Sleep and FitBit

I recently saw my primary doctor and complained of symptoms of hypothyroidism: tired, low energy, and irritability. He told me my thyroid levels were fine and suggested I needed a sleep study. The sleep study is scheduled for March.

I wore my fitbit to bed for the first time last night. I was in bed for 9 hours, 13 minutes (that may seem like a long sleep, but, I have found more sleep fights brain fog). Slept 8 hours, 28 minutes. Restless 41 minutes, awake 6 minutes, and had a 92% sleep efficiency. This isn't the same thing as a full sleep study, however, it is reassuring that the number doesn't indicate anything bad!

I am looking forward to seeing what the sleep efficiency becomes when averaged over a period of time instead of just one night.

December Update

Life gets busy and moves on. The thyroid cancer (that once was center stage) fades and drifts into the back ground. There have been many things I have wanted to write about on this blog, but other priorities have taken over. And that's the way it should be. We move on instead of dwell. We focus on new challenges.

My bloodwork at the end of November said I was slightly hyperthoid, but all my symptoms were hypothyroid.

The doctor cut my thyroid medicine from 175mg to 150mg on weekdays and 175mg on weekends.

I then met with my primary doctor and gave him my symptoms post "crash". I am tired all the time, no energy, brain fog, and short tempered. He diagnosed that I may have a sleeping disorder and has referred me to a lab for sleeping test. That test will happen in March.

My weight is up 50 pounds since I started having thyroid issues. I have been able to keep 6 pounds off after surgery, and I know I need to get the rest off. I suspect that if I am having sleeping issues it is related to the weight. And if I can drop the weight, I should be OK.

The challenge however, because I am so tired I sleep more. I sleep more, so I don't have much time to work out. And I look to bad snacks to try to snap me out of the feeling of being tired. All of that is bad and is a rut that may be difficult to get out of.  Perhaps this sleep study will help.

Aside from feeling tired? Life is back to normal. It is crazy and hectic and busy and that's OK. My wife has been an excellent partner and coach. When I get too tired and feel like I can't move, she kicks me in the butt and gets me going. There is plenty of work to do with the kids, the family, and around the house and it is good I have someone who can keep me going.

Weight spiral and crash

A change happened somewhere between 8 and 10 weeks post op. It was caused either by a change in my thyroid medicine dosage, or, by the "Crash" everyone talks about.

What is the crash? After a Thyroidectomy, you may go through a 6-10 week honeymoon period where your natural thyroid hormones are still in your body. At the end of this period, people describe the crash as being tired, fatigue, and brain fog. The post-crash period can last sometimes 18 months or longer as the doctors try to get the medicine levels correct. The post-crash time takes so long because the medicine adjustments can only be made every six weeks due to the half life of the medicine.

So... there I am. Ten weeks out and the crash happens.

Up until that point I felt on top of the world! I had lost 14 pounds and was planning to loose more.

After the crash, my energy disappeared and I was very tired. That resulted in three things:

1. Being tired, I slept more. If I didn't get at least 8 hours sleep, I suffered from brain fog. I can easily sleep ten hours and wake feeling like I only got six.
2. Because I was sleeping so much, I didn't have time to exercise very much
3. Because I was so tired I looked for pick-me-ups to shake the cob webs from my brain. These usually involves comfort food and high sugar treats.

And this the downward spiral. Less exercise, bad eating habits... and when I did exercise I lacked the energy for an intense work out.

I was very proud that I lost 14 pounds. But now 3+ months post-op, I have gained ten of that back.

I start each week determined to fix this. I know what to do and how to do it. But plans quickly fall apart as I struggle to get out of bed in the morning, and am ready for a nap after work. I know the saying: to get energy you have to use energy; but this is different.  It is a feeling of exhaustion.

My next blood work is in a few weeks and hopefully that provides insight into medication adjustments. In the meanwhile, I will just keep pushing myself as hard as I can to do what must be done.

Low Calcium Follow Up

In my last post, I described the aftermath of (what I believe to be) food poisoning. Here is the update.

Measuring how tired you are is difficult because it could be attributed to three things: you are tired, you think you are tired, or you medication is off. How can you tell for sure?

Imagine being at the store st someone asks "Are you feeling OK? You look sick!" Even if you were feeling fine before, just that comment will insert doubt, if a second person says the same thing? You will find yourself coming down with illness symptoms. There is some psychological occurring. The same can happen when being tired. If you tell yourself you are tired, or others remind you that you haven't had much sleep? You'll find yourself yawning by 10am.

Another aspect to being tired is having your medication be off. Too many people surviving on thyroid medicine are all too familiar with this.  Months and sometimes years can go by and you'll never snap out of it until the medicine is magically adjusted to an optimum level.

