I Hate People

Yes. I do. However, I do see myself trapped by that statement, as I am, obviously, a PERSON. To clarify, I hate people who are lazier and/or STUPIDER (yes, STUPIDER, to drive home how very STUPID these folks are) than I am. And yes. I'm lazy and stupid, but we're talking DEGREES of laziness and stupidity, and perspective, and perhaps self awareness. I know (to certain degrees) I am stupid and lazy; whereas there are some folks who tool along WHOLESALE UNAWARE that they are stupid and lazy.  And to those folks, I say, "FUCK YOU, ROYALLY. SERIOUSLY AND SIDEWAYS."

How might the statement "I hate people" apply to the "Wild Goose Chase Du Jour," aka, the granuloma discovered in my lung, you might ask?   Here goes.

I call my pulmonologist's office to schedule a consultation to check out my granuloma because I am having surgical procedures 7/23. I very clearly stated this, as DUH, I am not going to a pulmonologist FOR FUCKING FUN. I wanted to schedule an appt w/Dr. V, yet he's unavailable. So they schedule an appt w/Dr. L. Brilliant. So I contact my surgeon's office to see about getting the chest xray results faxed to Dr. L., only for me to do a quick GOOGLE NOW, and realize HOLY SHIT, Dr. L., isn't even a mother fucking pulmonologist.

Luckily I have nearly a full month until my surgery, and I'm very glad that I got my anesthesia consult done as early as I did, because what if I waited two more weeks, then I'd be spending the two weeks before my surgery running around, getting agitated and exasperated. I truly do hate people with the stupids.

I call back and was not even polite about it. I railed into whomever it was who answered the phone, and REITERATE I called to schedule an appointment w/Dr. V., who is a pulmonologist. I very clearly stated I needed to be cleared by a PULMONOLOGIST for my surgery, and yet, the dimwit scheduled an appt with an internist. Well, fuck-me-running, I already have TWO VERY fabulous internists I already see, so why would I want an appointment with some third internist, when that's not what I even effing need?

I'm not even apologetic at this point. I'm annoyed because as a result of their stupidity, I'm now enduring second party stupidity by annoying the surgical liasion at the surgeon's office with emails regarding extraneous shit. 

Best part of this story? The payoff? The doctor's first name?

DIMPLE.

How can I stay angry after reading that as a first name?

Putting Out Fires: One Step Forward, Three Steps Backwards

Yesterday was the day of doom. A day of EPIC proportions. I set my all time new personal BEST (if BEST is even the BEST word to describe the day) of trying to cram as many medical appointments into one day as possible. I do this to maximize my time in NYC, as each time I need to see a specialist, it requires time out of the office. 

So yesterday went thusly:

10 a.m. appt w/Bariatric guy in Morningside Heights. Fabulous appointment. Truly uplifting. Only problem was blood pressure was jacked about 150/100? thereabouts.

11:45 appt w/Renal guy  nr. Central Park East. BP 160/103. This is after 10 days of being on new dosage of BP Rx. Blood drawn, urine sample collected.

2 p.m. appt w/anesthesia consult for surgery in July. Blood drawn. EKG done. SURPRISE! Chest xray. Discussions on the assortment of ways I am an "interesting" patient: No NG tube, BP wonky, and will I or won't I need blood thinners post op? Also, the technician ticked me off with idle chitchat asking what surgery I was having, and when I said "ablation," the inane chit-chat went thusly:  

Idiot: "Oh, how many kids do you have?" 
Me:  "None." 
Idiot: "Oh, I guess you don't want none of that." 
Me: "I never really had a choice really. Too  many things wrong with me, and now I'm old. And with my luck I'll be the 1 in 1000 who gets pregnant after this procedure."  
Idiot:  *crickets* 
Me: "Yeah, it's usually at this point people run out of glib things to say to me." (Also worth mentioning, I'm sure this idiot needed to look up the word GLIB to know I insulted her.)

4 p.m. appt w/Therapist nr. Columbus Circle.

By the time the day was over, I was spent physically and emotionally. And all I could do was cry.

Bring us to THIS AFTERNOON. I get a call from my gyno informing me that before the anesthesiologist will okay the surgery, I need to consult a pulmonologist regarding an irregularity they found on my SURPRISE! chest xray. Apparently I have a granuloma in there. I suspect it might be from my trip to India in 2012. I find I get sick anytime we do international travel. I don't know if it's related to that or what. I'm disgusted at the thought of it being histoplasmosis. Gah. Hurry up and wait for the gyno's office to get back to me to see if I can use a local guy instead of going into the city for YET ONE MORE APPOINTMENT. 

