing with. it is very important, especially in today's world, to be kind to everyone. have a little patience with someone who is driving 20 miles below the speed limit. hold the door open for someone who is entering a store as you are exiting. say " hello in there" to quote john prine. these things do not cost any money, and can make someone's day. who knows when one might be on the roller coaster going down instead of up. as for me, i am just getting ready to" hold on tight with all my might."





Saturday, June 23, 2018

the thyroid cancer, and developing another primary cancer link.....

so, as many of you know who read my blog, i had thyroid/parathyroid cancer in 2010, and breast cancer in 2015. when i had thyroid cancer, i was vaguely aware of a possible link between having thyroid cancer and having breast cancer OR vice versa. i was interested in this subject, so i began to do some research. 

i will add here, that i did read that some people felt that there was a link between RAI treatment and the possibility of developing breast cancer. my" go to" thyroid cancer book, thyroid cancer, by m. sara rosenthal said that there was no proof that RAI treatment would cause breast cancer.  the author, a thyroid cancer survivor herself, felt that it was better to treat the thyroid cancer that you have, and be diligent about having regular mammograms. that is the path that i took- to treat my thyroid cancer aggressively, and to be completely honest, i would have the RAI again. my thyroid/parathyroid cancer was stage 3 and i had an aggressive area of follicular variant in addition to papillary thyroid cancer. i have since heard people argue back and forth on this possible link, but there is no evidence that i have found yet, anyway, that would definitively answer this question. my best advice, which is good advice for any woman if you have had thyroid cancer or not , is to have regular mammograms and do monthly  self breast checks. 

it was when i was undergoing chemotherapy for breast cancer, that i found this statistic: according to the american cancer society, cancer survivors can have a recurrence of their original cancer, but also are at risk ( the general consensus is 30%) of developing a new, unrelated cancer. this cancer is called a second primary cancer. to quote the american cancer society, " no matter what type of cancer you have had, it is still possible to get another new cancer, even after surviving the first." if you are a thyroid cancer survivor, it is possible to get any type of a second primary cancer, but these cancers have an increased risk for thyroid cancer survivors. they include:

* breast cancer- in women

* prostate cancer

* kidney cancer

* adrenal cancer

there is also an increased risk of stomach cancer, acute lymphocytic leukemia, and salivary gland cancer if you have been treated with RAI. since i have had a history of salivary stones after my RAI dose, i am paying particular attention to my salivary glands. i have had some swelling in my parotid salivary glands that i will be getting checked out. and yes, i would still have had the RAI treatment. it is an individual decision, made by each patient and their physician, but i still feel  that it was the best choice for me. 

i have had some people ask me where i read about  the 30% increased risk  of having thyroid cancer and then a second primary cancer. once source that cites this statistic  is an article in cancer epidemiology, biomarkers and prevention. i have seen higher percentages and lower percentages, but 30% seems to be the most common percentage that i have seen, at least so far.  this article in cancer epidemiology, biomarkers and prevention, goes on to say that a breast cancer survivor was 1.55 times more likely to develop thyroid cancer than a person with no history of breast cancer. the article also states that a woman who had had thyroid cancer was 1.18 times more likely to develop breast cancer than one with no history of thyroid cancer. 

WHY??  the article mentioned above stated that there are several possible explanations. for one thing, a cancer patient is more likely to go for check ups, thus other cancers could  possibly be detected earlier than in a person who has not had cancer. there could also be a common hormonal risk factor for both diseases- and those hormones  are  estrogen and thyroid stimulating hormones. this article states that use of RAI may have a very small impact on the development of other cancers, but the risk remains unclear. i was hoping for a definitive answer on this, but there does not seem to be one. again, when making  the decision to have RAI or not,  it is best to discuss the patient's best treatment based on staging, if the thyroid cancer has spread, how aggressive ( type) the cancer is, among other things. one needs to have a strong relationship with one's physician in order to come to the best decision as far as treatment and possible outcome.

my blog today is not intended to spread fear and mayhem. it is purely to inform others of the importance of regular screening tests, especially mammograms, if one is a thyroid cancer survivor. and thyroid screening tests if one is a breast cancer survivor.  i have always thought that knowledge is power. how we use that knowledge is not only beneficial to our physical  health, but helps our state of mind. knowing that we, as thyroid or breast cancer survivors, have made the best decisions that we can for ourselves should make us all sleep better at night. a cancer patient should be their own best patient advocate. read articles. be informed, keep copies of your tests and doctor visits. be informed. you be the boss of cancer, do not let cancer be the boss of you. 

Tuesday, June 19, 2018

"... i can't stand her doing what she did before, living like a gypsy queen in a fairy tale...well, i did not think the girl could be so cruel and i'm never going back to my old school." my old school, by steely dan

after you have had cancer treatment, surgery , chemotherapy or whatever, people tend to expect you to go back to the person that you were before your tango with the big "C". can you return to your former self? the short answer is " NO". but that is not always a bad thing. i do not like using the term " my new normal." but that pretty much sums things up.

cancer carries a lot of baggage with it, as i have said before. there is PTSD, for one thing. i have flash backs of my surgery and immediately afterwards. especially my first day in the shower after the mastectomies. nothing can prepare you for that. people have told me, trying to be encouraging, well,"they are only breasts, and besides, you will have perky ones now!". just to fill anyone in who thinks this, what i got was not a " boob job". my plastic surgeon said these exact words to me :" honey, you ain't getting no boob job." and believe it or not, i appreciated him saying  that. breast reconstruction was a long, and rather painful process.  my so called " perky breasts"  are rock hard , numb , and  my chest  hurts fairly often.  thanks to my 3D nipple and areola tattoos, i do  feel better when i catch a glimpse of myself in the mirror. i highly recommend the tattoos. i never thought i would try to persuade anyone to get a tattoo, but Vinnie Myers, who does only breast  3D tattoos, is a hero of mine.

