In “Good Luck and Cancer,” I wrote that my stint with cancer had lasted only three months from discovery to recovery. It turns out that this was a bit optimistic — though, I hope, not by much.
Today, the day after I turned sixty, I get to start a low-iodine diet.
The doctors made it sound like a huge burden, so I put off learning much about it until I needed to go shopping for this week. But it’s not nearly as bad as I’d feared.
I was afraid that I wouldn’t be allowed any salt, and I was close: obviously, iodized salt would be verboten in a low-iodine diet, but I also learned that sea salt — anything from the sea, in fact — also has iodine in it. And I won’t be able to eat any processed foods with salt in them, since I don’t know what kind of salt they used.
But most kosher salts are neither iodized nor sea salt, so I won’t be stuck in blandsville.
The bad news: There will be no bread (I mean, I guess I could make my own using acceptable ingredients, but I’m too lazy for that). There will be no dairy — no cheese, no milk, no ice cream. There will be no farm-fresh eggs — though I am allowed egg whites, at least.
On the other hand: I can drink coffee! I can drink alcohol! If I drank soda, I could (at least, any that don’t have Red Dye #3) — but I don’t. I’ve probably had one soda in the past I-don’t-know-how-many years.
I can have many meats, beans, pasta, and rice (basmati!) in moderation. I can have potatoes, as long as I don’t eat the skin. I can cook in vegetable oils! I’m allowed citrus (lemon juice tastes good in gin)! I can use spices!
Not at all what I feared, when I thought — and this is, apparently, a common misunderstanding — that I was embarking on a no-sodium diet. Thankfully, I am not.
But what’s all this about?
It turns out that removing a thyroid isn’t as clean as I thought; since it’s so close to sensitive nerves (most notably the voice box), it’s inevitable that some part of it will be left behind. That may or may not be a problem, but the doctor said there are three things that make them want to lean toward an excess of caution:
- They found two tumors. One was tiny, but the other was big enough to create some concern.
- They found traces of cancerous cells in the outer wall of the thyroid. This suggest the possibility that cancerous cells could still be in the tissue they had to leave behind when removing the thyroid (to protect the voice box).
- The found traces of cancerous cells in the veins within the thyroid. This suggests the possibility that cancerous cells were carried to other parts of my body.
Any one of these (except, perhaps, the last one) might justify a decision to simply watch for any further issues. And, of course, this will be true anyway — I will be in surveillance mode for the rest of my life. But all three together bring me out of the “low-risk” category, which makes them want to move on to what I’m calling phase two: radioactive iodine therapy.
The thyroid is the only gland that uses iodine. So they starve the body of iodine (the diet), and then inject a thyroid stimulating hormone, which makes any thyroid cells crave iodine even more. On the first day of the treatment — in a couple weeks, if my low-iodine diet works — they’ll have me take a low dose of radioactive iodine. Any thyroid cells in my body will grab onto the radioactive iodine and light up in a body scan — sort of a “before” picture.
The second day, they’ll do the same, only with a larger dose of the radioactive iodine. This will effectively burn out the thyroid cells — ablation, it’s called. The cancerous cells will be destroyed, and getting rid of these thyroid cells, whether cancerous or not, will make monitoring in the future much easier.
And I’ll be radioactive for a week! For much of it, I’m supposed to keep a pretty good distance between myself and others; for all of it, I’m supposed to prevent others coming into contact with any bodily fluids — no shared bathrooms, no shared food utensils, the works. The kids will be with their mom for that week. I’ll be on my own.
Phase two ends, assuming all goes well, in early October, with a final scan, presumably to be sure the ablation successfully burned out any leftover thyroid cells. At that point, I hope, I’ll be able to say that my trip to cancer town has really ended. Aside, of course, from the occasional visits to make sure things remain okay.
[Updated 9/16/21: Someone asked if the low-iodine diet is permanent or temporary. Thankfully, it’s temporary, just to set up the various body scans. If all goes as scheduled, I’ll be on the diet for just under three weeks.]
Here’s hoping my luck holds….
Photo by Yves Alarie on Unsplash