News Article: Robots preclude neck incision for thyroid surgery

Original article here: Robots preclude neck incision for thyroid surgery

Robots preclude neck incision for thyroid surgery

AUGUSTA, Ga. - Robots that revolutionized gynecologic and urologic surgery in the past decade now offer the option of removing at least a portion of their diseased thyroid gland without the hallmark neck incision, researchers said.

The thyroid, which sits just under the Adam's apple and controls the body's metabolic rate, is about the size of a kiwi. Benign and cancerous disease can more than double its size. Dr. David Terris, Porubsky professor and chairman of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery, has helped shepherd in minimally-invasive approaches that reduced neck incisions from several inches to less than an inch within the last few years.

The daVinci Surgical System, in which surgeons sitting at a console maneuver through tight spaces and around corners, enables access to the thyroid through the armpit, Terris said.

"In my opinion, if you are committed to not having a neck scar, this is the best way to do it," Terris said of patients who are trim, have benign disease and need only half of their two-lobed thyroid gland removed.

He and his colleagues – Dr. F. Christopher Holsinger, associate professor at the University of Texas MD Anderson Cancer Center, and Dr. Ronald B. Kuppersmith, clinical faculty member at Texas A & M Health Science Center – provide an overview of the robotic technique they are helping develop in the United States in the current print edition of Otolaryngologic Clinics of North America.

Although the armpit is farther from the gland than the neck is, simply raising the patient's arm during surgery shortens the path, leaving a fairly straightforward approach made navigable by the three- dimensional visualization and wrist-like maneuverability of the robot.

"The robot is what makes it possible to easily – and safely – do the work from that distance," Terris said. Surgeons gain access through a two-to-three-inch armpit incision, then work their way through skin and fat and finally in between two big neck muscles. "It's a long way down a big tunnel to get to that thyroid through the armpit that would not be possible without telescopes and long instruments," he said.

In the August 2004 edition of Laryngoscope Terris advocated the technique for select patients after comparing five minimally invasive approaches in pigs. While acknowledging that the armpit approach is a lot more work in humans, experience has enabled Terris to complete the procedure in less than two hours vs. under an hour via a three-quarter-inch neck incision.

Korean surgeons have the most experience to date with robotic thyroidectomy in humans and are using the approach to remove both lobes, Terris said, noting that cultural concerns about neck scars helped push Koreans to be pioneers in the field. He thinks improving technology will hasten the procedure's acceptance in the United States, where robotics in other medical procedures are already common.

In the journal article, the thyroid surgeons recommend that colleagues interested in the approach should complete robotics training, practice thyroid removal on cadavers, watch an experienced surgeon use the technique, then have a surgeon watch them.

A stitch in time...

...but how much time? How long does it take for dissolving stitches to dissolve?

At either end of my scar I can just about feel what feels like a tiny piece of fishing line. Now I'm sure my surgeon didn't use fishing line, he assured me he'd used dissolving stitches, both internally (obviously!) and externally...and that I could just ignore them, they'll go in time....but how much time.

Hubby kept insisting I was imagining it, we both stared and peered at my scar, but couldn't see anything...but if you brush your finger gently across the scar you can definitely feel the stub end of the aforementioned article, that I'll just call fishing line, one bit at each end of the scar.

So how long until they disappear?

Back to my GP next week for another pre-Endo blood draw, so if they are still in evidence then I'll get her to investigate.

I'm having a mixed response to the Bio Oil. I will of course keep going with it, and I hope that in a few months time I will be absolutely singing its praises to the highest...but my observations for now are both good and bad.

On the one hand, it seems to make the scar sore immediately after I apply it...the soreness is only temporary, and not all *that* sore if I'm honest, but it definitely results in soreness where there was no soreness prior to application. Is this just because the scar is getting direct physical attention for the first time in 3 weeks? Or is the evidence of some possible left-over stitches a sign that I shouldn't be using the oil yet, ie the site is not totally sealed yet?
But on a more positive note, it seems the gentle massage of the area, during application of the oil, gives instant results in improved neck mobility. I find the scar gets tight, and my neck gets stiff, both overnight and as the day wears on, and yet as soon as I've given it some gentle attention with the Bio Oil, the scar feels much less tight and I can turn my neck to the left and right with a lot more ease.

In other news...I finally got the Wii Fit out again, and had an enjoyable 30 minute session on it this morning. I know I mentioned starting again with it a couple of weeks ago, but when the crunch came down I just didn't feel up to it. But I was delighted to find a lot of my regular exercises weren't nearly as difficult or painful as I expected them to be. If anything, I could do most stuff, but obviously took it easier on some of the games. I struggled with anything that involved holding my arms above my head, that really seems to pull on my neck, and some of the more obscure yoga stretches weren't achievable because I was afraid of straining my neck. However I still had a satisfactory session, and worked up a good sweat!

Bio Oil for Scars

Yesterday I was given the all-clear by my surgeon to start using Bio Oil.

Many, many people have recommended it for helping to drastically reduce scarring (as well as improving the appearance of stretch marks and uneven skin tone).

Because he used dissolving stitches, and thus I didn't have to go and physically get my stitches taken out, I wasn't sure when to start using it...and my pharmacist had warned me that because Bio Oil is very thin I mustn't use it until the wound was totally sealed...so I waited until my surgeon said it was OK to use it.

Today is the day. Thanks to my lovely Mum I have a 200ml bottle on hand to get started with. And I reckon Amazon looks pretty competitive, price-wise, for sourcing any subsequent bottles I may purchase.

