Sunday, September 30, 2012

Dream Date

I dream a lot. A whole lot, in color, in b&w, and all shades between. Usually I try to forget my dreams and usually I am successful. Until recently, all the characters in my dreams were unknowns, sometimes even myself. I rarely dreamed about family and friends. That is beginning to change and it makes it much harder to slip out of the dream mode of thinking into the awake mode of thinking.
 
Just the other day, I had one about my beloved Pan. And an ex-friend. I have not spoken to M in several years. She really hurt me, deeply, and I do not forgive easily. Oh, back to the dream.
 
I don't know how I found out, but someone must have told me, that M had continued to email Pan even after our severed friendship. Not such a big deal, why would I care. She and Pan were friends too. But this same person must be the one who told me that she had bought them both tickets to Hawaii.
 
Again, so what? Pan would never consider traveling with her leaving me at home. That is until I confronted him about it and he told me he was going. I was devastated. I wasn't worried about him having an affair. But just by agreeing to accompany her, he had broken something in our relationship.
 
About this time my clock went off to take a pill and trying to reclaim the dream and change the outcome was forever lost. But I wonder, what turn it might have taken, had I continued to sleep? Do I even want to know?

Saturday, September 29, 2012

My kind of torment

When I came across this prompt from Brain Candy, I just couldn't resist. It reminded me of something I had done when I was much younger (at least in my 20's, lol).

If you could have anyone locked in a room so that you could torment them for a day, whom would you choose, and how would you torment them?

The four year old child was just so obnoxious. His parents had taught him "big" words to use just so he would sound smart. "Eradicate" the fly instead of "kill the fly." That one really stuck, because why in the world would you teach a four year old various ways of saying kill. But there were others as well.

I took it upon myself to bring him down a notch. Okay a 20 something picking on a 4 year old, not cool. Still it was entertaining and extremely funny to watch him get upset everytime his parents told him how smart he was.

I would do the same all the time. Tell him how "smart" he was, but made it sound like a really bad word. It is hard to write how it sounded, but it went something like "Oh, Bob, you are just sooooo smart," putting a sneer into my voice at the end.

Yep those were the days. I would never consider doing that today, because 4 year olds today are really that smart.

Friday, September 28, 2012

Pet Peeves

Have you ever been setting at home waiting for a utility repair or a new large appliance? All of us have at one time or another. But when I was talking to the Bug the other day, it came up that she had to get home to wait on the ac repair. They had given her a window of one hour. Which is better than the four hours you are normally expected to wait, but still.

Don't they understand that unless we go to work, they don't get paid. I can't think of any other business where it is okay to make someone wait for a product or service (except maybe a doctor's off , but generally it is only 5-15 minutes). It really annoys me that I have to take time off to have some work done. Sad thing is, we let them get away with it.

Thursday, September 27, 2012

The Move


“What? What was that you said?”
She must be hearing things because she could have sworn you were talking about moving. And not just moving like across the street or across town, but several states away. She didn’t know what to say or if she should say anything at all especially since she had actually heard it from someone else already.
You just assumed that she would blow a gasket and start another fight, taking it badly to the extreme and you seemed genuinely surprised when she didn’t. Why is that? She had always come to your defense, always backed your decisions. Though she does have a bit of a temper and tends to make her suggestions sound more like demands. Is that what caused this sudden rush to get away? Or is it because you know you have been living off her and her husband without contributing either monetarily or by helping around the house? Most likely it was a combination of both.
You could see it in her eyes as she realized that the two of you have been arguing more of late or so it seemed. But she really thought it would work itself out in the end, apparently not. So while she didn’t like the idea of you moving so far away, she could understand your desire to try and make it on your own. Again if you looked hard enough you might have been able to see the thought processes whirling in her head. ‘Make it on your own?’ while moving in with your dad and his wife. Yeah, right. She didn’t say that but oh she wanted to.
Soon enough the day came. Tears welled up in her eyes whenever she would look at you or the children. The children. How she was going to miss their laughter, banter and arguing throughout the house. And as you and your father packed up the truck and your car, she held tightly the little boy that would no longer be a bright star in the day for her. She was also remembering all the good times that passed between the two of you. Not just recently either, but throughout your life, wondering if she would ever experience that again with you.
Before long the vehicles were packed and it was time to head out. Time had flown so swiftly and you were about to take flight on a new and different adventure. One that did not include her. Would you ever regret that? Would you ever wonder what might have been if you had stayed? But the time to change your mind had passed and there was one last hug goodbye before embarking on your journey.
So with her head leaning against the warm chest of her husband and tears freely falling now, she watched as your car turned the corner. Her hope was that with this separation, the two of you could reach some kind of reconciliation. And she wonders when she might see you again.

