January 31, 2017 — Under the Needle

I haven’t posted anything here since last summer, because not much has been happening. Which is, of course, a good thing.

Yesterday, though, I went up to Memorial Sloan-Kettering in New York for a routine consultation with my endocrinologist, Dr. Fish. I’d had an ultrasound of the neck a week before, which told her that the lymph nodes on the left side of my neck that had been slightly swollen last summer are significantly larger now. That, coupled with a spike in certain chemical markers in my blood, indicates that thyroid cancer has very likely taken up residence in those lymph nodes, and is growing.

She recommended a needle biopsy of the lymph nodes, to confirm what we’re dealing with. (I asked her if it could be a return of the non-Hodgkin lymphoma, but she said she doesn’t think it likely. The blood test is pointing to thyroid cancer as the culprit.)

It was all very laid-back. Thyroid cancer is typically slow-moving, so there’s no particular rush about these things. For that reason, I was a little surprised a few minutes later when the doctor’s scheduler, seeking a date for the biopsy, asked, “How about tomorrow?”

I initially said no, that’s a little too soon, but when I learned the next opening she had was more than a month away, I took a quick survey of my calendar and said, “Why not? Let’s go with tomorrow.” I suppose there must have been a cancellation or something.

Which brings me to today. This morning I drove up to the Memorial Sloan-Kettering satellite facility in Basking Ridge, New Jersey for my ultrasound-guided needle biopsy.

Dr. Fish had clued me in to the fact that this would be done while I was awake, without anesthesia. “They’ll give you a little lidocaine,” she told me, “to numb the skin. But it’s a very tiny needle, so you’re not likely to feel any pain.”

Well, when I got there, the diagnostic radiologist who would be conducting the biopsy said there would be no lidocaine, because the biopsy needle is actually smaller than the needle they use to inject the lidocaine. The act of numbing the skin would be more painful than the biopsy itself.

I asked her if they had any lidocaine spray around, but she said no, they didn’t. That surprised me a little, but I figured, hey, they do this all the time, it will be fine.

I’ll say it ended up being not exactly fine, but tolerable. The doctor was right, the needle is very small. I’m so used to blood-test needles by now that I barely feel them going into my arm any more, and that was true of this needle as well, penetrating the left side of my neck. I did feel a distinct pressure from the needle as it advanced deeper below the skin, though. That pressure, bordering on pain, was uncomfortable, but the lidocaine wouldn’t have done much about that in any event.

Three punctures later, it was all over. I was lying on my side during that part of it, so the doctor told me I could watch it on the ultrasound screen if I wanted. I decided to do so. It was odd, watching the tip of the needle penetrate my lymph node, move up and down a few times, then come back out again.

Mission accomplished with the lymph nodes. Then, it was on to step two. Dr. Fish had also ordered a biopsy of the abnormal nodules that have appeared in my thyroid bed (where the thyroid used to be). Those are pretty stable, not having grown since last summer, but she figured that, while I was on the table, they ought to go ahead take a look at them as well.

This involved me lying on my back with my head stretched over a pillow positioned under the back of my neck. The target nodule was considerably smaller and a good deal deeper than the lymph nodes.

Same deal: very tiny needle, no anesthetic, but this one was aimed just below the base of my neck, smack dab in the center. This was a different sort of experience. Again, the surface puncture was barely noticeable, but the digging around deep inside crossed the boundary from pressure into pain. The doctor could tell I was in pain, and decided to stop after just one sample. She said she was reasonably sure she didn’t get enough tissue from the tiny nodule for a good result, but she didn’t want to proceed any further because I was clearly uncomfortable. The nodules weren’t the main target for today, she explained: the lymph nodes were.

I was grateful. If it had been strongly necessary, medically speaking, I would have been willing to tough it out. But I was just as glad when she decided to call a halt.

Results should be in within two or three days. It will be up to Dr. Jay Boyle, my thyroid surgeon, to communicate the results and begin the conversation about next steps.

Surgery will almost certainly be in my future — he told me that last summer — but the big question will be, when? The pathology results will tell us how aggressive my particular variety of cancer is.

It could be pretty soon, or it could be a matter of more watchful waiting.

The question will also be, what? Just an excision of the close-to-the-surface lymph nodes (fairly easy), or a removal of the nodules in the thyroid bed as well, with the risk of possible damage to the vocal cords?

Watch this space.