another accessory that comes with thyroid and breast cancer, and any cancer really, is the fear of recurrence. test anxiety is fairly common, and hard to explain unless you are a cancer patient. to this day, and it has been nearly three years since my last chemotherapy treatment, i get sick to my stomach when i smell the hand sanitizer in my oncologist's office. i turn green. and no matter if i shower off when i get home or not , the smell remains with me for the rest of the day. i used to get sick when i pulled into the parking lot, but i am a little bit better about that now.

there are other health conditions that i have now thanks to the cancers that i had. lymphedema can occur in anyone who has had lymph nodes removed. it is not a condition limited to the arms or legs. you can actually have this in your head or neck, if you have had  lymph nodes removed as you would if you have had thyroid cancer. it is important to see a special CLT ( a  physical therapist who has had extra training on  how to do lymphatic massage).  i wear active massage arm  compression garments, as that is where i have lymphedema. i also do the manual massage at home, as well as some other self care techniques.

for my thyroid cancer, i had a large dose of radioactive iodine, aka, RAI. while this gets rid of any rogue ( i have referred to them as Sarah Palin cells in the past) thyroid cancer cells that are trying to go to other places in your body,  there are a few  side effects to this treatment. would i have  the RAI  again? YES.  but i did have salivary stones about 7 months after my treatment. this has been an on and off thing. i am now having trouble with my parotid salivary glands. is it a stone or a cyst? i am not sure, but i am going to be checking on this- first with my doctor, and then with an ENT surgeon, if my physician  thinks it is necessary.

now for the positive side of cancer- there is one, believe it or not. here is some of what i learned :  i know what is important in life. i know who my true, real friends are. i appreciate my family more, especially time spent  with them. i do not let the little  annoyances in life  bother me as much. i would like to say, i do not let little stuff bother me at all, but i am trying to be honest here. i have found out that i am stronger than i thought. i am taking better care of myself- eating better, getting more sleep. and i try to find some quiet time each day- porch sitting, just to look around and be grateful. i tried learning to meditate, but my porch sitting time is as close as i could get. being out in nature is soothing to me. i think  when we connect with  nature, we feel that we are  a part of the world. i somehow feel less sick, less of a patient, and more just like someone who belongs. 

oh, and the song lyrics title? it has really nothing to do with this blog. it is just my favorite steely dan song.

Monday, June 11, 2018

" i almost cut my hair; it happened just the other day; it was getting kinda long, i could have said it was in my way. but it didn't, and i wonder why. i feel like letting my freak flag fly..." almost cut my hair, by crosby, stills, nash and young

hair is an issue that is near and dear to all of us- female and male alike. when we start to see our hair circling the shower drain, or populating our brushes, the subject of hair takes on an urgent quest for answers and treatment. there are many causes of hair loss- from medications we take, stress( we like to blame this for numerous problems), heredity, and certain health conditions. i am going to discuss hair loss associated with thyroid disorders, specifically, hypothyroidism. i will add that hair loss can also result from being HYPERthyroid, too. and as a side note, if you are taking the drug, anastrazole- a chemotherapy drug taken daily by breast cancer patients to block estrogen production, you may have thinning hair. there are other drugs that can  potentially cause hair loss or thinning. i am not mentioning them here, as i am trying to stay on topic. the list is long, and if you are really interested, you may check Webmd  for the full list.

if you have had thyroid cancer and had  surgery to remove your  thyroid, as i did, then you are the very definition of being hypothyroid. folks, it just does not get any more "hypo" than this. thyroid cancer patients have to depend utterly and completely on the dosage of thyroid medication that we take to feel good as well as to keep  our bodies functioning properly.  as the thyroid gland controls almost everything in our bodies, including our hair, it is very important to find the correct dose and type of hormone ( synthetic or naturally derived ) for each of us. this is not a one size fits all type of thing. and it can be a slippery slope- with lots of dosage adjustments, that, frankly, can be frustrating. i can not tell you how many times that my thyroid dosage has been changed- increased or decreased. i have tried naturally derived, synthetic, and i have also tried that wonder drug that some physicians will not prescribe, cytomel ( pure t3).

as i stated above, the thyroid gland controls almost everything in our bodies. and that includes our hair follicles. an imbalance in the T3 and T4 production in our bodies affects the development of the hair at the root. the hair will fall out and may not be replaced until the hormone ( T3 and T4) is back in sync. so, hair thinning or loss could be a result of poor levels of thyroid hormones. this could be a sign that a dosage adjustment is in order. in my opinion, it does not hurt to supplement with some vitamins or minerals to help our hair follicles.

low ferritin ( iron) levels in the body can also cause hair thinning or loss. iron is important for hair growth. if the ferritin level is low, the body- ever resourceful- will take the ferritin from the follicles and give it to more important organs, such as the heart.  you need to get tested and monitored for ferritin levels, though. taking too much is harmful for the body. i think that it is something to discuss with your physician and be monitored closely for.

