January 22, 2014

The Battle with Graves' Disease Part IV: Chickening Out....

The waiting area for all my endocrine specialist appointment at Changi General Hospital
After deciding to go for a total thyroidectomy to deal with my troublesome thyroid gland once and for all, I made an appointment to see my Surgeon, who will explain the surgical risks to me. If you have missed out on the previous postings, here are the links:

  Even though I have decided to go for the surgery, I did not inform my family, as I am not quite sure whether I want to go through with the procedure yet. Intensive research ensued.

First, let's find out more about the Surgeon.

There are many horror stories on the internet how a thyroidectomy procedure went terribly wrong and all of them agreed on one common thing. An experience surgeon will lower the risks of any complications. Armed with the my Surgeon's name, I Googled.

Hmmm, He is an adjunct assistant professor with an established medical school.

Aha! Facebook! 

Hmmm. Married, with 3 kids. Looks like a serious man in his late 40s. Good good, not a young chap who will accidentally slit my throat.

Looks like my Surgeon has all the makings of a good Doctor!

On appointment day, the Surgeon looks exactly like the person I googled online. That sets my heart at ease a bit. 

Than we got down to the business of examining all the possible implications:

1) I will be on Hypothyroidism and has to be on hormone replacement medication for the rest of my life. I was well aware of that even before the surgery.

2) 1% chance of Laryngeal nerve injury. Might be higher since my thyroid gland is so big. This will lead to a change in voice, and I might not be able to speak in a loud manner. This is a pretty big concern to me since I give talks and workshop, and is insanely proud of my loud voice.

3) 1-4% chance of Hypoparathyroidism .There are another 4 glands that are attached to the thyroid gland that regulate  the calcium in the blood. Side effects of this conditions include cramping of muscles or tingling sensations in the toes and fingers. Long side effects include increased risk of kidney problems. Calcium replacement hormones may be needed on top of the thyroid hormone. This is the biggest risk my both my doctors are concerned about.

4) The usual general anesthesia, excessive bleeding risks that comes along with any major surgery.

Estimated hospitalization days: 3 days. With complications: 7 days

After explaining all the risks and potential complications, I have to decide whether to move forward with the surgery date. So as usual, the Doc assure me that I can cancel my surgery anytime as long as it is one week before the surgery. He is also going for a month long leave during December. 

Oh well, might as well plan the date and I can back out later if I want to. After considering, I decided on 20th Jan 2014. Why? Because a it is one week before Chinese New Year and in case there is any complications, I will have more time to recover. Most people don't work or want to meet me during CNY anyway and the stock market shouldn't bother me too much as it has been going up during Capricorn/CNY period for the past 5 years (I was wrong on this. The stock market crashed during CNY)

So all the wheels were set in motion for the surgery and I will have to meet my endocrine specialist, decide in my hospitalization ward class and do a pre ops checkup. 

It's time to break the news of the surgery to my family and friends.

And I was rewarded with a storm of conflicting information, advice and stories of friend of friends/ aunt/ distance relatives who were cured of thyroid through a myriad of means without needing to go through the major surgery. 

After 8 years of battling with Graves', I think I am a semi expert on this topic by now, but I must still thank my friends and relatives who took the effort and  tried to find out other alternatives to cure my condition, even though I know deep down, that many of the suggestions most probably will not work. 

In any case, the advice that made me wavier came from my sister, whom spent a longer period of time battling Graves' disease, but abate a much milder form of the condition. She had her own struggles as her pregnancies were made complicated by Graves

She said," If you were feeling great and healthy now, why do you want to take this unecessary risk? Perhaps with a healthy lifestyle, and the right kind if diet over a long period of time, might reduce the problem?" 

Her solution was indeed tempting. However, I know that her advice was based on her own condition which is not as genetically advance and mutated (anti-drug/anti-radioactive) as mine, but still, the idea was tempting for me to give it a try for a few more years.

During my next appt with my endocrine doctor, I told him.

"Doc, I feel like pulling out from the ops and observe another year or two. What do you think?"

Than I told him my idea.

He replied, "Yes, you can continue in this condition, perhaps for life, but you have had this condition for many many years, way longer than most average patients with thyroid conditions. I am sure that you have already tried many methods to try to cure yourself of this condition. If you do not do anything about it when you are younger and healthier, you will have much more problems dealing with it when you are older. On top of that, you will have a much higher chance of getting a heart condition or stroke when you are older. Having heart disease is not too bad, but stroke! That's the worst way to die! I have seen people dying due to different conditions, but trust me, I will rather die due to other disease than due to stroke. Think about it!"

