Passed out while at work…

It was Monday morning, July 12, and I was ready to start back to my internship for a full week since returning from my total thyroidectomy. Today was now two peeks post op, and I could remove my steri-strips today. I was having a hard time determining if I should remove them before or after work, and finally decided I would wait until I came home from work. Well, as I realized, not all things go as planned.

It was about 10am, and I was in a patient’s room in the PICU with my Clinical Instructor, an Occupational Therapist, an OT student and the patient's nurse. The patient’s room whom I was in, was intubated and sedated, so I was delivering Passive Range of Motion (PROM) to her lower extremities. I had completed the stretches on her right leg, so I started working on her left leg. While I was starting to stretch her ankle, I started to feel lightheaded, have tunnel vision and cold fingers. With this, I tried to stay calm and mentioned to my CI that I wasn’t feeling well and needed to sit down. I walked over to the high back nurses chair in the room and sat down. About this time, I was starting to loose more vision, and heard my CI mention how she was going to grab some juice for me. In the meantime, the nurse had noticed all the color in my face had disappeared and my lips were white. She then decided if I were to pass out, it would be best not to do so in a chair that is about 5 feet off the ground. So she walked me over to the bedside couch, and in the meantime she mentioned that I lost consciousness for about 10 seconds.

The next thing I remember is seeing my hands on the couch. I mentioned that I thought I was still on the other chair. I was a little “out of it” to say the least. By this point, Kat, my CI had returned with some apple juice. I started drinking this and realized that sweat was dripping like crazy down my face, chest and back. Since the nurse, OT and my CI were talking about how long I was out, and my color, I asked if my color had returned. With a concerned chuckle, they said, “Nooot really.” They then decided to take a blood pressure reading, which read 57/30 (Well, this is not too good…). The next thing I realize, is there is a full team of residents, PICU nurses, and security in my room. I thought that they were doing rounds on the patient whose room I was in and almost called out to them “Sorry I am in your way. Do not mind me, keep doing what you need to with the patient.” Little did I know that I WAS the patient now. They had called Rapid Response on me and they were now lying me back on the couch, raising my legs, testing my blood glucose levels, listening to my heart and breath sounds, starting an IV (which later on hurt because my veins in my hand were not well inflated, but at the time I felt no pain) and drawing blood.

They had seen my steri-strips and asked me about my surgery. I mentioned to them that I have been struggling with my Calcium levels and that today I had noticed an increase in my tingling. So the next thing, there is a gurney in the room, two security officers and they are talking about transporting me to the next door hospital (Hospital of the University of Pennsylvania) via the underground tunnel. I looked around the room and saw the Rehab Physical Therapy Supervisor standing with my Clinical Instructor, talking about getting my items out of my locker downstairs.

So security is transporting me out of CHOP, through an underground tunnel (which reminded me of something similar to the underground railroad system) and to a pair of elevators that were painted like a rainforest jungle. One of the PICU nurses that was with me mentioned that I would soon realize that I was no longer in a children’s hospital (and boy was she right!). The atmosphere was totally different. When we arrived in the Emergency Department at HUP, there was more security officers and nurses awaiting my arrival (talk about an entrance). This was nice, because I didn’t have to wait to be seen.

So while I was there, they took a lot of blood and urine specimen to determine a reason as to my fainting. I had to go through my whole patient history, medical background and recent surgery. I also had to share with them that over the past 2-3 days, I had been having increased “bowel movements” (ok, I will be mature and say the word I really hate, “diarrhea”). Then all the nurses and attendings were gone for some time, awaiting my results.

It was incredibly nice that the physical therapy department at CHOP ensured that I was never alone. They made sure there was always one supervisor with me at all times. This helped me feel more at ease. It didn’t help that the ED was in the basement and I could not get any signal, so one of the supervisors would take my phone out and informed my parents of what was going on.

