By Nandini Murali June 2012 Through a cascade of convergences Nandini Murali was led to meet and vanquish thyroid cancer and coast her way to wholeness and health My hands clasped the bottle of Thyronorm – levothyroxine, a synthetic form of thyroxin, the miracle endocrine hormone. I bowed before the Supreme in a moment of surrender, chanting a couplet from the Vishnu Sahasranamaam and the Mahamrtunjaya mantra, as I slid the pellet-like white tablet down my throat. My body, starved of thyroxin, yearned for it like a lover longing for the beloved. Or the parched earth desiring the rain. I marvelled at the spectacular discovery of Dr Edward Kendall, the American biochemist who first discovered thyroxin in 1916 at the Mayo Clinic in Rochester, Minneapolis, USA, which won him the Nobel Prize in Medicine in 1950. Without him, how would the millions of people with thyroid disorders and thyroid cancer survivors, like me, deal with the absence or abnormal levels of thyroxin? A tiny butterfly-shaped sticker around the neck of the bottle proclaimed that around 90 per cent of thyroid disorders are undiagnosed, adding, “You are lucky.” Sitting on the bed inside the clinical isolation chamber of the Nuclear Medicine Department of a well-known hospital in Madurai, The thyroid cancer, located on the vishuddhi or the throat chakra is of special significance as the throat chakra is the seat of identity, self-expression, and creativity I acknowledged that for once, this was no mere promotional material crafted by a glib copywriter. For until that very moment, the thyroid was just a butterfly-shaped gland located in the throat, and thyroxin one of the many presumed constants in my life. I was oblivious both to its ability as the accelerator of the human body, and the disastrous consequences when the body is thyroxin-deprived.Indeed, in the last month, my life has been a cascade of such lucky convergences. Today, with the wisdom of retrospection, I see the synchronicity that was unfolding in my life, propelling me towards my destiny, much like the strong breeze that wafts the boat across the river.November 14, 2011. I was at the Government Stanley Hospital, Chennai, waiting to meet Dr Adi, medical superintendent, for a feature on the hospital. Destiny even willed the meeting, as the newly appointed dean of the hospital had not yet assumed responsibility. Seated diagonally opposite Dr Adi, in a room that was full of several other people, I heard him say, “Please come here. I need to examine your thyroid.” I wondered whom he was addressing and was incredulous when he insisted that it was me. His fingers gently palpated the right side of my neck where there was a bulge. He asked me to swallow a few times and that act sealed the diagnosis – a solitary nodule in the thyroid gland that needed immediate medical investigation. With the characteristic medical myopia of a non-medico, I dismissed his observation and instead was keener on getting ahead with the magazine feature. Later in the evening, I met Dr R Venkataswami, the well-known reconstructive surgeon, who, when requested to examine my thyroid, seconded Dr Adi’s diagnosis. Although his observation surprised me, it still remained in the periphery as there were demanding work-related deadlines and impending travel, both of which exerted a greater pull than a visit to the hospital. However, Dr Venkataswami’s persistent phone calls pushed me towards the investigations, including a gentle admonition that I must not take things lightly. His warning was ominous, although even then I was unsuspecting of what the next few days would unfold. The first step in the diagnostic process was an imaging technique called Radionuclide scanning. A normal thyroid gland – the only part of the body that absorbs iodine – absorbs the chemical from the blood and uses it to make thyroid hormones. When radioactive iodine (I-131) is administered either orally or intravenously, it causes the gland to ‘light up’ when imaged by a nuclear camera. Life can only be understood backward; but it must be lived forward. – Nietzsche The rate of accumulation is an indicator of the functioning of the thyroid or the nodules. A ‘hot’ spot appears when the gland is producing too much of the hormone, and a ‘cold’ spot when it is non-functioning or hypo functioning. Cancerous nodules are likely to be ‘cold’ because cancer cells are abnormal and do not accumulate iodine as well as normal tissue. By now, I had researched extensively on the Internet about thyroid diseases, and the implications of the findings of a Radionuclide scan. When the radiologist told me that he had detected a ‘cold’ spot on the scan that required further evaluation, the first signs of storm clouds loomed in my horizon. Ironically, the thyroid profile blood test was normal. The eternal optimist within me whispered, “If