And of course, this is on the heels of the other "fire" that was put out in the last two weeks... the thyroid wild goose chase. 

I don't feel sorry for myself. I'm just getting really angry. Not "WHY ME?" but just angry. I just want to get on with my life and this shit is just wasting precious time and energy.

Epitome of Awesome...

... which is to say UNAWESOME, of course...

Ultrasound came and went w/out so much as a text, email or call from sister or aunt to see how I am.
Biopsy came and went w/out so much as a text, email or call from sister or aunt to see if I have cancer or not.
 
Yet, today I get a text informing me that my nieces 5th grade graduation party is SUNDAY, yet no mention is made, even secondarily, inquiring as to the biopsy results.
 
Note: Five days is an insufficient amount of time to notify me of a party you have no doubt been planning for the last few weeks. Additionally, if you want me to attend a family function, perhaps some day, one day before I die, you'll arrange it on a SATURDAY, so I don't spend my entire SUNDAY driving 4.5-5 hours to sit at a party where I'll no doubt be ignored or irritated (or a combination of both), thus ensuring a horrid back spasm and an even bleaker outlook to start my work week. Fuckyouverymuch.

Benign

Nothing More To Add: Results Might Be in as Early as Monday Afternoon.

Dayenu Redux

I am one more health issue/syndrome away from needing a continuation page for my Medic Alert Bracelet. Yes. I'm dead, fucking serious. Serious enough to wonder if I am hitting that tipping point, and this is the slow slide into the abyss. Truly. That's where my mind is RIGHT. THIS. MOMENT.

And oddly, I'm almost on the brink of laughing. Yes. Seriously. Because I no sooner have intellectualized possibilities of how my biopsy results might pan out [cancer, yes or no?; if yes, papillary or follicular? Thyroidectomy (partial or entire)or nodulectomy?; will I lose my hair? will I lose more of my "me-ness" my sense of self? Accepting that quite possibly surgery and pain (at a minimum) are going to be some short time challenges to overcome], when a well meaning friend drops a conversational dirty bomb in my lap, sight unseen, something that hasn't been discussed, but now has me on hyperalert, worried. 

Hell, the biopsy isn't until tomorrow, with the results available maybe Tuesday or Wednesday of next week, and now I'm worrying about the scenario of "Well, it's not cancer, you've got rheumatoid arthritis."  I had just braced myself for the possibility of cancer, and weighing out the papillary vs the follicular (and not even thinking about lymph node involvement yet for either), and the idea of having RA is just too devastating for me. I dare say, even more devastating than the idea of cancer.

SHORT TERM:
Statistically speaking thyroid cancer (papillary) appears to be what I'll call "manageable." The thyroid is removed, either partly or entirely. Radiation is given. A restricted diet will be part of that "FUN" of the post-op experience while they determine hormonal balances and what not. Mobility of the head/neck will be slowed down/limited. Hormones will be taken daily. Ultimately the survivability of the cancer itself is quite promising, and a good lot of folks go on to live 30-40 years post op without their thyroid. I've read up, prepared myself mentally for a "prepare for the worst, hope for the best" type of thing, then the RA conversational dirty bomb gets dropped in my lap.

My mom's dad had RA and was pretty much debilitated from it (however, at 91 he was STILL more mobile and walked better than my mom does at age 67-68), and HIS dad had RA (and lived to be nearly 100-101 when he died, bed ridden for a good many years of the winter of his life). RA to me might as well be a death sentence. There is no cure. And considering that I cannot take NSAIDs and no doubt a good lot of the RA medications out there (Celebrex comes to mind) would cause ulceration issues for what is left of my stomach pouch after the bypass, the mere thought of rheumatoid arthritis scares the piss out of me. *Amazingly, my mother doesn't have RA, but OA. I'm not sure how she dodged that bullet, considering how many things that are wrong with her health.