another helpful supplement, though not everyone benefits from this, is biotin. another name for biotin is vitamin B-7. natural sources of this vitamin are found in small amounts in eggs, milk, and bananas. the B vitamins are water soluble vitamins that are beneficial for  skin, nails, and hair. some people have reported acne when using biotin. i think that if you try this, try the smallest dose first. i have seen OTC strengths from 1,000mcg all the way up to 10,000 mcg. probably the most important thing to remember about biotin, that even though it may be  working for you as far as hair growth goes, it can significantly affect many lab tests, including thyroid lab tests! it can give false highs as well as false lows. if you are taking this supplement, it would be wise to stop a good while before your blood work. also, i think it would be wise to let your physician know that you are taking this supplement. this is rather new information, so many physicians may not be aware of this as yet. there is an article that was published in the  january, 2016 issue of  Endocrine News about biotin use and interference with lab results. this might be helpful information to have when having this discussion with your physician.

some common sense ideas about being good to your hair include using a gentle shampoo, taking it easy on blow dryer and hot iron use, limiting or eliminating the use of hair bands for a tight ponytail style, and my favorite, using a silk pillow case. the silk, or polyester " silk" allows the hair to move over the pillow case without pulling the hair out. as a bonus,  it is so nice to sleep on. 

when i had chemotherapy for breast cancer ( it will be three years ago this august), i lost all of my hair- everywhere on my body. to be honest, i am rather obsessed with my hair.losing  it was pretty traumatic for me. i learned to tie  a head scarf really well, and wore a soft cotton sleep cap. i was pretty excited when my hair grew back! it took a while, and it was different- weird color and extremely curly, but i was happy to see it. i told my husband that i was going to let it grow to the floor, lol. of course, that did not happen. being hypothyroid has caused some thinning, and the chemo left me with a permanent little bald spot that you have to look for, but i am very conscious of. i have delved into trying to find out what supplements i can take , as well as other things i can do to make my hair more healthy and full. as with almost everything else, it is not a one size fits all kind of solution. but trying to keep my T4 and T3 levels within the good range seems to be one of the most important solutions. really, we are a hair obsessed nation, as a whole. this will be an on-going project for me, as it probably will be for everyone else facing hair loss. and after  having no hair, i will never, ever say that my hair was " kinda in my way."

Tuesday, June 5, 2018

i am afraid that i have the " could it be cancer again?" syndrome

in between my thyroid cancer in 2010, and my breast cancer in 2015, i had an unfortunate experience with a kidney stone. what caused it is up for debate, but bottom line is that i had to have surgery to remove it. it was painful, and i do not want to have one again. last month, i began to exhibit symptoms similar to my first encounter with " the rolling stone." everything bad thing that you hear about kidney stones, is true by the way! pain,stents, etc, it is in a class by itself. so, i went to my family doctor first- to get an x-ray and discuss the problem. my family doctor did an x-ray, and thought he saw " two suspicious areas" on the x-ray. uh-oh. what did that mean? i was having some of the symptoms as i had  the first time, but not all of them. i asked for a referral to my urologist, and made the appointment. my most unsettling symptom was pain in my back and around my side. not like when my kidney dropped it like a rock into my bladder the first time, and subsequently i dropped to the floor. but this time i had  a dull and constant aching pain.

upon looking at yet another x-ray, my urologist was not so sure that i had one or two kidney stones. my insurance company would not pay for a CT stone study like both my primary care physician  and urologist wanted, bless the insurance company's black heart, but they did approve an ultrasound. i have had to wait for that ultrasound for several weeks now. during that time, i let my imagination run away with me. you probably guessed it- i was worried that i might have kidney cancer. after you have had cancer once or twice, it does not seem all that implausible that you could have cancer again. i try so hard not to be neurotic about my health. i never used to worry about getting sick. really,seriously  sick, i mean. sore throats, sinus infections,etc. happened sometime. but cancer? no way! as i have said before, the thyroid cancer was not totally unexpected because i had had thyroid nodules for a while.  when they started growing, i knew something bad was happening. but the breast cancer really was a surprise  and not a happy one, of course.

so today, finally, i had the appointment for the ultrasound. i did not sleep well last night. i imagined that the next step might be a biopsy, and then what? good thing that they hardly ever check my blood pressure when i go to the urologist, because it would have probably been near stroke level. embarrassingly enough, i have the " white coat syndrome". i used to wear a white coat every day, for goodness sake! i talked to doctors and nurses all day. i was not afraid of them, i was afraid of what they might discover, i suppose. and one other thing. my urologist does not do a " clean catch" for women. oh no, they use a catheter for us. that is enough reason to send my blood pressure into the call 911 range. . but today, for the first time, the nurse handed me a cup! i looked at the nurse and said " REALLY??". I GET A CUP TODAY??  i grabbed the cup and ran before she could change her mind.

so, my urologist did not see anything suspicious on the ultrasound. he said that he would have felt better if  my insurance had allowed me to have a CT scan, but he said my kidneys looked just fine. false alarm, thankfully. no cancer. i am to come back if things get worse, or other symptoms pop up. i am probably the only person who wants to go to the grocery store, it was a health food store- by the way, to celebrate. but my sweet husband took me to the  " food matters"store  to get a few goodies. life is good again. the consensus is that i twisted some muscles in my back and side, somehow, and this combined with some side effects of the anastrazole ( a chemotherapy drug that i take every day to prevent a breast cancer recurrence ) were to blame. i hope that there comes a day, before too long, when i do not think " it might be cancer" right off the bat. i am not sure how many others have this " could it be cancer?" syndrome. i know that some of my close friends have this disorder. and i think it is a part of post traumatic stress. i am a worrier, but having had cancer twice takes things  to a whole other level.

so i went yippity, skippity, out of the health food store today, celebrating my good fortune at not having cancer again. you might be interested in knowing what i bought. i got some organic asparagus, an avocado,some lettuce,  and of course, some chocolate. but it is o.k. after all, the chocolate is organic.