the blood test is normal, is there anything to worry about?” The next diagnostic process was a Fine Needle Aspiration (FNA) that involves inserting a needle into the thyroid nodule to withdraw samples of cells that are later examined by the pathologist. Dreaded diagnosis The report from the pathologist declared that it was follicular adenoma – a benign thyroid tumour. This meant that I needed an elective surgery in which only the nodule would be removed. I decided to have the surgery in the last week of December, when I would be deadline-free, for a while, at least! A dear friend, who was closely participating in the medical drama, insisted that I visit the surgeon to fix the date of my surgery. I reluctantly went to meet the surgeon. Not too happy about the inconclusive biopsy result that made it difficult for him to decide on the surgical procedure, he wanted the biopsy to be re-evaluated and requested me to meet him the next day. Strangely, that morning I was unable to focus on work and for the first time, was apprehensive. I stumbled into the surgeon in the corridors of the hospital. “It’s papillary carcinoma of the thyroid. You need to get operated on immediately.” The C-word. My world stopped spinning. The axis of my life cranked, heaved, and split. Stunned, I replied that I was asymptomatic, and the possibility of cancer and surgery, seemed preposterous. However, his verdict that papillary cancer was one of the ‘best malignancies,’ as it was slow in spreading, and hundred per cent curable if detected early, bolstered my spirits. In my case, it was a stage I, grade I cancer. The providential diagnosis portended well for an excellent prognosis. Thyroid cancers are more common in women than in men, and papillary carcinoma is the most common thyroid cancer that mostly affects women in the fourth decade of their lives. While it was easy for me to come to terms with the C-word diagnosis, my family was devastated despite my reassurance that it was ‘one of the best cancers.’ Friends were unsure how to respond. There were several who reached out with spontaneity and compassion, while others were silent. Either way, I accepted their responses without judgment or condemnation. What is it about the C-word that evokes such extreme responses? Is it a brush with our own mortality? Or confronting our own fears about death and dying? Individually and collectively, my family and friends dealt with their pain and also rallied around to support me like the pillars of a temple. It saddened me to watch my surgeon-husband and my mother so vulnerable on the day of the surgery. In December 2011, I underwent a near total thyroidectomy in which the entire thyroid gland was removed, while preserving the parathyroids.The aftermath Although a veteran of many surgeries, there was no precedence for the acute post surgical stress that I was to experience in the month following this surgery. Even as early as the day after surgery, the plummeting levels of calcium in the blood – hypocalcaemia – triggered by the dwindling levels of thyroxin – unleashed a distressing constellation of symptoms. There was numbness around the mouth (the kind you experience after a dental procedure), cramps, and uncontrolled twitching, and trembling of the limbs, which often twisted out of shape like the gnarled branches of a tree. Fortunately, supplementation with mega doses of calcium tablets soon had the symptoms disappearing as dramatically as they surfaced. The ancient Greeks described thyroxin as the ‘hormone of the soul.’ From my experience, I can vouch that if the human soul has a molecular structure, it must be thyroxin. The miraculous hormone orchestrates and regulates myriad metabolic functions and molecular systems, including the complex neural circuitry of the brain with its swirling thoughts, emotions, memory, will, and imagination, all of which are manifestations of complex chemical processes.Even as early as a couple of days after surgery, I began to experience severe headaches that increased with intensity. For a full month, it was like atomic explosions inside my cranium that detonated and reduced my inner landscape into an arid vastness, bleached and alien. Painkillers did little to ease the pain. Nor did natural diuretics such as coconut water. Later my endocrinologist told me that the headaches were caused by extreme water retention due to profound hypothyroidism. Even the slightest movement was a supreme act of will. In contrast to my former energetic live wire self; I was now crumpled and fragile. I found external stimuli threatening and I sought refuge within the sanctuary of myself. Often, I would curl up into a foetal-state, and journey to the interiors of my body. I also felt emotionally labile and was surprised to experience bouts of deep sadnes
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