Making a Plan

It’s been three weeks since we found out that I have Thyroid Cancer. During that time it’s been a bit of a whirl wind of doctor appointments.

I had an hour long appointment with the Endocrinologist where she went over my lab report.  The biopsy showed that 98% of the cells gathered were malignant in nature.  So there was definitely no grey area of whether it is Cancer or not.  Based on the size of the tumor, it is likely that I have had it for 8-10 years.  That really took me aback.  How could it be that for 8-10 years – at least nine of which I was actively being seen by military doctors for thyroid issues – was this never found? How could so many doctors see me, see my frustration, my desperation, and not do more? Especially when the test that revealed the tumor in the first place is neither invasive nor expensive – a neck ultrasound.  My confusion started to burn into anger the more I thought about it.

During the Endo appointment we talked about the road ahead.  During the rest of the pregnancy, I’ll be getting my labs taken every four weeks to check my hormone levels.  I’ll also get neck ultrasounds every other month to check the size of the tumor, my thyroid, and the lymph nodes in my neck.  This will check the growth of the tumor and whether the cancer is spreading.  For more answers about my surgery, we had to wait for an appointment with the Endocrine Surgeon.

The week after diagnosis, I went for a follow up neck ultrasound.  They were even more thorough than the first, and after the tech had taken all the measurements she had the radiologist come in and double check everything including the lymph nodes.  The radiologist said that all of the lymph nodes looked clear to her. The final measurements from the report show that the tumor hasn’t grown since the first scan in June. It was important to get this information before we met with the surgeon.

The Endocrine Surgeon appointment was at one of the leading hospitals in the area, and she is part of a group of endocrinologists that are helping to develop a new type of biopsy for thyroid patients that can increase the probability that they will get the right kind of surgery the first time.  Her resident took my history, starting from the beginning.  The surgeon herself was easy to talk to. She explained that it’s reasonable to wait until after the pregnancy to have surgery.  She said that it would be better to do it in the first three to four weeks postpartum – and that seems extremely early to me.  I am thinking about going to get a second opinion on the timing.  I realize that it’s important to have the surgery, but it’s also important to me to have a stable routine with my baby before so that I’m not trying to recover from having a baby and having an organ removed at the same time.

So for now, there’s a lot of waiting and watching to do.  It’s a little unnerving for me to walk around for six or seven more months knowing that I have cancer.  My emotions have been going between relief, anger and determination.  Relief to have a diagnosis and know that my intuition about my health during the last few years has been right.  Anger because my previous doctors and treatment facilities failed to diagnose me earlier when it could have easily been done if they were more vigilant.  Determination to keep living my life as I have been – embracing every moment with my family, staying active and strong, and focusing on having a healthy pregnancy and a VBAC.

~Mama

CombatBootMama

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The Call

I got the call on Monday afternoon. It had been four days since they had done the biopsy and I had been waiting anxiously for the phone to ring.  I had just gotten home from work, and hadn’t even taken my boots off.  My husband held my hand as the Endocrinologist let me know that the biopsy showed that I have Papillary Thyroid Cancer.

Cancer.

Hm.

I was suprisingly calm in that moment. Suprising to myself at least. I am sure that my husband expected me to react more than I did. The doctor let me know that we would talk more about what it means and what the next steps are at our appointment later in the week and I could ask any questions then.  I could tell that she didn’t like making these calls at all, probably as much as people liked recieving them.

After I hung up the phone we sat in a bit of stunned silence. And then we went about our evening. He made dinner and I played with my Son. We changed and went for a run where we talked about what the treatment plan could be and how we hope that God will use this to his glory and his plan will be made clear to us somehow.  We talked about the baby and how we hope that it will be strong and healthy through all of this.  I remember telling him that I know I should have been more upset, but I’m such a planner – all I’m focused on is making a list of all the things that I need to do and need to know and need to ask. “I’ll have that breakdown moment evenutally, but just not this second.”

When we got home from the run we snuggled up on the couch and watched TV as a family like any other night.  We put our Son to bed and carried on our normal things. We sent a text to our Pastor to see if he could talk. Our Pastor was able to call us around 11:30p.  We are so blessed to have found a church family here where we know that we can call them any time of the day or night if we need something. We let him know the news and he prayed with us.