Then the attending came back, saying that my calcium levels were low, as well as several of my electrolytes (potassium and magnessium) and they would not feel comfortable with me walking out around society with levels this low, therefore the were going to admit me and give me fluids and monitor my response. Great. I have been out of the hospital for only 10 days, and here I am going right back in. So my supervisor called mom back and informed her and mom decided that she was going to find a flight out of Louisville that afternoon and fly into Philadelphia that night.

If I thought a Western Philadelphia Emergency Department was interesting, I was unprepared for the rooms that were upstairs. Now, this hospital is number 9 out of the top 10 hospitals in the nation, so it really is a nice place (medically) but the building appeared very old and they were squeezing a lot of things into a small place. (But then again, nothing could really compare to the Park Towers at Baptist East!).

So the rest of the day consisted of being admitted into my room, being seen my a team of endocrinologists, a team of internal medicine doctors and my nurse. By the time I got to my room, it was about 4pm. By then, one of the supervisors was out getting me lunch and then they were switching shifts of staying with me. It was really nice to have them around, because nothing is worse than being in a hospital, than if you are in a hospital 670 miles away from home and family. My room was not too bad. I had a roommate who was very sweet. The things that I thought were funny, was that I only had three channels on my TV (fit TV, ABC family, and some MSN news like channel). If I wanted more channels, I would have to pay via credit card to receive more. Also, my phone in the room could receive free calls, but in order to make calls, I needed to pay via credit card. How interesting…

The evening actually went quick. I had been receiving a plethora of fluids (IV, potassium, magnessium, calcium) because the overall reason they thought I fainted and or felt the way I did was due to dehydration and depletion of my electrolytes secondary to the diarrhea. So on top of my imbalance in calcium, I took myself to further levels. The Rehab supervisor was now with me and she generously went back to my room and picked up a few items for me as well as dinner. She stayed all the way until mom was in a cab at the airport (around midnight) before she went home. She was incredibly sweet.

Mom had arrived and it seemed like it was 10 days earlier with the two of us living in the hospital. (Sad thought, actually). Mom and I received the results of my blood tests and it seemed like my levels were responding very well to the fluids and my levels had climbed back up – yay.

So the next morning, the team rounded on me and decided to give me a little more fluids and send me home later that day. This was a good sign, since it took me several days to have my levels return to baseline before. During the day, I was visited by the other PT student at CHOP who came in on her way in for the morning. It was nice to catch up, because we were initially planning to grab lunch together on Wednesday to catch up – so I guess this took its place. And then around lunch time, my CI and one of the PT supervisors came by. It was nice to be far from home, yet still have visitors. Overall, the experience was a good one because the results turned out well. Mom and I made sure to find our own fun in the breakfast and lunch they brought us (they brought both of us a lunch plate that she ordered, which was handy so she didn’t have to walk to the cafe)!

I was discharged around 5:30 and transported down to the main entrance where mom had a decent adventure using the cab hotline to catch a cab. We took the cab about 6-7 blocks to my place and the two of us ventured up to my small room to crash. That night we picked up Italian from up the street and chatted the rest of the night. It was nice to see her again, since the last time I said bye, I was unsure of the next time I would see her. So overall, it was a bittersweet time. Neither of us were happy about the situation that required her to come up here, but we were both happy to have the time to spend together that we otherwise would not have had.

So I thought my excitement for Monday, July 12th was going to be taking off my steri-strips…BOY was I wrong!

Traveled to Redding Terminal Market…

On Saturday, July 10th, my suitemate, Reshica and I decided to travel to the Farmer’s Market at Redding Terminal Market. I had heard several suitemates talking about the great prices and produce available there, so I decided it was time for me to travel there too!

So Reshica and I had talked about going earlier in the week, so she stopped by to see if I wanted to go. We got our bags ready and walked to the 34th street station for the Market-Frankford Line that would take us right to 11th street for the Redding Terminal Market. We walked right out of the train station, and only had to cross a small street to get right into the market.

