Monday, January 28, 2013

Am i glowing? or is that just the radioactive iodine i have just had?

to quote my wonderful endocrinologist, " even the most accomplished surgeon can not possibly get all of the thyroid cancer cells." i do think that my endocrinologist is wonderful- i was not being sarcastic , but my surgeon( and his very large ego)  was not so happy to hear that he may have missed some of the bad guys.  so, after my cancer surgery, i had the option of having the radioactive I -131 treatment( to me it sounds like chemo- and that is what i usually call it) or not. it was a no-brainer for me. my tumors had " exploded " into my lymphatic system, to quote the radiologist, so there was no doubt in my mind that  some of those nasty little thyroid cancer cells were lurking around in my body, ready to cause mayhem and possibly start some thyroid cancer tumors elsewhere in my body. yuck.

to give a little bit of an explanation why use the I-131, to date, thyroid cancer can not be treated with traditional chemotherapy. although i believe that a new drug has been approved by the FDA to treat a certain type of thyroid cancer.( i do not have all of the information about this drug, but i can research it and get back to anyone who might be interested.) . but the norm for treating thyroid cancer after surgery is still to use the I-131. thyroid cells, cancer or otherwise, love, love, love iodine. our TSH stimulates the thyroid cells to gobble up iodine. so, if our thyroid is gone we should not have any thyroid cells left to munch down on the  iodine. after our thyroid surgery, the doctor will do a radioactive scan- using a small dose of radioactive iodine - that will show any thyroid cancer cells that have been left behind after the mother ship took off. to quote my radiologist again, my scan " lit up like a christmas tree." i decided that no matter what side effects that i might have, i would go ahead with the I-131 treatment.

to prepare for the treatment, i had to be on the low-iodine diet. we want those thyroid cancer cells to be very, very hungry when they do come across the radioactive iodine. my doctor recommended, and i agreed, that i get the thyrogen injections instead of being off of my medication for several weeks.i had to work, and i know that zombies are very popular now, but who wants a zombie to fill their prescription?  the thyrogen injection, or being off of the thyroid hormone replacement drug, will cause a pretty large  increase in TSH. TSH hormone encourages thyroid cells to eat (sort of like how your mother does ).

so i get my radioactive I- 131 dose after my two thyrogen injections ( one day apart). the technician that administered the dose looked like she was  embarking from a mission to the moon. the innocent looking capsule was in a glass vial inside a lead lined box. she handed a heavily gloved hand out to me and i took the capsule and swallowed. my mouth was sort of dry, so it took a lot of water. i had an hour to get home- that was when i would officially be radioactive. the radiologist told me not to go outside for three days. i said, " if i do, will the birds fall out of the trees or something?".

90 minutes or so after my I-131 dose, i felt very nauseous. i did not toss my cookies, but i sure almost did. i drank some cola ( my mom's cure for everything) and took a nap. i felt sort of funny- but i am not sure if i was just anxious about the treatment. i did have quite a bit of hair loss- but this could have  come from the removal of my thyroid and not just the I-131. the side effect that i am still dealing with, though it is not as severe as it was at first, is salivary stones . the I-131 gets into the paratid salivary glands and solidifies making " stones". it happened to get my attention for the first time when i was at work. my jaw/face swelled up and was hot to the touch. needless to say, it was painful. i have found that drinking lots of sour lemonade works just about better than anything. the sourness stimulates the salivary glands to get those stones moving. you can also use warm compresses, and taking ibuprofen may help with the pain/inflammation.

am i sorry i took the I-131? heck no. my hair grew back- mostly, though i still deal with a little more hair loss than the "average" person. the salivary stone issue has been bothersome, but if taking the I-131 has meant that i will be cancer free, as i have been for the past two and a half years, then it was worth it. everyone must make up his/her minds on this issue. RESEARCH, RESEARCH, RESEARCH!!! talk to your doctor and other health care providers, then make the best decision for you.

one thing though. i do NOT  like to hear- and it is up there with " thyroid cancer is the best cancer to have" issue, that the I-131 is not without side effects. as i said, it is thyroid "chemo" to me. no, it is not as bad as traditional chemo as far as side effects go. but it is not without side effects, and i do not like to hear doctors or other health care providers trivialize this treatment. to those of you who may be undergoing this treatment now, i wish you the best of luck.

for my next blog, i will stay on the thyroid symptom train, but it will be a surprise. i,e., i have not decided on a topic yet! but it will be forthcoming this week.