And here, gore fans (and I reckon its safe now for non-gore fans) is the latest scar pics, taken yesterday, 24 days after my thyroidectomy.


You can find out more info on Bio Oil here: www.bio-oil.com

And here's a link to Bio-oil on Amazon

Farewell to my Surgeon

Went back to hospital today for my post-op follow-up with my surgeon (yes, I know I was only there on Tuesday, to see my Endo - but that's how these guys roll I guess)

I was called in to the consultation room by his registrar, but then Mr S himself came in to have a peer at my neck.

They both stated that they thought it looked good, and was healing very well.

Apparently its perfectly normal to have good days and bad days, with regards to stiffness, pain and the tight feeling...that its all part of the healing process, where its all healing internally at different rates. And it'll probably continue to feel like this for a good while yet.
The remaining swelling was minimal, and the scar site itself they both declared looked excellent.

They reiterated that I need to keep the site protected from the sun at all times. That it will take up to a year before the scar heals completely and becomes strong, but that within a couple of months it should be barely noticeable.

I was given the all clear to start lashing Bio Oil on it, and we all bid a fond farewell to each other as my surgeon declared that as far as he was concerned I was all finished with his ENT department. But, should there be a further complication down the road (highly unlikely), all my Endo had to do was pick up the phone and Mr S would put me straight back on his patient list.

I thanked him profusely for all he had done for me. The more I looked into the horrors others have experienced after Thyroid surgery, the more truly appreciative I had become of my surgeon and his skills. (I did a bit of Google stalking - and have to say he comes extremely well recommended and appears to be very highly respected in his speciality by his peers!).
Post-op I had no numbness, no tingling. No obvious deterioration in my voice or vocal chords (other than initial soreness form being tubed during the op). No problems with my parathyroids, or calcium levels, either temporarily or permanently. And none of the other awful things that are known risks of this type of surgery, which have happened to others, and which my Fuzzy Thyroid Brain won't allow me to recall right now...

Oh, and one more bit of good news...they send a sample of the goitre/thyroid gland for a histology report as standard during the op...and mine came back *BENIGN*. Thyroid Cancer is one of the most common reasons to do a total thyroidectomy, but was never in question in my case. My thyroidectomy was due to my toxic multi nodular goitre, which, in addition to raising merry hell with my thyroid levels, was closing on my windpipe and slowly strangling me....but even so, hearing the word *benign* will surely always give someone a little lift!

Farewell Mr S, you're diamond!

I'm Free!

Yes!

They let me come home today!

My calcium levels stayed where they should, and showed no sign of going all crazy on us. And all in all, my surgeon was very happy with everything.

My chest drain came out yesterday...which was on the one hand, a total relief, from the increasing pain & discomfort it was causing me, but also a truly unpleasant experience at the same time. It works as a vacuum, and even though the nurse was as gentle as she could be when she was removing it, you could still feel the pipe desperately trying to suck you inside out as it was pulled through the hole in my chest.
It was also touch-and-go as to whether they would remove it at all. Apparently my surgeon doesn't like it removed until the previous 24-hrs have yielded a specified minimum amount of blood & goo, and the nurses had already informed me that when they'd emptied & measured that morning I was still producing too much blood & goo. But he also doesn't like to leave them in longer than 48 hours if he can help it...and so I pleaded with him, and he gave the nod to the accompanying nurse on his rounds that morning! Woo!
So I was left with a sore hole in my chest, covered by a nice white dressing...that continues to absorb all the goo that continues to ooze out, and swells up to bursting point - really very clever. A normal plaster just can't compare!
And I don't care, because I no longer have a rigid fire hose sticking out of my chest, causing huge pain whenever it moves by even the merest minuscule amount...and I no longer had to march around the hospital with a transparent tub of blood & goo clipped fashionably onto the lapel of my dressing gown - happy days!

And now I'm home. I'm wrecked, I'm wobbly, I spent most of the afternoon back in bed, and I feel (and look) like I've been hit by a truck....but I don't care, I can do all that in the comfort of my own home...without nurses telling me to eat more, to walk more, to generally do more of everything that I didn't want to do, and all that other nursey-stuff.

I have to say, on behalf of my poor, drained right arm, I'm home just in time...those poor veins have had a real hammering since Monday (4+ blood draws each day), and the Junior Doctor who came to do my last set of bloods last night did a truly amazing job of drawing blood from the side of my wrist, after we both scratched our heads for a while, watching all the conventional blood-draw veins wave their own little white flags of defeat and proceeded to bury themselves deeper, one after another, no matter what he tried.

But all that is behind me now...I'm home, I'm home, I'm home!!

And now I start my new life, without the help (or should that be hindrance?) of my thyroid gland!

Hospital food, and TV wars!

[posted retrospectively & not necessarily in order - 1st June, day after the op]

At some point in the afternoon I was moved to a semi-private room, where I shared with another girl. She'd just come back after developing some problems a week after tonsil surgery.
She proceeded to hog the TV remote control, stuck it on mute, then when Desperate Housewives came on later that evening I had to endure it at top volume (when she was discharged the next morning, the very first thing I did was grab the remote control from the side of her bed!)
I was still too tired & spaced to bother with resurrecting any sense of fairness over the TV availability, so I just plugged the iPod into my ears, and watched the moving pictures until Mum and Hubby turned up during visiting hours.

I still wasn't eating very much. I'd forced down a yogurt for breakfast, under great duress from stern-looking nurses. I accepted some soup for lunch, but couldn't get past one mouthful.
Don't get me wrong, I know hospital food doesn't generally have a great reputation world-wide, but I was pleasantly surprised by the variety, tastiness and quality of the hospital food I was given. When my appetite did return I really enjoyed each and every meal. But for now, I just wasn't hungry.