Finally, you might just be really tired. As we age, or levels of energy change. Or perhaps sleep is more restless. Or perhaps there is less of it.

Which ever the case, it can be difficult to self diagnose being tired.

After being sick from food poisoning, I was tired all day long. I could not get enough sleep and often took naps in the afternoon. 14 hours, 10 hours - it didn't matter how much sleep I got.

This lasted for six days, and then passed. It has been almost two weeks since I became sick and I feel great! I am back to seven hours sleep and tons of energy all day long.

But it is concerning. A relatively minor illness could pull be down so far, and it could last for so long. I have never experienced anything like that before. And I am glad it is behind me!

Scary Situation: low calcium

I had a scary situation happen to me today while shopping.

I had a meatball sub last night for dinner. Unfortunately it didn't agree with me and I suffered all night. I wasn't sure if it was going to come up or our out... And it finally came out through massive  Diarrhea. 

6am arrived and I took my Thyroid medicine as I always do, and went back to sleep.

 14 hours after going to bed, and 18 hours after eating the suspect meatballs, I woke up. Tired and low energy, but I had survived the meatballs.

I had no desire to eat anything until 24 hours after the meatball sub. I started feeling weak and light headed, so I ate just a normal meal, nothing special.

25 hours after the meatball sub, I went to the store to get a few things with my wife. While at the store, I started feeling tired. The light headedness, which had dissipated while eating, returned. My lips felt numb and my heart felt like it was racing.

My wife was talking to me at the store and I wasn't paying attention because the overhead store lights seemed to be... moving.

"Are you OK?" She asked.

"No," I answered.

Was I dehydrated? Was I low in calcium? Was I still sick?

We sat at a bench in the store while she retrieved her emergency roll of Rolaids and I took two. She then left me to purchase a bottle of water, which I drank.

My wife checked out of the store and drove us home. On the way home I had two more Rolaids.

Perhaps an hour after the incident I felt OK. Still tired, but OK. I am not sure what caused it - dehydration, calcium, or illness - because all three can have those same symptoms.

That was scary - I have never had that kind of an episode before. I am a big tough guy, I usually power through anything. For me to take a knee meant there was defiantly something wrong.

Changing levothyroxine

I am almost two months post-op and my doctor is increasing my levothyroxine dose. My last bloodwork numbers were:

TSH. 3.01   (.27-4.20)

T4 Free. 1.41.  (.9-1.7)

The doctor wants to keep the TSH closer to the lower half of the normal range (between 0.5 and 2).

As a results I will be increasing from 150mcg to 175mcg. I am not sure I am thrilled with this change because I feel really good. I have some times were I feel down in the dumps, but that is t often and it usually doesn't last long. My energy levels are high and I don't feel tired. Also, I have learned that TSH means less that Free T4 - in other words, if my T4 is good, that is what is important. I understand that if TSH is too high it could promote thyroid and/or tumor regrowth, but it isn't high - it is in range.

My next blood work will be in two months. In the meanwhile, stay tuned and I will let you know whether or not this change was good for me.

Second Postop Appointment with surgeon

Yesterday was my second post op appointment with the surgeon. 

Everything is good. He said my scar isn't silver because it goes some sun exposure, but he doesn't think that will be a problem. He did recommend massaging it more.

He doesn't believe I will need RAI, but said he would defer that decision to the endocrine Doctor.

I will see the surgeon every six months and they'll make decisions about additional tests in the future, but for now everything looks fine!

Thyroidectomy Scar: The first 45 days

Click on the video to see the progress of my scar over the first 45 days.

Online Support Groups

I participate in as many online support groups as I can. Support groups could be Internet message boards or Facebook groups or something similar. A very popular Facebook group is the "Thyroidectomy Group".

These support groups are wonderful. They are filled with people that are either seeking help, or people that enjoy helping. You can ask any question you may have and it is likely you'll get a dozen or two responses. I highly encourage anyone going through a Thyroidectomy to seek out one of these groups.

Just a word of caution.

The groups are filled with, as I mentioned, people who are looking for help. They have a problem and they are turning to the group for advice. That means these support groups are going to be filled with people's problems... And some of the problems are very scared.

I became involved with the support groups before my Thyroidectomy surgery was scheduled. I wanted to learn about the surgery and see what problems I could be facing. The more I read, the more I became scared. I started to imagine that all these problems everyone was having would happen to me! While certainly there are risks and something could happen, most of the things I read were never going to happen.

