Thursday, March 6, 2014

Total Thyroidectomy

Around 18 years of age, my thyroid gland decided to start getting busy.

Meaning, bigger.

Called a "goiter", the result of Hashimoto's thyroiditis, my immune system assaulted the gland over the years and prompted it to create scar tissue and increase its size. As far as it was concerned, this thing was a foreign body needing termination.

Fast-forward to age 40.

A friend of mine who works with kids contracts pertussis, aka "whooping cough", a childhood disease largely controlled with childhood vaccines, but which has found new life thanks at least in part to anti-vaccination activism. I happen to contract almost identical symptoms a short while later. I wake up nights with unprecedented difficulty breathing. My throat feels clogged with mucus, and the hacking cough lasts a good month or two.

I decide it's time to get this thing out of me. Total thyroidectomy.

I consult a local ear-nose-throat doctor. We commit to surgery. She gives me a warm hug on my way out of the initial appointment.

I go to a pre-op appointment. Alex, a Korean physician's assistant, opens the floor to me to ask questions. I ask my wife's questions first, how soon prior to the surgery can she see me? How long is recovery?

Questions answered, I'm out. The following Friday, I wake up at 5-dark-thirty to arrive at the hospital around 7am. The reception nurse, sleepy but awake, leads me into the prep area. I'm asked to disrobe into one of those humiliating ass-open hospital robes, and need help tying off the lower part. She reassures me, she's seen plenty o' butts, and helps tie the knot.

I'm led to a bed, where an intake nurse sees me next. We review my meds, whether I've taken aspirin, fish oil, any other OTC drugs that might cause excessive bleeding. Being a compliant patient, I've refrained from taking these for a full 5 days prior. I've even showered and scrubbed the area with a chlorhexidine-containing soap to minimize the number of microbes loitering around my neck.

The nurse inserts the IV into my forearm. The vein is sketchy, so apologetically she tries again, this time atop my hand. Success!

Bruce, the anesthesiology nurse, warmly greets me. A friend snaps a shot of me smiling wanly in the hospital bed, and then I'm wheeled off toward the operating room.

Upon arrival, Bruce whips a syringe out from his chest pocket, then injects its contents into my IV. Versed, he says. Cool! I'm hopefully I'll start feeling woozy, euphoric. No such luck, however.

I'm there, in the OR, a few minutes. Someone places a mask halfway across my nose and mouth. I breathe normally and then... like some ridiculously swift transition in a movie, I find myself in recovery. I have utterly no recollection of the events that transpired.

I gingerly probe my neck, and it seems genuinely less massive. The thyroid is gone, it would seem. A tube leading to a squeeze bulb meant to suck out fluids hangs at my chest, and the remainder of the wound is sealed with some sort of novel purple "glue" meant to bind incisions.

A friend along with my wife rescue me from the hospital and we drive. We decide to have dinner at a local sushi restaurant we enjoy. Despite the lingering haze of the anesthetic (which imposes a noticeable delay as I try to piss in the restroom), I find I can fairly easily chew and swallow our food. Famished, I devour it eagerly.

The first few days following surgery, I numb the pain with hydrocodone provided by the surgeon. Recovery is, thankfully, largely uneventful. Now at a week afterwards, the glue has all but fallen away, and the surfacemost areas of the scar have healed over. I now apply Mederma several times daily to deter the formation of an annoyingly visible scar.

I can swallow much more easily, and although now I add another medication to my daily regimen (levothyroxine, the brand name of the well-regarded thyroid replacement hormone), along with Humalog and Lantus to manage my type 1 diabetes.

It doesn't bother me as much. Just being able to breathe and swallow more easily is a wondrous thing.