This is a must-see place for anyone who visits Philadelphia. This terminal market has just about everything from produce farmer’s market, meat stations, fish stations, florists, ice cream, Indian and Pakistani foods, Thai, Chinese, etc, etc. Below is the map of the entire market and shows all the booths.

Today, the Reading Terminal Market, considered by many as one of the finest public markets in the U.S., blends together state-of-the-art systems technology without sacrificing its historical integrity. It’s not only a popular hometown attraction, but also the most popular Philadelphia tourist destination after the Liberty Bell and Independence Hall. More than 80 merchants offer patrons fresh produce, meats, fish, groceries, flowers, baked goods, crafts, books, clothing, as well as hard-to-find specialties and ethnic foods. Shopping and dining become a pleasure in this warm, inviting, and unique atmosphere. The Reading Terminal Market, as it was over a hundred years ago, is reminiscent of personal, neighborhood shopping, and still offers something for everyone. A trip to Philadelphia would not be complete without stopping here.

http://www.readingterminalmarket.org/about/somethingforeveryone

So as you can see, this market place has a little bit of everything! The farmer’s market is insanely cheap. I got: 4 kiwis, two heads of broccoli, 2 apricots, 2 cucumbers, and 2 green peppers for $4.10 (and that is even WITHOUT the student discount that they have every Sunday and Wednesday)! Reshica and I found our treasures and walked around some, but it is such a large place that you almost need to spend hours in (almost like a flea market) because you will never see it all in one quick tour!

From there, we traveled to Chinatown, because I mentioned to Reshica that I have never been to a Chinatown. She warned me that it was going to smell odd (and boy did it ever)! It was an odd smell, one that I could not describe if I wanted to. I was very tempted to go in one of the dozens of Chinese restaurants, but I wondered if I really wanted some food, how would I know WHICH one to go in?!?! There were too many to decide. Chinatown was about 4 blocks deep and 4 blocks wide. It was filled with other farmer’s markets, restaurants and several knick-knack type of stores. It was a very interesting adventure, but Reshica and I were talking throughout our walk that I almost missed most of it!

From Chinatown, we went into the Gallery which is connected to the 11th street SEPTA station. It declares itself to be:

Sensational Shopping in Center City Philadelphia

The Gallery at Market East is prominently located in the heart of Philadelphia’s thriving Center City. Adjacent to major historical attractions, The Gallery is amazingly convenient and bustling with activity. More than 40,000 people enter The Gallery each day for great stores and eateries, all accessible through one of the city’s busiest transportation hubs. With its giant directory sculptures and soaring four-story atrium, The Gallery is one of the city’s premier shopping destinations.

http://www.galleryatmarketeast.com/about_us

The Gallery was a neat place because it had stores that I recognized, such as Old Navy, Burlington Coat Factory, Claires, Bath and Body Works, but there were also stores that were not familiar. These included Five Below (which is similar to a Dollar General except that all items range from $1-$5), Kicks USA, Underground Market, and several others. While we were walking around, Reshica decided that she wanted to get her left cartilage pierced (and who am I to tell someone not to), so I supported her! We walked into a store and I helped her decide which color gem she should get and helped her decide at which location on her cartilage she should get it pierced. It was a fun and eventful time, and completely out of the blue! Overall, she was pleased with her decision and she said that it doesn’t hurt even now (which is awesome).

From the Gallery, I had mentioned an exchange store, Buffalo Exchange, that I had stumbled upon when I ventured into the city once before. Reshica was enthralled by the idea, so we decided to head there next. On the way through the city, we stumbled across LOVE Park, which I had been wanting to see! This is a park that was built in the 1960’s at the eastern end of the Benjamin Franklin Parkway across from City Hall.

LOVE Park in Philadelphia is famous as a mixed-use urban space and world capital of skateboarding, celebrated by millions as one of the most recognized landmarks of a $2 billion-a-year industry.

http://www.ushistory.org/lovepark/

To me, this park is extremely special because of the fantastic LOVE sign at one of the ends of the fountain. So Reshica told me that she would take my picture in front of the sign (YAY!). While I was standing in line (yes, there was a line to get your picture taken with this sign, it is that popular), we noticed a wedding party that had stopped at the park to take pictures in front of the water fountains and I am only certain that the LOVE sign was also included in their pictures (adorable thought!).