The support groups are an odd phenom sometimes. I don't mean to belittle it or make light of anything anyone is experiencing. But I'll read things like "I have a hang nail. Does anyone else?" And then half a dozen other people will respond "I have a hang nail too... It must be because we had a Thyroidectomy!" There are some interesting correlations that get made sometimes, and they are entertaining to read, but most of the time I am left thinking "guys, come on!"

Then there are some terrible stories. I recently read that a woman has been unable to die her hair - the dies won't take hold of the hair. Her conclusion was that it was due to her Thyroidectomy. Maybe it was. Or maybe it was due to something else (a new shampoo, a vitamin, etc), who knows? When reading something like that it is very easy to be left thinking "Oh my God, I will never be able to die my hair if I get a Thyroidectomy!" Which, as far as I can tell, is not true.

Sometimes things happen to you and it has nothing to do with a Thyroidectomy!

When I read about all the people having problems, I am tempted to draw a conclusion that there must be an epidemic of problems out there! But there isn't. There are far more people who do not participate in support groups than do. There is a huge population of people who had a Thyroidectomy, are doing fine, and have moved on with their lives. That population is not represented in the support group.

Only take medical advice from a doctor. That sounds right, doesn't it? Yet in these support forums, many people dish out medical advice. If you think your Free T4 number is wrong, there will be at least 3 or 4 people to tell you what to do about it. In my experience, I have found the advice to be a mix bag or guesses and great information. But I take the great information back to my doctor to get it verified. Some of the advice is "you need a new doctor". You can weigh that advice and consider getting a second opinion. Just be very careful blindly following medical advice in the forums (or anywhere other than from your doctor).

The online support groups are awesome. The information is incredible and the numbers of people ready to help is breathtaking.  I highly encourage participating in one. Just be careful and know what you are getting yourself into!

Standing order to check calcium

The Parathyroid are four seed sized organs next to the Thyroid that regulate calcium levels in the blood stream. I lost two parathyroids during surgery and my calcium levels were wonky for weeks afterwards. I stayed in the hospital for four days as they tried to get my calcium levels to raise from a 7.8 low.

Anyone having a Thyroidectomy might encounter calcium problems. It may take a while for the parathyroids to wake up, or, if parathyroids were lost during surgery, it may take time for the surving ones to take over all the duties.

When I was sent home from the hospital, I was taking 10.5 large calcium pills per day! And the blood levels still weren't at the 8.6 minimum. Eventually, the levels did rise.

I was concerned about this because at some point the parathyroids will kick in (which can be measure with a Pth test) and then I'll have to cut myself back until my numbers were within range.

I talked about this with my regular doctor. He agreed to give me a standing order to have my calcium checked twice per week for the next sixth months!

That order has allowed me to go through the calcium changes I needed without concern for making a mistake.

I have been cutting back my calcium supplements because taking too much supplement can lead to kidney stones. I actually cut back too far - my last test showed a dropped back out of range, 8.5. I would never have know this if not for this standing order!

If you have calcium concerns after a Thyroidectomy, talk to your doctor about getting a standing order for blood work. It really helped me!

Sunscreen after a Thyroidectomy

Click to see my video

Loosing Weight after Thyroidectomy: Calorie Deficit

This article is part of a series on loosing weight after a thyroidectomy

Calorie Deficit

If you normally require 1600 calories per day and you only consume 1400, then you have a 200 calorie deficit. Simple? Sorry, no. It can be difficult to figure out what you normally require (called your base metabolic rate, or, BMR). Many factors go into figure: height, weight, activity, metabolic rate, etc. Even though this may be difficult, figuring out your base caloric requirements is an essential first step in a good weight loss management program.

This is a very simple BMR calculator: http://www.bodybuilding.com/fun/bmr_calculator.htm

When filling out the calculator, I recommend that instead of entering the weight you are, you should enter the weight that you should be according to this chart:

Simply find your height, follow it across to the green area, and then look up to see what your weight should be. I recommend using your desired weight because most Westerners (with rare exception) live sedentary lives, and the calculator lacks the means to adjust for that. 

The calculator is built for normal people, not people with thyroid conditions. If you are a little hyper or hypo, your metabolic rate may alter, and your base calories may rise or lower. Use the calculator as a starting point. Then adjust your base calories up or down as you better understand how your body is working. 

So there you have it. You have your base calories. If you eat more than that? You gain weight. If you eat less than that? You loose weight. Simple right? Well... read on...

How many calories is a pound?

A pound is equal to 3500 calories. That is a massive number of calories! If you cut 300 calories per day, it will take 12 days just to drop one pound. All you have to do is eat a couple of cookies one day to blow hard earned results. You should determine many calories per week you would like to deficit, and then come up with daily plans (eating and exercise) to achieve the goals.