LONG TERM:
Rheumatoid arthritis would mean the eventual curtailing and discontinuation of the things that bring joy and meaning to my life: Travel and Crochet. I've come to accept the notion of not having children of my own. Okay. I'm accepting that on a moment by moment basis, and it is still hard (some days harder than others). But to think of the things that bring me joy, traveling the world with my husband, and crocheting, and let's face it, being able to walk of my own steam, unassisted, independent. As it stands, given my mother's assortment of health issues and how her inability to be her own advocate and get treatment at crucial times when it could have made a difference, only to see her handicapped, house bound, and bitter, that's enough for me to be HYPER AWARE and GRATEFUL of every step I am able to take.  The idea of being HOBBLED & wheel chair bound? No travel? No crochet? Perhaps unable to write my own name or type letters on a keyboard? Perhaps unable to grasp a knife to cut a tomato or run a brush thru my own hair?  In the long term, that is not living. It's merely existing and being a prisoner of pain. I just hope that if this were to be my fate, someone would have the good sense to smother me in my sleep once things got so deteriorated I'd need a wheelchair or I can't brush my own teeth. Seriously. 

I have no doubt that the friend who was suggesting a papillary thyroid cancer/RA connection was trying to be helpful but it's about as helpful as someone trying to cheer me up or show support by saying:

"Hey! Maybe it's not cancer, maybe it's LUPUS!"
"Hey! Maybe it's not cancer, maybe it's MS!"
"Hey! Maybe it's not cancer, maybe it's ALS!"

So, it's not bad enough I still have tomorrow's fine needle biopsy to endure. And now I'm even MORE scared shitless than I was before.

It's just too much to process.

In summation (if you're keeping score):

Papillary cancer = lower recurrence rate, but also has the possible bonus WILDCARD of rheumatoid arthritis

Follicular cancer = higher recurrence rate

Snippet From a Thread, Elsewhere

[This is a snippet of a reply I left in someone else's thread involving their (in)fertility.] 

[...] "At this stage of my ("unproductive") journey,  I'm using Maude (of the 70s flick "Harold and Maude") as my role model. I *want* to live a life rich with meaning and deliberate choice. I'm just at the point of accepting this (and no, there was no "choice" for me to make regarding motherhood), and (intellectualizing) if my journey won't involve kids (of my own), what will my "deliberate choices" be? 

Of course, this is made even harder when you've come to just barely accept your own fate/destiny/narrative, when someone comes along and pities you, when really that's the last thing anyone needs. FWIW, I'm the only non-breeder amongst my family, so as if the drama with our mother isn't enough to be off putting, the alienation I feel from others (as they don't know how to either respond to or process my infertility, or worse, come up with their own conclusions about why I don't have kids). 

I have come to truly embrace my friends, as THEY are without a doubt the biggest influence/impact on my life (next to my husband).

End note: 
Regarding pity. I'm not someone who defines themselves one way or the other, that I am "somebody special" because I'm Mrs.Whutwhut, or that I'm "somebody special" because of where I work. And I envision that I never ever indulged in the notion of me being "so-and-so's mom." So this (infertility, non-mom) is merely a state of being. It does not define me any more than being white, or being female, or being American, or being (fill in the blank here). So when I mention in passing, "oh yes, I've got female troubles," or "hey, yeah, I'm dealing with infertility," the very last thing I need is someone's pity."

I've found that a good lot of folks confuse empathy for pity (and visa versa), and for whatever my 2 cents is worth, I think some folks are incapable of truly being empathic, as sometimes their own pains are too close to the surface (can't see the forest for the trees, that type of perspective), and incapable of any true depth.

Sometimes there are no words. Outright silence is even worse. However, I think the best response is rather succinct: "Hey. I care. I don't know what to say. I'm here for you." Even if "here" is you being there, sitting in silence, while someone does word vomit to deal with what they're dealing with. Even if you being there is to take them out for coffee, a momentary distraction.

What The "F"

Friday.
Fourteenth.
Fine needle aspiration (biopsy).

Hurry up and wait 11-12 more days before we know anything conclusively.

Blood Work: A Trajectory

Cortisol is problematic. So far every other test (so every six months) the numbers spike. I suspect it might be White Coat Syndrome given the horrid quality of care/service I get at Quest Diagnostics. I'm tired of complaining to corporate about it, as it doesn't amount to jackshit in the scheme of things, and I've seen zero improvement. And the last time I was there (May), the blood draw was so bad, I had a very painful welt the size of a halved tangerine in the crook of my arm for DAYS.