Tuesday, May 29, 2018

is there a link between RAI use in treating thyroid cancer and the development of breast cancer?

i have been interested in this question for some time now. well, for 3 years, anyway. i was diagnosed with stage three, papillary with follicular variant thyroid cancer in 2010. after surgery to remove my entire thyroid and two parathyroids, i received a high dose ( 155 millicuries) of RAI. in 2015, i was diagnosed with invasive lobular breast cancer, stage 2b. i have no history of breast cancer in my family, and i did not have any other risk factors associated with developing breast cancer. did the large dose of RAI have anything to do with my breast cancer, or was it something else?

when i was making the decision to have or not to have the RAI, i did read that some scientists thought that perhaps a high dose of RAI could be linked to developing breast cancer. my " gold standard" book on thyroid cancer is " thyroid cancer" by m. sara rosenthal. she is a thyroid cancer survivor herself, and her book presents the pros and cons of the disease and treatment in a way that is informative, but readable. her take on the RAI issue, was that perhaps the RAI might slightly increase the incidence of breast cancer, but getting the RAI- in her case- was worth the risk. she recommended that if the physician in charge of your thyroid cancer treatment  thought the RAI was necessary, then it would be wise to get the RAI. but she also said that patients should have all diagnostic tests necessary, especially yearly mammograms.

adding to the confusion, is the fact  that according to a study in taiwan, which covered the entire population, if a patient has had thyroid cancer, they have a 33% increased risk of developing a second primary cancer. i have read this statistic in other studies, as well. to make matters even more complicated, according to research published in " Cancer Epidemiology, biomarkers and prevention", thyroid and breast cancer survivors are at risk of having  the other cancer. in a study conducted by dr. raymon h. grogan, an assistant professor of surgery and director of the endocrine surgery research program at the university of chicago medicine and biological sciences in illinois, researchers found that a breast cancer survivor was " 1.55 times more likely to develop thyroid cancer ( compared to a woman with no history of breast cancer)". and " a woman who had had thyroid cancer was 1.18 times more likely to develop breast cancer than one with no history of thyroid cancer. "

i found one study that said that a large dose of RAI had very little  impact on the development of breast cancer. for a patient like me though," very little" might be more significant. i have read that only 5 to 10% of all thyroid nodules are cancerous. sounds pretty good, but if you happen to be in that 5 to 10 % group, the statistic takes on a whole new meaning. in the above mentioned study about the breast cancer and thyroid cancer link, the authors came to this conclusion: " the use of RAI in the treatment of thyroid cancer may have a very small impact on the development of other cancers at a later date, including breast cancer. how great the risk is remains unclear."

so, basically, after researching this topic ( this continues to be a hot topic on many thyroid cancer forums), i did not find any conclusive studies or evidence that RAI and breast cancer are linked. could they be? yes. it could also be the breast cancer- thyroid cancer ( in women) link. then there is the 33% risk of developing a second primary cancer. what should you do if you are considering RAI therapy after surgery for thyroid cancer? good question.

 i will tell you why i decided to get the RAI. as i said, i had read that there could be some link to breast cancer. BUT, my thyroid cancer had an aggressive area of follicular variant, along with the papillary area. i had three tumors which had burst and infiltrated into  my surrounding tissues. two of my parathyroids were also cancerous. my endocrinologist said that even the most brilliant surgeon can not possibly get all of the cancer. some of the cancer had escaped, you might say, and was in my neck. luckily, even though i had positive TG ( a thyroid cancer marker) for three and one-half years after my surgery and RAI, the cancer did not move to my lungs or bones. would i have the RAI again after knowing that i would develop breast cancer five years after my thyroid cancer? absolutely. i had yearly mammograms- i might have had them every six months, but hind sight is always 20/20. that was my decision. this is an individual decision. what i decided to do may not be the best course of action for someone else.

my best advice, and the take away from this blog, is that when deciding about the RAI consider all sides of the story. read up on the type of thyroid cancer that you have and what additional treatments are recommended. if you are a woman, BE SURE to get regular mammograms. we should all get regular screening tests as recommended by our physicians. i wish that there was a definitive answer to the question of RAI use and breast cancer. i will keep researching, and hopefully we will have an answer soon.

Monday, May 21, 2018

" ...the only thing to say every silver lining's got a touch of grey... i will get by, i will get by, i will survive...the abc's we all must face, and try to keep a little grace, ... we will get by, we will get by, we will survive. " from Touch of Grey, by the grateful dead

whenever one of my cancerversaries rolls around, sort of sad to have more than one, i get a little introspective. this time, on the 22nd of may, to be exact, i will mark three years of being a breast  cancer warrior. no, i do not use the word survivor. i prefer a stronger word, as i do not feel like a victim. i will admit that i cry a little, but i actually laugh more.i am so thankful to still be here with my family and friends. i do wonder as to why i am still here- what purpose have i left unfulfilled? what small or great things am i supposed to do?

on these cancerversaries, i also  look back on the process that brought me to this point in time. i had wonderful physicians, nurses and other health care  professionals working with me. the person that stands out, and i am talking here  about my adventures with breast cancer, is the radiologist who stopped the lumpectomy that i was getting prepped  in the hospital to have. she took one look at my latest x-ray, and said" i believe that there is another area of cancer not associated with the tumor and i would like to do a stereotactic biopsy to check it out." two other radiologists saw  that one particular area; one when i had the ultrasound at the beginning, and the other time when i had the needle biopsy. they both  remarked that it  looked " weird". i foolishly thought that if it looked that weird, they would do further testing, or at least consult with the surgeon. here is one example of not following my own advice. be your own best patient advocate. if things seem weird, something is probably not right. fortunately for me, i went home that day after the stereotactic biopsy and the results were in. there were indeed two areas of cancer. i went back to the surgeon the following week, and my "lumpectomy and radiation" changed to " bilateral mastectomies and three months of chemotherapy.". the radiologist who stood her ground, so to speak, said that she had to be able to sleep at night. she also said that she tried to treat her patients as she would her family. i am forever in her debt. there is no doubt in my mind that she prevented me from having a recurrence, and possibly even saved my life.