Calorie counting

We all hate it, but it is absolutely necessary. Losing weight means counting calories. I recommend using a tool to count calories like Loose It or My Fitness Pal. With these tools, you enter what you eat and how much you have worked out and it will report back your calorie deficit. If the deficit for a day doesn't meet your goal? You can jump on a treadmill and burn off whatever is missing to hit the goals. If you don't keep track of calories, you'll be flying blind and won't be able to understand the results.

Loosing Weight after Thyroidectomy: Diet

This is part of a series based on loosing weight after a thyroidectomy.

Diet

Controlling your eating is essential for a diet success. Basically, you should take your base calorie intake (figured above) and cut 300-500 calories from it.

Not all food is created equal. A gram of carbohydrate or protein is only 4 calories. But a gram of fat is 9 calories. Not all carbohydrates and equal - those with sugar can generate up to

7 calories per gram. 

There are some foods, such a food containing high fiber, that can help to make you feel full. Fruits and vegetables can be an excellent source of healthy low calorie fiber.

As you can imagine, a gram of sugar has an incredible number of calories versus any other kind of food. White flour is one step away from sugar because the human body is very efficient at converting white flour into sugar. You should avoid foods made with white flour as much as possible. Instead choose whole grains and other alternatives which are more difficult for your body to break down.

Drink lots of water. When our bodies are low on a nutrition it will give your body cravings. I bet you have never had a craving for water! If you are dehydrated, your body will start craving foods so it can draw water out of the foods. You can answer that problem by drinking plenty of water all day long. Pay attention to the color of your pee - that is a great indicator of hydration.

If you are someone who struggles to eat fruit and vegetables then you can play a game with your diet. Allow yourself to eat all the fruits and vegetables you want for "free" - don't count those calories. For example, if you are hungry and don't have any calories remaining? Grab some free celery sticks. The additional calories will be minor compared to the health benefits.

No Calorie Reduction Diet

I mentioned earlier that generally, cutting calories helps more for long term weight management while exercise burns off the fat. I also recommend a combination of calorie reduction and exercise. Lets dive a little deeper into these two.

If you simply switched your diet to healthy whole foods, fruits and vegetables, lean meats, removed sugar and white flour, kept your nutricians balanced, yet did not reduce your daily calories? The health benefits would be incredible. Some people find that making this kind of a diet change with no reduction in consumed calories is enough to produce powerful work outs that lead to weight loss and positive long term results. Whether or not it contributes to weight loss, such a diet would have positive health benefits.

The important thing to remember is the consumed calories should not be more than determined in your BMR estimate above. If you put on some weight, it was likely due to consuming too many calories and it may take a calorie reduction just to get back to a zero deficit. In other words, you may have to eat less simply to eat the appropriate amount each day.

Diet Confusion

I wrote about body confusion above. There is also something called diet confusion. If you eat the same general things every day, your body will get used to it and you may find that your reduced calorie diet is becoming less effective. Part of the reason may be that you are allowing calories to sneak back in. When you hit a rut, a great trick is to do a one day diet confusion. Go off your diet for one day and eat foods you normally don't. That doesn't mean you have permission to eat an entire chocolate cake. Instead, you may want to go to a buffet and challenge yourself to try foods that you don't like or normally don't choose, eat in quantities (more or less food) that you don't normally eat. Often, this will wake up your reduced calorie diet success.

Five Meals

Your body is a metabolic furnace. If you want the furnace to keep burning, you must keep feeding it. Instead of 3 large meals, do 5 smaller and well balanced meals. For example, between breakfast and mid-morning snack, do 500 calories. Between lunch and mid-afternoon snack do 500 calories. Then, leave the rest of your calories for dinner. Try to have one of those meals per day be a good leafy salad, very light on the dressing.

Avoid starvation

Weight loss can come to a grinding halt if your body enters a starvation mode. If you don't eat enough, your body tells itself that it must be in a time of meek living. It will actually slow your metabolic rate to the lowest it can withstand so that calories can be stretched further.

This is great if you become lost while crossing the desert. It is not so great on a diet.

Starvation mode can also be very bad for individuals with Thyroid conditions. Once starvation mode kicks in, it can impact T3 and T4 levels. The bottom line? Keep your metabolic furnace burning by eating, eat enough to stay out of the starvation zone, and eat the right things to fuel your fitness goals.

Advice From Others/Fads

People with Thyroid issues will hear all kinds of advice and all kinds of fads: gluten free, carb free, akins, and more. None of those really matter, some of those are dangerous, and some will not produce long term success. What matters is producing a calorie deficit. I think this topic is like a religion for many people as they swear nothing else worked for them until they tried a fad. My answer? Hey - whatever works for you is fine - if this fad was the thing that kept your motivation? Then that is awesome. Just know that a calorie deficit with a balanced diet is the healthiest answer for long term success.