I hope that when more people come to visit, this is a place that we can come for SEVERAL photo opportunities! I LOVE Love Park!

We finally found Buffalo Exchange and had a nice time looking around for clothes. We each found a treasure and while we were there, we both decided that we needed to take a NYC trip with another suitemate of ours (Alyssa), and find more exchange stores. I have so far found 3 fabulous finds at this store and it is always fun because every time you go in, there are new items. People can buy, sell or trade clothing. So if you are willing, you can find some fantastic finds!

We ventured back to our place, with bags full of produce and clothes. We decided to close off the evening watching Grey’s Anatomy episodes on my Netflix account and eating popcorn. I would say it was an overall fantastic Saturday out on the town. Not only did I find some great places, but I also found a great friend in my suitemate.

Thanks for traveling along with me!

Had a Total Thyroidectomy…

(Part Two)

So my blood was tested at 5 am (Wednesday, June 30th), and I mentioned to mom that I knew my results were not going to come back clean because I still felt tingly. But with that, we both went back to sleep until about 7 when my surgeon arrived to my room. He turned on the lights and woke me up, but this morning was unlike the last morning. My tingling was now so severe that it was all down my legs, arms, my entire face felt like it was tingling and twitching, my arms and legs felt like lead and it was hard to pick them up. My hands were so tight that I could not squeeze into a fist and my lips were puckered, sort of like an old man. I was rather freaked out by such things and when my dad walked into the room for the morning, I realized I was freaking out my parents too.

When my lab results returned for the morning, my Calcium levels had dropped from 7.2 to 6.5. So even though I was taking Calcium, my levels still dropped. This alarmed my doctors and my nurse, because a 6.5 I was very close to seizure levels. So they administered IV calcium and oral calcium with the addition of vitamin D in hopes that my levels would return quickly. My levels would be checked again that afternoon to determine how my levels adjusted to the new calcium.

During the second day, I started to have more visitors. Josh’s father, Phill, and friend John came by to visit me. It was nice to see and chat with them. I even had beautiful flowers delivered from the entire Duckworth family, which was so kind and thoughtful. Later in the day, Molly stopped by and brought me a balloon and silly bandz (zoo animals, which I have three on my arm now :-)).

She stayed and chatted during the afternoon and helped the day fly by. While she was there, my nurse came in to inform me of what my afternoon lab results were (7.6). This showed improvement from the morning, but the doctors still wanted me to stay another night to recheck the levels in the AM to see how I could hold the values. So….this meant one more night (#3).

Mom had already mentioned that if I were to stay another night, she wanted to see if she could borrow a wheelchair for me and take me on a little field trip. The nursing assistant said they don’t normally allow trips (since most patient’s choose to go smoking) but she realized that this was not my reason. So we were allowed to go down to the 2nd floor mezzanine (OUTSIDE!!!). We left a note on my bed and mom and Molly transported me around. Mom wanted to show me around the 6th floor Park Towers where I was staying because she was so impressed with all the amenities. We traveled outside to the mezzanine and it was fabulous. I never realized what it is like to be stuck inside for several days and not even feel outside.

Molly was so gracious to take my picture and I was so delighted to show off my sweet gown and newly revealed steri strips!!

While we were on our field trip, I ran into two other ladies from school: Cristina Carillo and Rachel Amshoff. It was so nice to see more people and talk with people (outside of my hospital room). It helped me feel a little more “normal” if that is even possible!!