After a few minutes of thinking how miserable it is to die of stroke, and having a similar experience when I was paralyzed for 3 days prior to this discuss, I can understand what he meant. 

 Steeling a my heart, I told my Doc

"Heck! Let's go ahead with the surgery. Get this over and done with!"

January 21, 2014

The Battle with Graves' Disease III: The Thyroid Strikes Back!

I am sure many of my dear readers know about my 8 years battle with Graves' Disease and I have posted a couple of posts on this issue and my visits to the hospital.

In case you have forgotten, here are the links:

Part I:  Five Stitches, Two Weeks Running Ban: The Prologue to my Running Hobby.A Life changing Experience 

Part II: The Adventure of being poked and probbed at Changi General Hospital

My medical took a new turn on 20th Jan 2014 as I was pushed into the surgical room for a total thyroidectomy. Many asked me why did I choose to undergo such a major surgery and have I considered other alternatives. I will have to elaborate what happened since the radioactive iodine treatment...

Changing into the surgical gown
 After my near death experience with Thyrotoxicosis as a result of an overactive thyroid gland due to the radioactive iodine treatment (RAI), I was put under observation for 2 years to monitor the aftereffect of the RAI. There has been cases whereby the thyroid cells take up to one year to die off as a result of the radiation, and the docs were hoping that there was the case. As the end of the day, there is only a marginal improvement in my condition. Prior to the RAI, I am taking the maximum dosage of 30mg of carbimazole and yet, the hormone levels, indicated by T4 and TSH remained out of the healthy range. After the RAI, the blood count level came down successfully to the normal zone, with a dosage of 25mg of carbimazole on weekdays and 30mg on weekends. It means that only a small portion of my thyroid gland was destroyed by the RAI and any tweaking of this formula downwards, will lead to a spike in the thyroid levels again. In order to check the condition of my thyroid gland post RAI, the doc ordered an ultra-scan on the thyroid gland sometime on the 4Q of 2013. 

As usual, more complications arised.

The ultra scan revealed a nodule, which has the potential to grow cancerous if left unchecked. For now, the doc diagnosed that it should be benign, but to be sure, a biopsy should be performed. However, the RAI which I have underwent previously had scrambled the cellular structure, that the biopsy may not have any conclusive results, which might lead to a surgery which they need to cut me open to take a look at the lump. I was given these options:

1) Continue with the current condition and pray that no other complications kick in.

2) Do a RAI again. However, due to my resistance to RAI the last time round, the Doc is not confident that the procedure will kill off all the thyroid gland. If the RAI fails again, the celluar structure will be even more messed up and they may really need a surgery to take a look at the lump.

3) Perform a partial thyroidectomy. Given how powerful and unpredictable my thyroid gland is, the reminding thyroid cells may still produce enough hormones to put me back at a hyperthyroid condition again. A second surgery or RAI to remove the thyroid will have much higher risk.

4) Perform a full thyroidectomy. Takes away all the thyroid problem once and for all, but accompanying that, a new set of problem and lifelong medication.

It was a very difficult choice to make! I was tempted to maintain my current condition as I feel pretty good and healthy after all these years but the stupid lump is complicating matters. So, as a consultant myself, I asked the all important question that all clients should ask:

"If you were in my shoes, which option will you choose?"

Doc hesitated for a while and replied, "I will go for the full thyroidectomy."

 I considered for a while.. Heck! This stupid gland has been bothering me for the longest time, disrupting much of my life. Let's go with what the good Doc says!

"In any case, just book an appointment with the Surgeon and let him explain to you the surgical complications. You can cancel the procedure anytime within these few months."

Sounds like a good deal! I booked an appointment with the surgeon and began researching on life after a total thyroidectomy.
   

January 4, 2014

Farewell ECP! - A visit to the dysfunctional expressway (4km)


Good Morning! ECP!
The biggest news in Singapore this week. The closure of a segment of the most scenic section of the East Coast Parkway Expressway and the 2 hours jam at the newly opened Marina Coastal Expressway (MCE) which is an expensive, undersea and boring expressway which will replace the ECP. The former ECP cuts through some of the most scenic and expensive real estate in Singapore and after pleads from one of the richest man in the world, Sidney Adelson, owner of Sand Casino and the Marina Bay Sands, that he needs more space to expand the integrated resort, the government decided to reroute the expressway. (Baseless allegations. Pure speculations on my part. Adelson did appeal for more space though!)

Accolades

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