during the forty years that i worked as  a pharmacist, i really tried to do the same. i gave my patients the best care that i possibly could. i enjoyed the interaction with patient  counseling, and i liked answering questions . i also enjoyed helping people find OTC medications that might help them. my husband and i talked about when would be the right time to retire. we both agreed that if there came a time when we could not give 100% of ourselves to the work, we needed to step down. that is one reason that we both retired last year. chemo brain is real, ha. and i get tired easily,too. those 10-13  hour days are not so appealing anymore. i am enjoying having some time to do my crafts, attend activities involving my grandchildren( that i was mostly unable to do before), and just having some " me" time. every day is full, believe me. when people ask me, " what do you do all day?", i do not know where to start. and now, there is the flower and vegetable garden to work on. i do not sit around, and frankly, i told my husband that i think we are busier now than when we were working full time.

maybe this is a wonderful  gift. a gift that i am eternally grateful for. the gift of more time with my family and friends. i try not to think (too much) about a recurrence. i try not to get too stressed out when testing time comes around. i try to give back to others, even though it is not in the context of my professional  work now. i will survive. i am a two time  cancer warrior.


Tuesday, May 15, 2018

Lymphedema - causes, diagnosis, treatment and self care.

cancer carries a lot of baggage with it. PTSD, anxiety, fear of recurrence, also fear of getting a second primary cancer ( it is about 30% after thyroid cancer), testing anxiety, and other health disorders. i am going to discuss lymphedema. why? well, i have this condition due to cancer surgery, for one thing. for another, i know of several people who have this disorder/ side effect and need more information . i was not prepared for the lymphedema. i thought that the newer surgery for breast cancer- removing and testing the sentinel node, thus removing fewer lymph nodes, would prevent this from happening. i will add here that the sentinel nodes are the first ones into which a tumor drains. tracer material (a  dye) is injected and used to detect these nodes so that they can be removed and tested. removing fewer lymph nodes lowers the risk for lymphedema, i assume, but it certainly does not eliminate it. i also had surgery for thyroid cancer, at which time eleven lymph nodes in my neck were removed .

we have literally hundreds of lymph nodes in our bodies. the function of these lymph nodes is to help the body collect waste products, and probably more importantly, is a vital component of our immune systems. the best description of a damaged lymphatic system that i have ever heard came from my physical therapist. she said " imagine that our lymphatic system is a ten lane highway, transporting fluid into our blood stream. everything is going along fine until some lanes are closed. all of a sudden, that ten lane highway becomes a two lane, or even one lane highway. imagine the backup!" if this were a  backup of cars, there  would be wrecks and a lot of cursing. the backup of our lymph nodes will probably result in lymphedema- or swelling in the part of the body affected, as well as immune depression in that area.

it is important to note that while lymphedema is more commonly observed in the arms and legs, it is quite common in people who have had head or neck cancer. lymphedema at any location is best diagnosed and treated early. untreated lymphedema can cause many consequences- from heaviness in the area, to visible edema( swelling), soft pitting edema, and lastly, firm pitting edema which has permanent tissue changes. patients who have had surgery and/or radiation for head and neck cancers have about a 50% chance of developing lymphedema. LET THAT SINK IN! i was surprised when i read that statistic, which comes from four European studies.

how do you get a diagnosis? there are some expensive tests, or the most common way is by observation, patient history ( cancer surgery and treatment), and measurement. in my case, i saw a physical therapist. and not just any physical therapist, but one who is a CLT( certified lymphedema therapist). a CLT has to have at least 135 hours of training and pass an exam to be certified. a physical therapist who is not a CLT, may get some lymphatic training in school, but i would heartily recommend going to a certified physical therapist.

this is my experience with getting  a lymphedema diagnosis and receiving some treatment. i noticed that the arm on the side  where i had sentinel lymph nodes removed during my bilateral mastectomies, was beginning to swell a bit. this was several months after my surgeries and treatment were finished. i asked my family doctor for a referral to my physical therapist, who then measured both of my arms in several areas. this measurement was done a couple more times during and after my treatment to measure my progress. the treatment my physical therapist used is called " manual lymph drainage massage". this encourages the flow of lymph node fluid out of the arm or leg. it is not for everyone. if you have blood clots or infection, massage should be avoided. lymph nodes are very close to the surface, so the massage used is gentle, and the CLT did the massage in a particular order to get the fluid moving in the correct direction. this worked very well for me, and i showed improvement after several sessions.

i also wear a compression garment every day. the one i wear is called an active wear compression garment. it gently stimulates the lymphatic system. i tried the traditional compression garment, and while it may work for some, it was tight and uncomfortable for me. i found myself not wearing it because it was so tight and difficult to put on. i really like the active massage garment. it is an important part of self care, which is where i am now. i will also mention that it is important not to get sunburned or injure the affected limb ( bug bites, cuts, etc) if possible. remember that  your lymphatic system is compromised now, and even a small cut or bug bite could cause cellulitis- a serious skin infection.

Lindsay Lewis, a CLT at MD Anderson cancer center, uses a special program to help patients with lymphedema caused by head and neck cancers. it involves gentle massage, special garments, skin care techniques and special exercises. my CLT did tell me that even in the CLT certified physical therapists, there are those who specialize in arms and legs and those that specialize in the head and neck area. be sure to ask what area a CLT specializes in before you begin treatment.

