Thursday, November 19, 2009

Surgeon Visit Number One

Very sorry for the delay with this update. The entire family is now in Fort Lauderdale visiting my Grandmother (Nannie) and Great Aunt Betty. They are both in their 90's and really the only family remaining on my fathers side. My original story started to some degree with my Aunt Betty back in 2002 because we were all flying in for my Aunt Betty's 90th birthday. 'All' really only represented my Mom and Dad from South Carolina and myself from Los Angeles. My father was an only child and that is apparently a genetic trait for I am also an only child. That does not lead to large family get togethers at least it it relates to my fathers side of the family tree.

Anyway, it was a few days prior to departure for my aunt's birthday and I was struggling to get a response from my father regarding last second plans. This was very unusual because we talked literally every day and as it turns out, my worry was justified. When I picked up the phone, I could hear in the tone of my mothers voice that something was not right. She told me my Dad was in the hospital and had arrived with only minutes to spare because he was failing to get enough oxygen as his red blood cells were being suffocated from all the bad white blood cells being created from what would ultimately be diagnosed as leukemia. Anyway, I never made it to see my Aunt Betty and amazingly have not been back since. She is now 97 years old and has never seen my children so this trip is a very important and long overdue one. To be honest, she has only seen Crea one time and that was at our wedding 10 years ago. I have some amazing memories with my Aunt and Nannie and it was great seeing the spark light up in each of them today as they watched the kids running around their place. As it turns out, this trip turned into a needed break for Crea as well. The news we received regarding her cancer has been very tiring. I am exhausted thinking about it and can only imagine how exponentially more difficult it is on her.

So, back to my wife. As with the first diagnosis, the news is all good. I should correct this to say the news itself is horrible.......the chance for a positive outcome is very high. Here are the facts as I know them. Outside of the fact that I would have a hell of a bedside manner, I certainly was not meant to be a doctor so this will be written in a very elementary manner. Five years ago my wife was diagnosed with thyroid cancer. Albeit cliche, if you ever have a gun to your head, are being told you must choose a cancer and that you must choose a form of cancer without hesitation.........your answer should be 'Thyroid Cancer'. Whether that is factually true......I do not know. I do know the survival rates are extremely high. That is what we were told 5 years ago and that is what we are being told today. In fact, we are being told that 30% of the time, thyroid cancer will return after the first treatment. I am fairly certain that we were not told this the first time around. Had we been told this, we might have been less surprised on November 3, 2009. I want to add here out of respect for my wife that while the survival rate is very high, my wife still has cancer. Cancer takes lives. We all know it is horrible so I am not really sure how easy Crea rests at night with the news that survival rates are high. She has something inside her that ultimately can take her life and it is a scary place to be. She is not in control. Cancer is in control. I think the reason I say this is that I do not want to belittle the situation in any manner. I will digress slightly back to the loss of my daughter Isabella. While a very small minority of the population, I have encountered folks that seem to believe all should be fine since 6 years have elapsed since Isabella's passing. I know others that have lost children and they agree with the following statement as well: while time does somewhat heal your wounds, you are NEVER quite the same after the loss of a child. Things can be perfectly normal one second and in the next you see something that takes you right back to a hospital room watching your wife go through labor that does not conclude with the usual crying baby to let you know all is well. You flash back to holding this little angel in your arms screaming in hopes that it was all a bad dream and that she....or you....would open your eyes and everything would be okay. It can be as simple as the end of the movie, 'The Butterfly Effect' (watch it and you will understand) in which my wife and I instantly went from ok to hysterical. Recently it was a picture in the video for the song 'Trinity' by Paper Tongues. It was a baby's hand laying face up in the hand of an adult. I have that same picture with Isabella, Crea and myself. It instantly took me back........and solidified 'Trinity' as my anthem for this new challenge my family faces.

I am good at digressing so let me get back on track. We are visiting 3 surgeons during the month of November. The first was Dr. Adashek at Cedar Sinai on November 16th. He came highly recommended as one of the top surgeons in this field. My thought process surrounding the different visits was to be certain that surgery was required. After meeting with Dr Adashek, we are fairly certain surgery is required so now it will come down to Crea choosing which surgeon she is most comfortable with. Another self discovery from this appointment was how uneducated I think I was the first time around for Crea. I remember sitting in the waiting room with family and I remember being scared but when I look back, I think I was uneducated. It could have been my subconscious just trying to focus on 'survival rates' as that was a much more positive place to look than the bad things that could once again impact my family.

