Saturday, November 29, 2014

Thyroid Cancer Scare

"Trust that everything happens for a reason, even when you're not wise enough to see it."   ~ Oprah


Continued from my previous post ...
I decided to seek a second opinion so I called Mount Elizabeth Medical Centre and requested for an appointment with a specialist.

Endo 1: Dr. Daniel Wai (#03-04 Mount Elizabeth Medical Centre)

The customer service agent booked me an appointment with Dr. Daniel Wai. Before I went to see Dr. Daniel Wai, I did a research to find out about him.  I've read that he was awarded the "Service with Heart Award" by the Singapore General Hospital 3 times, in recognition of the excellent service he had given to his patients. 

Here's a link to his website.
http://drdanielwai.com.sg/

18th October
I was scheduled for 9:30AM but I arrived early at 9:00. I didn't wait long because the first patient did not come on time, so his assistant told me I can come in.

He smiled and said hello, then he asked "Are you a Filipina?" Yes doc, I replied. I told him I wanted to consult the result of my thyroid FNA that was done at Alexandra hospital. I didn't have my blood test result and ultrasound so I only showed him my FNA result. "Next time you should get copy of your test results because you paid for those tests", he said.

He studied my FNA result, then he looked at me and said "You have follicular lesion". "Is it suspicious doc?", I asked. "Are you a nurse?", he asked.  Haha, I said no.  "Yes, it's suspicious. Do you have family history?" No history of thyroid cancer doc. 

He said that there's also a lot of blood in my nodule, which is not good. Therefore, a repeat FNA will not be helpful as it will most likely give the same result. The only way to find out if it's cancerous or not is to do surgery, so that biopsy can be done on the whole nodule. He also told me that even if my nodule is benign, surgery is still recommended because of the size (mine was > 4cm).  He did physical exam and he found that my trachea was deviated to the right. He advised me to undergo surgery as soon as I can and not to waste time anymore.  He told me not to worry because 80-95% of thyroid nodules are benign, but it was hard not to worry.

Dr. Daniel's reco: Surgery

Reco at Alexandra hospital: Repeat FNA after 3 months. 

Dr. Daniel googled Alexandra hospital then he said he knows the head surgeon. He's an excellent surgeon but most likely he has long list of patients for surgery. He said he can also refer me to a private surgeon at Mount Elizabeth, but  he said it's very expensive because Mt. E is a private hospital. I told him I still need to check my medical insurance benefit.

He didn't charge me the full amount for first time patient.  It was my first visit but I saw repeat visit on my record. Naawa yata sa akin :). He's a nice doctor. Well deserved "Service with heart award" recognition.

"What seems to be a problem or block is often really a blessing in disguise." - Doreen Virtue


I called Alexandra hospital but I was told that Dr. Chitra is on leave and will only be back end Oct. I asked if I can directly book an appointment with the head surgeon, but I was told that referral should come from Dr. Chitra, so I need to wait for Dr. Chitra. 

To wait or not to wait? This turned out into a blessing in disguise.

Endo 2: Dr. Loh Keh Chuan (#10-05 Mount Elizabeth Medical Centre)

http://www.endocrinology.com.sg/clinicalservices.htm

God always gives us what we need ... in time.

I talked to a friend and told her about my thyroid problem. She advised me to talk to one of our friends who had thyroid surgery several years ago.  I didn't know it. I should have known this earlier.  I came to know Dr. Loh Keh Chuan through her. She said Dr. Loh is an excellent doctor (her number 1 endo), so she advised me to go to Dr. Loh. I got Dr. Loh's clinic number and I immediately booked an appointment. Then everything happened so fast!

First visit: October 24, 2014

His clinic was jam-packed. He must be really good. I waited for more than an hour (my appointment was 11:30 and I was already hungry).  Finally, I heard Dr. Loh calling Gloria (yes, that's me).

He shook hands with me and he introduced himself.  I like Dr. Loh, he has smiling face :).

I told him about my thyroid nodule that was discovered by Dr. Chitra at Alexandra Hospital. He said he knows Dr. Chitra. I found out later that Dr. Loh was a student of Dr. Chitra. Then I showed him my FNA result. He looked at the report but he didn't tell me if it's suspicious. I didn't ask. Then he did ultrasound.

He explained to me that my nodule is huge (4.8cm based on his ultrasound), and maybe I have it for years already (this was not detected early in my previous annual health checks). I have follicular lesion, which can be adenoma (benign) and can also be carcinoma (cancer). However, this is difficult to classify on FNA, therefore, a repeat FNA will not be helpful. My only option is surgery so that they can send the whole nodule for biopsy to find out if it's cancerous or not. He asked if we have family history of thyroid cancer. I told him we don't have family history. "How about relatives?", I replied I don't know.

