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Thursday, September 1, 2016

Hypothyroid Experience - Doctor's vs Patient's Point of View

I was searching through the net to see if the one who invented levothyroxine received a Nobel prize for his/her significant contribution to the field of medicine. Edward Calvin Kendall was the surgeon responsible for isolating thyroxine.  But he did not win a Nobel prize for this discovery.  Although he did receive another Nobel Prize for his other discovery.  Charles Robert Harington and George Barger were the two chemists who synthesized  thyroxine, also to my disappointment, they did not receive a Nobel Prize for this. Well from a doctor and patient's point of view, if I could travel back in time, I would have probably personally thanked them for their discovery.

I was supposed to try and attempt to go to hospital today and try if I can already function as a resident.  But as I woke up this morning, I felt really dizzy and nauseous that I've decided that it will be best for my sake to just stay at home for the day.

I underwent total thyroidectomy, and it's been more than a month since surgery.  I was contemplating if I should share my experience of being a thyroid patient.  One of my mentors commented in my Facebook page that I was chosen as one of the few surgeons to go under the end of the knife as a patient.  At that time I don't know if it's a good thing or a bad thing.  As a doctor and hopefully soon to be surgeon, I think I gained better understanding of how a surgical patient feels.

Doctor's Point of View:

We as doctors are taught in medical school what are the functions of thyroid hormones, its importance and what are the symptoms of hyperthyroidism and hypothyroidism.  We were taught on how to recognize the symptoms and how to treat them.  Since in this field, the pharmaceutical drugs have been developed, this has gained little attention in terms of its importance.  What I'm trying to say is that, when you diagnose hypothyroidism or hyperthyroidism, at the back of your mind, and you'll tell your patient, oh! that's ok, we have drugs for your disease and we can treat your illness.  We don't see it as a disease that can really affect a patient's daily life.

As a surgeon, you have no choice, you have to take out the thyroid gland because you're trying to save the body from a more grave disease or complication if we don't treat it now.  Once you take the thyroid gland out, we tend to refer the patient to endocrinologists and the endocrinologists will then be responsible post-op in the long term care of the patient since this is already their specialty.

As surgeons, we were taught that thyroid disease has a relatively good prognosis, as long as patient can take the thyroid hormones, and that our job besides the care of our patient's wound is to reassure the patient that the worst is over and that they're on their steps to recovery.

We surgical residents in UST when asked by other people, what in your life as a resident ang "Di mo na babalikan kahit bayaran ka ng P1 million pesos." All residents will answer the same thing, even consultants will answer the same thing, "Yun maging 1st yr GS resident ulit, kahit bayaran ako ng P1 million, d ko babalikan yun."  I had the same answer until recently.  For mine is changed, I'm willing to go back as GS resident even for 2 years, than to experience again my more than 1 month feeling of hypothyroidism.

Patient's View
I was hypothyroid for 32 days. I think this picture will pretty much summarize what hypothyroidism really feels like.

1st week Post-op
My neck was numb, I honestly couldn't feel a thing.  There's a little hoarseness of my voice. At day 3 postop I was discharged.  At home I feel like normal, except for the numbness, actually I had diarrhea and as a doctor also I just replace my losses with my regular diet.

3 days after having loose stools, I woke up in the morning really dizzy and nauseous, I was light headed and my vision is like spinning, but I know it's not vertigo.  No one was in the room, I had to go out to find some adult or someone who can help me.  And that's when things went wrong, I fell hitting my back to a corner of a cabinet or chair, I can't remember.  I was rushed to the hospital and admitted for electrolyte imbalance.  Moral of the story? Always have an adult or someone with you at all times.

2nd week Post-op
Now I'm beginning to feel the symptoms of hypothyroidism.  Everyday, you wake up differently.  You're unsure if you will feel ok, or you will feel dizzy, or weak, or you just want to vomit.  This time you'll realize in your previous years that I'm healthy pala that I can wake up everyday even with lack of sleep as a medical student, intern, resident and function as a normal person.  This is the time when I realized that we should be always thankful that we were able to wake up carefree everyday before we had surgery. You get hungry easily also, and you get fat easily also. Moral of the story? Thank God everyday for being able to wake up to a new life.  As a resident, we should always listen to our bodies and not abuse it.  We tend to push through and continue our hectic life as a doctor that we abuse our bodies even if our bodies are telling us that they're tired.  As a hypothyroid patient, we should listen to our bodies and not push ourselves too hard.

This is also the time, when I started feeling blankness of my thoughts.  I'm a type of person who always has something on my mind, whether it be worrying over stuffs, or daydreaming about some things in life.  This is the first time in my life that my mind went blank.  I can't think, I tried making myself useful by doing some research paper that I need to pass for a research paper contest, but it was really hard, I can't formulate a sentence properly. I was just staring blankly at the computer screen.