At some point during the morning they emptied the vacuum pump on my surgical chest drain. Overnight it had sucked lots of blood & goo out of me, and I was now becoming more aware of this hose sticking out of the front of my chest. They kept calling it a tube, but it certainly felt like a ruddy great hose! And it was really starting to be a very sore pain-in-the-arse. I had a little clip on the container, so when I went off for walkies ( the nurses were adamant that I should be marching laps of the hospital on a very regular basis - what happened to rest & recuperation?) I could clip the vacuum container-thingy onto my clothing...and thus I could march about, with my lovely container of blood and goo on full public show, hanging off the lapel of my dressing gown...nice!

My surgeon came around at some point in the morning, to tell me how pleased he was about how it had all gone. He apologised for the size of the scar, but said it was as small as he could manage, given the size of the goitre.

Roughly every 6 hours, day & night, a vampire came visiting (different one each time) stealing lots of blood from my poor right arm, and disappearing off with a swish of their cape.
On the strength of these visits I was kept informed of the fact that despite being a Grave's Hyper patient my calcium levels hadn't dipped at all, but that they would continue to monitor them, We all concurred that this can only be due to the sterling work I had been doing with my Endo's Senior Registrar over the last few months, chipping away at my carbimazole dose, ever so slowly, so that for the first time in over 2½ years my blood levels not only come down into range, but had also stayed in range for over 6 weeks. My surgeon had explained to me that the more Hyper I was at the time of the operation, the more my calcium would crash as my body went into instant withdrawal. So thanks to Dr. R and his endless patience and gentle ways, we were pretty much as good as it gets on the day of the operation. But also many thanks to my surgeon, for having a steady hand and not harassing my parathyroid glands whilst he was in there digging about with his scalpel, as that was another common cause of a calcium crash.

Late in the afternoon new girl moved into the bed next door. She was brought in with stomach pains, and put on our ward for observation as there were no beds available on the general wards. We got on great, and came to a mutually beneficial agreement over the TV Remote. She made me laugh so many times, and listened carefully when my mother joined the nurses in nagging me to go walking. She made it her mission to take me off for random walks around the place, as and when she'd decided I'd been laying around too long. If you ever read this, and recognise yourself as that girl, well, thanks J, you were a star!

Meanwhile mum and hubby, when they weren't being doting relatives beside my bed, and listening to my alternating mumbling, croaking & whingeing, were amusing themselves between the 2 shifts of visiting hours, by shopping lots in the local shopping centre and sampling all the muffins in the coffee shops they found!

A friend of mine worked on a neighbouring ward, so she kept me sane too, by popping in whenever she got a chance to make sure I was OK and had everything I needed. She helped break up the long, slow mornings between drug rounds, vampire visits and blood pressure checks. Thanks N, you rock too!

And just for the gore-fans amongst you, here are some pics of my neck and chest drain, taken less than 24 hours after the operation...absolutely no idea what I had to smile about....I was sore, woozy, uncomfortable & grumpy - it must have been a morphine-induced smile, is all I can say! :)

Just Let Me Sleep

[Again, posted retrospectively, as I was in absolutely no fit condition to post on the day]

OMFG! That has to be one of the worst 24-hours in my life.

This update has the potential to be very long, so grab a cuppa and make yourself comfortable...

...are we sitting comfortably, then we'll begin.

Yesterday was the day of my Total Thyroidectomy. We arrived at the hospital at a sprightly 8am, and reported to the Admissions Office. I'd been fasting from 10pm the night before, and hubby and mum had been great in the morning, skipping breakfast out of sympathy and trying to drink their tea/coffee as discreetly as they could (bless!). As we drove past the petrol station with the *best* coffee machine in the whole wide world, hubby very cleverly distracted me with some inane conversation, and continued on the journey to hospital.