He also explained to me the procedure, i.e., hemithyroidectomy (remove my left thyroid lobe with the nodule), then frozen section biopsy will be done (quick test) during surgery. If there are no cancer cells, the surgeon will not remove the entire thyroid gland and will just do hemithyroidectomy. However, if final biopsy comes back positive for cancer,  I have to go back for a second surgery for completion of thyroidectomy (removal of the entire thyroid gland).

OMG, 2 surgeries! 

Dr. Loh might have noticed the anxiety written all over my face. So he said "Don't worry, 90% of thyroid nodules are benign, that is 9 out of 10. If it is cancer, it's curable. Thyroid cancer is very slow growing, it takes years to grow, so don't worry, okay?." 

He asked where do I want to have my surgery done. I told him I prefer to have it done at Mount Elizabeth. "Okay", he said "I will refer you to a surgeon".

He wrote a recommendation letter to Dr. Hong Ga Sze (the surgeon) and asked me to bring the letter to Dr. Hong together with my test results in my next visit. All me pre-surgery tests were done on the same day. 

Second visit: October 29, 2104

I came early at 8:30AM, full house again.

Dr. Loh cleared me for surgery, but he prescribed Vit. D supplement to correct my Vit. D deficiency and changed my med for blood pressure, as my ECG showed fluctuating blood pressure. Then he sent me to Dr Hong Ga Sze. 

The Surgeon:  Dr. Hong Ga Sze (#12-15 Mount Elizabeth Medical Center)

Before my surgery, I did a research about Dr. Hong Ga Sze to find out more about him. I've read that he is one of the top doctors in Singapore and he is a cancer surgeon. His expertise includes breast cancer, head and neck tumours, including thyroid tumours.  He has more than 20 years of experience, so he must have done thousands of thyroid surgeries already. Excellent! 

http://www.honggasze.com/

I went to his clinic, full house also.  His 3 assistants were all busy.  I filled up the registration form and gave my test results and Dr. Loh's recommendation letter. I was told to wait. I was so nervous. I dreaded the thought of having surgery. 

I waited for about an hour, then finally the nurse called me in to see Dr. Hong.  He was reading Dr. Loh's recommendation letter when I came in.

The nurse told me to sit down. Dr. Hong looked at me, he said hello, then he asked "Are you a Filipina?" Yes doc. I told him the background of my thyroid problem, when and where it was discovered, and what tests were done, etc. "Okay, show me your FNA result", he said.

He studied my FNA result, then he said in a very serious tone "It is suspicious of follicular carcinoma. Do you have family history?" "No family history on thyroid cancer doc", I replied. "How long have you been here in Singapore?", I replied, 10 months. He checked my neck and he also did ultrasound. 

After that, he discussed the surgery procedure (same as what Dr. Loh had explained to me) and the risks associated with thyroid surgery (my mind went blank, I can only remember he said the risk is low at 1%). 

"Do you have questions?" he asked. "I have hypertension doc, is it risky"? He told me not to worry about it, it's not risky. "You will be fine." he said.  I asked if I can delay the surgery to January, but he advised me not to delay it. So I told him I will have it done in November so I have enough time to recover before the Christmas season (assuming that I will only have to undergo 1 surgery). I dreaded the thought of having 2 surgeries.  

I was thinking of having total thyroidectomy so that I don't have to go back for second surgery if my final biopsy is bad, but this will require thyroid hormone meds for life! I didn't bring this up. Doctors know best (they know what they are doing).

He told me to talk to his ladies outside so we can finalize the schedule of my surgery. 

Fast forward, I had my surgery (hemithyroidectomy) on 18th Nov (3 weeks after my first visit with Dr. Loh, that was fast!).  

Dr. Hong told me I did well. My throat was sore, but I didn't lose my voice (thank God!). I was able to talk immediately after my surgery, but it was so difficult to drink and swallow. My voice was hoarse for the first 3 days and it was back to normal after 4 days.  I stayed at the hospital for 2 nights and I was discharged on 20th Nov. 

Post Op Visit and Final biopsy result:  Nov. 24 (6 days after surgery)

Dr. Hong was so happy when he told me about the good result. Finally, I saw Dr. Hong Ga Sze smiled :))). He said it's follicular adenoma, it's benign! Thanks be to God. So happy and relieved! Praise God! Answered prayer. #foreverthankful 


I received a call last week from Alexandra hospital, I was told that I was scheduled for repeat FNA 27th Nov. I said I already had my surgery :).

