Initial results from Ultrascan

I got some initial results from the ultrascan today.

On the left, I have a vascular lump 2.5cm x 2cm x 1.7cm "circumscribed heterogeneous solid nodule with central cystic degeneration and tiny areas of calcification".

On the right I have a 3.9mm solid nodule & 2.7mm hypoechoic nodule. I wonder if that means I have 2 lumps or whether it's one with 2 characteristics?

So I guess the concern now is that I have a 'complex solid nodule with a cystic structure & calcification and moderate vascularity - 2.5cm in diameter'

So I will have to have a biopsy after all - booked in for Friday morning.

I had to call up a medical dictionary to look at some of the terms - (ultimately I know not to rely on the radiology report; I need to have some clarification from the pathology & my other doctors)

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from wikipedia & medical-dictionary.thefreedictionary.com

Vascular: An organ or tissue that is vascularized is heavily endowed with blood vessels and thus richly supplied with blood.

circumscribed:bounded or limited; confined to a limited space.

Heterogeneous is an adjective used to describe something that has a large number of variants or different forms; is one that consists of many different items, which are often not easily sorted or separated, though they are clearly distinct.

A nodule describes an aggregation of similar cells or particles

Interestingly, A cyst is a closed sac having a distinct membrane and division on the nearby tissue. They may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, the cyst could go away by itself or will have to be removed using surgery

degeneration: deterioration; change from a higher to a lower form, especially change of tissue to a lower or less functionally active form

Calcification is the process in which the mineral calcium builds up in soft tissue, causing it to harden.

hypoechoic: in ultrasonography, giving off few echoes; said of tissues or structures that reflect relatively few of the ultrasound waves directed at them


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My general understanding is that a calcification or round lump/nodule is nothing to be concerned about. However the vascular & irregular lumps are more of an issue - that's the vasular and Heterogeneous one.

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I did a search and found this one in wikipedia: http://en.wikipedia.org/wiki/Thyroid_cancer

It's interesting to note that....

The blood assays may be accompanied by ultrasound imaging of the nodule to determine the position, size and texture, and to assess whether the nodule may be cystic (fluid filled). Also suspicious findings in a nodule are hypoechoic,^[3] irregular borders, microcalcifications, or very high levels of blood flow within the nodule.

Less suspicious findings in benign nodules include, hyperechoic, comet tail artifacts from colloid, no blood flow in the nodule and a halo, or smooth border.

so the fine needle biopsy is a good alternative at the moment in the diagnosis of what these lumps are...

It's interesting, from memory, some of my thyroid function tests have been low (and back to normal) again over the last 18 months or so - we just assumed that it was due to the bleeding HHT disorder.

So it's interesting to find these lumps now.

I didnt know where the thyroid was, so when they did the ultrasound, I was a little surprised. See this image


http://thyroid.about.com/library/links/blthyroid.htm

Symptoms of hypothyroidism usually go along with a slowdown in metabolism, and can include fatigue, weight gain, and depression, among others.

The symptoms of hypothyroidism are often subtle, but can include

• Fatigue *yes
  
• Depression *
  
• Modest weight gain*
• Cold intolerance
• Excessive sleepiness*
• Dry, coarse hair
• Constipation
• Dry skin
• Muscle cramps*
• Increased cholesterol levels*
• Decreased concentration*
• Vague aches and pains*
• Swelling of the legs*

Interestingly I've been complaining that my hair feels different at the moment. It used to be very thick, but now it seems quite thin, different to normal.

I've also had some really really bad cramps in the legs - the last one on saturday night/sunday morning was so bad I couldnt straighten my leg for the day nor put any sort of pressure on it. It's taken about 36 hours to come good! I've had some leg cramps (only 1 other bad one like that) but given 1/2hr or so it sorts itself out.

I'm getting around the memory problem / concentration problem by utilising a diary & notebook - didnt realise it was also an issue until I saw the above list!

I thought it was me getting old!

The chronic fatigue & tiredness we put down to blood loss; but maybe not!

Interesting again...

Ultrasound

I visited the local ultrasound place today & had the scans on the thyroid.

Took about 20 minutes - get the results next week.

Thankfully no needles! (this time anyway).

I took Christopher along. He thought it was great - watching the radiologist work & watching the bits come up on the "tv" screen!

Doctor's Visit

I went through with my normal GP the circumstances of the last couple of weeks to bring him up to speed.

My blood pressure is still above normal, so he's increased the "AM" medication with a review in 2 weeks. It's not too high now, but needs to be lowered for my hospital visit.