After we returned back to my room (my mom was very nervous about staying out too long), Molly had to head back but before long I had more visitors! Leanne came by and brought me delicious sushi and a chocolate frosty, while my Aunt Nancy and cousins, Amanda and Hayden stopped by with magazines. While the four of them were there, it was nice to enjoy typical conversations and just chat with people (again, that were not associated with the hospital). It is nice to have outside influences to keep you going. Before long, it was time for each of them to leave. But it wasn’t too much after that when Jenna showed up. She was so sweet to bring me a PINK Louisville shirt, body fragrances and a fantastic little tote bag! She was too kind and it was great to be able to talk with her too. You never really realize how much your friends care for you, or how much you care for your friends, until you are in a time of need. You realize that your friends are there for you, no matter what.

Around this time, dad had stopped by with dinner for he and mom (left over Fazoli’s spaghetti and two bottles of wine!). It was cute to see them catching up on the past days events (whether it was about the dogs or dad at work), while they enjoyed their wine.

It was getting late, and Jenna had already left. Dad and I were watching a show on TV and mom was starting to settle in for yet another night. We tried to convince dad he could stay longer, but he said he needed to get back to the dogs (understandably so). So he left with a few of the items we had accumulated over the past few days and mom and I decided to settle in for the night (hoping that this would be my last night).

Day #3

My calcium levels were checked again Thursday, July 1 in the morning. My surgeon and endocrinologist stopped by in the morning to chat about discharge plans, because my calcium levels had returned to 7.9. (I had called my general practitioner regarding previous calcium levels taken in March and found out it was 9.3). While they told me I was discharged, it still took several hours for them to get everything together. But it allowed me time to clean myself up and put on NORMAL clothing (what a concept!)

So I was all ready to get my orders and head out of there. But in the mean time, my lunch had not been delivered, so mom and I decided to take a walk to the family lounge. On the way, I saw my fellow classmate, Kevin Beale (whose clinical internships were all at Baptist East, and ironically today he was on my floor!) and sat to chat with him some. It was nice to see yet another friendly face and be able to talk about some PT things too!

While we were out there, my nurse came back to my room with my lunch tray (that for some reason was not delivered to my room…), so I returned to eat up. And before long, my nurse had returned with my discharge papers (which seemed like a decent stack) and my mom went to go grab the car. It seemed like forever before wheelchair transport was at my room to pick me up, and ironically the transport tech was yet another student from Bellarmine (they are ALL over Baptist East!). He took me all the way across the hospital and landed me at mom’s car.

Now I was on the way home…to continue to recover.

For the next few days, I went to the lake with mom and dad. Throughout the weekend, I realized I started to feel stronger, gain more endurance and feel a little more like myself. By Tuesday, July 6th, I was flying back to Philadelphia to return to my internship at CHOP on July 7th. What a whirlwind of a time….

Thanks for taking the ride with me :-)

Had a Total Thyroidectomy…

(Part One)

Josh flew to Philadelphia June 23rd as previously planned and I was able to spend some great time with him, his family that lives near Philadelphia and John. Over the weekend, we stayed at John’s house and on Sunday Josh, John and I drove back to Louisville so that John could return to his house and so I could have my surgery on Monday.

Monday, June 28th came around the corner and I had my overnight bag packed for the hospital. People kept asking if I was nervous, and I honestly was but I think I tried not to let it show too much (but I don't think it really worked). I'm not really sure which part made me nervous, whether it was the actual surgery, recovery, or any sort of complications that might arise.

I am grateful for the nurse I had who took me back to get prepped for surgery. She was very kind and asked me who had come to the hospital with me. I informed her my mom, dad and Josh were there. She then asked me if I wanted mom to come on back and sit in the room with me. I was taken off guard, because usually they do not allow your family members back until after you are prepped. But she assured me that if her daughter was being prepped, she would like to be with her too. So with her permission, I told her to bring mom on back. So mom came back during the prep work and then dad and Josh were allowed back a little bit later.