The ladies in Admissions gave me my file and sent me up to my ward, where I was greeted by the sister...and instructed to loiter near the nurses station and await further instructions.
First was a quick interview with my surgeon's registrar, he drew blood for testing, and filled out some forms.
Then sister came and asked me the same questions, and quite possibly filled out identical forms.
There was no bed presently available...and so we were given the ward sister's office as our temporary HQ...that's when it all started feeling a little surreal. However I was assured my op would be done shortly, and there would be a bed available when I came back up from the Recovery Room.
The next interview was with my anaesthetist...and I have to say she was absolutely lovely! She answered all my stupid questions with confidence and more than a little humour and humility. For me the biggest fear has NEVER been the operation itself, I have been looking forward to getting that gland removed...my biggest fear has ALWAYS been the general anaesthetic....I guess I've watched too many hospital dramas and hospital horror films....and when I asked her if I would wake up, she beamed and said " yes of course, I guarantee it 100%". She must have been a little confused by my look of complete horror, and then understanding dawned on her, when in my small (now shaky) voice I continued "...during the operation"....she laughed, held my hand, and again said "I absolutely 100% guarantee that you will not wake until I allow it"
I was brutally honest about my smoking, and the fact that I had tried and totally failed to give up prior to the operation...but she said that whilst it did make things a little more difficult for her, it certainly didn't make it impossible and wasn't really that much of an issue. She constantly reassured me that she didn't foresee any complications at all. She filled a few more forms out, and then told me she'd see me in the theatre.
Sister bustled back in to the office and informed me that I'd go down to the theatre within the next hour and a half, but first I had to go and get an ECG....this would help the anaesthetics team get a good picture of my heart, immediately prior to the op. So off we trotted, and got hopelessly lost...I'd always gone up to the ECG rooms from the Outpatient's Dept in the past, and approaching it from a different direction threw me completely and I lost my bearings.
ECG done, and all looking good (or so I was told anyway) we trotted back up to the ward.
I was dying for a pee at this point, and hunted around the ward for a loo....aaaaaah!
Then literally, 2 mins after I'd visited the loo, Sister came in and asked me for a sample....but I've only just been!?
Sister said I'd be going down to theatre in an hour, but I had one more little mission to attend to...I had to go to the X-Ray Dept this time, and get a Chest X-Ray (an extra job because I was a smoker I guess). Sister suggested we go for a walk, and see if I could work up a pee sample that way. The chest x-ray was totally clear, which is always nice to hear when you're a smoker. And so we went for a bimble around the hospital. Mum and hubby by this time were flaking from not eating breakfast, so I conceded to let them go to the coffee shop, where they could scoff muffins and cappuccinos...whilst I nipped out to the smoking area (bad girl!). We were sitting around whilst they finished their coffee & cake, and thinking just *how* surreal this all was. Here I was, sitting in the coffee shop, fully dressed...and meant to be being wheeled in for a major operation in less than an hour...?
One more smoke, and then we headed back up to the ward. Sister asked if I'd managed to pee yet...but no such luck. She said I had half an hour to produce, or they'd bump me down the theatre list...talk about putting someone under pressure, and considering I'd been fasting completely (no food or drink) for the last 12+ hours, where was this pee meant to manifest from?
She told me that the pee sample was compulsory to test for pregnancy, and that without it they wouldn't go ahead.
I have an abiding memory of sitting in one of the loos, tears of frustration pouring down my face, pleading with my kidneys to do something, anything, anything at all...because otherwise all this would be for nothing, and if my bladder held out much longer I'd be sent home and bumped to the next day. I should add that Sister did apologise unreservedly for not giving me the sample pot as soon as I appeared on the ward that morning, as is her normal pre-op routine, but we caught her on the hop and she totally forgot...but that didn't change facts...if I didn't pee, I didn't get my trip to theatre.
Then joy of joys....the tiniest of dribbles....but Sister had assured me that even the smallest sample would be sufficient, I just had to hope this tiny dribble wasn't too small, as the thought of going through all the trauma of trying to pee again was too much!
Phew - she rewarded my efforts by giving me a sexy, back-less theatre gown to wear, along with some sex-kitten disposable knickers and a pair surgical stockings to die for (I've brought the stockings home with me - my hubby is a very lucky man!)
And then, dressed for a killer night on the town, we sat in a holding room...where Sister, tongue-in-cheek, asked my Mum if she had provided the sample for me, out of desperation. We all laughed and that helped break the tension that was now building inside me.
Sister explained that I had been moved down the list, but only by one place, and only because of the delay in providing my pee...but that the lady who had moved up in front of me was only having a small procedure done, and would be very quick. And so we waited.

But all too quickly it was time to go. I had hoped for a trolley or something, but no, Sister insisted I could walk just fine...and so, in my best theatre outfit, with my arse hanging out the back, we all trooped down to the theatres...hubby walking shotgun, and mum walking as close behind me as she could, without looking like a complete weirdo ha ha!

The would only let one relative into the Pre-Op Staging Area, and so mum came in with me...and finally I was given a bed/trolley to sit on, with a big fluffy duvet. A troop of various medical staff came along, with various (curiously identical) forms to be completed. A nice young man came u and introduced himself as my anaesthetist, and I think I confused the hell out of him when I told him that he wasn't the lady I met earlier...then he laughed and said she was his partner, and they worked in pairs.
My surgeon also paid us a quick visit. I almost didn't recognise him in his scrubs, I had only ever seen him previously in his suit etc. He talked through the procedure again, and reminded me of the potential problems, and also of the low statistical probabilities etc, etc, and then said if I was good-to-go he'd see me in there shortly.

We were given magazines to read, a stack of OK, and Hello, and I was dismayed to see the young lad in the bed next to me was given a copy of the latest Irish Vintage Scene...which he clearly didn't want to read. So when the nurse had disappeared I suggested a swap. Strangely he didn't want to read OK or Hello, but he did pass IVS over to me, so I could lose myself in lovely Vintage Cars whilst I waited for my call to theatre.

And soon enough, I was collected up and wheeled off down the corridor into the theatre itself. I had to shuffle myself over from the trolley and onto the operating table myself, which was more than a little surreal and most undignified, trying to hide my butt from all and sundry as I wriggled across...and when everyone trooped into introduce themselves I did ask them if they had forgotten something. They looked at me blankly, and so I asked them whether I was...erm...meant to be asleep right now...just in case they needed the fact that I was still wide awake and fully conscious made aware to them. Then my lovely lady anaesthetist walked in and said, "no, that's what I'm here for".
She gently laid my left arm on a sticky-outy panel (I just *know* that's the technical term for it!) and carefully put the cannula in. Various members of staff talked some inane chatter to me, and the last thing I remember is one of the theatre nurses holding my right hand and asking me how I coped walking 6 dogs....I remember feeling a bit frustrated because the words I wanted to use to answer her wouldn't come out...and then nothing...