As people age they may develop sensitivities to things like gluten or diary. If you never needed to pay attention to your diet before, you might not have noticed it. There is research that says individuals with thyroid problems have a higher chance of developing problems with gluten. That doesn't mean you will develop a problem, it just means you have a higher chance of it. Discuss your risks and symptoms with your doctor.

Don't Eat Out Of The Box

It is a bad habit to sit down with a box of crackers or cereal and start eating. Before you know it? You have eaten too many! For best results, plan your eating day the night before. Fill storage containers with what you plan to eat. Then stick to it - only eat the contents of the storage containers. 

Loosing Weight after Thyroidectomy: Exercise

This topic is part of the Loosing Weight After Thyroidectomy series.

Exercise

Suppose you are determined to loose weight by diet alone. Or by exercise alone. It is by combining diet and exercise that the magic formula falls into place. For most people a dieted calorie does not equal an exercise calorie because they play different roles. A diet calorie tends to do better with weight maintenance. An exercise calorie tends to do better with increasing MBR for a short/quick calorie deficit. Combining the two will help with weight loss that has the best chance to stay off for the long term.

Kinds of exercise

Not all exercise is equal: there is, generally, cardo and resistance training. 

Cardo is things like the treadmill, Zumba, walking, etc. Cardo will burn calories while you are exercise, however, the moment you stop? Calorie burning stops. Also, Cardo weight loss isn't solely focused on burning fat. Cardo will also reduce muscle during weight loss. 

Resistance training is things like lifting weights, push-ups, naudalis, exercise bands, etc.  This activity tends to burn less calories during exercise than Cardo does. However, the caloric burn continues after the exercise as your body repairs and strengthens those muscles. These kinds of exercise will increase your metabolic rate (how fast your body burns calories).

The best exercise plan? Is to combine Cardo with resistance training.

Body confusion

The human body is an incredible machine. It is built to adapt and survive. If you walk on a treadmill everyday, you body will adapt to that a find a way to efficiently burn calories. That means a workout that once produced results no longer will. 

To avoid adaption, use body confusion. Mix things up. Don't do things the same or in patterns. If you did the treadmill yesterday, do an elliptical today. Resistance training tomorrow. Zumba the next day. By continually changing a routine, your body will stay confused and unable to adapt.

Another approach is to design 10 Week exercise plans. At the end of ten weeks your body will have adapted, so, it is time to do something completely different. Perhaps you spend 10 weeks walking at lunch time, then spend the next ten weeks swimming after work.

The Exercise Machine Says I Burnt 300 Calories!

Exercise machines, like treadmills and stationary bicycles, will estimate how many calories it believes you used. But the machine really has no idea. It can get close if it knows your weight and age, but it really doesn't know the intensity of your work out and various other factors. Use these as just an estimate and not as a true number.

Exercise with Intensity

Intense workouts will have the most impact. If you are on a treadmill, don't just plop along a 3mph for thirty minutes. Mix it up - go faster, go slower, raise the elevation, and have short periods where you are very challenged and your heart rate goes up (to a safe level), and then cool back down, and then hit it again. If you are doing resistance training? Start with a light weight to get the blood flowing (50 reps). Move to a medium weight to get that muscle pumped (12 reps). Then blast the muscle, tearing the fibers and promoting growth with something really heavy (5 reps). Keep the intensity high to get good results

Eating Back Your Calories

Under this concept, suppose you exercise 300 calories. You would then eat 300 calories to return to zero. I have read that many people can lose weight by eating back their calories.

Actually, I think they have miscalculated their BMR. Somehow, even with eating back their calories, they must still be producing a deficit. 

If you are in a situation where you overeat (perhaps you are going to a party of a festival) then it makes complete sense to exercise extra to counteract obtaining those additional calories. But that isn't really 'eating back your calories'.

I Have No Energy

I often hear people with no thyroid or thyroid problems complain about a lack of energy. Sometimes they'll work out one day, and be wasted for the next two. I have not experienced that, so, I don't have any specific advice. I just have some ideas that I hope will help. First, to get energy, we must use energy. As we build our stamina, we can do more. Perhaps do some lighter/shorter exercise and slowly increase over time. You don't have to run a marathon. just walk to the mail box and see if the mail has arrived if that is all you can do today.

To look like an athlete

We all look at athletes and appreciate the long muscular frames. Many people would prefer a body that looked like an athlete versus the body they have. If your goal is to look more like an athlete, you must be prepared to do the things that athletes do: eat they way they eat, train the way they train. Many athletes have spent all day at the gym for years - are you really prepared for that level of dedication?

