This blog entry also appears in my Caring Bridge site, posted March 16, 2015.

Over the past few weeks, I’ve dutifully reported to several medical appointments, getting blood drawn, a neck ultrasound, and a visit with my endocrinologist. In the process, I’ve learned more about myself than what mere statistics tell.

One thing I learned is that, for me, I think it would be better to get the lab reports first, before I see the doctor. I expect that physicians are reluctant to do that generally, because they want to be present to explain the results, and I can empathize with that sentiment. However, I’m really not good (and that’s an understatement) at generating questions spontaneously. What that means in practical terms is that I almost always have questions AFTER I see the doctor, but few during my visit. Having a chance to look things over and go into my visit prepared with questions would be beneficial to someone like me.

From a medical perspective, what I learned is something which really just reinforces what I already knew – real life is rarely neat and tidy. When we see the world as black and white, it is because we’re looking too closely. The proper focus gives us gray. And even something as seemingly-solid as medical data can be pretty ambiguous.

In 2010, 2011 and 2012, the blood work showed that I did not have detectable levels of the antibody for thyroglobulin. That’s as it should be. Last year my oncologist explained that there’s really only one reason someone like me – with no thyroid gland and a history of papillary carcinoma – should have detectable levels of that antibody. That reason is that there is, somewhere, a bit of metastatic thyroid tissue at work in my body. In 2013 (unbeknownst to me, because my then-endocrinologist didn’t alert me, and I didn’t know enough to see it as an issue in my printed lab results), my antibody reading had risen to 32 IU/liter. In 2014, I was notified that the level had risen to 62 IU/liter. The detection limit (the lowest level measurable by that analytical method) was 20IU/liter.

When I realized that my then-endocrinologist had neglected to tell me about the elevated antibody level in 2013, I found a new endocrinologist. As amply documented in this blog, I had surgery in June and radiation in August. The antibody level fell back to 32 IU/liter after radiation. At my post radiation visit, it was resolved that I would see the (new) endocrinologist in March. In anticipation of that visit, I had a blood draw in late February. A week or so later, I had that ultrasound.

My relationship with my new endocrinologist is very favorable. In an upbeat fashion, she told me that my results were good, and went on to report that my antibody level was now 16 IU/liter. That surprised me, and colored the rest of my visit. I expected that the antibody level would be undetectable. We discussed how in May I would have some routine blood work, and in July I would again undertake the process of getting a thyrogen-stimulated full-body scan. Any remaining metastasis should show up in such a scan.

Lab results were e-mailed to me. It turns out that a new analytical method has been adopted, with a lower detection limit. In the past, my current antibody level would not have been detectable, so I would have reasonably assumed that I was antibody (and cancer) – free. However, it is entirely possible that my antibody level in 2010 – 2012 was below the detection limit for that analytical method, but above the current one. We can never know, so comparing the results over time is something best done with big caveats.

It also turns out that my ultrasound results were ambiguous. No lymph nodes were declared to be “highly suspicious”, but an “increased number of reactive lymph nodes compared to indeterminate cervical lymph nodes” were noted. The report also documents “an indeterminate though likely reactive appearing lymph node is noted inferior to the left thyroid bed”, and an “indeterminate, though likely reactive left mid lateral neck lymph node”. “Reactive” lymph nodes are typically considered to be characteristic of an immune system stimulated by infection. My own post-visit research revealed that “surgery is often required for malignant and indeterminate nodules”. The report’s language is very cautious, because ultrasound isn’t foolproof. It consequently leads to interpretation in whichever way one tends to lean – optimistic or pessimistic.

Immediately after my appointment, I felt pretty positive. Going over the actual lab reports, I began to feel like, while the news wasn’t bad, it wasn’t a clear endorsement of my situation either. My antibody level is down, significantly. It is below the old lower limit of detection. But it is still detectable. The picture from my ultrasound was better than it had been last May, but it wasn’t without some reason for caution. I spent a good deal of the next few days trying to decide how to feel about it.

At some point over the weekend, I remembered reading this quote from Eckhart Tolle: “The ego loves to complain and feel resentful not only about other people but also about situations. What you can do to a person, you can also do to a situation: make it into an enemy. The implication is always: This should not be happening; I don’t want to be here; I don’t want to be doing this; I’m being treated unfairly. And the ego’s greatest enemy of all is, of course, the present moment, which is to say, life itself.” To say “I’m being treated unfairly” is a rather juvenile way of seeing the world, isn’t it? It is the voice of the ego which complains about what is. “The voice of the ego, [is] no more than a conditioned mind-pattern, a thought. Whenever you notice that voice, you will also realize that you are not the voice, but the one who is aware of it. In fact, you are the awareness that is aware of the voice. In the background,there is the awareness. In the foreground, there is the voice, the thinker.” That takes a rather deep route to get to my realization, which is this: my test results are as they are. Judging them is not only of no use, it condemns me to an unpleasant steaming, stewing status.

It is a pathological mind which takes positive results (a situation) and declares them to be the enemy because they aren’t perfect. Nobody, least of all me, benefits from that. My labs objectively measured my situation as an improvement over where they were last May and last September. There is reason to be grateful for that.

Cancer is a good teacher. It teaches us patience. Either we learn, or we do not. There is nothing more to do in this situation until – more testing is done. And there’s no point in doing that testing until I’m further removed from the radiation therapy I had last August. So, in July, I’ll have another full-body scan (with the attendant low-iodine diet). Until then, there are three months of todays, untold this-moments, repeated one after another. I shall endeavor to concentrate on each, to be a good student of cancer’s curriculum. Because that’s the way it is.

What it is, and what it was, what shall be shall be, yeah
Sometimes it happens in the strangest ways
Sometimes it’s hard to believe (do you believe?)

https://www.youtube.com/watch?v=jFgOSoKeGGQ