My Broken Butterfly

In this post I am going to share my biopsy story and walk you through the process. I’m including tips and answering some questions you might have.

• What: Thyroid nodule biopsy. This is called a FNA or Fine Needle Aspiration biopsy.

• Why: To see if nodule(s) are malignant (cancer).

• Where: Baylor Clinic, Baylor College of Medicine in Houston, Texas.

• Who: Performed by Interventional Radiology.

• When: March 20^th 2017.

• My variables that should be considered when reading this: My nodules were in the back of the thyroid, not in the front which makes for a more complicated biopsy. I also had 2 biopsies on each side of the thyroid which created more swelling instead of a single biopsy.

warning! IF YOU ARE READING THIS BEFORE A THYROID BIOPSY ASK IF LIDOCAINE WILL BE USED BEFORE SCHEDULING or going. IF THEY SAY NO, RUN!!! refuse any biopsy without lidocaine injection.

They should have discussed blood thinners prior to your biopsy. I am not a doctor, but I wanted to let you know to double check if they forget or you aren’t sure. I was asked to have a light breakfast, so I chose to have a bowl of oatmeal at the hotel. I feel like this was the right decision. I wouldn’t recommend anything spicy or even all that solid. You might want to pass on meat too. Yogurt or a protein shake might be a good option. Be sure to get some water in before!

I arrived at imaging, did the usual check in. An ultrasound tech came to get me. They do not allow anyone else to go with you because of sterilization. She took me to a different room from where I had my previous ultrasound done. This was more like a doctor’s office room with a counter, sink, and supply cabinets. The bed was different too, once again like you’d see in a doctor’s office with tools to raise or lower it. There was an ultrasound machine and tools on a steel table. It looked like what dentists have for their tools.

We had a discussion about the potential risks and what to expect for recovery. I don’t remember everything that was discussed, but you don’t have to worry about this part too much. Just answer the questions they ask and ask your own if you have any! They want to make sure you are safe and understand what will happen. Finally, I had to sign a consent form. These things are always scary since they list the worst of the worst outcomes. But the tech assured me again that this is very safe.

We also discussed my previous biopsy and she assured me this one would go better. Just like the endocrinologist did. They should also double check your allergies. Since I’m allergic to latex, they triple checked to make sure everything in the room was latex free. She told me this was the best doctor at Baylor and she would let him biopsy any of her daughters. That made me feel better.

I was asked to change into a medical gown. My memory fails me if I had to put on a cap, but you may or may not depending on your clinic. The ultrasound tech came in to prep. They will explain how they want you to be positioned. You will likely have a pillow placed under your neck to expose the area more. It’s possible you already had the pillow technique done on an ultrasound before, it’s not different.

The IR doctor came in and introduced himself. A lab tech person joined him and he introduced her. She would be processing the cells and putting them on slides for the pathologist. This would be a total of 3 people in the room, excluding me. She spent all her time at the counter/sink in the other part of the room so I didn’t see her much though. He looked at the ultrasound machine first to see where nodules were, so he could inject my neck with lidocaine in the right places. He informed me that he was just going to biopsy the 2 larger ones. My neck was sterilized (similar to a surgery) at some point and the surgical stuff came out. Gloves, masks, and drapes round my neck.

So to recap the steps at this point: 1. Q&A from tech plus signing consent forms. 2. Changed into a gown (with or without cap) with basic prep from ultrasound tech. 3. Doctor and lab tech come in. 4. Doctor does his own ultrasound of my neck to plan the biopsy out. 5. Final prep is done for show time.

The doctor prepared the lidocaine injections. I was told that while this will numb most of the pain, I might feel some pain in the thyroid area since they can’t numb that. When the final location was determined he injected them into my neck in different (but strategic) places. While this part is absolutely sucky and painful, this is the better alternative. If you’ve had a local injection before, its the typical lidocaine burn and sting. We waited a few minutes for them to “kick in” and he got the biopsy needles ready.

I really recommend that you don’t look at the tools too much. They look scarier than what they should. There is an attachment they add to the needle/syringe which I assume makes it easier for the doctor performing it? It almost looks like a large gun trigger or what a basic 3D printed glue gun might look like. It makes the whole thing look huge when in reality the actual equipment is about the size of what you get for lab work. Yes, I shared this because you will see them one way or another. But know the contraptions are added to what you are actually getting and it isn’t that large.

It was time for the needle to be inserted. You are requested to be VERY still with no sudden movements. Depending on where they biopsy, you could be asked to tilt your head. That usually consists of look right, left, up, etc. It wasn’t too bad once the needle was inserted. I felt pressure around the skin area and some discomfort in the thyroid. A way to describe the thyroid discomfort is like taking your nail and scratching, but not breaking the skin.

Here is what you need to know: They don’t just put the needle in the nodule, pull the syringe, take out the needle, and you’re done. The doctor “bobs” the needle. They move it up and down while still inserted. While it does look like it, it’s not quite a repeated stabbing. This sensation feels odd for sure. Picture your nodule being a trampoline and the needle has to bounce on (more like inside) it to get your cells. This is probably the best way I can describe it. You will not have one trampoline session either. Trampolines are fun after all, you can’t go just once! Every time the needle goes in it’s called a pass. You will have multiple passes per nodule on different locations. This is to get an accurate picture of the cells within the nodule.