...until those evil, nasty people in the Recovery Room started up with their Prisoner Of War Torture Techniques....you know the bright lights, the sleep deprivation, and shouting, lots of shouting...everything was so bright, and they all seemed so loud....but they got extra excited and extra loud every time I tried to close my eyes against the bright lights. I'm fairly sure I was rude to them, and more than once, as 'sod off' didn't seem to be working, so I had to reach into my head for much stronger ways of expressing myself. And all the inane questions they kept asking, over and over again....do you know who you are, do know what day it is, do you know where you are, do you know why you're here, will you open your eyes, keep them open, no you can't sleep, we won't let you, yada yada yada.....just leave me alone, I'm very tired and I want to sleep!

Bumpety-Bump

And I've already been 'bumped'

Going in this Sunday now, instead of Thursday, to be slashed either Monday or Friday, depending on whether I still need 'blocking' before the op.

Judging by my interpretation of this month's blood tests I'd say he'll do me on Monday though, as at the moment, the important ones are within 'normal' lab ranges...although my TSH is higher than I'd like it.

Should get more info tomorrow though, as I have an appointment with my Endocrinologist in the afternoon....who's meant to be working with my surgeon on sorting my levels prior to the operation.

Sunday suits me better anyway....Mum doesn't arrive off the ferry from the UK until Saturday, and it'll be nicer to see her and catch up on stuff before I go in...but please cross your fingers that I don't get 'bumped' again

Oh Crap !!!

Just heard from my surgeon's secretary....I'm being admitted next Thurs (27th) assuming my bed is still available. I have to ring in morning to check.

... and then he'll stick the knife on the Friday or Monday, depending on my latest bloods (taken yesterday).

Stones & Scalpels

Down another 1lb this week, which is OK.
Two 1lb losses in 2 weeks, and since starting these were the only two weekends I've so far spent at home, not drinking alcohol and not eating semi-crap...go figure? Clearly if I go out drinking & carousing over a weekend I lose more weight? Good thing I've got a 3-day music festival coming up at the end of the month!

And, I hesitate to say it, but that's my first stone gone...even though I promised myself, for my own sanity not to count this in stones this time, but instead to stick to 10lb segments...but, well...its my first stone...woo!

In other news, regarding my thyroid...the appointment with my surgeon *was* my pre-op consultation, and I'm now officially on the waiting list, and due to complications with my windpipe being compressed the surgery is supposed to be sooner rather than later. I will be admitted a week beforehand because my thyroid is so toxic that they have to get my levels as near to perfect before the op, otherwise the complications afterwards will be more severe, yikes! So, guys & gals, it could be next week, next month or next year...but more likely to be within the next few months.
I mentioned my GA fears to him, with regards to my weight etc...but he said he's operated on 'larger ladies' with no problems, and the operation really does need to be done ASAP because of the windpipe problem so they are unwilling to let me go too long.
Still, I'm going to keep plugging away with the Xenical as it really is the only thing that has worked for me for years. And I'm now "Double Wii Fit-ing" each day, to really go to task on the cardio and aerobic exercises....overweight or not, I want to be as heart-fit as I can be before the anaesthetist plugs me with happy juice!

As you know, I have Grave's Disease/Hyperthyroidism, complicated by a large, toxic, multi-nodular goitre...however I have only just learned that this pesky goitre has compressed my windpipe down to less than 8mm in diameter!!! Hence the problems I have with breathing, swallowing and snoring like a "pig with bronchitis, on a freight train" I feel I surely should have been informed of this after my CT Scan last summer...I distinctly recall my Endo saying the scan was fine and everything was good...ho hum!

So there you have it...my weekly update...the weight is still coming off, and the surgery plans have been brought drastically forward!

And I'm Officially On The List!

Well folks...if you missed my status update on Facebook yesterday, it looks like its all been brought forward...and I'm now officially waiting for my operation date Here in my grubby mits is a pink carbon cop of my Admission Request Form!

I should have posted here last night....but I'll confess I was a total emotional wreck yesterday and my head was all over the place....when a friend rang me yesterday to confirm my attendance on today's Festival Promotion jaunt I think I scared him silly, poor chap...I think he thought I was dying.
Its not as if I didn't know I was due to have this operation, I just thought I still had another 9 or so months to get used to the idea (as well as get thinner/fitter for the General Anaesthetic!)....but no, yesterday was officially my Pre-Op Consultation, with my surgeon leaving me with the immortal words, "next time we meet will be on the operating table"...so I guess I went into a kind of shocked state...and I couldn't honestly tell you what I did most of yesterday afternoon, apart from cry a lot

Apparently I'm now considered fairly urgent, as my goitre has now compressed my windpipe down to 8mm diameter (hence the freight train snoring, ultra hoarse voice and total inability to breathe if my head is held in certain positions)...and I was told that if it compresses the windpipe any more then they will have to something drastic & gory to open my throat up to allow me to keep breathing....which I have to say sounds fecking scary! And as my surgeon said, if they're doing that, then they might as well get on and do the thyroidectomy...and so he doesn't want to wait until its that serious....i.e its serious enough right now, without waiting any longer for it to inevitably get worse.

And also, as my thyroid is considered toxic...I will also have to go in a week or so earlier, in advance of the normal admitted pre-op hospital crap, so that they can forcefully block my thyroid from working. To reduce the 'withdrawal' my body will apparently go into almost instantly once the thyroid gland is removed, they need to get my TSH levels absolutely perfect (or as close-to as it will allow them), and sustain the levels there for a few days...and that's using meds & methods not available on prescription, presumably nasty IV stuff

After the op they won't release me until my calcium levels are stabilised and/or controllable...apparently calcium is the very first thing to react and go tits-up instantly once the gland is removed. He said normally this is 2 or 3 days, but one patient he did last year was held in for 6 weeks because they just couldn't get control over her calcium levels.

