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Posts Tagged ‘surgical intervention’


Experience with Thyroid Cancer

Author: Larry H. Bernstein, MD, FCAP

 

 

I retired from my position as pathologist in charge of clinical laboratories after five years at New York Methodist Hospital, with great satisfaction in mentoring students from the high schools and university undergraduate programs nearby interested in science.  I was fortunate to experience the Brooklyn “cityscape” and vibrance, and to work with other physician educators in surgery and cardiology and pulmonary medicine. Most of my students participated in presenting papers at professional meetings, and some coauthored published work.  But I was about to enter a new phase of life.  I returned to my home in Connecticut and immediately accepted a temporary position for less than a year as the Blood Bank – Transfusion Medicine Director at Norwalk Hospital, which also afforded the opportunity to help with the installation of an automated hematology system, and to help in the quality monitoring in Chemistry.  It was a good reprieve from the anxiety of having nothing to do after an intense professional  career.  When that ended I went to Yale University Department of Mathematics  and found a collaborative project with a brilliant postdoc and his mentor, Professor and Emeritus Chairman Ronald Coifman.  A colleague of mine many years ago had done a project with the automated hematology, but it was too early for a good interpretive hemogram.  I had sufficient data in 8,000 lines of data containing all of the important information.  We managed to develop an algorithm in over a year that would interpret the data and provide a list of probabilities for the physician, and we used part of the data set for creating the algorithm and another set for validation.   In the meantime I also became engaged in twice weekly sessions in Yoga, Pilates, and massage therapy, and did some swimming.  I also participated in discussions with a group of retired men up to 20 years senior to me. I also did two rounds of walking around the condonium that was home to my wife and I.

 

Then I noticed that I became weak and short of breath in walking around the condominium streets and had to stop and hold a tree or streetlamp.  I was long-term diabetic and was followed by a pulmonologist for sleep apnea for some five years.  This was an insidious health presentation, as I had had good pulmonary and cardiac status at that point in time.  Then an “aha!” moment occurred when my laboratory results showed a high level of thyroid stimulating hormone.  It was one of a rare instances of hyperparathyroidism occurring with a thyroid tumor.

I then had radiological testing of the head and neck, which led to a thyroid biopsy.  I then chose to referral to Yale University Health Sciences Center, where there was an excellent endocrinologist, and it was a leading center for head and neck surgery.  All of this took many trips, much testing, biopsies of thyroid and its removal.  There also were 3 proximate lymph nodes.  In undergoing the tests the technicians said that they had never had a patient like me because of my questions and comments.  It was a papillary thyroid cancer involving the center and right lobe, with a characteristic appearance and identified by a histologically stained biomarker that I reviewed with my longtime friend and colleague, Dr. Marguerite Pinto.  The surgery and followup went well.

 

However, I developed  double-vision (diplopia) and was referent to one of a handful of neuro-ophthalmologists in Connecticut.  Perhaps related to the hyperthyroid condition, I had developed an anti-thyroid antibody that disturbed the lower muscle that moves the right eye.  This required many test over months, and my wearing a special attachable lens gradient to equalize the vision in both eyes.  The next requirement was to watch and wait. It could be corrected by surgery if it remained after a year.  Nevertheless, it subsided over a period of perhaps 9 months and I removed the attachment with sufficient return of my previous sight.

In the meantime I was writing a lot over this period, and I also began to watch MSNBC and Turner Classic Movies on a regular basis and found relief.  I’m not a “laugher” and have had a long-term anxiety state.  I enjoyed watching the magic of Charlie Chaplin, Al Jolson, Lassie, and whatever caught my fancy.

My daughter was accepted for a tenure earning faculty position competing against a large field of candidates for an Assistant Professorship at Holyoke Community College in Western Massachusetts. Her husband had invested 15 years as a Navy physician and neurologist, having graduated from the Armed Services Medical School in Bethesda, and given this opportunity, decided to forgo further service  would pay for their child’s future college education.  He is very bright, knowledgable, and a blessing for a son-in-law.  We went through the sale of our house and the search for a living arrangement near our daughter, all while I was going through my therapy.  It was undoubtedly the best thing to moving near the daughter.

The move became an enormous challenge.  It took time to sell the condominium, which was  desirable in  a difficult market.  I became engaged in trashing what I need not save, but I had to review hundreds of published work, unpublished papers, saved publications, and hundreds of photographs large and small, that I had kept over many years.  I had to dispense of my darkroom equipment, and we managed to give much away.  It was very engaging.  It was impossible to be overwhelmed, but also tiring over the long haul.

Prior to moving, my wife had trouble swallowing, and she was subsequently found to have an esophageal carcinoma at 20 cm, and invading the submucosa.  We made arrangement for treatment by Massachusetts General Hospital, which could be done at its cancer affiliate in Northampton, MA.  The move was made, and we have temporary residence in a townhouse in Northampton, woon to move to an adult living facility.  My wife is lucky enough to have a squamous cell carcinoma, not adenocarcinoma.  Her treatment needed careful adjustments.  She decided to live it out whatever the outcome.  However, she has done well.  She maintained her weight, underwent radiation and chemotherapy, which is finished, and is returning to eating more than soft food and protein shakes. She has enjoyed being a grandmother to an incredible kid in kindergarten only a block away, and engaged in reading and all sorts of puzzles and games.

My own health has seen a decline in ease of motion. I am starting physical therapy and also pulmonary therapy for my asthma.  Having a grandson is both a pleasure and an education. Being a grandparent, one is relieved of the responsibility of being a parent.

In following my wife’s serious illness, which precluded surgery, we have had phone calls from her sister daily, weekend visits nonstop, and more to come.  She has been very satisfied with the quality of care.
My triplet sister calls often for both of us.  We also call my 95 year old aunt, who is my mother’s sister.  My mother’s younger brother enjoyed life, left Hungary as a medical student in 1941 and became an insurance salesman in Cleveland. He lived to 99 years old.  He outlived 3 wives, all friends of my mother.
His daughter has called me for a medical second opinion for a good fifteen years.  She was a very rare patient who had a pituitary growth hormone secreting adenocarcinoma (Addison’s Disease) for which she had two surgeries, and regularly visits the Cleveland Clinic and the Jewish Hospital of Los Angeles.

 

 

 

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