This is also the time you feel really weak, you can't open a jar properly, you body is so heavy you wish to just sleep all day, but you can't sleep.  During this time, I also had trouble sleeping, I would stay awake up to 2am with a blank mind, you feel really uncomfortable, you know something is wrong with your body but you can not pinpoint exactly what it is.  And what's worse, there's nothing you can do about it.  Sometimes you'll wake up in the middle of the night because you feel uncomfortable and you can't tell what it is, basta you feel there's something wrong with your body.

During this time mild depression also comes in.  I can still remember that I cry every night for losing my thyroid gland.  You come to think, how can I be a resident if I feel this way. How can I keep up with the challenges of being a doctor? Should I have chosen a specialty with less stress than surgery? As a female surgical resident, we exert extra effort vs a male surgical resident, because by default, females have weaker smaller bodies compared to male.  We have to exert twice or thrice the effort to keep up with male surgical residents.  But how can I do that if I can't think 4x or 5x more, how can I do that if I c don't have the strength to do it?

3rd Week Postop
I get weak more easily as time goes by.  Applying simple make-up can make you feel dizzy and want to vomit.  You started feeling the numbness of your neck to be less numb than earlier post-op.  This was also the time that I feel I no longer have my thermoregulation, meaning I get cold easily, your hands and feet will feel cold easily.  And it will take 3 layers of blanket to protect you from a normal air-conditioned room. You wake up in the middle of the night because you feel uncomfortable.  You get hungry and weak more easily.  You get fat easily.  These are the things you'll experience the whole day.

This time my mind is always blank.  I can't do anything academic anymore, you'll just get frustrated.   I watch lots of tv series during this time, since it's the only thing that can you can do. I even attempted to watch a movie with my sister.  She felt I was walking really slow compared to a normal average person walking.  After watching a movie, after walking out of the movie house, I felt dizzy that we had to sit and rest in a restaurant.  It took around 1 hour for me to recover and we just decided to go back home.

During this time you'll feel guilty as a daughter.  Here you are, a resident, a doctor, but you're salary isn't even enough to support your own daily living.  You can't even pay your own hospital bills, and as a resident you don't have any benefits given by your hospital in terms of hospital fees. You envy those nurses, cashier employees, lab technicians, they have benefits when they get sick that the hospital give them discounts, and they work on 8 hour shifts, while as a resident, you spend 30 hrs in the hospital and you get nothing when you get sick.  Thankfully doctors have their own norms that we don't charge fellow doctors, so I was able to save money from professional fees of all my attending physicians.  You're at the age where you should be the one supporting your parents financially or at least help them financially, but you can't do anything about it, and you still get sick and be a bum and a burden to them, because your body can't freakingly help you, you can't think, you don't have the strength to do so.  It's really so frustrating for a young patient.

4th week
I had my TSH results: > 100.  My gosh! I'm really really hypothyroid beyond reasonable doubt! When will this end?  Finally I was scheduled for RAI

6th week
I received my RAI and after 2 days I was allowed to take thyroid hormones.

After taking thyroid hormones
3  hours after taking thyroid hormones, I felt the heaviness lifted from my body.  Though still weak, I can feel lightness already.  I felt a really BIG difference.  After 2 days of taking thyroid hormones, I was able to wake up without feeling dizzy or nauseous.  I can now see a little hope on my condition.

I feel normal for the next 4 days, that I thought I can go back to the hospital already.  I've been on leave for more than a month already.  And gladly I was able to go back to crafting and I was able to little by little do some research paperwork.

Until yesterday, I woke up at 2am and unable to sleep after.  So I just surfed the internet.  By 6am I'm already feeling dizzy and nauseous.  I'm feeling the same symptoms of hypothyroidism again, my body is a little heavy despite taking my thyroid hormones.

This morning, I woke up feeling dizzy and nauseous that I decided to stay at home instead of attempting to go back to work.  One thing I learned from this whole experience is to always listen to your body and take your steps to recovery little by little.  If you feel weak and not comfortable you should take a step back and relax and rest first.  Because your body is no longer the same as before, you have to take care of it more and listen to it more than ever.  You wouldn't want to fall again for which if you hit again your back you may no longer be lucky again to have no fractures. And the spine is one of the things that can change your life when affected, you can be paralyzed just because you were so stubborn on continuing with your activity despite your body telling you to pause for a while.

I'm still battling my hypothyroidism, but at least I'm less depressed now than before thanks to thyroid medications.  I sincerely would like to thank people and drug companies who made these drugs available for the patients.

This is really long.... Sorry... but I hope this post can help fellow junior interns, senior interns, surgical residents, patients in understanding hypothyroidism especially after thyroidectomy.
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