Just get started

Regardless of what your goals are? Just get started. What can you do today? Right now? Can you stand up and walk to the front door? Do it. Tomorrow, walk to the driveway. They next day to the end of the driveway. Then to the neighbor's driveway. And then beyond. Starting small will leave you with a sense of accomplishment and encouragement to do more the next day. You may find exercise will have a snow ball effect to the point where as you slowly increase your activity, you'll crave to do more activity. To get energy you must burn energy, and the euphoria may be enough encouragement to keep you going.

No Pity Party

I was recently reading a story about a young cancer survivor. She explained that upon a cancer diagnosis, she reverted to being a child, collapsed, and had her parents take care of her.

I think few people are fortunate enough to have that as an option. I know I certainly didn't!

I am the head of a household and chief bread winner. Three kids and a wife. Thirteen years ago my parents were faced with difficult retirement financial challenges, so, I built a ranch house onto the side of my house and they live there, also dependent on me and my income. 

Everyone looks to me for strength. The kids, obviously, but also my parents who are in failing health and under constant fear they can't take care of themselves.

I shed no tears for this cancer diagnosis. My journey started two years ago with the detection of goiter Even two years ago there were no tears - I just wanted to get this done and get it behind me.

The only time I shed tears for cancer was when my wife thought she might have breast cancer. There was a lot of private tears and begging to God about that. Thankfully, the tests came back and she was fine.

Upon early thoughts that I might have cancer I decided to take a position of strength. I think it is a Father issue, but not just an issue for Fathers, to show no weakness nor vulnerability. I knew my children would look upon this as an example of how to deal with life's challenges. They were not going to see me lying in bed all day balling my eyes out. To be truthful and honest, that meant I wasn't going to do it in private either.

I developed a story line that ended up being mostly true: "I would be fine. Just need to get the Thyroid out and everything will be normal again. And the thyroid surgery is a piece of cake, nothing to worry about." This is what I told my parents, my kids, and, most importantly, myself.

I then continued to do everything I normally did right up until the surgery. After the surgery, during my hospital stay, I made it clear to my wife that I didn't want the kids to visit nor my parents. I told her that if the kids needed to visit for some kind of emotional closure or something? Fine. Otherwise they could wait until I got home.

I knew that after the surgery I would be seen as weak and vulnerable. Imagine, a big tough guy like me wearing a gown and being helped during a walk by a tiny little nurse. Of course it was necessary, but not the image I wanted anyone to remember or have.

After a few days in the hospital, I returned home. I need to assure everyone that everything was gong to be OK, they had nothing to worry about, and the king of the castle was still there for everything they needed. We gathered into the living room and I answered all the questions they had. When the questions were done? We all got back to work.

Even though I needed rest, and I took rest, I kept myself highly visible and active. There were times I might have slept all day, but I knew that wouldn't do me or them any good. They needed to see the situation as being stable and normal.

I found that the impression of strength isn't only important before the family, it is also important at work because I am a manager. My employees have entrusted that I will battle the big fights for therm, will shield them from damage, and will protect them with good direction. 7 days after surgery I returned to work and hit the ground running with incredible energy. I was exhausted by the end of the day (at least, my voice was), but I showed my employees that they had nothing to worry about. I was back.

There were no pity party, no wallowing, no fear spreading, no unnecessary concerning others. No reverting, no crying fits, no self doubt. Only a portrayal of strength. It is my job to assure those who rely on me that they will be OK, and that I can provide them stability. I am grateful that I have been and continue to be able to do this throughout my Thyroid Cancer.

Loosing Weight after Thyroidectomy

Many people with Thyroid issues find they gain weight and then struggle to take it off. For some, this is the first time they have dieted, or, first time in a long time. For others, the same old tricks that worked before are no longer working. If you fall into these categories? This article is intended to help. I hope it will give you some new ideas, some new things to try, and help you hit your goals. As always, consult your doctor before starting any diet or exercise changes.

The Basics

Loosing weight requires a calorie deficit. Sounds simple? Not really. It can be very confusing. The confusion can be amplified if you are on Thyroid Hormone Replacement Medicine which makes the deficit become a moving target.

Calorie Deficit

Learn about Calories and Calorie Deficit with this article.

Exercise And Diet

Learn about exercise with this article.

Learn more about diet with this article.

Motivation

Lack of motivation is the reason most weight loss activities fail. If loosing weight was easy, you would have already done it and wouldn't be reading this article. This is tough. And there are so many distractions for your time, energy, and eating habits. Those who are successful are motivated by something, and I would suggest that a cancer diagnosis provides some great motivation! Another idea is to schedule a trip. Make the reservations and pay for it so you know it is going to happen and there is no way to avoid it. And then start working on weight loss so you can hit your goal in time for the trip. Instead of a trip, perhaps it is a family or class reunion, or some summer clothes that you purchased and want to wear. The point is, you need to understand why you are losing weight, you have to remind yourself of that reason every day, and the reason has to be significant enough to keep you going.