I have no doubt that the stress I undergo each time I've been to Quest Diagnostics has adversely affected my cortisol levels. The undue wait time, the rushed nature of finding a vein, how harried the single solitary lab staffer is. To under staff a  heavily trafficked site like Quest does is not only a fuck you to those who work there, but also to the clients/patients who rely on this being the most proximal lab for them to go to for their blood test needs. Plus? Most of us are fasting, so yeah, make us all wait LONGER, make us MISERABLE while we're there. Fuck you. I'll take me, myself, and more importantly MY INSURANCE MONEY elsewhere. Labs are a dime a dozen. I think there's one spitting distance away. Sayonara, motherfuckers.
Anyway, where was I? Oh yeah... A trajectory of my blood work results:


5/2/13:
Creatine, Random Urine 91
Protein, Total Urine
Urine Total Protein 769 H Range: 50-240 mg/L
Protein Total, Urine 846 H Range 21-161 mg/g
Creatine: 0.62 Range 0.50-1.10 mg/dL
Bun/Creatinine Ratio Normal Limits
Uric Acid: 5.3 Therapeutic target for gout patients: <6 br="">Albumin 4.2
Cortisol, Total serum  31.0 H (Reference range: Cortisol AM 4.0-22.0 mcg/dL; Cortisol PM 3.0-17.0 mcg/dL
C-Reactive Protein 0.1
Hemoglobin A1C 5.3 (Reference range: <5 br="">

2/20/13:
Creatine:  0.57 (ref: 0.50-1.10 mg/dL)
Bun/Creatine ratio Normal limits
Protein (serum) 6.7 (6.1-8.1 g/dL)
Albumin 4.1 (3.6-5.1 g/dL)
C-Reactive Protein 0.1
Hemoglobin A1C 5.5
(No microalbumin tested in Feb)
Uric Acid: 5.5 (2.5-7.0)  *Therapeutic target for gout patients: <6 br="">Cortisol (total serum): 21.9H (Cortisol a.m.: 4.0-22.0 mcg/dL)

November 2012:
Creatine: 0.64
Bun/Creatine ratio Normal
Microalbumin (random)  314H <30 br="">Blood Moderate (2+) negative
C-Reactive Protein 0.1
Hemoglobin A1C: 5.3
Plasma Renin ACT, LC/MS/MS  8.37H (0.25-5.82 ng/mL/h
Uric Acid: 5.3

July 2012:
Creatine: 0.66
Bun/Creatine ratio Normal
C-Reactive Protein 0.1
Hemoglobin A1C: 5.5
Uric Acid: 5.7

April 2012:
Creatine: 0.67
Bun/Creatine ratio Normal
C-Reactive Protein 0.1
Hemoglobin A1C: 5.5
3A Adnrostanediol-G 30L (60-300 ng/dL)
Uric Acid: 5.5
DHEA Sulfate: 448H (25-220 mcg/dL)
Cortisol: 10.9  (Cortisol a.m. 4.0-22.0 mcg/dL)

Obviously, between the cortisol, microalbumen and the uric acid, SOMETHING is cookin' in my kidneys. I have been wanting my docs to adjust/tweak my blood pressure Rx for months now, as I have been having "break through migraines" which are not in line with my usual, predictable menses-related migraines.  Endocrinologist mentioned something about the possibility for Cushings. (Yet no retest for anything. Yet. We have more pressing matters. Read on.)

Yes. I have about seven thyroid nodules, one of which is problematic, as it's nearly an inch in size, is close to my windpipe, and has "unclean margins." Hurry up and wait for four days to hear back from the diagnostic center, to find out that HURRY UP AND WAIT the earliest they could get me in for a fine needle biopsy is NEXT FRIDAY, which means that it will be nearly two solid weeks (from today) until I finally know if this nodule is cancerous or not, if so, what type of cancer is it (papillary vs follicular, for example), and if it's not cancerous, can we get this thing out of me LIKE YESTERDAY, M'KAY?

I've sent a thoughtful email to my bariatric office to find out, if, worst case scenario, if the thyroid (whether partial or entirely) needs to be removed, will this adversely affect my body's ability to absorb calcium, as being someone who is living post-op gastric bypass I am already contending with vitamin absorption issues, I want to know how this will impact me.

At this juncture, I'm not getting morose or morbid. I want as much information I can muster as possible, regarding how am I going to live, quality of life wise, post-op, should my thyroid be removed. I'm not indulging in death fantasy yet. Ideally I'd like to live to a nice old age like my late 80s, have a good meal, a few good laughs my last day and perhaps lay down for a nap, and it'll be GOOD NIGHT IRENE. I do NOT want to even think about dying a grizzly death of cancer, being taken apart piece by piece like my grandmother was for seven years following an oral cancer diagnosis. Nope. I just want to know what's it going to take for me to get through each and every day. Pills? Supplements? What's one more pill in the grand scheme of things?