Lymphedema is a life long condition. it can have serious consequences if not diagnosed and treated promptly. there does not seem to be enough information for patients and health care professionals  about this side effect of cancer and cancer treatment. i urge everyone who has had head, neck, breast, or other cancers and may think that they have lymphedema to seek treatment. and be informed. remember that knowledge promotes understanding.

Addendum: two important things that i forgot to post! first, be sure to remind your physicians and nurses not to take blood pressure readings in the arm that you have lymphedema in. you should also not get blood drawn from that arm!

secondly, there is a very good blog  that addresses lymphedema on a personal level, by a lymphedema patient. her name is Sue Callison and the name of her blog is " Sue Callison- My lymphedema life". she talks about self care and dealing with lymphedema on a daily basis. she also sells the active massage products that i am so fond of!( Solidea Active Massage compression garments) please check it out! and by the way, i am passing along this info with no compensation from her company or anyone else. i do not profit in any way from any of my blogs. i am just trying to help others.

Saturday, May 5, 2018

" when life gives you lemons, instead of champagne, don't worry little children, and don't complain. remember you're golden, so find some sugar cane. when life gives you lemons, make lemonade." Lemonade, by alex boye

i have used this song before in at least one previous blog, maybe two. if you are not familiar with alex boye, especially this song, i urge to you to give him a listen. recently i was reading some comments on a thyroid cancer facebook site, when i came across some  discouraging and i think sad remarks from a thyroid cancer survivor. this woman would not stand up and be recognized at some function as being a cancer survivor, because we all know that thyroid cancer is the GOOD CANCER, and she felt undeserving of the title of cancer survivor. now, i will admit that i am a little uncomfortable using the term " survivor" when it relates to my thyroid or breast cancer. this is only because i like to think of myself as a warrior, not a survivor. survivor to me seems like a passive type of condition. like a person did not fight hard to get well, that perhaps they only hung on, like a rat on a sinking ship, while someone else did the hard work.

i have never been bitter about having had cancer twice. i have never said " why me?" what good would that do? i knew about the 30% chance of having another primary cancer when i had thyroid cancer. was my breast cancer caused by my RAI dose, or something else? i knew that some people think that a large RAI dose can  possibly cause breast cancer. i also knew that if i did not have the RAI, i might have a recurrence of my thyroid cancer, and it might just come back with a vengeance so to speak. what to do? i was informed, and i made the best decision that i could make. i do not regret my decision in any way. in offering advice, i will say that a person needs to be informed of the risks  verses the benefits of all treatment for cancer. i made sure to get my yearly mammograms, and that is how my breast cancer was discovered. it was a little more advanced, and the type of breast cancer that i had was a little more aggressive than i would have liked. but making sure to have all of the tests that are recommended for you is essential. early diagnosis and treatment are keys to treating any cancer.

another thing that worries me is when someone says that they have " survivor guilt." i have said above that i did not ask why me, nor was i bitter about having had  cancer twice. but also, i have not had any survivor's guilt. i feel empathy for those dealing with conditions worse than mine. being in health care, i saw these patients on a daily basis. maybe that is why i did not feel sorry for myself. i mean, there is always someone who has it worse than you do, to be blunt. i did the best that i could do to take care of myself. i am here, why i am not sure, while some  others have not been so fortunate. but i feel proud that i have tried my best. i told my husband that if either ( or both) of my cancers returned, i would know that i have fought hard, and i have done everything that i could possibly do to live. i am a cancer warrior, not a survivor!

having a good, positive attitude is so very helpful to having  a good quality of life. my family doctor asked me if i was depressed. i told him no, and he looked very surprised. i understand the difference between clinical depression, and situational  depression. i know that some people have chemical imbalances and can not help that they are depressed. but with me, i am able to choose to be happy. i choose happiness- i have not let cancer beat the pollyanna attitude out of me. when i was little and i would get sick, i would  tell my dad " don't worry, i will feel better tomorrow." that is pretty much how i feel now, as an adult. i am not saying that things are always puppies, butterflies and rainbows for me, but i try to make the best of what happens. in other words, if i get a bunch of lemons, i make lemonade- just  like alex boye does.

thyroid cancer is NOT the good cancer! i think that this will have to be said about a million more times before word gets around. or before people listen and understand. all of you out there who are thyroid cancer patients are not just survivors, you are warriors. just like me.

Sunday, April 29, 2018

Medullary and Anaplastic thyroid cancer

these two types are the serious and more difficult to treat thyroid cancers as compared to the differentiated thyroid cancers that  i just mentioned. this will be a basic overview of these two rare cancers. it is extremely important, if you have one of these types,  to see a physician who specializes in these cancers. there are also support groups on the thyca.org website that offer information and support for those patients dealing with either of these types of thyroid cancer. 

medullary thyroid cancer begins in the "C" cells of the thyroid gland. these "C" cells produce the hormone calcitonin . it is very important to note that elevated levels of the hormone calcitonin in the blood stream can possibly be an early indicator of medullary cancer. there can be a genetic link associated with this cancer. medullary cancer accounts for about 3 to 5 percent of all thyroid cancers.

