A Surgery, the C-Word, and a Book

Three weeks ago, I had a thyroidectomy. 

Me after my thyroidectomy.

The thyroid is a butterfly-shaped gland located at the base of the front of the neck. The gland is responsible for producing hormones that control nearly every function in the body: metabolism, cardiovascular, and reproductive, to name a few. I've had thyroid issues, namely Hashimoto's (an autoimmune disease) and hypothyroidism, for more than twenty years. For the most part, I've been able to address these issues by swallowing a daily pill containing hormone replacement. Alas, a time arrived when I could no longer control my thyroid with medication.

Last July 4th, in the middle of scouting a new bicycle route through the lovely Green Mountains of Vermont, I suddenly felt as though my body had been filled with a fast-setting concrete. And then I lost my energy in an instant, as though a switch had been turned off. I didn't think the problem was thyroid-related, as I had never before had such a significant drop in energy. After a series of tests to rule out other concerns, my doctors and I circled back to my thyroid.

I met with a surgeon who explained that my thyroid was heavily scarred and nodule-speckled from chronic thyroiditis. To put it in simple terms, my thyroid was toxic. No wonder I was so fatigued. My surgeon recommended a total thyroidectomy. The body can, after all, manage without a thyroid; I would simply need to take a higher dose of the same pill I'd been taking for the last twenty years. The surgeon was confident that a thyroidectomy would lead to a "significant improvement of life." As an added bonus, by removing my thyroid, I would be ridding my body of its autoimmune disease. That sounded quite wonderful. I'll take that 'ectomy, doc!

Cheers to a significant improvement in life!
Although it may look like a cute little plastic wine flask,
that little pouch is collecting fluid from a drain in my neck.

I had the surgery bright'n'early on the morning of Monday, December 20th. The procedure lasted just under two hours. As I would be staying overnight in the hospital for monitoring purposes, I spent the rest of the day sampling nearly every popsicle and yogurt on the menu, walking laps around the floor, and sleeping. When the surgeon visited the following morning, he told me my thyroid looked much worse than he had anticipated. Eeks, that was not good. He said he was glad we got it out when we did. Yeah, that was good.

One risk of a thyroidectomy is a permanent hoarse or weak voice due to nerve damage. For the first three days, I sounded as though I had smoked six packs of cigarettes a day for ninety years straight. I was grateful to hear my voice return in full force on the fourth day. Another common risk of surgery is permanent damage to the parathyroids. The parathyroids are four tiny structures that are attached to the thyroid and responsible for regulating calcium in the bloodstream. My surgeon was able to preserve two of my four parathyroids; the other two were entangled in the mess of scarred tissues. My surgeon removed these two entangled parathyroids and then autotransplanted them into my neck muscle. In the first days after my surgery, I popped calcium tablets as if they were candy. A week and a half later, my parathyroids kicked back into action. Phew, risks avoided!

The most wondrous event happened a few days later on January 1st. On that day, the new year greeted me with a generous gift -- my energy. Just as quickly as my energy switch turned off on July 4th, the switch had flipped back on. What a glorious way to welcome in the new year!

To be honest, the return of my energy was almost a little too much. Imagine someone who slowly goes blind over the course of twenty years. When that person's vision is instantly restored, the overwhelming transformation from darkness to 20/20 can be a wee bit overstimulating. 

My incision two weeks after surgery.
This could make for a good Halloween costume -- no make-up needed!

Closure on the surgery came with receipt of the pathology report. This report, typically delivered in about ten days, was delayed an additional week, compliments of Covid. The pathology report appeared a little after 10pm on January 6th in MyChart, the online medical record portal used by my healthcare system. I opened the report and started skimming through the medical mumble-jumble. As soon as my eyes saw the word "carcinoma," my stomach tied itself into one heavy knot and then fell kerplunk to the floor. I scrolled my eyes up to the top of the report, this time meticulously reading every single word. I relied multiple times on Dr. Google to help translate the findings for me.