Wednesday, September 26, 2012

A letter from MiLady

I'm sure Nuke updated you when I left the hospital a week ago, but I wanted to let you know what's been going on since then. They tried to release me the day after surgery, but I was not able to tolerate oral pain meds yet, so I made them keep me 2 more days until I could. Imagine that! Less than 24 hours after major surgery and they wanted me to go home! Not happening.....I want your readers to know that they are their own best advocate for their health, and the doctors don't always get to call the shots. If something isn't right, don't be afraid to speak up.
Once I got home, I felt better....sleeping in my own bed, not being poked, prodded, and squeezed every 4 hours makes for a good rest. This past Friday (and today to a lesser extent) I was/is having problems regulating my calcium. Either they damaged/removed my parathyroids when they removed the thyroid, or the parathyroids are "in shock" from the surgery. Either way my calcium is trying to get too low. I'm having a weak, shaky type feeling.....very similar to low blood sugar, except no matter what I eat or drink the feeling doesn't go away. So, I called my Endocrinologist and she upped my calcium until I can get in to see her on Thursday.
She wanted to see me Wednesday morning, but I'm due back at MUSC to see my surgeon for a follow-up and to get my pathology report. We'll know what stage my cancer is then. I'm hoping for no more than a stage 2.....I don't know how I'll react if it's stage 3. My CT results from last month don't show anything suspicious below the neck, so I am reasonably sure it hasn't metastasized.
Hopefully I'll also find out if the cancer is familial or just sporadic. Keeping my fingers crossed for sporadic, and that I haven't passed it on to TiMon and Brindel. There is a history of cancer on my dad's side of the family (throat-dad, colon cancer-g-dad,and a great-aunt who had some sort of throat cancer), but no one except me had MTC. Lol... I always have to be the "special" one. Anyway, my general outlook has improved since I got through the surgery. Hopefully it will continue to improve after the path reports. I'll keep you posted.
Love to you and Pan!

Was I in control of my day?

Never Stop Smiling & Utopia ©Laitha's Designs; Scraplift from April Showers
I think these prompts were timed with the days I work. But in answer to the question, yesterday I was in control of the day only insomuch as that it did not interfere with my boss' designs for my day. He's not demanding, so I pretty much can work at my own pace in my own time. Just as long as I get it done. So in that respect I do have some control.

Tuesday, September 25, 2012

I wished I could have skipped housework

Never Stop Smiling & Utopia ©Laitha's Designs; template by MJAJ Designs
That is so silly, I have so little to do without the kids here. Make a bed, wash a few dishes, vacuum. But no matter what I really hate housework. More so than most I believe (that should have gone on yesterday's list huh?)
 
Still most got done and I spent the rest of the time, on the computer, reading a book or playing pokemon again. 

Monday, September 24, 2012

Thyroid Awareness Month


September is Thyroid Cancer Awareness Month. Did you know that thyroid cancer is the fastest increasing cancer in the United States? Throughout this month, Bite Me Cancer will post helpful information about thyroid cancer as well as inspiring stories of survivors.
My own daughter-in-law was recently diagnosed with a rare form of thyroid cancer that can only be treated with surgery. I am going to see if I can get her to send me her thoughts, feelings and reactions to this news throughout the month. And how she and Nuke are dealing with the situation.

Now its up to you to do the research, check out the advancements made, and support you can provide. Soon, it may be someone you know.

I believe

Never Stop Smiling & Utopia ©Laitha's Designs; template by Connie Prince
That I can make a difference.
That I can live up to my potential.
That I can make people happy.
That I can be me without compromising myself.
That I can be happy, in and of itself.
That I am a really intelligent person, capable of holding a conversation without feeling embarrassed.
That I have a strength to work through any adversities that may plague me throughout my life.
That I can say no, if I really needed to.


Sunday, September 23, 2012

If I could change yesterday would I?

Never Stop Smiling & Utopia ©Laitha's Designs; template by Connie Prince
Don't think so. We spent the weekend with our parents. Tom with his family (he's probably wishing he could change it). But me... I like spending time with mom talking about anything that happens to strike our fancy. We have alot in common. She is so well rounded (in the intelligence department, not in girth) that any conversation we have is both educational and entertaining. 

Saturday, September 22, 2012

Through the lens

Flights of Fancy ©Cherie Shields; Shades of Reality ©Laitha's Designs; scraplift from poohbear
The last gift I received was the 300mm telephoto lens Pan bought me for my birthday. I'm so excited to have it, now I just have to make the time to put it to use. About the only time I use the camera these days is when the young'uns are here. But with this bear of a lens I'm going to have to do more with it. 

Friday, September 21, 2012

The pressures of the day

Flights of Fancy ©Cherie Shields; Shades of Reality ©Laitha's Designs; scraplift from Julie Wells
Yesterday was a work day and about the only pressures I get from there are from the reps. Who are always demanding the same thing week after week. Usually because they lose what I have given them. Yesterday was no different. Guess I had best be grateful that was all there was.

Thursday, September 20, 2012

3 minute fiction - The Nurse

NPR's All Things Considered has this contest where you can submit a short story that can be read in 3 minutes or less. They are judged and the best ones are put up on the site. I think they are up to round 9. Anyway, I'm not a writer and I will not be submitting mine but thought I might still try my hand, push my bounderies, so to speak, and put them down here. So from round 2 (bolded is what you had to use) here is my 3 minute fiction:

The Nurse

The nurse left work at 5 o’clock dreading the moment when she must exit through the throng of reporters surrounding the doors inquiring about her patient.

All she could think about was why they felt it was their duty to follow and hound her with questions she could or would not answer. She had not taken this job to be a celebrity or even to have her 15 minutes of fame. She wanted to be a nurse so that she would matter, so she could take care of people, ease their suffering.

Can’t they just leave her alone? No, they are the most insistent of people, grasping for the least bit of gossip or juicy news that can be publicized throughout the country and most probably the world. She shook her head thinking about the young man ensconced in the bed on the third floor. He was much like her, all he wanted to do was make people happy with his talent. But then, maybe he enjoyed this kind of adulation. She would have to ask, she supposed.