Cheers,
glo_gee

Monday, November 24, 2014

My Thyroid Story - The Beginning

"Pray, hope, and don't worry. Worry is useless. God is merciful and will hear your prayer." - Padre Pio

It all started last April 17 when I went to Alexandra Hospital for check up and to get prescription for maintenance med for my hypertension. Alexandra hospital is the nearest hospital in our place, 10 min walk from our condo.  I called the hospital for appointment.  Dr. Chitra, a senior consultant at Alexandra hospital was assigned to be my doctor. Since it was my first check up with her, she asked a lot of questions about my medical history.  I like Dr. Chitra. She is warm, friendly, and she spends time getting to know her patients. Then she asked me "Do you have goiter?". I replied I don't know.  She said she noticed a lump on my neck. She thinks I have goiter so she sent me for thyroid blood test and advised me to come back for follow-up check up after three months.

As soon as I got home, I looked at the mirror and checked my neck. That was the time that I noticed that I indeed have a lump on the left side. I had never noticed it before.

I then checked my previous annual health check results from Kobe Kaisei Hospital Japan the past 3 yrs. There was no indication of lump or goiter in my 2011 and 2012 results. I wonder why the doctors at Kobe Kaisei Hospital did not detect it. Maybe it was not noticeable at that time so it was not detected.  I found out it was detected in my last annual health check last Dec as suspected mild goiter. I overlooked it due to crazy sched last Dec, working on my relocation to Singapore on top of my crazy work load. Then we flew to Singapore on Dec. 30, 2013 and never had the chance to have follow up consultation at Kobe Kaisei hospital.


Lesson learned: Don't take for granted your annual health check. This is very important !! 

Fast forward, I had my follow up check up with Dr. Chitra on the 31st of July.  She told me that my blood test result came back normal, so it's not goiter. I asked what it is if it's not goiter. She said I need to have an ultrasound to find out.  She sent me for ultrasound and told me to come back for the result after 2 weeks. I knew they saw something in my ultrasound based on the reaction of the one who did my ultrasound
. My heart was beating so fast when I walked to Dr. Chitra's office on the 28th of Aug.  As I anticipated, Dr. Chitra told me that a large 4cm solid nodule was found in my thyroid gland occupying the left lobe. She was surprised why it was not detected in my previous annual health checks. She said my nodule is large and maybe it has been there for years already. Since she is not an expert on thyroid issues, she consulted her Endo friend by phone on what to do next. The Endo recommended to do FNAC to rule out cancer. I'm loving Dr. Chitra, she really cares for her patients. 

According to Wiki*
Fine-needle aspiration biopsy (FNABFNA or NAB), or fine-needle aspiration cytology (FNAC), is a diagnostic procedure used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscope



Before my FNA, I made a mistake of watching on YouTube how the FNA procedure is done. Big mistake! I was freaking out when I went for FNA on the 4th of Sept. I knew my blood pressure was also high. The nurse told me to relax. She said it's just FNA, not surgery. I did deep breathing and I managed to relax after a few minutes (Now I know that deep breathing is also JSJ - Jin Shin Jyutsu). 

Then Dr. Lim Choo and the Pathologist proceeded with the FNA procedure guided by ultrasound.  I was told to hold my breath and not to swallow while they were taking samples from my nodule. I was praying so hard that I wouldn't feel so much pain. My neck was poked 4 times. It felt like I was bitten by a big mosquito 4 times. I was so relieved when they told me it's finished.  It was not as painful as I imagined, but it was uncomfortable. 

I called the hospital 2 weeks later but I was told that the result is not yet in and it usually takes 2-3 weeks to get the final report. That was so frustrating!  It would have been faster if I had my FNA done at a private hospital.  

When I called again, they scheduled me to see Dr. Chitra on the 6th of Oct (a month after my FNA).  It was so stressful waiting for the result. I prayed so hard that God will give me the strength to deal with this trial.  I asked my family, brothers, and sis-in-law to pray for me. I also prepared myself for the worst. I was so ready when I went to see Dr. Chitra, only to find out that my FNA result was inconclusive :(. She was not able to explain to me the result well because this is not her expertise (she's an internist). 

Diagnosis: 
FNA Atypical; Follicular lesion of undetermined significance. 

Comments: 
A definitive cytological diagnosis is difficult on this sample. Follow-up and a repeat FNA after 2 months may be helpful. 

She referred me to an endocrinologist who would be able to explain to me my FNA result. I was supposed to go to the endo on the 4th of Nov. but I decided to cancel my appointment. I didn't want to wait for another 2 months to have repeat FNA, then wait again for another month to get the result. 

I prayed so hard for God's guidance to lead me to the right direction. I came up with the decision to consult a specialist at the Mt Elizabeth Medical Centre. Too bad I wasn't able to get a copy of my blood test and ultrasound, but I managed to take a photo of my FNA result using my phone. 

To be continued in my next post ...