I have absolutely no idea how the system works...but I presume, because of the co-ordination required between the ENT dept and the Endo dept, with regards to getting me in early and getting my levels stable...that hopefully means I won't get my op 'bumped', so once I'm in I'm staying...if that makes sense?

I have a routine appointment with my Endo on the 20th April...so if I haven't heard anything before then I'll hopefully be told more then, and maybe given a time-frame.

My surgeon just said he was aiming to do it ASAP...but I don't know if that means next week, next month or next year

So, surgery then...

I'm finally on the waiting list for a Total Thyroidectomy.

I was not meant to have my Pre-Op consultation until December, so was rather surprised when I got an appointment with my surgeon sent to me for today...I went along to see what he had to say, and basically, as per my most recent scan, my goitre has now compressed my windpipe to around 10mm and so they are unwilling to wait another 9 months (which was supposed to be *my* get fit/get thinner 9 months! ) because if it squeezes my windpipe any more they will have to take drastic action and do something nasty to my throat so I can continue to breathe....I was still shocked at hearing the first bit to be honest, so didn't take *all* the gruesome details in, sorry.

No idea how soon or otherwise the op will be, but it was indicated that it will be sooner rather than later, and apparently I need to be in for a week before hand, because my thyroid is incredibly toxic at the moment, so they will plug me into to some intra-venous happy juice, and forcefully stop my thyroid from functioning, prior to the op...which is meant to help reduce any nasty problems post-op.
With regards to post-op, the surgery will apparently cause me to go hypocalcaemic pretty much instantly...so I will then have to stay in until my calcium levels are back under control, either naturally, or by then taking a calcium supplement for the rest of my life, in addition to the thyroid replacement meds I'll be on for the rest of my life (ho hum!)
I'll also have a drain tube put in for at least 2 weeks afterwards apparently, and won't be able to talk for a while (yeah, yeah, yeah...hopefully it won't stop my typing though! )

Hubby did a YouTube search for thyroidectomy surgery at work this afternoon....and strongly recommended that I *DON'T* do the same!
He also suggested I avoid films such as 'Awake' and 'Flatliners' until after the op too....he's SO thoughtful, ha ha!

I also need to confess that I've never had a general anaesthetic before and I am utterly, utterly bat-shit shit-scared

Easter is a Chocolate-Free Zone

Down 1lb this week....and considering the 'chocoholic/food-gorging weekend' that's in it I reckon that's pretty good going!

I did sneak one creme egg....just one, honestly! After all, I think its law to eat at least one at Easter isn't it?

But other than that our household is an 'Easter-Egg-Free Zone' and that has made this weekend a whole lot easier to deal with, whilst I'm taking Xenical

However, as yesterday was not only Easter Sunday, but also my husband's birthday...and I'm really not that much of a miserable cow....I made him a Fat-Free Chocolate Cake, and adding my own small twist, I sliced it in half, like a Victoria Sponge, and spread in a layer of WW Raspberry jam....too, too good!! Awesomely good...and really not all that sinful!

In the morning we had poached eggs on brown toast, and for our main meal we enjoyed a Roast Chicken, using this recipe, substituting chicken for turkey....with Herby Roast Potatoes, plenty of steamed veg, and some low-fat chicken gravy

So I really don't feel deprived of my Easter pig out....we did pig out, but in a Xenical-friendly way

Today, we're making soup with the left-over chicken, and loads of veggies. Yum!

Off to see my surgeon on Thursday...and still no clearer as to why I'm seeing him now, in April, and not in 9 months time in December ....will report back soon!

Good News & Scary News!

Down 3 lbs this week...woo hoo!

Delighted with that...although I reckon its totally undeserved!

Knowing I was heading into the weekend from hell...with a friend's very messy birthday party on the Saturday night....and an almost-equally boozy night planned with another group of friends on the Friday night, before trying to act naturally in front of a TV camera crew on Saturday morning....meant that I chickened out and stopped the blue pills Thursday evening. Again, I tried to make the best decisions I could, but also knew I wouldn't be punished by over-doing it a little.

So I think my saving grace was Wii Fit Plus....oh how I love that! I did 40 mins each day all last week, and I truly think that is what made the difference and got me over the rocky road that was this weekend just gone.

Ramped it up to a 60 minute session today, and hope to sustain that each day this week....although this evening I'm definitely feeling those extra 20 minutes that I did today...so will go back to 40 mins of daily routines if I'm struggling.

The weather here today was utterly horrible.....cold, cold rain and nasty wind...the dogs didn't want to stay outside for any longer than necessary, and neither did I...so for days like today the Wii Fit Plus is *perfect*!!! Looks like the rest of week is going to be just as horrible, and the forecasters are even talking about snow...so I am delighted I broke the bank and forked out for it. The Wii will more than earn its money this week, that's for sure!

In other news I was kind of confused to receive an appointment letter this morning for the surgeon who's going to be operating on me...for the 8th April....10 days time!!!? I was under the impression that I wasn't going to be seeing him until December....so yikes, now I'm feeling my weight loss is inferior again, and he's going to tell me off for not being a Perfect 10, and tell me that he can't operate, blah blah blah....very curious to see what he says at that appointment, but also dreading it....I thought I had until December to get as much weight as I could off, before I hit the operating table...and now I'm not so sure what is going on at all?
Also had a job interview last Friday....I so badly need a job right now, and so desperately *want* the job I was interviewed for...so any weight loss I may (or may not) show next week will no doubt be due to the fact that I've been chewing my nails down to the knuckles with anxiety, waiting for their decision... I'm meant to be informed by the end of this week.