Shunning the crowd as she pushes her way through, she finally makes it to the safety of her vehicle. But as she looked up to put the key in the lock she notices a sad, gangly young man leaning up against her car.

“What is it you want?” she sighs exhaustedly.

“Please, ma’am, how is he doing? You see, he is my brother. He has been trying to keep the family out of his limelight, but if I tried to make my way up there…. You can see what would happen.”

Giving him a little hope but no real information, she asked him to meet her at the 5 and Dime around the corner during her break the next day. This would give her some time to think.

As morning dawned, she made her way through the reporters once again. Stopping at various rooms to check up on her other patients, she finally ended up at The Room. Taking a breath, she walked in, sat down and started a conversation. She explained about meeting the young man the day before, asked about the relationship, and, of course, how he was doing. Getting a satisfactory answer she then began preparing for her meeting later that morning.

Time flew as she kept herself busy and before long she began her trek to the 5 and Dime. As she approached she could see the young man sitting at the soda counter with a cup of coffee in hand waiting for her. He stood as she got there and she handed him a bag, telling him to go change.  When he returned from the restroom, he looked just like your ordinary, everyday orderly that no one would take a second look at.

With a smile of a job well-done, it was time to make their way back to the hospital with heart-pounding anticipation as to whether they would make it through. And oh, yes, they did, with a pat on one another’s back they made their way up the third floor. Then seeing the look on her patient’s face as he gazed at his brother, made her realize that it was all worth it. Both would be fine in the times to come.

But throughout her life, she would always wonder just what it was the gangly young man saw in her that made him trust her?

Wednesday, September 19, 2012

OMG

Halloween is just a month away; Thanksgiving, two; and Christmas, just three. I'm so not prepared. Are you?
 
Give me at least 6 more months to prepare... :)

Tuesday, September 18, 2012

A day older and not a penny richer

is how I feel, lol. But the fact that I am still here is something to celebrate. So I will continue to feel a day older and no more than that.

Monday, September 17, 2012

Thyroid Awareness Month


September is Thyroid Cancer Awareness Month. Did you know that thyroid cancer is the fastest increasing cancer in the United States? Throughout this month, Bite Me Cancer will post helpful information about thyroid cancer as well as inspiring stories of survivors.
My own daughter-in-law was recently diagnosed with a rare form of thyroid cancer that can only be treated with surgery. I am going to see if I can get her to send me her thoughts, feelings and reactions to this news throughout the month. And how she and Nuke are dealing with the situation.

Now its up to you to do the research, check out the advancements made, and support you can provide. Soon, it may be someone you know.

Everything, nothing

It's hard to answer some prompts when they are actually meant to be answered when the day is done. So I am going to take a guess about what went perfectly about my day. Let's see.... It's Monday. That's a good start. Except Monday is my Sunday, which means I will be going to work tomorrow. That's fine, I like what I do. Indy will be calling me to help with his homework, which means listening to him read for 15 minutes. That's always a bright spot. Now if he would just pick books appropriate for his age. By that I mean words that he can actually pronounce.

Sunday, September 16, 2012

My boss threw a gala

of a retirement party for one of the employees. It was really nice of him to do so, even if he couldn't be there. He was getting his daughter settled into college in California.

Saturday, September 15, 2012

Last words spoken aloud

were to Pan as we started to fall asleep. "I love you." It's the last thing we say to one another every night. Great tradition, if you ask me.

Friday, September 14, 2012

A message from MiLady

Received this Wednesday night:

Hi Mom,

One last night then we leave for MUSC. They want me there at 5:30am! So I told Nuke that we have go drive down the day before (3 hour drive one way) because I wanted a good night's sleep before surgery, and being woken up 2-3 times a night while they check my vital signs. Of course, if I'm lucky, they'll give me some good drugs and I won't even care or remember. :-)  I should be packing, but I really don't feel like doing it. I wish I knew how long I am going to be there. Since it's such a long drive, I probably won't see Nuke again until they release me (of course he's staying for a while after I come out of surgery, but then he'll go home). I hate that it's so far from family and friends.

I'd be so much more comfortable here at the hospital I used to work at because I know most everyone there. I'll be truly alone at MUSC once Nuke leaves. OMG, I sound like a drama queen, but it's really how I feel. I've not been away from Nuke for more than a day since we got married. I really will hate being away from him, family and friends, and my fur babies. It feels like time is dragging, yet speeding up at the same time. I mean, time is dragging because I'm ready to have this over with, but all too soon Friday will be here and I'm not ready to be so isolated. I don't even know if I'll be able to talk after they're done. I lost my voice for a few days after the first surgery. Nuke thought it was funny, and installed a "Stephen Hawking"-like program into my laptop.....it was too funny! I swear, you and Pan have warped his sense of humor...it's so great! One of my sisters told me I found the perfect man for me, and she is right. You've raised a wonderful son, and I want to thank you and Pan for that.

Well, I need to pack, and then try to sleep some so I can drive. Nuke's still on night shift, so he can sleep while I drive. Nuke will call you after I'm out of surgery to let you know how it went.

Much love to you and Pan!
Hope to hear from them soon.

UPDATE 7:05 a.m. CST: MiLady is now in surgery. Please keep her in your thoughts and prayers.