i will mention treatment of medullary cancer ( MTC)  here because it is a little different than treatment of the differentiated thyroid cancers. surgery to remove the thyroid gland is indicated, as with differentiated thyroid cancers.  unfortunately, medullary thyroid cancer does not respond to the radioactive iodine treatment. early detection is key to survival. there is an aproximately 90% survival rate after 15 years if detected early, surgery is performed, and the disease has not spread to distant sites. if there is some involvement in the neck area, the survival rate is reduced to 76%. if however, there are distant metastases( the disease has spread, in other words)  the survival rate drops to only 3%. there have been two new drugs approved for the treatment of MTC within the past couple of years. . the names of these chemotherapy drugs are: vandetanib and cabozantinib. there are side effects that one might expect with traditional chemotherapy drugs. careful monitoring of patients with MTC is crucial- to determine the staging and if chemotherapy or radiation is indicated. quality of life is also a consideration.

anaplastic thyroid cancer (ATC) is " one of the most aggressive solid tumors to affect humans." according to the Journal of Oncology, vol. 2011, article ID# 542358. this type of cancer is not present in children. it occurs in adults over 65 or  70 years of age. in one study, cited by the Journal of Oncology, 67% of patients were over 70; females comprised 70% of those patients, while
 males comprised 30%. thankfully, ATC makes up only 1 to 2% of all thyroid cancers. the median survival rate of ATC is only 3 to 5 MONTHS.

treatment for ATC is surgery, and can include the chemotherapy drug doxorubicin. only 22% of patients respond to this chemotherapy drug, however. newer drugs are being studied, and hopefully there will be a better treatment on the horizon. ATC is a rapidly growing, aggressive, " get your affairs in order" type of cancer. the very best thing that can be said about ATC is that while differentiated thyroid cancers are on the rise, and are the fastest growing( in numbers) cancers in the US, according to the American Cancer Society, ATC cases are actually decreasing.

so, i have provided a quick overview of the main types of thyroid cancer. i sincerely hope that this information has been of some help. perhaps those reading this are thyroid cancer patients, or have a loved one or family member who is a thyroid cancer patient. with better education, comes better understanding. i began these blogs when one of my physicians called my thyroid cancer the " good cancer". i wonder what he would say after reading my blogs...

Follicular thyroid cancer, 101

Follicular thyroid cancer comes from the follicular cells of the thyroid. as i said, i hope, in my last blog, these follicular cells produce and store thyroid hormone. this type of thyroid cancer usually occurs in older adults- aged 50 and older. this type of cancer accounts for about 10 to 15 percent of all thyroid cancers. hurthle cell cancer is a rare, thankfully, and usually more aggressive form of follicular cancer. hurthle cell cancer is less likely to respond to the RAI, than say " regular" papillary or " regular" follicular." it is more likely to spread into the neck via the blood vessels, generally not the lymph nodes, thus spreading the cancer to other parts of the body. those parts usually  being the lungs and bones.

a term that one might come in contact with is " differentiated thyroid cancer" which includes both papillary and follicular types of cancer. this just means that they are somewhat similar to a non-cancerous, or normal, thyroid cell. differentiated thyroid cancers have a higher survival rate because of the iodine link to normal thyroid cells. normal and cancerous thyroid cells of differentiated thyroid cancers will both take in iodine. if you feed the differentiated thyroid cancer cells radioactive iodine, they will eat it up like a normal, non-cancerous thyroid cell. but it will hopefully kill them and their buddies,too. in this situation, it is better to have a differentiated thyroid cancer than a non-differentiated one. but of course, there are many other factors to consider- staging just being one.

the survival rate for both papillary and follicular thyroid cancers is around 90% if diagnosed early. the rate of recurrence is still around 30% for follicular as well as papillary, and recurrences of follicular can occur decades later after the initial diagnosis and treatment. as with all types of thyroid cancer, tests, blood work and monitoring will need to be done for the rest of a patient's life. the good cancer? i think not.

now on to the next blog... it is a combo of two very serious thyroid cancers: medullary and anaplastic. 

Wednesday, April 25, 2018

Papillary thyroid cancer, 101

Papillary thyroid cancer is the most common type of thyroid cancer. about 80% of all thyroid cancers fall into this category. papillary ( as well as its buddy, follicular) form in the follicular cells of the thyroid gland. these are the cells that make and store thyroid hormone. as a side note, it is important to mention  here that this hormone contains iodine. this explains why RAI works in the treatment of these cancers.  the variants of papillary thyroid cancer, which i will mention, but not go into detail about, are as follows: columnar, diffuse sclerosing, follicular variant of papillary( i had this,too), hurthle cell, and tall cell. while papillary cancer is considered slow growing, the variants of papillary thyroid cancer can grow and spread quicker than " just plain" papillary thyroid cancer. this is where it gets a little confusing. the follicular variant of papillary thyroid cancer is different than " just plain" follicular cancer. it is considered to be slower growing than the other papillary thyroid cancer variants. HOWEVER, papillary cancer can certainly spread to the lymph nodes in the neck, as well as to other parts of the body. i have been told by my radiologist, that when thyroid cancer spreads, two of the favored locations in the body are the lungs and bones. this may explain some tests you may receive if you have this type. examples:  chest x-rays, cat scans, etc.

people in their twenties to sixties tend to get this type of thyroid cancer. but a person of any age, even a small child, can get thyroid cancer. according to the American Academy of Otolaryngology- head and Neck Surgery,  " thyroid cancer is the third most common solid tumor malignancy and the most common endocrine malignancy in children. it occurs four times more in females than in males. " papillary thyroid cancer is the most common kind of thyroid cancer in children, as well as in  adults. the signs and characteristics of papillary cancer in children are pretty much the same as in adults.