And then I had my breakdown moment, snuggled in my husbands arms on the couch.

On Tuesday, I woke up feeling rested and fresh and normal. I didn’t feel like I had Cancer. Could it really be true?  How long has this been inside me? Months for sure, but it could have been years.  Years of the doctors telling me that I was wrong and that my intuition was off track.  I got ready for the day and went to work like any other day. We had decided that we would keep the news to ourselves until after my appointment on Thursday so that we wouldn’t have to try to answer questions that we didn’t know the answers to. After work I went to an ICAN meeting, and although I didn’t share that night, it felt good to help some other moms that are going through some struggles right now.

Wednesday I woke to a gloomy day outside, made the family breakfast and went to work like any other day.  I went about my day like any other. It felt like I was just waiting around for answers though.  Only one more day until the appointment. My emotions were definitely on edge, and I let a work situation bother me more than it should have.  I was ready for answers.

Thursday we woke up very early and dropped our son off at a friends house so that we could go to the early morning appointment.  Traffic seemed extra slow along the parkway, but it could have been my impatience too. By the time we made the hour drive to the Endocrinologists office my stomach was in knots and had a pounding headache.

The Endocrinologist is very good at explaining everything to me.  She is, by far, the most responsive, thorough and communicative Endo I have been to in the past nine years.  She confirmed that the Fine Needle Aspiration Biopsy showed that I have malignant Papillary Thyroid Cancer.  It is an extremely treatable and slow growing type of cancer and we talked about the next steps in the process.

Since I am currently 15 weeks pregnant, and it is such a slow growing cancer, it is reasonable to wait until after the baby is born.  We will have to work out the timing, but they will be doing a full thyroidectomy.  The tissue will be sent to pathology and based on those results they will decide if radiation, chemo or even nothing else needs to be done.  So for now our next steps include getting an additional thyroid ultrasound to remeasure the tumor and compare it to the ultrasound measurements in June.  Second, we will be meeting with an Endocrine Surgeon and talking about the surgery itself and the timing.  Third, I’ll be getting my thyroid hormones monitored each month for the rest of the pregnancy to make sure that they stay in the right range.  I’ll be having a followup monthly with my Endocrinologist as well.

She also talked with me about some other lab results, and diagnosed me with Hashimoto’s Thyroiditis.  I still have to do more research about this diagnosis, but she indicated that with the removal of the thyroid this will essentially be irrelevant after that.

While it is not so great to hear that I have cancer, it has also been a big relief.  After years of feeling frustrated by the medical system, I finally have answers as to what has been causing so many of my symptoms.  I feel like a big weight has been lifted off of my shoulders and we can move forward.

I will keep all of you updated about this throughout the journey.  Thank you all for your continued prayers!

~Mama

CombatBootMama

Hiring our Monitrice

I have talked about the process for hiring a doula or monitrice in another post, and as the end of the first trimester came upon us we knew that we needed to get moving and hire ours! We decided that a Monitrice would work best for us for several reasons. First, I wanted to be sure that I could labor at home for as long as possible before going to the hospital. Second, my husband wanted to make sure that whomever we hired had medical knowledge to be able to identify any red flags that could indicate an emergency while I’m laboring. Third, I wanted a trained person to be able to stay with us throughout my labor at the hospital, instead of the flitting back and forth of the busy midwives at the hospital.

Over the past few months, I had been collecting the names and recomendations for several home birth midwives in my area. I was able to find five or six that area mothers had used and had stories about.  I tracked down their Facebook pages, websites and anything else I could find about them to narrow it down.  Based on all of that information there were really only two that I knew could work for us and our family dynamic.  I emailed one and recieved a reply, she was no longer taking any clients at all – homebirth or monitrice.  I then contacted the other and she replied back quickly wanting to know more and to talk.

We spoke over the phone for about an hour, talking about my previous birth experience and what we are looking for in a Monitrice.  Then we set up an appointment to meet. She warned me that she had two homebirth clients due that week so it may change.  And change it did! The day our meeting was planned she was called to a homebirth and we had to adjust to the following weekend.