With the first surgery, I remember it taking far longer than I thought it should. I was beginning to lose my mind wondering what was going on when the surgeon finally came out. He said it went well but he definitely did not seem as upbeat as I hoped he might be. I think it was this moment.......when the surgeon shared his findings......that I let my mind go to the reality that could have come from my wife having cancer. He explained that the cancer had made it to several lymph nodes and he also informed us that he had to remove one parathyroid gland. 'Lymph node' echoed in my head. I let it rattle around and then I stored it for 5 years until the doctor told us the cancer had returned. I knew the 'lymph node' news was not the best news but chose to focus on the fact that my wife was okay. Regarding the parathyroid gland, that is important to know for the next surgery. We all have 4 parathyroid glands that serve the function of controlling the amount of calcium in our blood and bones. You can definitely function without one but calcium levels have to be monitored for Crea.

In case I have not been clear, Crea's first surgery involved the removal of her thyroid gland. During that process, the cancerous lymph nodes were discovered and the parathyroid gland was removed. The next step of treatment involved radiation therapy administered via radioactive iodine. Removing the thyroid gland is not the same as removing an organ. You can not be certain you removed it all or that some thyroid tissue did not break off and land somewhere else in the body. It is because of this that the radioactive iodine is administered. Your thyroid gland absorbs iodine so if you add radiation to some iodine, go on a diet that deprives your body of all iodine and then take in the radiative should go straight to any remaining thyroid tissue and kill it. This is what Crea did. She went on a funky diet that had zero iodine and then took a little blue pill (not sure it was blue but you have to love The Matrix.....after reading this to her I was informed it was HUGE and ORANGE) and was then quarantined for what I remember to be a month. From there it has been maintenance and monitoring and until November 3rd, all was well.

What we learned on 11/3/09 was that over the course of the prior 12 months, what were minor abnormalities had grown to over 1 centimeter. Three lymph nodes are affected and there is one extra node that is not a lymph node but its very own growth. In addition to the growths is an increase in the level of of thyroglobulin in Crea's blood. Thyroglobulin is a protein that can only be produced by the thyroid gland. The fact that it increased, combined with the growths above are a very good indication that there are still thyroid cells in the body. The last fact is that the growths described above were only discovered via ultrasound. This is important because part of the maintenance is taking some doses of radioactive iodine for the sake of body scans. During these scans, nothing was ever seen. You might think..great news but, in Crea's case, it is not. Because there is thyroglobulin, there are thyroid cells. Because these cells are not absorbing the iodine, it is the last indication that there is something wrong with these remaining cells........i.e. CANCER. These are the facts. Dr. Adashek did a great job at being thorough and walking us through the trail of evidence. Unfortunately the evidence is clear. He added further clarity to the situation by giving the following information:

-the cancer inside Crea is suppressed. Because she has no thyroid, she takes medicine every day. This medicine, Synthroid, is a synthetic thyroid hormone that replaces the normal hormone her body would have produced. It also keeps any remaining thyroid cells in her body from actually working which keeps the cancer at a slow growth rate.
-because of the first point, he said we have the option of waiting until after the Holiday season for the surgery.
-most importantly, and this hit me like a brick, he said this is not something you would wait until Summer to remove. This put a very small band around the process and brings me back to the point that my wife has CANCER.....albeit the good is CANCER and it must be removed. I think the other alarming piece to this statement was that we waited so long the first time around so that Jaden could be born. Nobody gave us this Holiday versus Summer analogy and I am not sure if that makes me feel better or worse. Had someone given us the analogy, would we have acted differently. I am not sure. I do not like to live with regret but I also hate that tiny thought that asks.....did we do the right thing? As I am typing right now, my wife sits 10 feet away from me.....alive and playing with our little girl Thalia. Another 10 feet away is my son Jaden playing and watching television. All are with me of typing this......the right decisions were made and I can only pray that this next surgery is successful and my family stays intact.

The final points tie to the surgery itself. Dr. Adashek is going to look into greater detail at the results of the first surgery and have an expert look at the latest ultrasounds. Beyond the risk of cancer is the risks tied to removing the cancer. These risks are twofold:

1)Crea has already lost one parathyroid gland. The hope is that the one she lost is also the one near the current cancer. This would make it easier to get to the growths and remove them without harming another parathyroid gland.

2)The surgery entails being in close proximity to Crea's vocal chords. There is risk to harming the vocal chords especially because there is now scar tissue in the area that could make it more difficult to find the cancerous growths.

Thanks for reading. Thanks for all the amazing support. We have received very kind words, very kind offers and very generous donations that all mean so much. In the days since I communicated news of my wife's cancer (we have not named it for it is not a welcome guest), over $3,000 has been donated to Team in Training. That is amazing. People are good. People care. People can accomplish anything. People can change the World. It is because of this that I am certain CANCER will be beat.

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