PS - Anyone else starting to notice a pattern on my weekends...? I really, really need to rein that in....whilst I seem to be getting away with it for now, I know its going to bite me in the arse at some point, and sooner than I think too!

All Systems Go!

A couple of days late with this weekly Xenical update...don't know where my time is going these days?

Warning, its a long one...grab a cuppa and make yourself comfy!

Anyway...1 pound down this week....which is OK. I'd like to have seen more, but I'll happily take any loss on my scales...looking back over my diet for the previous 7 days, and it seems OK, so I can only conclude its all down to my laziness regarding water intake, and not being as disciplined regarding exercise.

Monday was spent in hospital (routine appointment, not an emergency!)
First up was my dietitian who I see every 2 months (and can chat on the phone to at any time if I'm having a crisis). She weighed me in at 300lbs, whereas my scales weighed me that morning at 295lbs...which is OK...at least now I know the margin of error for my scales (hers are calibrated regularly!), and as I use mine weekly, and only get to sit on hers every 2 months, I will continue to use the figures on my own scales for my weigh-ins. Also, my weigh in at home was in my jim-jams...and in her office I was fully clothed...not 5lbs difference I'm sure, but still.

Then after my appointment with her, I then headed to the ENT department, for my appointment with the consultant surgeon who's doing my op. And had a very interesting session there...which involved a conference call, in my presence, with both my dietitian and my Endocrinologist...and the conclusion that they have now officially drawn is that I am, for definite, one of those 4%ers who actually gain weight whilst hyperthyroid, instead of more typically suffering dramatic weight loss, despite increased appetite.
So...they have decided to go ahead with the op now, regardless of how much I weigh...and the deadline for my pre-op consultation is 9 months (that's when I'll finally be put on the surgery waiting list - so fingers crossed could be on the operating table before march 2011...which is excellent news.
Not only because I will no longer feel like *such* a huge failure every time I go into hospital and get weighed by the nurses in the ENT & Endo departments...who do absolutely nothing to hide their disdain and tut loudly as they update my patient records each time.
And secondly, because for the last 18 months I feel like my life has been on hold waiting for a decision on my surgery...initially they were adamant they wouldn't do it until I was below 200lbs, and now they have conceded that it just needs to be done, sooner rather than later, regardless of my weight.
Until I have this op we have virtually no control over my thyroid function, and I'm not allowed to start a family...so although its only a pin-prick in the far distance, I do finally feel there is some light at the end of the tunnel...rather than treading water, and spending another couple of years trying to shift weight that won't move, whilst the ticking of my body clock gets louder and louder until it finally gives up and I'm too old to realistically start a family.
I am so delighted to have finally had a definite decision from my Endo regarding my status as one of the rare 4%ers - its something he has mentioned in the past, but previously refused to confirm it for definite. But it really does seem like the more I try and tickle my metabolism into working for me rather than against me, the more my thyroid fights back and suppresses my metabolism even more.

However, despite the relief of being recognised as a 4%er it doesn't let me off the hook...I still have to keep going, popping the blue pills, and watching my diet like a hawk...it just means my journey will be more difficult...and still the pressure is on to drop the weight, because despite the fact that they are now going ahead with my operation, regardless of my weight, I do also recognise that the heavier I am the harder it is for the anaesthetist, and the higher the risk for me....so it is in *my* own interests to get as much weight off as I can, and to get as 'heart-fit' as I can, before the anaesthetist comes at me with his cocktail of drugs...

I'm trying to walk every day (not just the daily dawdle with the dogs - but a proper, get puffing walk out)...but the Irish weather is so unpredictable its just not always possible.
I'm also trying to cycle more...in fact after my hospital appointments on Monday I drove down to the Shannon, and cycled for about an hour down the river path...felt great afterwards, really chuffed with myself! But cycling locally is reserved strictly for the brave, our local lanes are populated with speeding local lads in their rice-racers, of half blind monks from the local monastery who probably don't have driving licences but who are generally ignored by the local Gardai...despite going out decked in all the hi-viz gear I can find, and looking like some safety fanatic I've had my pedals clipped a couple of times in the last few weeks...so am now limiting my cycling to when I have the time to drive out and find a properly designated cycling trail off the road...or when I'm out bikejoring with my dogs.
So, yesterday I purchased a Nintendo Wii and Wii Fit Plus....I collect it tomorrow...and I just hope I'll be disciplined enough to do it daily.
Would welcome comments from any of you guys regarding the use of Wii Fit to help keep you fit and get the weight off...have absolutely no idea what to expect, but both my GP and my Dietitian have recommended it.

I also really need to get on top of my water intake though, I truly feel that is the key!

Oh, and as of Monday, I'm 10lbs down from my start weight of 305lbs...so that's the first part of my personal 10 x 10 in 2010 Mission done! Yay!!!

Blimey....that was a long post...almost a stream of consciousness spewing from my keyboard! If you've got this far, thank you x

ENT Surgeon Appointment - 13 July 2009

Out of bed early, after an exhausting week away. I wake up dizzy, and continue to have short dizzy spells as I got about my morning chores. A little perturbed I check my blood pressure. It comes in at 144/75, systolic is a little high at 144, but diastolic is good at less than 80...neither reading would explain the dizzy spells, so I put it down the last remaining dregs of this head cold I've been suffering from.
A quick bath, then I head up the road. I'm getting used to the alarming amount of hair that comes out when I wash my hair, regardless of the amount of conditioner I use...but its still distressing to see all that lovely hair just falling out all over the place, with very little encouragement. I often get my husband to detangle my hair after a bath/shower as I just find it too upsetting. Its easier to close my eyes and let him deal with it...out of sight, out of mind.

