22 February, 2009

California suits me perfectly



As the years have gone by, I have found myself hating winter more and more. It reached the point where our short summer season turned into about a month of enjoyment and two months of mud season and dreading the autumn because I knew that nine long months of cold and dark were on their way. Yes, the autumnal displays were beautiful, but all too short lived, and hard on their heels were snow, ice, and darkness at 4 pm.

After 41 years in the northeast, I pulled up stakes and headed west in my new job as a traveling nurse. I've now been in southern California for five months and can honestly say that I have never been happier in my life. Work still has the same challenges, and on occasion has left me in tears of frustration, but it rolls off once I'm home again. Cold here is a relatively balmy low 50s, and though I break out my wool coat, its worn with sandals and minus the hat, scarf, longjohns, and other cold weather accoutrement. I'm a half hour from the beach and even went skinny dipping in the ocean in December. There are flowers all year long, as well as new treats like cactus fruits, churros, and cerviche. The bellydance community here is warm and wonderful though there does seem to be a pronounced cab vs tribal line of division. If we wanted to, we could go see a bellydance performance every day of the week, and on some days, more than one. Add to that my wonderful sweetheart and life here makes me happier than I've ever been before.

7 comments:

O.T. said...

Please ignore my comment if it sounds stupid , but do you have thyroid problem, cause your neck looks swollen?

gonnabecanuck said...

Actually, its not a stupid comment at all! Thank you for taking the time to post about it. I was just diagnosed with a mass on my thyroid and am having it worked up now.

O.T. said...

I wish I would be wrong, but the bump on your neck is very obvious on that picture. With head at this position the “fat fold” disappears, but the thyroid mass sticks out and moves upward during swallowing.
According to the present clinical guidelines (AACE, 2005) all solid palpable nodules of 1 cm and larger should undergo the FNAB. Assuming you know the size of this mass from the ultrasound, it will be good idea to know if the nodule has any of the following: irregular borders, increased blood flow inside it, or micro calcification? [Such features are increasing the chance of malignancy to 22%]. Most ultrasounds can show smaller nodules in addition to the large one; the Swiss cheese like image on the monitor [aka heterogeneous echotexture] suggestive of thyroid inflammation [thyroiditis].
During the biopsy make sure that they are using high frequency ultrasound even if nodule is readily palpable [this will help avoiding hitting the blood vessel and going to get sample from the nodule itself].
Best of luck!!

gonnabecanuck said...

Thank you once again! My mass is 3.5 cm and fine needle aspiration biopsy is definitely in my near future. I see an endocrinologist in two days--I don't know if he'll do the biopsy at the initial consultation (though I wish he would--I'm going NPO just in case), but I've been doing some research and want to also have an antibody test done to look at the possibility of an autoimmune problem like Hashimoto's disease.

Ironically, I've been telling my PCP for at least three years that I suspected something was abnormal with my thyroid and was in essence given the brush off as if I was just grasping at straws looking for a quick fix for my weight. I ended up seeing a new MD for something entirely unrelated (I'm 3000 miles from home), and he picked up on it right away. Miracles evidently still happen.

Thank you so much for the advice! It was quite timely even if I hadn't ended up at the new physician's office for another more minor issue.

O.T. said...

Any update on your status yet?

gonnabecanuck said...

I still don't have a definitive answer, but the ultrasound results were highly suspicious. The mass is actually 3.6cm, solid, does show heterogenous texture and has a doppler signal so its probably got its own circulation. My ultrasound guided FNAB is in a couple of hours and I'm going to insist upon a copy of the results as soon as they are available. The endocrinologist is going on vacation for three weeks and I don't want to wait that long to know exactly what is on my plate. I'm sure we won't be able to start the appropriate treatment until after he gets back, but I do want to know the definitive diagnosis. I'm actually a little anxious about it because the hoarseness that came six weeks ago has not resolved, and I may be a little paranoid about it, but its making me afraid that it is a malignancy and that there is vocal cord involvement. I'll deal with whatever I need to, but the limbo of not knowing is worse than having a definitive diagnosis, even if it is cancer.

Thank you so much for asking and for taking the time to follow up!

I am curious--how did you happen upon my little blog out of all the blogs on the vast world wide web?

O.T. said...

No problem
I am currently working on my term project about ultrasound use for thyroid screening, and left a comment on one of the blogs about patient’s experience with thyroid disease, explaining how to calculate volume of the nodule from dimensions obtained by the ultrasound. One week after that the follow notification which I forgot to turn off directed me to your comment [and your blog].
By clicking on picture where you are standing next to the tree looking up, I noticed obvious mass on your neck and asked that question just in case.[I don’t understand why your previous doctor did not pay attention to it!].
Some notes about your ultrasound. If the blood flow is noticed on the periphery of the nodule, this in most cases indicates benign lesion; the blood flow inside the CENTER of the nodule used to be suspicious, however the recent study indicates that 50% of large benign nodules also have increased flow. Lymph node involvements and otherwise homogenous echo structure of the rest of the gland [solitary nodule] are considered suspicious. The hard and round nodule most likely represents follicular neoplasm; therefore the FNA results should be reviewed by experienced cytologist; sometimes the proton resonance method is used to differentiate between the benign lesion and the cancer.
And never forget about second opinion!
Best of luck!!!