The next thing I know, I’m being taken back to the operating room and saying bye to everyone. I chatted with the nurses and then it was time for the oxygen mask (which only means one thing: anesthesia time). All goes black…and then…I hear a guys voice, talking about my increased heart rate, my increased temperature and talking to me asking me questions. I open my eyes and see a fairly open room with one other bed in the room. Then nurses are walking past me, saying good night to the guy that is with me. I realize I am in recovery, but overall I feel ok. I feel very tired, very tight around my neck, and just overall wiped out. Apparently I was in recovery longer than initially expected (about 2.5 hours instead of 1-1.5 hours), more so because of my increased heart rate and fever that developed. I remember looking up at the clock and realizing the time was rather late. After some time, the guy that was with me started talking about the room I was being transported to, and the tv and how the rooms are really nice. I just went along with it all, and I cannot even remember if I was engaging in the conversation with him.

Before I know it, I am being rolled into my nice room with dark wood cabinets and mom, dad and Josh waiting for me (with Family Guy on the tv, of course). Apparently the initial site of me was slightly concerning with my washcloth over my forehead, ice pack on my neck, nasal canula tube for oxygen, IV tubes, blood pressure cuff on my arm and a look like I just went through an obvious traumatic event – I mean, why would you think I would look concerning??

That night, mom and Josh stayed with me throughout the long and eventful night. I received pain medication and antiemetic (anti-nausea) medications. I didn’t really seem tired throughout the night and maybe its because there were so many things going on. My night nurse was checking up on me every hour to assess my vitals since I was still fresh out of recovery and could have had a compromised airway along the way. So the night continued and the nurse would ask me along the way if I was ever having tingling in my lips or hands. I was uncertain as to the reason, but Josh kept reassuring me that if I started to feel such sensations that we needed to inform them.

So around 4am, I started to develop tingling in my fingertips and lips, so I informed Josh and he went to my nurse. So instead of having my blood levels checked at 5:30am, the phlebotomist came in a little after 4am to assess my calcium levels. The next large event was the morning when dad came in to check on his way in to work and then my surgeon came to visit. I informed him of the new tingling but they informed me that my calcium levels were at 7.8 and normal values are 8.5-10.1, so they assumed that my levels were not entirely below normal to be producing such levels. At this time, I was getting very uncomfortable; I was itching as a result of the pain medication, my legs were starting to tingle, I had intermittent compression boots on that were driving me nuts amongst all the nerve sensations and I felt like my skin was crawling. So once they switched my pain meds, I started to feel a little less itchy, but still tingly. My voice was starting to gain strength and showing no signs of damage to my vocal cords – Yay.

So dad and Josh left and then it was mom and I left in the hospital. Even though I didn’t receive much sleep overnight, I was not extremely tired, but decided I should still sleep. Throughout the day, I continued to be tingly and my day nurse seemed to be baffled by my continued tingling that was now in my neck, to my lips, down my fingers, and down my feet. People kept telling me it was because of the superficial nerves that were involved with the surgery – but I know my anatomy and I KNOW there is not one nerve that travels to each and all of those areas, so I am not crazy. I started to develop a very large hacking cough as a result of being intubated. When I would cough (or I should say attempt to cough), the tingling got worse and was driving me insane. It started to get so bad, that I started crying and it was at this time that I think my nurse realized that I was not making things up (hello!!!). So my blood levels were taken again and I was told I would hear from my surgeon and endocrinologist later that day.

I had a nursing assistant that came into my room and told me she would help me with my “bath.” This was an overall experience. So I was in bed, she brought over the soap, washcloths and tub of water. She said that we were going to do this together – she washed my back while I washed my face, she washed my legs while I washed my arms. Then I mentioned I needed to use the restroom. So she helped me in, and while I was in there she made mention that now was a good time to wash my “purse.” Mom looked at me with a little confusion – but I returned the look and told her that I thought I understood what the nursing assistant meant. She meant for me to wash my private areas but referred to calling them my “purse.” So needless to say, mom and I got a big kick out of this and tended to tell a large majority of people the joke.

On my first day, I had my first “real” visitor where Tessa came by after she got off work around noon. She stayed with me for a few hours and we chatted about things. It was nice having her there and seeing her company.

