Some like it hot

The GP looked at my throat as I moved aside my stole a bit and I instantly picked up on his reaction with my special sense. It felt like a teeny tiny registering of quickly camouflaged alarm.

He asked me to swallow a couple of times and then nodded.

Thus, I was initiated into the world of thyroid nodules by being informed that there are two kinds; hot ones and cold ones. In my fledgling understanding, it seemed hot nodules were a problem, so to rule that out, the doc scribbled me a note for a radio isotope scan. I did feel some doubt though and wondered why he didn’t ask me any questions regarding physiological symptoms that would indicate hyperthyroidism (a condition in which the thyroid produces hormone in excess of the body’s needs) or why he didn’t even feel my throat area a little bit. Based on the little I had read on the internet, it seemed more logical to get a simple ultrasound first. Nuclear medicine seemed a bit… extreme, as a first step in diagnosis, and I called up the doctor again after going home, to voice the concern I hadn’t expressed earlier. He stuck by what he had said, that an ultrasound wouldn’t reveal a hot nodule.

And so it came to be that I made an error in judgment, deciding to trust his word instead of seeking another opinion, the consequences of which drove home to me the very real importance of my inner voice.

The only place to get a scan like this in Karachi is the Atomic Energy Medical Centre. conjuring up such grand impressively science-y visuals! Going there presented a different scenario altogether. Looking around at the sea of mostly women , mostly lower middle class , I observed and felt a lot of the misery in the waiting area of the floor that was apparently dedicated to the functions (or lack thereof) of the thyroid. I couldn’t believe I had hopped out of my bubble straight into this sea, though without the distress as I suffered no symptoms of dis-ease. Striking up a few conversations with different women I stood or sat next to , I asked what they were experiencing, what brought them here, were they happy with their treatment, how hard was it to cope? Most were already on daily thyroxine pills to counter hypothyroidism, when the gland produces too little hormone for the body to function optimally. One was a young girl in her 20’s with irregular menstruation, one was an elderly woman in a wheelchair with a humungus goitre, struggling to eat and breathe, one simply felt tired all the time and wasn’t happy to be told to stop consuming rice , which was the one love of her life. One woman innocently asked me the meaning of a word written on a poster which made me feel the privilege of my education. One of the women I met disclosed that she had lost her brother recently, and that had really changed her life for the worse.

I chanced upon a very illuminating blog post titled Emotionally, Psychologically and Spiritually Decoding the Thyroid and I’ll quote a few things from there :

“If you struggle to communicate–whether the difficulty is not listening to others or not expressing yourself effectively–you likely have health issues in the areas of the mouth, neck and thyroid…people with thyroid problems are frequently very intuitive but are unable to voice what they see because they too often struggle to keep the peace or win people’s approval. 

“Louise Hay, author of “You Can Heal Your Life” says that Thyroid function has to do with self-expression, but specifically about “having my turn” to do so.  She also mentions that the throat area is connected with “our ability to speak up for ourselves, ask for what we want”, and if we shy away from what we want, this “usually means we do not feel we have the right to these things.” 

“One of the most fascinating results of fifth-chakra distress that I have observed clinically is a loss of the so-called twinkle in the eye. It’s hard to define exactly what that spark in the eye is, because it’s a rather amorphous physical condition. It is not simple clarity of the sclera, nor focus of the pupil. Nonetheless, almost anyone can recognize it, and most people are attracted by it…..

Since the fifth chakra, or throat chakra, governs the thyroid gland, it would seem possible that the lack of a twinkle in the eye is merely a reflection of low levels of the stimulating thyroid hormones, T-3 and T-4. However, I believe the truth lies deeper. I think that when the throat chakra is dysfunctional, it robs us of the proverbial spark of life that ignites the twinkle in the eye.

(Makes a lot of sense then why the vast majority of those suffering from thyroid issues are female.)

To move on with my own story, I was led into a basic room (not the fancy interior I had imagined an ‘atomic energy centre’ to be) where a regular looking nurse wearing a protective apron injected my hand with a combination of radioactive iodine and some kind of dye that helps the gland show up on a screen. I felt a rather sharp pain that I don’t think I was supposed to, but my concern was casually dismissed. I hugged my hand and followed instructions to go to another floor for the scan itself. Yet another very basic room with a very used-looking yet functioning machine in which I had to lie down and be still for a few minutes while the imaging happened. The results a week later showed that It wasn’t a hot nodule and Huz and I rejoiced, not realizing that we were not only NOT out of the woods yet but were about to go even deeper. The outpatient doctor I met next discussed my results, felt my neck properly and asked me to get a blood test and an ultrasound done on the same premises. This would help in gauging the size and nature of the nodule. I drew a blank when asked by the lab doctor how long I’d had it though.

The thing with cold nodules of the thyroid is 95% turn out be benign, and mine was only 1.5 cm, a tiny one, hypoechoic and bang in the isthmus, a word I first learned in geography class. Geographically, an isthmus is a strip of land that connects two land masses, like the isthmus of Panama. In the thyroid it is a narrow band of tissue that connects the two lobes that wrap snugly around your windpipe.

I was all set to sigh with relief and settle myself safely in the benign category, but the outpatient doctor had other ideas. Keen to rule out the niggling 5% chance of it being ‘suspicious’…..I have a feeling she was hesitant to use the C word…she sincerely advised me to get a fine needle aspiration test done as soon as possible.