UPDATE #2 9:09 a.m CST from Nuke:
She's out and in recovery. Dr.  said everything went well! I should be able to see her within the hour.
 

How can you be stressed

when Friday is the first day of your weekend. Well I guess it is possible. One of the kids may call with bad news, that would be stressful. Something may happen to Pan, definitely stressful. But I'm going to stay optimistic that today is going to be stress free.

Thursday, September 13, 2012

Free Time

what a concept. Actually I will spend my free time today either scrapping or reading. My two favorite pastimes. Probably scrapping since I have just finished reading the six books I purchased less than a month ago.

Wednesday, September 12, 2012

The computer I use the most

depends on what I am doing. If I am at home, I normally use my desktop. The monitor is bigger. But if I am traveling or just don't want to head back to the computer room, I use my netbook.

Tuesday, September 11, 2012

A word from MiLady about Thyroid Cancer

It hit me last night. I started feeling pretty depressed while I was home alone (NavyNuke being on 3rd shift). I began to wonder what toll 4 surgeries in less than 10 months would have on my overall health. Then the fears set in.....my one great fear/terror is to be (or to still be is more accurate) intubated after surgery. I've worked in hospitals, and I've seen people being tied down/restrained because....even while under sedation, they know that tube is down their throat. Then when they lessen the sedation to see if you can breathe on your own (tube still in)....just thinking about it is stressing me pretty badly. I can't tell Nuke how I'm feeling, he'd stay home every night with me until the surgery, but I refuse to be the reason he doesn't pass the class he's taking.

He's wanted that class for years, and now that he's finally in it, he can't concentrate on it fully because he's worried about me. So, to keep him from worrying more, I'm keeping it all inside me and acting like it's still no big thing...just an inconvenience. Same with my mother and sisters......if I even give them an inkling of how I feel now they'll start to panic. And of course, I'd never, ever tell TiMon and Brindel. Mommy is the rock that they know they can depend on, she'll always be there. They know I have cancer, but of course I downplayed it.

Mom (Tink), I appreciate you letting me hijack your blog a little. Even though it's public, you know I'm picturing you here while I'm telling you these things. I know I can lean on you a little for support, because you won't break down like the others would. You and Pan would just tell me funny stories while I cry and laugh on your shoulders.

I love you both! (And don't worry....Nuke doesn't read your blog....he's too busy studying and worrying. :-)  )

Host of favorite gadgets

I love gadgets. Have drawers full of them. Some I have posted pictures of here. Some I haven't. I just recently bought an avocado pro, but haven't gotten to use it. Supposedly it preps avocados faster and replaces 5 kitchen tools. You can open, pit, slice, scoop and mash the avocados, all with the same tool. I'll let you know if it works when I get around to using it.

Monday, September 10, 2012

Thyroid Awareness Month


September is Thyroid Cancer Awareness Month. Did you know that thyroid cancer is the fastest increasing cancer in the United States? Throughout this month, Bite Me Cancer will post helpful information about thyroid cancer as well as inspiring stories of survivors.
My own daughter-in-law was recently diagnosed with a rare form of thyroid cancer that can only be treated with surgery. I am going to see if I can get her to send me her thoughts, feelings and reactions to this news throughout the month. And how she and Nuke are dealing with the situation.

Now its up to you to do the research, check out the advancements made, and support you can provide. Soon, it may be someone you know.

I intentionall wasted

Wednesday, August 29, reading. Reading scrapbooking lessons, blog posts, just about anything to keep from doing something else. That is until Indy skyped to do his homework.

Sunday, September 09, 2012

Money, money, money.....Money

Ex-son-in-law owes us some money. Don't really care at this point and time. We really like the guy (as does his ex-wife, but only as a friend). Though it did come up in conversation recently. Daughter and the Princess were discussing the fact that her dad (the xsil) "loaned" her the money to buy some  special tennis shoes she needed for volleyball. He wanted to teach her a lesson about money. Well, being that we were in a car together, Pan and I couldn't help but overhear the conversation, especially since the Princess didn't think he was being fair. Our solution..... Tell him to deduct it from the money he owes us (maybe that would be a good lesson for him, huh?)

Saturday, September 08, 2012

My life would be easier if

I just let it. Come on, we are all responsible for our lives and if we want them to be easier all have to do is "make it so." I think I will start working on that immediately, just as soon as I get up from my nap.

Friday, September 07, 2012

A Note from MiLady on Medullary Thyroid Cancer
Here are some FAQ’s on the FB site for Medullary Thyroid Cancer (MTC), which is what I have. As to how I feel about it, and/or dealing with it….I’m just educating myself about it. Since it’s not causing me problems (didn’t even know I had it until I went to my ENT for something else) it doesn’t occupy my every waking thought….yet. J  I’ve always been a pro-active person when it came to my health. When I got the diabetes,  I kind of “threw away” what I knew about it from my grandmother having it, to read up on new treatments, new ways of dealing with it. When I found out about the BPD-DS that could put my diabetes into remission, I researched it for a year before I did it. Now I have this MTC and once again the researching begins. I’ll send some more thoughts, issues, reactions from family and so forth soon. I don’t want to overwhelm you all at  once. Thank you for putting this on your blog for me!

MTC FAQ’s

What is Medullary Thyroid Cancer?
 