My husband and I drove to her house for the meeting, and we could immediately tell that our worries of winter weather could be valid. Her road was up the side of a steep hill, and was all gravel so cannot be plowed.  We started praying for a mild winter! Her home was on the side of the mountain, and was a log cabin style.  Her husband met us at the door and talked with us while we waited for her to be ready (we were nearly 20 minutes early having over estimated the drive time).  Our families are similar with several service members, and he even showed us a picture of his daughter with General Franks from her deployment.

Once she was ready, we got settled into the conversation easily.  We talked about my previous cesarean section and what I liked and didn’t like about my labor experience during that time. We went over our expectations and what we are hoping for by hiring a monitrice as well as some concerns that we have.  We were curious about how the dynamic would be between her and the hospital staff, as she is well known as a home birth midwife in the area and she has transfered patients there in the past.  She assured us that as a monitrice they will probably love that she is there as it makes their job very easy.  The hospital where we are going is very busy – more than 10,000 births per year.  So the providers are constantly going between patients and don’t get to spend a lot of time with the laboring mothers.  By having the Monitrice with us we will have a fully trained midwife with us throughout the entire birth and that is something that I really look forward to.

We also discussed nutrition, and staying healthy throughout the pregnancy. She also was able to give me ideas on how to avoid having so much water weight at the end of the pregnancy which I hope to follow including decreasing my carbohydrates and balancing the ones I do eat with plenty of protien.  Many of the things we talked about are right on track with how we view healthcare in general.  In our family we try to avoid artificial or synthetic medications, instead trying our best to find natural replacements or whole foods.  She was of the same mind on many of these things and it put our minds at ease that she is the right choice for us.

She also checked to see if I have any seperation of the abdonminal muscles, or diastasis recti, and I do have a one finger width gap. So she showed me some ways that I can keep excercising and keep my abdominal muscles strong without causing any further separation.

We ended up speaking for more than two hours and at the end both my husband and I were definitely sure of our decision.  She is also affordable and works with us on a payment plan, so that definitely helps!  We are very excited to have another supportive provider on our team as we work towards our VBAC!

~Mama

CombatBootMama

Second Prenatal Visit: 13 Weeks

My second appointment during this pregnancy came in my 13th week.  I have just cleared by my endocrinologist to start taking my Thyroid medication again and I am starting to feel better already. It is most likely a combination of both the medication and entering the 2nd trimester.

I went to my appointment in uniform, since I was going straight from work and my husband wasn’t coming with this time.  I think I make the nurses chuckle a little by already having my weight measurement ready for them rather than stepping on the scale whilst in uniform.  The boots alone add 4 pounds! If they weigh me themselves, the wont deduct pounds for clothing so I like to skip that part and I weigh myself that morning.

The midwife I met with today was great. She’s spunky, down to earth and isn’t sugar coating anything. We talked about pain management a bit during this appointment. I had heard that the family doctors can administer gas and air during labor at this hospital, but she indicated that I would have to switch to them as my providers if that is what I wanted to use.  Since this group of midwives has a stellar reputation for VBAC success, I am hesitant to do so.

We also talked about epidurals. During my last labor, the epidural did stall my labor for more than five hours so I would like avoid getting one so that my labor progresses.  I feel that I would have been less exhausted when I had reached the pushing stage if I had foregone that intervention (since it had worn off anyways). She indicated that that was fine, but to understand that if there was an emergency and a CS was neccessary that they would use general anesthia.  I am very claustrophobic, and the inablity to feel my body or move was traumatizing for me during my son’s delivery. I have through a lot about what she said since we spoke, and based on my emotional and mental reaction to the spinal block during my sons delivery, I think that general anesthisia may actually be the better solution for me if there was a true emergency.

I also talked with her about what the group of midwives expects regarding a timeline at the end of the pregnancy. She said that they allow VBAC patients to go until 42 weeks as long as the baby is healthy and there are no complications.  Upon 42 weeks, if the cervix has ripened they will opt for an induction using membrane sweeps, foley bulb, and pitocin. They absolutely will not use cervadil or other chemical dialators. If the cervix has not ripened they will schedule a repeat cesarean for 42 weeks 1 day.