From what I could tell, the left lobe of my thyroid contained two tumors. The first tumor was a papillary thyroid carcinoma, the classic form of thyroid cancer. The report explained that this tumor was well-encapsulated and had a significant margin. I assumed this meant the tumor had been fully addressed by the surgery. The second tumor was a hyalinizing trabecular adenoma. An online search informed me that this type of tumor was rare but typically benign. The report explained that this adenoma had a "unique immunohistochemistry finding"; the tumor had markers indicating malignancy, which meant this tumor was super-duper rare. Unlike the other tumor, this one was not fully encapsulated. 

This is my toxic thyroid.
These glands look absolutely devoid of life.
The lobe on the left harbored two stowaway tumors.

I went to sleep that night concerned about this not-well-encapsulated super-duper rare tumor. Had it been fully removed by the surgery? Was it possible the cancer could have spread beyond my thyroid? 

In the middle of the night, I had a sort of hallucinatory dream. In this dream, I was on my death bed watching my life flash before my eyes. My life appeared like a story with a tidy beginning, middle, and fully resolved conclusion. I wasn't at all afraid of dying, and I found that to be hugely comforting.

Though cancer sucks, it is good for one thing. It is really good at providing perspective on life. I've always had a sense that I wouldn't live a full life, that I would die some early, tragic death. That's one of the reasons I quit my job and "retired early" when I was in my mid-30s. In the nine years since, I've done so much living. I feel as though I've lived multiple lives in one. If this rare tumor did end up being responsible for my early death, I'd be okay with that. And if it doesn't, then I will keep waking every morning grateful that I have been given one more day. 

There is an impressive array of cancers. As far as cancers go, mine was an easy cancer -- a very easy cancer. For one, I didn't even know I had cancer until after it had been removed from my body. How different it would have been knowing I had cancer prior to my surgery. As they say, ignorance is bliss. For two, most thyroid cancers respond well to treatment and aren't life-threatening. Even if I had known I had thyroid cancer, it wasn't likely to kill me. For three, the cancer was (hopefully) addressed by a surgery I was planning on having anyways. I'm grateful I didn't have to choose between treatment options or deal with the yucky side effects of radiation or chemotherapy. If I had to choose a cancer, this would be the cancer to have. That not-well-encapsulated super-duper rare tumor will be monitored by my doctors over the next few years. If something suspicious appears, I'm confident knowing my doctors will be on top of it.

I can't help but wonder how many other cancers are hiding out within this body of mine. Cancer from the food I've eaten, the chemicals I've put on my skin, the smoggy air I've breathed, the stress I've experienced. I'm sure cancers are tucked away in places that may or may not ever be discovered before I die. 

My incision three weeks after surgery
and my new pendant celebrating my freed butterfly.
With time, the scar will blend nicely with the folds in my neck.

In the few months leading up to my surgery, I was too fatigued to do much other than take short walks. I had always wanted to write a memoir, and this seemed the perfect time to do so. 

One might assume this memoir would be about my travels in recent years, those both on and off the bike. I don't know how many times I've heard someone say, "Sarah, you should write a book about your bike travels." My memoir is indeed about traveling, but it's about a different kind of travel. It's about a journey in healing. Though this may be difficult to believe, my journey in healing has been far more meaningful than any journey I've ever taken on two wheels.

The working title of my memoir is Freeing the Butterfly. The story sheds light on how our inner body is connected to our outer experiences. My memoir begins by telling about the origins and evolution of my thyroid disease. In the spirit of Bessel Van Der Kolk's The Body Keeps the Score, I am convinced that this disease is a manifestation of experiences from my childhood. The second half of the memoir tells about my journey in healing. This journey began four years ago when I dedicated my 40th year as My Year of Self-Love and traveled to India in search of healing through yoga and meditation. The story continues up to my surgery three weeks ago when my disease was physically removed from my body and my butterfly was finally freed. 

I am absolutely loving the process of writing this memoir. I am finding it to be highly therapeutic. Cathartic. Insightful in making sense of my life experiences. I plan to complete a solid first draft before the beginning of summer. I'll take a break for a while to adventure in the warm and sunny months. With fresh eyes, I will revisit my story in the fall to make revisions. My goal is to have my memoir finished by year's end.