MTC is a carcinoma of the connective tissue (the "C" cells) within the thyroid. A good definition exists in Wikipedia: http://en.wikipedia.org/wiki/Medullary_thyroid_cancer
 
Medullary thyroid cancer is completely different than the more common papillary and follicular types. Medullary thyroid cancer is usually not classified in terms of differentiation because it does not arise from the thyroid cells themselves, but rather from the specialized "C-cells" that are in between the thyroid cells. These C-cells are also sometimes referred to as parafollicular cells. They are found mostly in the upper and middle parts of the thyroid and they produce a substance called calcitonin which can serve as a marker for medullary thyroid cancer. Although we know that calcitonin is somehow involved in the body's regulation of calcium, we do not know its exact function. We do know that people who have had their thyroids removed surgically, do not require replacement of calcitonin for normal function and a healthy life.
 
There is an excellent introduction to MTC that you should read, written by Melissa Hays, a member of this group.
 
My Dr. does not seem to know much about MTC, what should I do?
Medullary Thyroid Cancer (MTC) is a fairly rare form of thyroid cancer, and because of that, many doctors (including many oncologists and endocrinologists) have little to no experience with the disease.   One of the most important decisions you can make in your cancer care is to choose a doctor who has a deep understanding of this particular disease. Therefore, it is a best practice in MTC care to seek initial treatment at an MTC Center of Excellence.
 
What is an MTC Center of Excellence?
An MTC Center of Excellence is a medical facility that has a focused practice in researching, diagnosing, and treating Medullary Thyroid Cancer. Doctors at these centers routinely see dozens of MTC cases and are typically involved in the latest research, conducting and monitoring clinical trials, and formulating treatment protocols.
 
A partial list, in random order (Needs EMEA/APAC contributions)
The University of Michigan’s Multidisciplinary Thyroid Cancer Clinic,  Anne Arbor, MI
MD Anderson Cancer Center, Houston, TX
NY Thyroid Center at Columbia University, NYC, NY
Memorial Sloan-Kettering Hospital, NYC, NY
Mayo Clinic, Rochester MN
Massachusetts General, Boston, MA
Johns Hopkins, Baltimore, MD
Cleveland Clinic, Cleveland, OH
Siteman Cancer Center, Univ. of Washington, St. Louis, MO
Yale School of Medicine, New Haven, CT
 
What kind of Dr. should I see for MTC?
Care for Medullary Thyroid Cancer is typically managed by a multi-disciplinary medical team. In many cases, an Endocrinologist coordinates care with the necessary surgeons, radiologists, and oncologists to see that you are getting the best care.
 
Is MTC serious?
MTC is a serious disease. Left untreated, it can be a fatal disease. Surgery is the only way to cure MTC if it is treated before it escapes the thyroid. There is not currently a method to "cure" metastatic MTC, although with proper treatment and management, a patient can lead a long and healthy life. There is significant progress being made on pharmaceuticals to control the growth and spread of MTC.
 
Will my children develop MTC?
Medullary Thyroid Cancer can be hereditary, or can be sporadic. With the sporadic form, your children are not at any greater risk than anyone else of developing MTC. However, with the hereditary forms of MTC (know as MEN2A, MEN2B, and  familial MTC), blood relatives of the patient (children, grandchildren, siblings, and parents) should be examined for MTC. Therefore, it is very important that MTC patients undergo genetic testing to determine the root cause of their disease.
 
What parts of the body can MTC affect?
If MTC is diagnosed and treated while still contained within the thyroid, typically only the thyroid and perhaps the parathyroids are affected. However, in many cases, MTC is not diagnosed until it has grown outside of the thyroid and into the lymph system. MTC is typically a very slow growing cancer, but it tend to spread to distant locations fairly efficiently. While the different forms of MTC act slightly differently in where and how quickly they spread, it is not unusual to see MTC metastasize (spread) to the head, neck, and chest lymph nodes, bones in the ribcage, spine and pelvis, as well as in liver and lung tissue. these metastatic sites might be minuscule (even too small to "see" on an image or scan) but they contribute to the overall tumor load a patient must bear.
These microscopic metastatic sites are often managed through observation and are acted upon only when they become large enough to be intrusive.
 
How do I know the "Stage" of my MTC?
A complete description of staging and nodal involvement is available here: http://www.springer.com/cda/content/document/cda_downloaddocument/0-387-29014-1_thyroid.pdf?SGWID=0-0-45-314789-0
 
Age is not a factor in staging patients diagnosed with medullary thyroid carcinoma (MTC).  MTC staging is determined by the size and distribution of MTC tumor cells:
o    Stage I Thyroid Cancer - The diameter of the tumor is no more than two cm (less than an inch wide). No cancer was found in regional lymph nodes or distant sites in the body.
o    Stage II Thyroid Cancer - The spread and the growth of the cancer may be qualified in two ways:
§  The diameter of the primary tumor has grown and ranges from two to four cm. No cancer was found in regional lymph nodes or distant sites in the body.
§  The primary tumor is larger than four cm in diameter has started to grown outside of the thyroid. No cancer was found in the lymph nodes or other parts of the body.
o    Stage III Thyroid Cancer - The spread and the growth of the cancer may be qualified in two ways:
§  The tumor can be any size and may have grown slightly outside the thyroid.
§  The tumor has spread to lymph nodes around the thyroid in the neck but not to distant sites.
o    Stage IV Thyroid Cancer - The most advanced stage of thyroid cancer is differentiated in to Stage IVA, Stage IVB or Stage IVC depending on where the cancer has spread to:
§  Stage IVA - Cancers in this stage have grown beyond the thyroid gland and have spread into nearby tissue. Cancers in this stage may have also spread to lymph nodes in the neck and upper chest, but not to distant sites.
§  Stage IVB - The primary tumor has grown into the spine or into nearby large blood vessels. The cancer may or may not have spread to lymph nodes, but has not reached distant sites.
§  Stage IVC - The thyroid cancer has spread to distant sites, but may or may not have grown outside of the thyroid or into the lymph nodes.
 