He went through the scan report & advised me that I now have 2 lumps on my thyroid. Interesting as my thyroid readings have been a bit up and down lately (say over the last 9 months). So I'm wondering if that's related! That would at least account for why I've been putting on a bit of weight & very tired & lethargic.

The report requires further scans - an ultrasound (which I've booked in for SATURDAY - a nice way to spend the weekend...) and then a fine needle biopsy.

That does not thrill me at all, but has to be done.

It will be interesting to see whether these 2 lumps are a cancer or just something benign. Only time will tell.

I'm just grateful at this stage that these lumps were 'accidentally' discovered!

CT Scans

Last Thursday I had the CT scans done.

Some of them were done with an injection - I've had that before, where the machine injects the fluid into you at a critical point in the scan so the machine can pick it up & record what's happening.

I had a brain & head scan as well as a trunk scan (upper body).

I picked up the report on the weekend, but couldn't really make any sense of it as it was a bit too technical.

Visit to Sydney ENT

Last Wednesday I visited the Sydney ENT. He had a nice office in ULTIMO.

I walked up from Central Station to Broadway, then down the back streets to the unit.

He had his office in a 4 story renovated warehouse. I've never been in a converted warehouse building, so it was a bit unusual for me - but ok. They've done a good job; nice professional offices.

Anyway - it was a cold blustery day - thankfully I dressed warm & it didn't rain!

I had to fill out the usual forms saying who I was & what I was there for, etc - just the usual stuff & had to wait in the room for a while - as I was early.

Then I started to bleed (just a bit) so that was annoying - as I got all the way into Sydney "ok" until that point.

Once it was my turn I had a chat with the ENT surgeon who confirmed that if I have HHT there is nothing that he can do - (cure wise) but treat the symptoms like the other ent's. However, his solution is different.

He explained about the argon laser - he described it a bit differently to how I understood it - it sends out pulses of plasma that seal the bleeding bits in the nose.

He did 2 exams - one just with the light & goggles - so he could see the bleeding area. Then one with the anesthetic. He sprayed so much that I went numb down my throat & numb down my lips - very strange for 20 minutes or so!

But to do the (deep) exam he had a knitting needle type device that went straight in. e tried my right - but that bled straight away. So I had to hold my nose to stop the bleeding; stay calm and breath calmly while he stuck most of this "probe" almost all the way in on the left.

Breathing & being calm is the secret! It doesn't hurt - you just sort of feel it moving in & around, a little discomfort, but no pain. He did the same on the other side.

he did say a couple of good things - that I dont have many spots "deep" in my nose - just one "inactive" spot right at the back & lots near the front. So he can do his wonders with me with this machine.

I was wondering whether my really bad bleeding a couple of years ago was from this now "inactive" spot at the back as myself and the doctors could not stop the bleeding in hospital - it seemed to be deep (not from the front) and very difficult to stop! (eg, 4hrs + severe bleeding without stopping!) I guess the new steps that I am taking - keeping the nose moist & the other medicines has helped.

At the end of the exam he suggested I get some CT scans done of the upper body. That's to see if there are any of the spots in other organs at the moment. I've also sent off the admission forms for Bankstown hospital. So I go onto their waiting list & assume when a free time comes up in the future, they'll call me (or I call the surgeon again if things get carried away...)

very tired

I have been having the liquid iron supplement daily now, but am not feeling too well.

Very tired.

Have started to bleed a bit from my left side now. So I'm getting bleeds back on both sides.

Tomorrow I see my normal ENT in Penrith to see what she has to say, then on Wednesday I see a new ENT in Sydney about this new treatment. It will be an interesting & hopefully not too exhausting week!

IRON & blood

I mentioned in the last post how important iron in the blood is - but dont really know too much about it - other than when I've lost a lot of blood I'm really sick, tired and fatigued.

The last blood test I had was fascinating, as my iron level had dropped to 1/3rd below "normal minimum" - and that was only after 4 days of severe/moderate bleeding. (About 40mins - 1.5 hour bleeds).

I know now after visiting another ENT that leaving myself to bleed this long (unassisted) is wrong. I still have to get over the "mental block" in calling an ambulance after 15-20 minutes. I think my greatest fear is bleeding to death in hospital!!!! I always tend to be left alone while they treat the "real" patients. Probably doesnt actually happen like that, but that's how you feel sometimes!!

I've found that they come quick if you bleed on the carpet - they dont like cleaning up the mess. *mental note for future visits!

Anyway, I digress....

