An Update on My Lump

As you may have read in "Gotta Get Right", I saw a doctor two weeks ago for a routine checkup. I had a bad cold that day, so she took a look at my lymph nodes, and surprisingly she found a lump on my thyroid. She referred me to a radiologist for an ultrasound to find out things like the position and size of this lump, as well as whether or not it had a fluid center like a cyst, or a solid center like a tumor. Another piece of information the ultrasound would yield was if the tumor had its own blood supply. My doctor couldn't believe I wasn't having trouble swallowing or breathing because of the size of the mass. I told her I was pretty oblivious I guess. I think being a triathlete also contributed, as we are pretty used to dealing with discomfort. But ever since she pointed it out to me, my lump began to hurt, and I can feel it when I swallow, or lay a certain way to go to sleep. I couldn't help but think about this, one of my favorite movie quotes:

So, I was pretty nervous all week waiting for the ultrasound. When I had it done last Wednesday, I asked the technician if she could tell me anything about it as she was performing it, but she said she wasn't allowed. At the end, I asked her if she was able to tell me if she found the lump, and she said "Oh yeah." Not exactly great news, but at least I would get an answer. One funny thing is that I got really freaked out during the procedure because I could kind of see the screen, and I saw a big white mass (my thyroid) and a big black circle right next to it. When she flipped it to the doppler mode for checking blood flow, the black spot lit up like crazy. I broke out in a sweat. When I got back to my computer at work I google image searched "thyroid ultrasound" and it turns out all I was looking at was my carotid artery! I decided to stop playing amateur doctor and wait for the report.

I got the report on the ultrasound while on NC for business on Thursday. I knew it wasn't great news since my doctor and left a message on my VM that she needed to speak with me, and no other details. When she called back, here's what she said: There is a single 4.5cm solid tumor on the left lobe of my thyroid. This is roughly the size of a walnut. It does not have cystic components, its solid throughout. It does have its own blood supply, and it doesn't have calcifications. The doctor told me that she was ready to move forward with a fine needle aspiration biopsy to see if it was thyroid cancer. I knew going into the ultrasound that 95% of thyroid nodules are benign. But, a lot of those nodules are found incidentally while doing an ultrasound on the neck for other purposes. Mine was found because it was jumping out of my neck at the doctor. And from some reading I did I knew that given the size of the tumor, coupled the facts that I am male and its a solitary mass, the likelihood was always more than the typical 95% benign. I asked her what she thought, and she seemed to indicate, in her best "bedside manner" type of language that cancer was a likely outcome. But she also told me about how 85-90% of thryoid cancers are entirely curable, and its not a bad treatment regimen. Just a surgury to remove the thyroid, and then a few weeks later a possible radioiodine treatment in the hospital. It was still tough news to take, and it was tough telling my folks about it. Becca was great; really, really supportive and made me feel better about the whole situation.

Here's a picture of the lump, you can see it when I swallow:

The Plan:
On Friday, my doctor and I came up with a plan of attack. See, because its so large and is causing compression in my neck, it has to come out whether its benign or cancer. The only choice to make is if to take the entire thyroid with it or not, and as far as I understand this has to do with the histology showing cancer. So, I am getting an aspiration biopsy next week, either Monday or Thursday at Thomas Jefferson by an ENT specialist. Typically this has to be performed under ultrasound guidance, but the earliest I could be seen for that was May 7th, and we decided my mass is so large and I am so skinny they could hit it from across the room with a needle, making the u/s unnecessary. I should get some pathology that day, and a full report the day after. If it turns out to be cancer, I will go see one of the best head and neck cancer doctors in the world at Fox Chase, thanks to a connection my CEO had there (thanks so much!!!). If its benign, I get an appointment, perhaps with the same ENT to get the lump, and at least part, if not all, of my thyroid removed.

One uplifting bit of information I got was from my extended family. It turns out my cousin had a pretty large benign thyroid mass, and had her thyroid removed last year at age 41, and is doing great on Synthroid. And my grandmother had two masses incidentally discovered during a CT scan in the 1980s. One was lemon sized, the other grapefruit sized, the latter growing down into her sternum. She also had a total thyroidectomy and has been on Synthroid almost 30 years now. So, given this family history, maybe its just a natural DeWire thing to have these giant thryoid tumors removed as you approach mid-life?? Given the good longevity genetics of the DeWire genes (I have several great grandmas, aunt, uncles, etc who are 90+, and one that made it to 102), I will take the good with the bad.

So, since this is a triathlon blog, I suppose I should post an update on what this all means for my racing season. Obviously, triathlon is way down the priority list right now. As of Thursday night, after having a great 90min run with my old NC tri pal Kit Phillips though Umstead Park that morning, I have suspended my training plan for IM CDA. I am fighting off another cold, and have felt generally lousy for a while now, and my main objective is to get heathly first. I am still planning on attending the race in Idaho, and if I am healthy enough and not recovering from surgery, I still may race; with the new goal being to enjoy the day and finish smiling, rather than press myself to a new PR. In the immediate future I have a 10 miler scheduled, and I am not sure what to do about that. I'd really like to run it, and I can't imagine anything will happen tumor-wise by then except the biospy. They say throid tumors grow slow, sometimes over 10 years, so there's no question I have already done an Ironman or two with this thing in me, so 10 miles probably won't hurt me. We shall see how I feel going into next weekend.

Hearing you might have cancer is, of course, news nobody want to hear. But Becca and I feel very fortunate for everything the past couple weeks. We are lucky I had a cold the day I saw the doctor, lucky she decided to give me a quick exam, and lucky she found the mass. And we are lucky things are not worse, as they always can be. We're really lucky there's still a good chance I don't have cancer, and even if I do, its a pretty simple one to treat. I wanted to say thanks to everybody who called or emailed and expressed their concern and support and sent positive vibes our way. I was really impressed on Becca's blog how many of her readers, who have no idea who I am, still sent warm wishes. I've decided to chronicle the events to come on my blog, mostly as a therapeutic means and a personal diary, so I'll keep updates on here as I have them.