Like I've said to friends, I don't know if I'm THAT strong, if I'm THAT much of a stoic, or if I'm THAT much in shock about the possibility of this being cancer.

And if I had my 'druthers, I'druther and just assume get all my surgeries/procedures all done at the same time or the same week, so I can get on with the business of recovering and more importantly get on with the business of LIVING. As it stands, I have my ablation and tubal ligation scheduled for next month at Mt. Sinai, and I'druther get my nodule-ectomy or thyroidectomy done at the same time, as the doctor I'm seeing for that is at that hospital too.

Sis and aunt both are aware of what's going on, yet neither one of them have texted or called me to see how I am doing. In stark contrast the very few folks at work (boss) as well as a friend of the husband's (who has adopted me, as sort of an adopted older sister) seem incapable of NOT asking how I am doing. Heavy duty stuff I'm going through for sure, but no sense in worrying until I know, DEFINITIVELY, what I am going to worry about. 

PS: FUCK YOU QUEST DIAGNOSTICS! FUCK YOU SERIOUSLY AND SIDEWAYS. IN YOUR PROVERBIAL EAR AND REAR END.

Dayenu! (It Would Have Been Sufficient...)

Seems like I'm putting the DIE in Dayenu...

If I just had to deal with PCOS & Syndrome X, dayenu.
If I just had to deal with fatty liver syndrome and hypertension, dayenu.
If I just had to endure RnY to turn some of that shit around, dayenu.
If I just had my joint pain, herniations, carpal tunnel, and plantars fasciitis, dayenu.

If I just had my "optic nerve druzen," dayenu.
If I just had my adenomyosis, endometriosis, and infertility, dayenu.
If I just had my kidney issue, hypertension (yes, a 2nd utterance), and migraines, dayenu.
If I just had 7 thyroid nodules, one of which is "suspicious," aka has "unclean margins," dayenu.

Summation: Monday I had three appointments. The trifecta of suck as it were.

1st appt: Nephrologist. Nothing new. Cortisol still high. Pee in a cup. Still no resolution on my blood pressure Rx, which we have been talking about changing or tweaking for months now.

2nd appt: Ultrasound of thyroid. Oh yes. Fabulous. Asshole doctor is a no-show, but diagnostic center gave me choice of continuing w/a different radiologist to read and interpret the findings. Okay. Fabulous. Seven nodules (thought I had just one), with one being close to an inch in diameter, and with "unclean margins." RED FLAG. Of course, HAD the asshole doc been there, I could have seen about getting a fine needle aspiration done THAT DAY, but no. I'll have to burn another day (or half) a day to come back into the city for this nonsense. Which means, I have to wait yet again for an office to call me back to let me know when they can fit me in, and of course, they cannot get this shit done today, or tomorrow or even this week. My anger is righteous, and brewing moment by moment. I went into this appt armed with the knowledge (thanks to Dr. Google) that if it were thyroid cancer, there's an 80% chance it's benign. Radiologist contradicted and said it's closer to 90%. Okay. So I exit the building, get pinged by the husband, and find out his grandmother passed away earlier that morning and he wanted to go home asap, but would wait knowing I had a 3rd appt later this afternoon.

This day is getting better and better.

3rd appt: Endocrinologist. Of course nephrologist never forwarded him any information from our appointment earlier in the day, so the blood pressure Rx discussion gets shelved YET AGAIN (I'll tell this to my migraines and heart flutters, I'm sure there's therapeutic benefit in that, right?). He calls me into his office, the inner sanctum, instead of the exam room. Glum as a chum he informs me that things aren't good, and I need to get a biopsy done ASAP. And oh yeah, remember that 90% the radiologist quoted? Yeah, well that's closer to 75%-70%. Plus, with the size and location of that 1 inch motherfucker? Even if it's not cancerous, that doesn't mean that surgery is out of the question because if it continues to grow, it's a choking hazard. As it stands, I can feel it when I swallow, and I have discomfort when I swallow hard tablets and supplements.

And of course, the place that does FNAs don't do them on the days I already HAVE appointments, which means ADDITIONAL time off. And of course, given the fact that the thyroid is MILES away from my endometrium and fallopian tubes, when I have THOSE procedures done next month, I cannot get the thyroid done at the same time, so I can recover from all of that mess at the same time. Oh no.

I'm bearing my burden well, thankyouverylittle. I'm just not bearing the burden HAPPILY.  I'll power thru the best I can like I always do, but yanno what?

DAYENU! Enough. Just, fucking, ENOUGH already.