How does MTC treatment differ by stage?
The type of treatment your doctor will recommend depends on the type and stage of the cancer and on your overall health. Listed below are "typical treatment plans". however, your doctor may have reasons for recommending other treatments. Don't hesitate to ask him or her questions about your treatment options.
 
Most doctors advise that patients diagnosed with medullary thyroid carcinoma (MTC) be tested for other tumors that are typically seen in patients with the MEN 2 syndromes, such as pheochromocytoma and parathyroid tumors. Screening for pheochromocytoma is particularly important, since the unknown presence of this tumor can make anesthesia and surgery extremely dangerous. If they are forewarned, surgeons and anesthesiologists can medically pre-treat the patient to make surgery safe.
 
o    Stages I and II: Total thyroidectomy is the main treatment for MTC and often cures patients with stage I or stage II MTC. Nearby lymph nodes are usually removed as well (central compartment or modified radical neck dissection). Because the thyroid gland is removed, thyroid hormone therapy is needed after surgery. For MTC, thyroid hormone therapy is meant to provide enough hormone to keep the patient healthy, but it does not reduce the risk that the cancer will come back.
Because MTC cells do not take up radioactive iodine, there is no role for radioactive iodine therapy in treating MTC. Still, some doctors advise giving a dose of radioactive iodine to destroy any remaining normal thyroid tissue. If MTC cells are in or near the thyroid, this may affect them as well.
 
o    Stages III and IV: Surgery is the same as for stages I and II (usually after screening for MEN 2 syndrome and pheochromocytoma). Thyroid hormone therapy is given afterward. When the tumor is extensive and invades many nearby tissues or cannot be completely removed, external beam radiation therapy may be given to try to reduce the chance of recurrence in the neck.
For cancers that have spread to distant parts of the body, surgery, radiation therapy, or similar treatments may be used if possible. If these treatments can't be used, vandetanib or other targeted drugs may be tried. Chemotherapy may be another option. Because these cancers can be hard to treat, another option is taking part in a clinical trial of newer treatments.
 
Recurrent cancer: If the cancer recurs in the neck or elsewhere, surgery, external radiation therapy, targeted therapy (such as vandetanib), or chemotherapy may be needed. Clinical trials of new treatments may be another option if standard treatments aren't effective.
 
Genetic testing in medullary thyroid cancer: If you are told that you have MTC, even if you are the first one in the family to be diagnosed with this disease, ask your doctor about genetic counseling and testing. Genetic testing can find mutations in the RET gene, which is seen in cases of familial MTC and the MEN 2 syndromes.
If you have one of these mutations, it's important that close family members (children, brothers, and sisters) be tested as well. Because almost all children and adults with mutations in this gene will develop MTC at some time, most doctors agree anyone who has a RET gene mutation should have their thyroid removed to prevent MTC soon after getting the test results. This includes children, since some hereditary forms of MTC affect children and pre-teens. Total thyroidectomy can prevent this cancer in people with RET mutations who have not yet developed it. Of course, this means that lifelong thyroid hormone replacement will be needed.
 
If your genetic testing shows that your case is sporadic (no gene mutation caused the cancer), ask your doctor to test the tumor tissue itself for mutation. In rare instances, even though the cancer occurred sporadically, the tumor cells mutate and begin behaving like MEN2A tumors. This is rare, but important to know as the treatment plan will be different these cases.
 
How do I know my doctor is following the right treatment plan for my MTC?
The American Thyroid Association has published guidelines for the treatment of Medullary Thyroid Cancer.  It is available for download here  http://www.thyroid.org/professionals/publications/documents/MTC_Guidelines.pdf
 
What is calcitonin and what role does it play in MTC?
The parafollicular cells (the "C" cells in your thyroid that MTC affects) produce a substance called calcitonin which can serve as a marker for medullary thyroid cancer. Post-surgery, any remaining cancerous cells will usually continue to produce calcitonin, and that become an indicator of the speed at which remaining cancer cells are multiplying. Doctors follow calcitonin levels to calculate the calcitonin doubling time (CDT). This is used as an indicator, along with another test for CEA, of the volume of remaining MTC cells and how quickly those cells are multiplying. Although we know that calcitonin is somehow involved in the body's regulation of calcium, we do not know its exact function. We do know that people who have had their thyroids removed surgically and who have no remaining parafocular cells, do not require replacement of calcitonin for normal function and a healthy life.
 
Can MTC be prevented?
There is no known cause for sporadic MTC,and therefore it is impossible to prevent. However, the spread of familial MTC can be controlled by performing prophylactic thyroidectomies on the siblings and offspring of known MTC patients, thus preventing those relatives from developing familial MTC in the future.
 
How come MTC was never found in my body until now?
MTC often lies undetected. In sporadic MTC, unless an unusual lump or pain is felt in the neck area, MTC is often not diagnosed until the patient presents with a lack of energy, or digestive issues that are caused by the increased level of calcitonin in their bloodstream. Sometimes a routine blood test will show increased CEA, and that will lead a physician to the MTC.
 