Before I knew it, my surgeon was coming by and assessing my calcium levels that have since dropped from 7.8 – 7.5 –7.2 throughout the day. My surgeon informed me that sometimes the parathyroid's that are attached to the thyroid, but remain in place upon the removal of the thyroid, can get stunned. He believed that all 4 parathyroid's remained after surgery. The function of the parathyroid's are to control calcium levels (amongst other things too). So since he assumed these must have been stunned and I should probably start some calcium overnight and test my levels in the morning to see if my body is able to maintain the levels themselves. My surgeon also mentioned that in the morning I should be able to go off my liquid diet to a soft food diet (yay, no more clear liquid soup).

Following his visit, my endocrinologist stopped by and performed an interesting nerve test that involved me parting my mouth, and he tapped right at my mandible and masseter muscle which produced a twitch at my eye and mouth. He indicated that this is a sign of low calcium levels and again mentioned the need for calcium supplements.

So there I was, needing to stay in the hospital for night #2, but with hopes that I would start to have reduced tingling. To make time go by, mom hopped into my bed and we started watching “August Rush” on my laptop. Dad visited us in the middle of the movie and brought mom dinner and me some easy Mac! It was nice to visit and we had a good dinner together. Dad had to return home to take care of the dogs and mom and I were left to finish the movie (and me have my two doses of Calcium) before bedtime.

The nice thing about night #2, I did not require continual checking in every hour and was able to sleep all the way through (that is until my blood was taken for my calcium levels at 5am).

(Day 2: To Be Continued…)

Been told I need a Total Thyroidectomy…

Back in March/April, I found a few enlarged lymph nodes on the right side of my neck.  I informed my primary care doctor about it, and together we decided that I should have a CT done to investigate further.  The same day I had the CT done, my doctor called me to say that the lymph nodes did not appear to be pathologically enlarged but some nodules were discovered on my thyroid and the radiologist suggested further investigation.

The same week, I went to have an ultrasound of my thyroid.  The results of this showed that I had two nodules (one 0.8 cm and one 1.0 cm) on the left lobe of the thyroid and one nodule (0.6 cm) on the right lobe of the thyroid.  The radiologist suggested I undergo further examination within 6 months to investigate the consistency of the nodules, but my primary care doctor decided she wanted to be a little more aggressive due to my medical history of a genetic mutation predisposing me to a number of cancers. 

So one and a half weeks before I was to move to Philadelphia, I was already scheduled to see a hematologist/oncologist for a blood condition/my genetic mutation situation.  So while I was there the doctor decided to get me into an endocrinologist appointment before I left to determine if this situation needs to be investigated further.  I was squeezed into my endocrinologist appointment the day before I left for Philadelphia.  While at this appointment, he determined that he wanted to fine needle aspirate the 1.0 cm nodule on the left lobe to determine if there are any questionable cells.  He assured me that more likely than not the cells turn out just fine, because thyroid cancer is very rare.

So I was scheduled to have my fine needle aspiration the morning I was to leave for Philadelphia.  My mom and I went in to my appointment (which was entirely uncomfortable) and then went on with the regular plans to head north.  About a week and a half into my internship in Philadelphia, my doctor was contacting me about the results of my biopsy. 

It seems that the biopsy revealed Hurthle Cells which are associated with Hashimoto’s disorder as well as follicular thyroid cancer.  Due to the uncertainty of which cells are contained in the Hurthle Cells, my doctors decided that the only way to determine whether the cells were benign or malignant, the thyroid needed to be removed.

I was already planning on flying home for my dad’s birthday party the weekend of June 11th, so my doctors decided to squeeze me in for a surgical consult.  At this consult, we decided that both lobes of the thyroid needed to be removed due to potential investigation that might be needed in the future.  Therefore, my total thyroidectomy was scheduled for June 28th.  This would require a week off from my internship that would then be tacked on to the end of my rotation, making my last day November 19th at CHOP.