Some people find motivation socially. Either joining a group of others that are losing weight, partnering with a friend, or participating in an exercise class. You want to establish relationships so that if you miss an event, people start asking where you are.

Finally, another form of motivation is to hire a personal trainer. Many gyms offer personal trainers on an hourly basis ($30-$100 per hour or more). You schedule appointments with the personal trainer such that if you don't show up? You lose your money. Personal trainers are professionals at keeping you motivated and helping you achieve your goals.

Hunger feeling

Some people who are overweight have a very strong hunger sensation and a very weak sensation of feeling full. If you have this problem, you will need to train your stomach.

Training your stomach to be less hungry requires eating smaller meals. I call it "Shrinking the size of my stomach". By eating smaller meals you will train your stomach to not be so hungry all the time.

Feeling full may be any other sensation you need to train on. Most of us all feel stuffed after a big Thanksgiving Day meal. Most of us also know when to stop eating when you feel full. But some people have that sensation muffled or diminished to the point they don't notice it anymore. Pay attention to your body and feel for clues when your body has enough. It may take practice to get good at this.

Fat Cells

Fat cells are like sponges. They sit waiting for a little bit of fat to pass by and they absorb it very efficiently. When you lose weight, the fat cells don't go away. They just dry up and sit there. That is one reason why it can be very easy to regain weight.

Suppose someone who is very skinny eats a large chocolate cake. Their body takes the extra calories and deposits them into fat cells. But the skinny person has no fat cells. So, the skinny person must burn part of the calories to produce the fat cells so it can store the remaining calories.

Now suppose a previously fat person eats a large chocolate cake. The fat cells is sitting and waiting to absorb those extra calories, and they do so quickly and efficiently.

There are operations that you can go through to have fat cells removed. The problem is that fat cells are distributed around your body naturally. If you remove some fat cells here or there, then your body won't look natural if you put weight back on. It is best to avoid the surgery and live a life of weight control.

Safe Amount Of Weight Loss

People dream of losing ten pounds per week and obtaining their desired size in months. You didn't put on the weight quickly, so it is unlikely you'll take it off quickly. Besides, you'd have to run on a treadmill for five hours per day to lose that much weight! That isn't realistic.

Most studies believe a safe amount of weight to lose to promote long term weight loss is one or two pounds per week. That probably means you need to have a long term approach to your weight loss goals.

I Have Tried Everything And Nothing Works

I hear this very often and hopefully I have provided suggestions that will help. If you are really stuck, you must increase your activity or decrease your food. Be careful of unaccounted calories (butter on your toast, cream in your coffee). Focus on more fruit and vegetables. Make sure you are using body and diet confusion. If you still can't lose the weight? Know that being healthy will have tremendous long term benefits whether or not you reach your weight goals.

The Impact Of Age

When I was younger, I could be active all day without rest. I never tired. Now that I am older, I am ready for a nap at noon. As we age, our energy levels naturally decrease. I have read several times where someone post thyroidectomy begins exercising and learns they simply don't have the energy they did when they last worked out ten years ago. Some of that could be due to a thyroid hormone imbalance, but some of that feeling could just be the natural impact of age. If the decrease in energy is due to age? Well, to get energy we must use energy. Use a little more energy every day, and the amount of energy we have can slowly rise.

Another natural aspect of aging is that our metabolism slows down, we become less active, and we require fewer calories. When I was a teenager, I would eat five quarter ponders and it wouldn't even phase me. Now, one quarter ponder covers me for lunch and dinner! I believe there are milestone ages where our calorie needs take a nose dive. When I hit my forties, it seemed like overnight my calorie requirements just back fired on me. I'm suddenly eating turkey bacon and low fat cheese, or, hold the bacon and the cheese.

How often to step on the scale

Weight fluctuates day by day due to many different factors. You may be up a little one day, down a little the next, then back up on the third with no explanation. I set my goal for one pound per week, and then weigh myself at the same time every Saturday. But due to weight fluctuations, some Saturdays I would see amazing results while others produces discouraging results. I have found better success weighing myself every four to five weeks. I find that tends to level out the weight fluctuations. Whatever frequency you choose, just pick one that isn't going to lead to disappointment, which could lead to diet failure.

Special Consideration for Thyroid Issues?