Familial MTC is often detected by testing as a result of a relative discovering they have MTC. When genetic testing shows that a person's MTC was caused by a genetic issue, the geneticist will inform all the family members that might be affected and instruct them on how to proceed. This often results in the discovery of pre-cancerous conditions or undetected, operable MTC that has not, up to that point, been an issue. Families receiving these instructions should follow them carefully in order to prevent future issues with this disease.
 
What is CEA, and what does it mean for an MTC patient?
CEA, or Carcinoembryonic Antigen, is a substance that may be made by advanced MTC that should be tested for in the blood along with calcitonin. CEA can also be used as a marker for possible later recurrence of disease. More aggressive MTC often make more CEA.
 
Why are Calcitonin levels important?
A blood test to check the level of calcitonin in the blood should be done in patients with an established or suspected diagnosis of MTC. It can also be used as a screening test for patients with a family history of MTC, who are at risk of developing the disease. Calcitonin levels can be used to estimate how much cancer is in a person's body, as well as monitor for persistent or recurrent disease after surgery (as a tumor marker). Depending on the initial calcitonin level, additional radio graphic studies such as a CT scan of the chest, neck, and/or liver may be ordered. Calcitonin is NOT produced at a standard rate by different patients with the same disease. In some patients, their MTC emits very little or no detectable calcitonin while in others, a great deal of calcitonin is produced by the MTC. More important than the volume of Calcitonin present at any given moment  is the rate at which that volume increases over time. This is calculated at the Calcitonin Doubling Time (CDT).
 
What is CDT (Calcitonin Doubling Time), what does it mean for an MTC patient, and how is it calculated?
The monitoring of calcitonin levels play an important role in the follow-up and management of patients with medullary thyroid cancer.  Calcitonin Doubling Time is the measurement of the increase of an individual's calcitonin level over a long period of time, typically a rolling two year period starting at the lowest measurement post-surgery.  Calcitonin doubling times of > 2 years seem to be associated with a better long term prognosis then those < 6 months. A CDT Calculator is available here: http://www.thyroid.org/professionals/calculators/CDTC.php
 
How do medications treat MTC?
Unlike the “differentiated” thyroid cancers (Papillary and Follicular Thyroid Cancers) that are cancers of the iodine-seeking thyroid cells, MTC is a cancer of the “C” cell, a connective tissue that does not attract iodine. Therefore, radioactive iodine (RAI), the prevalent treatment for papillary and follicular thyroid cancer post surgery is ineffective for MTC.
MTC is treated medically, surgically, and radiologically. In terms of medicinal treatments, there are primarily two forms of medicine – traditional “chemo” treatments, and “targeted pharmaceuticals”.  There are also a number of medicinal approaches to treating symptoms and side effects encountered by the MTC patient, but those are varied and are standard approaches that won’t be covered in this answer.
·        “Chemo” treatments - There has been limited success in the use of systemic chemotherapy to treat patients with metastatic MTC. The most prevalent traditional chemo tried for MTC is doxorubicin, and has shown very limited response. Some work has been done to position the doxorubicin within the MTC cell using magnetic micro particles, again with limited success.
·        Targeted pharmaceuticals – The most current research is focused on targeted pharmaceuticals that address MTC through a function known as “growth blocking.” The most advanced research is investigating the mechanism by which cells “communicate’ that they are to divide and multiply. This research focuses on the VEGF receptor and with Receptor Tyrosine Kinases. The idea is to interrupt the communication pathway so that the MTC cell does not divide and multiply. Progress has been made on this mechanism over the last two decades and in 2011, the first drug using this mechanism was approved for MTC treatment. That drug, generically known as vandetanib, and marketed by Astra-Zeneca branded as Calpresa, has shown promising results in clinical studies and is now available to the general market via prescription. Calpresa is not a “cancer cure,” it is a cancer growth blocker, interrupting the growth factors that trigger the cancer cells to divide and grow. Scientists are also investigating other ways of doing this such as:
 
o    Lowering levels of the growth factor in the body
o    Blocking the signals inside the cell that start up when the growth factor receptor is triggered
o    Blocking the growth factor receptor on the cancer cell
 
Most of the treatments developed so far work by blocking the signalling process. Cancer cells are often very sensitive to growth factors. So if we can block them, we may be able to stop cancers from growing and dividing. Growth factor blockers (inhibitors) are an exciting new way of treating cancer. Scientists are working on developing new inhibitors for different types of growth factors.
 
How often will I need  blood work and scans done?
The frequency of blood work and scans depends on your doctors assessment of need. Usually, after surgery or radiation treatments, doctors like to see patients, perform blood tests and order scans more frequently. Sometimes these are done monthly (particularly blood tests and doctors appointments) until the doctor is assured that the disease is stable; then the tests can be scheduled every 3 or six months. Scans are usually done every 3, 6, or 12 months, depending on the doctor's assessment of your particular case.
 
How am I going to pay for all the things associated with MTC?
In many parts of the world, health care is supplied through a centrally funded government program and at little to no direct cost to the patient. In other countries, like the US, health care is funded by public and private insurance plans. Depending on your own personal  financial needs, costs of a serious health care  issue might be funded through employer benefit plans, the Medicaid program, Medicare, or private insurance plans. For those still left with large expenses, most medical facilities will establish a long-term payment plan for the remaining balance.
 