it is not clear what causes thyroid cancer. some sources state possible  exposure to radiation. two things that i have heard mentioned as possible links are :  dental x-rays without the proper precautions and x-rays of children's feet for easier  shoe fitting ( this was done in the 1950's i think. i did not have that done, by the way). there are several theories, but no one knows of a definitive cause as yet. a FORMER endocrinologist of mine, kept asking me " why do you think you got thyroid cancer?" she made me feel like it was my fault somehow. i only saw this doctor briefly. my current endocrinologist has never asked me this question. since no one can be sure what causes thyroid cancer, all that we can do is to make wise decisions when it comes to our testing and health care.

treatment for papillary thyroid cancer is generally surgery, and possibly RAI ( radioactive iodine) dosing. my treatment was a total thyroidectomy, removal of eleven lymph nodes, removal of two parathyroids, which were also cancerous, and a large dose of the RAI ( 155 milicuries). i received the RAI  a couple of months after my surgery. the decision to have RAI therapy or not  is generally decided by the radiologist or oncologist after the surgery. my tumors had ruptured and spilled out into my neck area. i had three tumors, two of which were fairly large. some patients do not want the RAI, due to side effects. it is an individual decision, with no " one size fits all" solution. my endocrinologist told me that even the most brilliant surgeon can not get all of the tiny bits of the thyroid cancer cells that have made it out of the tumor into the neck area. i decided to have the RAI since it made the most sense for me. i would make that decision again, by the way, even with the salivary stones issues that i have had. traditional chemotherapy drugs do not work for this cancer, which is another fact to consider when coming up with an individual treatment plan.

papillary cancer is slow growing, yes, but it can spread. depending on the staging, papillary cancer can have an excellent survival rate.( about 90% if diagnosed early ).  but, the rate of recurrence is about 30%. and recurrences can occur decades after an initial diagnosis. monitoring- ultrasounds and blood work,usually- will continue for a lifetime. changes in doses of thyroid hormone replacement drugs will also occur. it is not easy to suppress TSH, therefore hopefully preventing recurrence, and at the same time, finding the dose that the patient feels good on.  it is a slippery slope, and one that i can attest to.

next blog: follicular thyroid cancer, 101


Tuesday, April 24, 2018

What are the different types of thyroid cancer? And yes, there are more than just one...

as i mentioned in my last blog, i told my gynecologist that someone who had anaplastic thyroid cancer would certainly not think that thyroid cancer was " the good cancer". the fact that he seemed confused, and seem not to know that there are several different types of thyroid cancer, was the inspiration for this blog. i know that most thyroid cancer patients know that there are different types, but i thought that it might be a good idea to discuss each particular type of thyroid cancer. this will be another mini series of blogs relating to the same issue. each type of thyroid cancer will have it's own blog, and i will provide the information that i have on each type of thyroid cancer. details on  new treatments for and research on treating the different types of thyroid cancer may not be available to me now, so please do not think that what i have to say about the different types is the definitive last word, so to speak. and i probably do not have all of the information, but i will give you what i have.

and, it depends on what sources you are consulting, as to how many types of thyroid cancer are defined. some sources say four, some say five. some cancers, such as papillary, have different variants, but are grouped under the umbrella of just papillary. i will mention these variants briefly. staging is very tricky and a little complicated. i am not going to go into this, as it would take several blogs to cover it. if you are interested in staging, or if your physician has not told you your stage( i would advise that you ask your physician, first, of course) there is a detailed breakdown of staging on the thyca. website. every thyroid cancer patient should make thyca.org their friend.

i have decided to discuss four of the various types of thyroid cancer. and i will briefly mention any variants of these main groups. the groups are as follows: papillary, follicular, medullary, and anaplastic. some people have just one, and some, like me, have a combination of the above mentioned types.

at this point in my introduction, i can not stress enough the importance of being your best own patient advocate. be informed by reputable websites, books, and knowledgeable health care professionals. know your type of thyroid cancer, stage, and best treatment options. keep all of your test results, and overviews of office visits in a notebook for easy reference. i mentioned this in a blog that i wrote some time ago, but one time  my endocrinologist was missing some test results in my folder that she needed to see. it seems that her office had switched computer program systems, and the test result that she needed to see had been deleted. i happened to have my " thyroid book" with me, and poof, there was the test that she needed! your doctor has many other patients- you are not the only one she/he has to take care of. take care of yourself by being informed. it is the best piece of medical advice that i can give to anyone.

one thing holds true for any patient who has/had thyroid cancer. it is a life long condition. it requires constant testing and monitoring  for recurrences. ( which can occur decades after the initial thyroid cancer diagnosis.)  there is also regular blood work done  to make sure that patients' TSH is suppressed, if need be, for example. T3, free T4 and other tests also are important and certainly affect the quality of life. it is a roller coaster ride for almost everyone, with frequent dosage changes being the aggravating norm.  thank goodness for thyroid hormone supplements, but nothing can compare to  the thyroid hormone made by a healthy thyroid gland.

enough of the introduction. my next blog will discuss papillary thyroid cancer.

Thursday, April 19, 2018

a thank you to those who follow my blog...i was surprised and honored by this.

Anuj Agarwal anujsagarwal@feedspot.com

7:47 AM (11 hours ago)
to me
Hi Bea Young-Smith,

My name is Anuj Agarwal. I'm the Founder of Feedspot.

I would like to personally congratulate you as your blog Losing the Butterfly has been selected by our panelist as one of the Top 15 Thyroid Cancer Blogs on the web.


I personally give you a high-five and want to thank you for your contribution to this world. This is the most comprehensive list of Top 15 Thyroid Cancer Blogs on the internet and I’m honored to have you as part of this!

We'd be grateful if you can help us spread the word by briefly mentioning about the Top 15 Thyroid Cancer Blogs list in any of your upcoming post.

Please let me know.

Best,
Anuj