Wednesday, January 23, 2013

depression and hair loss-- uh, no thanks.

entire books have been written, and will be written, on the subject of depression. i think that everyone has some idea what depression is, thanks to the media. " depression hurts, blaa, blaa, can help" for one example. it basically boils down to our thyroid glands, when we suffer from depression related to  hypothyroidism,not being  able to supply the hormone necessary to help our other organs function properly. as a pharmacist, i see so many people on antidepressants. i know that these medications can really help in some cases. but, i would love to see doctors take the time to find out if the depression is caused by a brain  chemical imbalance, a hypothyroid condition, diabetes or other autoimmune disorders, a life event ( death of a spouse,etc) before antidepressants are prescribed. i will give you an example. i know a young woman who was suffering from depression and was immediately prescribed antidepressants. she improved somewhat, but was still having depression along with other symptoms that would indicate a thyroid disorder. she was finally tested for thyroid disorder, and BINGO, they discovered that she was hypothyroid. she was then prescribed thyroid hormone replacement, and is doing much better. it makes more sense to me, and is better therapy, to determine what factors are causing the depression and then use that information to determine treatment.

antidepressants can be a good option, of course, but so can talk therapy, exercise, and of course, just getting a diagnosis of hypothyroid disease, if that is the case,  and receiving treatment for that . we live in an " instant gratification" society. we want results, and we want them now. i understand that the patient wants to feel better right away . but i would like to see more investigation and more communication between the patient and health care providers before antidepressants are prescribed.  it is important to get this symptom of hypothyroidism under control because it has such an effect on the quality of our life. this is how things would work in my perception of an ideal world:  if you are depressed- and suffer on a fairly regular basis, get tested for hypothyroid disease. if you are hypothyroid, your doctor would prescribe a thyroid  hormone replacement drug for you. then use talk therapy and exercise and see if that helps. if you still do not have the quality of life that you desire, the doctor would try an antidepressant drug.

on the subject of hair loss, it also results from the changes in our metabolism due to decreased thyroid hormone. you only need to look at any women's magazine these days to realize how important good hair is! i would like to be able to tell everyone that there is a magic pill out there for hair replacement. there is not, i am afraid. being on the correct thyroid replacement dose helps of course. multivitamins may help somewhat- especially the b vitamins, but it not guaranteed. what may help a little is  to use a gentle, organic if possible, shampoo and conditioner. and of course, try not to overuse the flat iron or curling iron. these can be hard on our hair and we need to take care of the hair that we have! i had quite a bit of hair loss after the I-131 treatment  and my thyroid removal  surgery. but i am thankful that i did not lose all of my hair like some women do  who have "traditional" chemo after, say, breast cancer. one benefit of my job, i guess you could say, is that i always- every day- see people who have more serious issues to deal with than i do. that being as it may, i think that next time i will discuss the side effects, benefits,etc, of the I-131 treatment. it is a form of " chemo" and it is certainly not a walk in the park, as some doctors would like for us to believe.

Sunday, January 13, 2013

" all aboard!!" here are two more symptoms of hypothyroid disease ( and hopefully some ideas to make living with them just a little easier)

today i am going to talk about the two "C's". one of which nobody likes to mention in polite company. and i am talking about CONSTIPATION . there, i said it. as a pharmacist i get asked about this problem every day. unfortunately, now i have some personal experience with this difficult hypothyroid issue. not everyone who suffers with constipation is hypothyroid of course, but i would bet that everyone with hypothyroid disease has struggled with constipation if not routinely, then from time to time.

when asked by a patient about what to do, i always take the natural approach. if a person gets "addicted" to a harsh laxative then that can lead to other problems- electrolyte imbalance, absorption issues, and well, heck, you have to go out and buy the laxative on a pretty regular basis. first, i  recommend some lifestyle changes, i guess you could say. make sure you are getting enough exercise- walking is great, and make sure that you are drinking enough water. fiber is important, of course, and a fiber supplement can be a good idea, but eating enough fruits and veggies is best. remember that red meat is constipating, and i am not talking about giving up red meat, just try to replace some meals with chicken or fish. red meat tends to take longer to digest and will remain in one's digestive tract for a lot longer than most other foods, thereby slowing things down. probiotics are great- i do not like the texture of yogurt, so i take a probiotic supplement. there are several good ones, but i have found that different ones work better for different people so one just has to try and see what works best for them.

this issue  takes some time to come to terms with- it is not an overnight fix . everyone lives a hectic lifestyle, and our schedules vary from day to day. i have found that organic, unfiltered ( has some apple puree in it) apple juice works well, prunes work well for some people. if worst comes to worst, and i am pressed to recommend something over-the-counter, i usually recommend a fiber supplement- powder, not pills( they can cause more problems), or a product like miralax. this is not a stimulant laxative, it is more like a fiber product, and can be taken for a period of time.i have to say here that if you have tried all of the above with no success , or have " bleeding issues" please see your physician.

now, on to the next " C". coldness. an under active thyroid means that our metabolism is too low, as we all surely know, and our bodies can not generate enough heat to keep us warm. sometimes i feel like i work at the north pole. i am the only hypothyroid person there- the others being either pregnant, pre-menopausal, or menopausal, or men. the air conditioning is on all year long and i freeze to death! i wear insulated silk cammies  under my blouses- layering is best, and i always have a sweater on under my lab coat. i have found,though, that at night i am the coldest. i know that my thyroid medication level is down, and my body is struggling to provide warmth. one simple tip that does help me at night, is wearing socks to bed. my husband likes a cool bedroom, so we turn the heat down at night. i have several blankets,etc, on the bed. i guess you could say that it is the concept of layering again.

i hope that i have provided some useful information and tips about the two "C's". i know that the topics have been discussed and then some, but sometimes it is good to review. next stop on our thyroid train ride will be depression and hair loss. see you then......