Will I be able to work full time with MTC? 
Each case is different. Depending on when your cancer was discovered, the staging of the disease in your body, your general state of health outside of cancer, age, and many other factors, MTC can be a "small bump" on the road of life, or a major detour. Many MTC patients take short term disability leave from work during their initial treatment (which might include surgery, external beam radiation, and medications) to allow their body to heal and adjust to life without a thyroid, then return to work part time or full time, depending on their financial needs and speed of recovery.  For others, it signals the time to retire, focus on their health, and enjoy some family time.
 
What is my life expectancy with MTC?
Again, each case is different. However, MTC is a cancer you can live with and manage. There are many MTC patients who are in their second decade of managing this disease. And as time continues, progress is being made on new treatments and methods of dealing with MTC. For a newly diagnosed patient, the most critical decision you will make affecting your prognosis and life expectancy will be choosing a treatment center. Going to an MTC Center of Excellence (see above) for you initial treatment, surgery and followup will give you the best opportunity for a long and healthy life.
 
Where can I find more information that has the facts about MTC? What are more sources of information about MTC that I can access online?

Guilt is over-rated

and I refuse to admit that I felt guilty about forgetting my anniversary, every one's birthdays and holidays. Next to my mom (we share the spotlight on this one), I am the worse at remembering dates. For years I even had Scamp's birthday wrong, and I gave birth to him. And my own anniversary? Pan can tell you stories about it that would have you rolling on the floor.

Thursday, September 06, 2012

Vacuum, laundry, cull out the

fridge is on the top of things I should be doing today. Maybe it will happen, maybe it won't. But either way, I'm fine with it. Aren't you?

Wednesday, September 05, 2012

My last doctor's visit

was just last week. And I had to go in to get the results of my blood work. Well, Quest had not sent the results over (long back story about my anger management on this one), so the nurse had to call over and have them sent. While I waited and waited. They finally got there. My doc was ecstatic about the results. Cholesterol, normal; thyroid, normal; diabetes, 5.6 (which is the point at which pre-diabetes starts). Six months ago my diabetes score was 6.6. Yep, I'm a happy camper, now. The doctor was sooo happy with the results that she started talking about all the other tests I need to have done. I agreed on scheduling two of them soon, the others will have to wait. She was fine with that, until she started talking shots. Flu, pneumonia, tetanus.... Flu she wants me to have in October, but I had to get the other two that day. Not happy at all. Anyone who knows me, knows just how I react to shots. I managed. Now I am healthy and going strong. Still tired though, ummmm.

Tuesday, September 04, 2012

A trip to Ireland and Germany

would be wonderful. I think I would really like to spend some time doing genealogy research in both countries. Maybe throw Sweden and Scotland in to the mix for a rip roaring time of finding out just how bad my ancestors were.

Monday, September 03, 2012

Thyroid Cancer Awareness


September is Thyroid Cancer Awareness Month. Did you know that thyroid cancer is the fastest increasing cancer in the United States? Throughout this month, Bite Me Cancer will post helpful information about thyroid cancer as well as inspiring stories of survivors.
My own daughter-in-law was recently diagnosed with a rare form of thyroid cancer that can only be treated with surgery. I am going to see if I can get her to send me her thoughts, feelings and reactions to this news throughout the month. And how she and Nuke are dealing with the situation.

Now its up to you to do the research, check out the advancements made, and support you can provide. Soon, it may be someone you know.

I recently learned

Main Street Magic Bundle ©Connie Prince; template by Connie Prince
that astronomers/physicists have changed their minds once again. And that they believe that life and water on planet earth began on a comet. All well and fine, but how did the comets come by such a bountiful soup of creation? Dare I ask?

And then again, some are saying that life began on asteroids. Seems that when they all smashed together to produce a planet that any life would have been obliterated or that the merging of one or more asteroids may have rearranged the atoms to produce life. But then what do I know.

Sunday, September 02, 2012

Even though they are grown

Main Street Magic Bundle ©Connie Prince; scraplift of Jo Corne
there are still times when I question my parenting skills. Could I have done better? Should I have been more/less firm? Etc, etc.... Not much I can do about it now. And I am very proud of the way my children have grown and matured. Each is an exceptional human being and they have surpassed any thing I could have wished for them. Way to go kids.

Saturday, September 01, 2012

I wish I didn't have to decide

Animal Crackers ©Created by Jill; scraplift from Liberty McDonald Cameron
on what to have for dinner. It gets to be a real chore sometimes trying to figure out what to fix, especially since I have to make two dinners. One for me and one for Pan. We can't seem to agree on the same food types or how they are prepared if we do. Oh well, could be worse, right?

On a different subject. Have you ever finished a scrapbook page and then wished that it was flipped or mirrored or both? That's what happened with this page. After looking at it next to the left hand page, I decided it would be better if the focal was on the right hand side. A year or so ago, I would have just left it because it would nearly be starting from scratch to change it. Now with the help of Cassel's ClipToIt and SwitchItAll, I can make my dreams come true in less than 10 minutes. First I used SwitchItAll to mirror the whole page quickly, then because I used her ClipToIt to group each photo to a mask, I was able to go in and mirror those individually (you know so they were in the right orientation. Most it probably didn't matter, to anyone but me, but seeing Hollywood backwards was just wrong, lol).