I also got to hear the baby’s heartbeat and it was coming in strong at 158 bpm.  What a beautiful sound!

As I continue through my pregnancy, I will be seeing a different midwife in the practice at each appointment.  I hope to start formulating a list of questions to ask each one so that I can get to know each of them better.  This way when I am in labor they are all familiar and I can know what to expect from each of them.  If you were seen by a different provider each appointment, what questions would you ask?

~Mama

CombatBootMama{written on 7 July 2014, delayed publishing until after our announcement!}

First Trimester Genetic Screening

During your first trimester of pregnancy, you may be offered a genetic screening test.  A screening test is used to show if a patient’s risk is high or low for a specific disease or condition.  If the risk is high, then further diagnostic testing can be done. The most common screening tests for pregnant women estimate the risk of the baby having either Down syndrome or spina bifida.

A blood test and an ultrasound are used for these screening tests.  Human choriaonic gonadotrophin (hCG) and pregnancy associated plasma protein PAPP-A are measured using a blood test.  Women are more likely to have a baby with Down syndrome if hCG is high and PAPP-A is low.

the-tube-333213-m

An ultrasound is also used to indicate the risk of Down syndrome.  The nuchal translucency, or the amount of space between the spine and the baby’s neck, is measured.  During my screening, the tech indicated that they like to see a space of less than 3mm at my gestational age (12w 5d).

Both the blood test and ultrasound results are used in conjunction with other risk factors like the mother’s age to determine the risk.  The combined accuracy rate for the screen to detect the chromosomal abnormalities mentioned above is approximately 85% with a false positive rate of 5%.  If the risk is higher than normal, many providers will arrange for you to meet with a genetic counselor to talk about what these results mean and decide if further diagnostic testing is right for you and your family.

It is important to remember that Ultrasound technology, while useful for medical screening when necessary, should not be over used.  According to the American Pregnancy Association, “The ultrasound is a noninvasive procedure that, when used properly, has not demonstrated fetal harm. The long term effects of repeated ultrasound exposures on the fetus are not fully known.”

Genetic screenings are not required, and you can of course decide that it isn’t right for you.  It is important to make an informed decision before consenting to any testing or procedure during pregnancy.  For more information about genetic screening tests visit the American Pregnancy Association page.

CombatBootMama

Thyroid Complications

I have been struggling with a condition called Hypothyroidism since 2005. This happens when your Thyroid gland, located in the lower front of your neck, does not produce enough thyroid hormones. This can cause symptoms including fatigue, muscle pain, weight gain or difficulty losing weight, constipation, dry skin and scalp, decreased libido, irregular menstrual cycle and more. Thyroid hormone is essential for the optimal function of every system in the body.

Over the past few years, I had been receiving treatment from the military hospital system, but the majority of my symptoms were dismissed because my lab test for Thyroid Stimulating Hormone (TSH) fell within the normal range whether I was on thyroid medication or not.  After I had my son, they dismissed my symptoms as Post Partum Depression (PPD) and refused to give me thyroid medication at all. For the next year and a half I struggled to stay ahead of the exhaustion and the weight gain – even while training for my first full marathon.

Since moving to our current duty station, I have been able to see a new Primary Care Provider who has been supportive and thorough. During my first appointment with her she patiently listened to me and my concerns. She ordered a complete set of Thyroid labs to include not only TSH, but also the Thyroid hormones T3 and T4, thyroid antibodies, and even a cortisol test, to get a complete picture of my thyroid function. More importantly though, she also ordered a Thyroid Ultrasound to check for nodules, cysts, or tumors. She said that there was probably no issue, but “shame on me if I miss it!”

On June 2, I went for the ultrasound and they discovered a large growth on the right lobe of my Thyroid. It measured 2.6 cm long and 1.5 cm wide with coarse calcification. Based on those markers of size and the calcification, she refered me to an Endocrinologist to get a Fine Needle Aspiration (FNA) Biopsy. I immediately called the Endo and set up the first available appointment that they had – July 10!