Its over an hours' drive to the hospital and all the way I'm chasing the ETA on my Sat Nav, inevitably I'm running late and getting stressed.
I land at the receptionist's desk at 10.57am, for an 11am appointment...and proceed to be ignored for 5 minutes as the two receptionists go about their business, discussing last night's TV with passing nurses, and basically appearing to do all they can to avoid dealing with me. I'm wondering if I'd mistakenly worn my invisible jumper when one of them deigns to notice me.
The checking-in process completed I take my seat, thankful that I'd remembered to pack a book into my handbag.

Two hours later and I'm regretting not putting two books into my bag, as I turn the last page on the book I started just two hours previously.

I sneak out of the open door for a cigarette, leaving my name with a fellow patient, also waiting patiently for their appointment, also two hours after their allotted appointment time.

Finally, 2½ hours after my appointed time of 11am I am called in to see Dr H. The first thing he asks me is if I've had my CT Scan yet. Sadly the reply is negative, and I can see from his expression that this meeting is kind of pointless without the CT results. We joke good naturedly about hospital efficiency. I point out that I am returning to the hospital in one week's time to see my Endocrinologist anyway, and wouldn't it be great if the CT Scan was scheduled for the same day, to save me an extra trip into the hospital...and we both laugh at this highly unlikely scenario. That would make far too much sense to whomever is responsible for scheduling such things.
Undeterred by my lack of CT Scan results, he proceeds to poke and prod at my neck anyway. He has a good poke in my ears (heaven only knows why?), pokes his torch up my nose....(well I suppose as an ENT Surgeon he wants to get his money's worth from any patient), before sticking his hands around my throat again for a further squeeze. He squirts yucky tasting stuff up my nose and assures me that my nose and throat will shortly go numb. I can taste ammonia, he tells me its benzocaine based....either way it stinks, and tastes horrible as it slides down the back of my throat....but it isn't half as unpleasant as the huge long scope he then pokes up my nose, and pushes down my throat. Quite a strange sensation....I don't think my throat is as numb as it should be, I can feel every centimetre of it and its at least 30cm long. Feels odd to talk to him, and answer questions, while this huge long piece of cable is sitting at the back of my throat, by way of my left nostril.
After it is removed my nose runs uncontrollably, and the attending nurse kindly passes me a packet of tissues. She advises me not to drink or eat anything for at least an hour, until the anaesthetic properties have worn off.
Dr H ponders what he has seen and announces that he thinks the Goitre on the right side has spread under my collarbone, and that this will make extraction more complicated. We will know more and have a clearer picture once this damned CT Scan has been done, but for now all we can do is speculate. Mysteriously he tells me that if it is down under my collarbone he won't be able to perform the surgery here....I assume 'here' means this hospital, but I'm not too sure what this statement means. he goes on to discuss other things and I forget to ask him to clarify this statement. I must remember to ask my Endo next week if he has any idea what this means.

Then the discussion turned to weightier matters...if you'll pardon the pun. He expressed concerns, on behalf of his anaesthetist, regarding my weight, and he stated that he'd like me to lose a minimum of 6 stone (preferably 8 stone) before he'd consider passing me over to his anaesthetist...I guess this means he won't be scheduling me for surgery either, until I lose this weight....regardless of my CT Scan results, and regardless of my thyroid problems. Oh, and he'd like me to ditch the smoking too...well that's a given, and is high up on my to-do list as it is.
I joked that I'd set about starving myself between now and my next appointment and he did have the good grace to apologise in advance for his crassness, as he quipped that "no fat people came out of Belsen".

I go back to him in 2 months time....14th of September to be precise, and I will try my hardest to have lost at least a stone or two by then. Oh, and I'll be pi**ed off if I haven't managed to give up smoking by then too. If I haven't had my CT Scan by then, well I guess it'll be yet another wasted appointment....got to love the Irish Health System....

Endo takes my Goitre seriously!

When I was getting my bloods done the other day, in preparation for today's Endo appointment, I mentioned to my doctor that nobody at the hospital had been too concerned, or even interested in my goitre, no matter how often I mentioned it. I also showed her how much the right hand side had swollen up in recent weeks. She laughed and said "one look at that, and they'll be *VERY* interested this time, trust me!"

She wasn't wrong.

Once again, I was given a consultation with another fresh-faced young intern, but I didn't stay with him for long. One look at my goitre sent him scurrying for the Consultant Endo, and the rest of my appointment was with the boss himself.

He has decided to refer me for a CT Scan to check out the goitre, and also to an ENT consultant...just to make sure they have that covered. He mentioned the possibility thyroid surgery again, but also reminded me of the RAI option - essentially the decision is mine, I just need to do my homework and make the decision, if it comes down to it, but in the meantime it was worth setting the wheels in motion in case I decide to opt for surgery. I guess the goitre is what is worrying them, more than than my malfunctioning thyroid. He reassured me that it all still could come under control with the meds, and all this is purely speculative, but bearing in mind waiting lists for referrals etc we may as well go ahead and make a start.

My bloods are still out, my TSH is too high, and my Free T4 is too low - indicating that I'm very firmly in the Hypo camp right now. So we've dropped my Carbimazole from 30mg/day to 15mg/day.