So what foods are rich in iron?

I was told "all the green ones", but thought I'd check it out....

I found this web site: http://www.healthcastle.com/iron.shtml - but this talks about heme iron & non-heme iron. I dont know what they are!!!!!

But - it says good sources are...

Iron Rich Foods containing Heme Iron

	Excellent Sources		Good Sources
	Clams Pork Liver Oysters Chicken Liver Mussels Beef Liver		Beef Shrimp Sardines Turkey

I'm really not sure about the pork, chicken or beef livers. They dont appeal to me AT ALL!
I like beef, turkey & sardines. I guess the shrimp are prawns?

and then

Iron Rich Foods containing Non-Heme Iron

	Excellent Sources		Good Sources
	Enriched breakfast cereals Cooked beans and lentils Pumpkin seeds Blackstrap Molasses		Canned beans Baked potato with skin Enriched pasta Canned asparagus

I wonder what the difference is with canned asparagus as opposed to fresh asparagus? Pumpkin seeds surprised me - I've had them before. They are nice to much on.

Not many other green vegies there!!!!!!!!

I found a bit in the article on the heme iron - which is interesting

Absorption of iron from food is influenced by multiple factors. One important factor being the form of the iron. Heme Iron, found in animal sources, is highly available for absorption. Non-heme iron on the other hand, found in vegetable sources, is less available.

now this is a confusing one... in the same article, it says

The absorption of Non-heme iron can be improved when a source of heme iron is consumed in the same meal. In addition, the iron absorption-enhancing foods can also increase the absorption of non-heme iron. While some food items can enhance iron absorption, some can inhibit or interfere iron absorption. Avoid eating them with the iron-rich foods to maximize iron absorption.

Iron Absorption Enhancers

Iron Absorption Inhibitors

Meat/fish/poultry Fruits: Orange, Orange Juice, cantaloupe, strawberries, grapefruit etc Vegetables: Broccoli, brussels sprouts, tomato, tomato juice, potato, green & red peppers White wine

Red Wine, Coffee & Tea Vegetables: Spinach, chard, beet greens, rhubarb and sweet potato Whole grains and bran Soy products

Ok - I've found the vegies. Surprisingly, strawberries & grapefruit! Didn't know spinach was bad - but I dont like it anyway. Surprising is whole grains & bran - I supposed to have them to keep me 'fit & healthy on the inside' - but they are also inhibitors!!!! Tomato juice is the other surprising one!

I found another article on iron in the blood - see http://ods.od.nih.gov/factsheets/iron.asp

This has a few interesting facts as well -

Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions. Iron is also found in proteins that store iron for future needs and that transport iron in blood. Iron stores are regulated by intestinal iron absorption [1,8].

So that's probably why I get light headed & lethargic after a lot of bleeding.

This table is probably better put than the other one

Table 1: Selected Food Sources of Heme Iron [10]

Food	Milligrams per serving	% DV*
Chicken liver, cooked, 3½ ounces	12.8	70
Oysters, breaded and fried, 6 pieces	4.5	25
Beef, chuck, lean only, braised, 3 ounces	3.2	20
Clams, breaded, fried, ¾ cup	3.0	15
Beef, tenderloin, roasted, 3 ounces	3.0	15
Turkey, dark meat, roasted, 3½ ounces	2.3	10
Beef, eye of round, roasted, 3 ounces	2.2	10
Turkey, light meat, roasted, 3½ ounces	1.6	8
Chicken, leg, meat only, roasted, 3½ ounces	1.3	6
Tuna, fresh bluefin, cooked, dry heat, 3 ounces	1.1	6
Chicken, breast, roasted, 3 ounces	1.1	6
Halibut, cooked, dry heat, 3 ounces	0.9	6
Crab, blue crab, cooked, moist heat, 3 ounces	0.8	4
Pork, loin, broiled, 3 ounces	0.8	4
Tuna, white, canned in water, 3 ounces	0.8	4
Shrimp, mixed species, cooked, moist heat, 4 large	0.7	4

Looks like I have to make a big increase on the oyster quota!



So what happens if you are low on iron. Glad you asked - the article has a table of symptoms!

Signs of iron deficiency anemia include :

feeling tired and weak decreased work and school performance slow cognitive and social development during childhood difficulty maintaining body temperature decreased immune function, which increases susceptibility to infection glossitis (an inflamed tongue)

That could explain why I get cold when I've lost a lot of blood! - and also get a lot of infections. Never had or thought about glossitis! Sounds horrible!

Anyway, a lot of interesting information!