It was hard waiting a month to get more answers. Especially when researching more about Thyroid nodules and cancer.

After the long wait, my husband and I made the hour drive to the specialist in the hopes if getting more answers.The Endo went over my family history including all relatives with Thyroid dysfunction. She then explained more about the biopsy process. There are three results that can come from a Thyroid FNA. Malignancy, benign, or inconclusive. Malignancy indicates Thyroid cancer and the standard of care is either a full or partial thyroidectomy followed by radiation treatment. Inconclusive results would warrant additional FNA to try to get a better tissue sample, and monitoring the growth of the nodule. It can lead to a partial or full thyroidectomy. A benign result would mean that they would watch the growth every six months to a year to ensure that it isn’t growing rapidly or changing. After explaining all of this, she went on to explain that she was in a new office and did not have the equipment there to do an FNA. So after a month of waiting, I had to call and make an appointment at a different branch of the practice to get the biopsy. The soonest that they can see me is August 14, over two and a half months after they originally found the growth.

As we continue to wait for answers, the endocrinologist is keeping a close eye on all of my Thyroid hormone levels.

For as upset and scared as I was when the nodule was discovered, it was also very validating to me. After years of having doctors dismiss my concerns regarding my health, there was finally proof that there was a source of my symptoms and they could no longer be dismissed and ignored.

We are staying as optimistic as possible and we are praying for healing every day. I will continue to post updates as we find out more.

~Mama

First VBAC Prenatal Visit

We were very excited for our first pre-natal visit this pregnancy. I actually had a mixture of excitement and nervousness. I had researched area providers with the help of my local ICAN Chapter, so I knew that the midwife group I chose was not only VBAC Friendly but had a good success rate and reputation. My husband came to this appointment so that both of us could talk to them about our hopes for this pregnancy.

The appointment was actually broken into two parts, the first being a sit down with a nurse. We went over my medical history including going over my previous labor and cesarean section. Family medical history was also taken thoroughly. She gave us a welcome packet that included suggestions for safe medications for common pregnancy related maladies, a list of pre- and post-natal classes that they offer, a list of symptoms that they want me to call or come in if the occur, as well as some information about the labor and delivery department.

The nurse was very encouraging, and she put some of our other more general concerns to rest. Namely that the facility is across town from us- through a tunnel and two bridges away! So if we needed to go during rush hour it could potentially be a very uncomfortable 30-40 minute drive. She said our plan to have a doula or monitrice would help with knowing how urgently we would need to get to the hospital, and whether we could wait for traffic to ease.

The second portion of the appointment was an exam with one of the midwives. There are eight different midwives in the practice and they try to have patients see everyone throughout the pregnancy. In this way, no matter who is on duty they are a familiar face. During the exam the midwife went over my current medications and medical history again. We talked more about the reasons for my previous cesarean section and my plan to have a vaginal birth with this pregnancy. Because my CS was due mostly to malposition,and I had completely dilated and effaced, she said I am a good candidate for VBAC. As a VBAC patient I would also have one appointment with the OB at the hospital to go over the hospital VBAC policy and ensure that I have the information about the risks of both reoeat cesarean and VBAC.

The midwife also did a very brief vaginal exam and although I was only 9 weeks at the time she was able to find the heartbeat with a doppler! A strong 170 bpm! She said it was very normal to have such a quick rate this early.

I felt much more at ease at the end of our appointment. I felt that the nurse and the Midwife both listened to our concerns and were understanding of our want for a VBAC. There are a few questions that I did come uowith after the fact that I want to remember for my next appointment:

– Do they have the capability to offer gas and air as a pain management method during labor?
– Do they have tubs for laboring and birth, and do they restrict their use for any reasons?
– What treatment plan do they usually follow when a VBAC mom goes past their due date?

I am excited for this journey and hope to keep all of you updated along the way. Have you had a VBAC? Was your first prenatal visit during that pregnancy similar to mine? What other questions do you think I should add to the list?

~Mama

CombatBootMama