I got breaks between each pass due to placing the collected cells on a slide. I could ask for additional time if I needed it. MAJOR TIP: Try to keep your breathing stable and slow. If it helps, close your eyes. Try some guided visualization techniques prior to your biopsy and use them. I won’t claim like other people that it will completely take away all the anxiety, but it will help. Prayer is another option. Think about past memories, no funny ones though. Keep busy mentally. Plan a party, craft project, or even mentally redesign part of your house! Your biopsy will go much better if you have something to do in your mind away from the procedure. I’m a fidgety type person so it makes me nervous to be completely still. That gets amplified to 1000 when a needle is in your neck and you Absolutely. Shouldn’t. Move. Thinking about anything else helped.

We reached the part where both nodules were biopsied and it was time for a pathologist to review the slides. If the pathologist thought they were sufficient, I was free to go. If not, I would need additional passes. Everybody left the room at that point, so I was by myself. They lowered the lights so I could rest. The ultrasound tech went to the waiting room to update my mom on what happened until that point and what would be happening next. It felt like a long time, but it was probably 20-30 minutes.

The doctor came back in and said I would need a few more passes. I was able to get a little more lidocaine, but there is a limit to how much you can get in a period of time so I wasn’t as numbed up like I was earlier. While these passes were significantly more uncomfortable, they were tolerable. At no time did I feel like I couldn’t handle the pain/discomfort. After the additional passes, the doctor informed me we hit our limit for each nodule and I was done. I received an ice pack to immediately place over my neck and several others since I had a long car ride home. They told me I did a great job. I walked out to the waiting room feeling amazing. I conquered something that had haunted me for years. No longer did a biopsy have any power over me.

Let me stop here and answer a few questions:

• Can I drive myself? If you are 1. About 30 minutes or under from home and 2. A low traffic area, you probably can. An hour is iffy. Any more than that is an absolute NO. If you want to be on the safe side have somebody else drive you home.

• Can I go back to work the same day? I’ll be honest, no. I don’t recommend this. And if you want to attempt at that, don’t bank on staying the whole day. Your swelling will likely increase as the day goes on. Your neck will start to get sore. You could have issues with your voice, I did! Ideally you need to rest and ice your neck.

• Okay, so when do you think I can return to work? I think a good litmus test is when you can speak without pain or if you can hold your neck up comfortably. If you have one nodule that was biopsied, would say depending on your job, perhaps the next day. If your situation was like mine, you probably need at least 2 days off. I really can’t say for sure, it is dependent on so many factors. My biggest advice is listen to your body. If you feel like you aren’t ready yet, don’t push yourself.

• Can I be alone or should I have a family member with me? Sure to either one. Whatever makes you most comfortable. While this isn’t a surgery, if having somebody around helps your recovery or that would make you feel better, go for it! If you do better alone with just you and Netflix, that’s cool too. My advice with that in mind is to already have soft snacks like applesauce, gelatin (the usual or vegetable based), smoothies/veggie juices, or pudding ready when you get home. Your neck might be too swollen to eat regular foods yet and I don’t recommenced going out shopping afterwards. Here is my exception to whatever floats your goat (that’s intentional): If you have small kids, YES get help or have grandparents kick in. I think that would be too much.

• What do you recommend for ice packs? Something that has give. You are going to want something that gently lays over your neck. Hard ones will not work. Honestly, frozen peas might be perfect for this. I already had an ice pack in my freezer that was soft and pliable and it worked great. You will want more than one to rotate with.

• Are there some other foods you recommend? Yes, besides what I mention above Sonic slushes are PERFECT. The ice consistency goes down easy and helps soothe the soreness. Icees work too, but Sonic CRUSHES this.

Let’s talk about recovery! I feel like this is an “expect the worst but hope for the best” situation. My recovery was longer than I anticipated. We’re family here so I will be completely honest. My biopsy was harder to recover from than my thyroidectomy in the throat area. The swelling was a real issue and I couldn’t eat solid foods for a while. To give you an idea from March 20th to my first appointment at MD Anderson on April 6th, I struggled. I was still bruised and sore to the touch, but thankfully not consistently sore. I’ll admit that my ultrasound at MD Anderson was definitely uncomfortable. Although I’m telling you about the difficulties, I’m confident you will make it through the hard parts! I would recommend expecting one full week of not being 100%. Don’t try to be Superwoman or Superman. Take it easy!

Here are two pictures of my bruising:

I think recovery is so unique to the individual so I want to stress that you just have to take it day by day. I also want you to know that you need to take all the time you need and don’t be afraid to ask for help. Yes, this is “minor” but you still need to recover. If anybody gives you trouble about this just send them to me!

Do you want to hear a funny story? Of course you do! So anybody that knows me knows I am a HUGE My 600 lb fan. I love seeing people turn their lives around and I root for them. I actually coped with my trips to Houston by pretending I was going to see Dr. Nowzaradan. Remember this, it will tie into my thyroidectomy later. My poor mother due to the stress of what just happened AND Houston’s never ending construction made a wrong turn. That wrong turn was AMAZING!

While I was laying in the passenger seat tilted back I started noticing familiar buildings. I said no way. NO WAY. I told my mom to keep going.

GUYS. WE ENDED UP AT DR. NOW’S OFFICE BY ACCIDENT. IT WAS INCREDIBLE.

This was such a blessing to me and I took it as a sign of encouragement.

• Final thoughts: You’ll get through this. It can be uncomfortable, but tolerable and I have faith that you will do great. Don’t be afraid to speak up if you need a break during the biopsy. Please go easy on yourself during recovery and go at your own pace. Don’t think you are “being a baby” or something like that. It is a sign of strength, not weakness, to ask for help. I believe in you and I’m sending you a virtual hug!