I went home and fell asleep while stroking my poor hand, worn out not just by scanxiety but also a general uneasiness because of the abrupt influx of words I was not expecting to hear. When I woke up, the side of my hand started to inflate rapidly as I watched in horror. The swelling took a day or so to subside, and turned into multiple shades of blue, purple and green as the days went by.

What I didn’t sign up for was an uncomfortable feeling of tightness under my chin and jaw and I didn’t know what the cause was. Something told me it had something to do with the scan injection and a little search on the internet confirmed this. I found out that sometimes the dye that accompanies the radioactive iodine can cause one’s salivary glands to swell or become inflamed.

For weeks I felt better if I wrapped a stole tight around my head to support my chin, pressing and massaging the muscles around my neck to ease the discomfort.

One thing I was beginning to learn was it helps to focus on breathing. A mindful inhale followed by a mindful exhale does a lot to take away the very physical feelings of stress and I can still access a place of calm through all the fears . It also helps to walk out the door to a nearby park, sit under a tree and hum. Humming with a deep exhale somehow brings peace. Being in nature is grounding. Being with my cats is calming. Immersing myself in focused work or gardening takes me out of an anxious state.

It’s all about regulating my nervous system through life’s vagaries is the lesson.

Also, to listen to my intuition.

The first doctor I consulted may have been misguided in advising the radio isotope scan that caused me so much needless pain and worry when an ultrasound would have sufficed, yet I’m glad I had that whole experience, not only to humbly find myself in the collective soup, but also to learn that the government hospital runs efficiently enough and that it doesn’t tax poor people with exorbitant medical costs. All the procedures I undertook that day amounted to less than five thousand rupees, crazy when you know that just a blood test at a private hospital to check for vitamin D costs the same.

Signs

It’s been a minute as they say nowadays, and I’ve skipped even journaling for several months let alone this, so no idea how or where to begin , unless I leave beginnings and endings alone and start with the now.

In the now, I am at home, a tad too well fed due to the kindness of friends and family sending us food as I recover from a major surgery. Day 5 draws to an end, and I am feeling better, though still uncertain and unfamiliar with this new configuration of me.

My vocal cords feel strained, unable to produce the sounds I’m used to producing. I tried singing along a bit to an old Lata number but couldn’t emit the higher notes required. I sure hope that’s temporary.

The incision scar on my neck feels like a thick cord under my skin, though the surgeon did an impeccable job of sewing me up after removing my thyroid gland. Once it heals, I am assured it will be unnoticeable, a necklace scar. I have some nice new scarves and necklaces to look forward to acquiring as future accessories, but to be very honest they could never compensate. I feel like I’ve lost a very dear lifelong friend, and no one seemed to understand that I felt an isolating sense of deep grief as I came to terms with my diagnosis.

I had a nodule in my perfectly functioning thyroid you see, I even know when it sprung into being. It was 5 years ago and at the time it had felt like a slight obstruction somewhere in my throat and I was concerned enough to go get it checked. The doctor asked if I was sad or depressed and I was of course, since my father suddenly passed away. So I was told it was probably psychological and to forget about it, which is just what I did, though once in a while I would find it impossible to swallow a regular well-chewed-but-glutinous bite of tandoori naan. And over the next few years if I felt as if my neck looked different, I just chalked it up to ageing and stopped looking at myself too much in the mirror.

Fast forward to early 2022, I was meeting a couple of old school friends for lunch and one of them had been looking fixedly at my neck as I was talking to her until she burst out with a ‘Munira, what’s that on your neck?’ I knew what she meant of course, it was the little knobby Adam’s apple right in the centre of my throat.

Completely unconvinced by my assurance that SOME women do indeed have these masculine structures, she urged me to go have it checked, that sometimes biopsies can shrink lumps like these if they draw out fluid. Later, she told me I looked pissed off, as if she had said things I didn’t want to hear, which was indeed true. I refused to believe MY body could have grown a dubious lump that needed biopsying, and it rankled for a few days to the extent that I decided to avoid said friend henceforth, thinking uncharitable thoughts all the while. Of course I had no intention of going for a checkup, everything was fine, I had no symptoms of any kind and if people were beginning to notice changes in my neck, I’d just do a better job of wrapping a scarf.

And I suppose I may have continued to bury my head in the sand if the universe didn’t do something to get my attention…again.

I may have been gardening or perhaps scrolling Instagram when a certain woman I have followed for a couple years popped randomly into my head , and I wondered why I hadn’t seen any posts from her of late. I visited her profile and noticed I had liked her last post which was from sometime in April 2021. There had been nothing since then , and it wasn’t even as if I interacted with her much or anything of the sort. I suppose the thought of her was a mystical foreshadowing, for the very next day she finally posted. It was a picture of her with a brave smile on her face in a hospital bed, not the usual well-groomed image I was used to seeing from her. But it was the bandage on her neck that made my scalp tingle before I even read the caption , where she disclosed that she was MIA due to being diagnosed with thyroid cancer last year.

This didn’t feel like something I could ignore anymore……and I may or may not have gone to the GP the very next day. I had no idea what I would get myself into with that visit, but at that point it began to seem a lot like an inevitable I knew absolutely nothing about.