Suppose you are Hyper or Hypo and/or don't have a thyroid. According to my doctor, the calorie deficit principle still applies. I heave read some research and some papers from doctors who disagree. Earlier I said: before you embark on weight loss or exercise, consult your doctor. That is even more important for thyroid issues because you'll want your T3 and T4 levels monitored to make sure diet changes don't result in negative effects, and that your levels stay optimal for promoting weight loss. Your doctor may guide you to eating healthier, watching nutritious, eating whole foods, and sticking to lean protein. Keep your doctor involved during your progress.

Conclusion

You have lost your thyroid, however, you have not lost your ability to lose weight. With or without a thyroid, losing weight is difficult, but it can be done. It requires life style changes that include eating and exercise to produce a deficit for losing the weight.



Want to read more?   This is a cancer survivor's fitness site.
Health and Nutrition from a thyroidectomy survivor

Revision 3A

Thyroidectomy post-op Week 5: the Stitch

My Thyroidectomy incision was closed with dissolving stitches on the inside and glue on the outside. This is what it looks like 5 weeks post-op.

I did not have a drain installed during surgery so, as a result, I have developed swelling in the area below the scar.

On Day 10 of post-op I went to the surgeon for my follow-up appointment. The nurse removed the glue and the incision started looking much better. But then I started noticing something poking my finger everytime I rubbed the incision. 

It is difficult to see in a picture but that white dot is an exposed stitch! I have read a little about exposed stitches and I believe the doctor will likely pull it out at my appointment on the 30th

The idea of the Doctor pulling out a stitch is not a pleasant thought. My imagination tells me it will really hurt and I imagine there is an undissolved knot on the other end.

I have also seen pictures where the stitch was pulled out and it left s hole (a deep divot) that never fills and has to always be cleaned. I hope that doesn't happen to me!

As luck would have it, guess what happened this morning? The stitch fell out! That little spec on the paper towel is all that is left from it. 

Thyroglobulin test results

My Thyroglobulin test result arrived the other day. It said I had less than .2!

In addition to the thyroglobulin QN, the Endocronologist also checked to AB, or, Antibodies. Antibodies can skew the results of the QN test. My antibodies were in range: 24 (0-40).

I contacted my Endocronologist to make sure I was interpreting the test results correctly. I received the reply today: That is exactly the result we want. It means that you have no active thyroid tissue in your body. 

Woohoo! That means I probably won't need Radioactive Iodine (RAI) treatment! I have to get one more blood test at the end of the month to compare the results just be to sure.

On the one hand, I am a little sad about not getting RAI because I wanted to report on the experience and I was looking forward to a little time off from work. But on the other hand? Thank you God for possibly sparing me from RAI! Thank you, thank you, thank you!!!

Bearing the Scar

I am coming toward the end of 4 weeks post-op. Everytime I go out (Shopping, dinner, etc) I wear a button-up shirt to hide the scar. Even when I go to the gym I wear shirts that ride very close to the scar so it is less noticeable.

This weekend was my first time out bearing the scar.

My nephew survived reoccurring lymphoma by getting a stem cell transplant from a donor to n Germany. He suggested that we go to Oktoberfest in a nearby town. I figured: if I can't bear my scare to someone who has spent his entire adult life fighting cancer, and has more scars then I hope I ever will, then I will never be ready!

This was a little difficult for me because sometimes I forget about the scar, but am reminded when someone else notices it and stares for a moment.

My Mother said a few weeks ago "Are you worried that is someone sees your scar that they will think you tried to commit suicide?" Honestly, I hadn't even though about that aspect. Thanks Mom for making me just a little more self conscious! 

When people stare it is normally just a glance that goes on too long. They see it, wonder what it is, realize it is a scar, and then they go on with their business. Beyond that? No one cares!

I had a great time at Oktoberfest. I didn't have to keep covering up my neck for making sure the top button of my shirt was secured. This was a chance to trade some stories as we both went to the same cancer center and both encountered some of the same people who work there.

After leaving Oktoberfest I accompanied my wife grocery shopping. After a little while at the store I had completely forgotten about the scar. Everyone was so busy doing their shopping that they didn't notice my scar. Or, perhaps I was so busy shopping that I didn't notice anyone noticing.

It was a good day bearing the scar. I feel much more confident about it now.

PS Bare versus Bearing

Bare is to expose. While my scar was exposed, it has been a burden on me to keep it covered

Advice When Heading to the Hospital

You have the date scheduled for your thyroidectomy. Now what? What do you need to take to the hospital? What do you need to have at home? What will the stay be like?

Luckily, I have several posts that I believe will help!

List of what to take to the hospital

List of what to have ready when you return home

Have an advocate while you are at the hospital

My surgery experience

Post-Op Updates

I hope these help!

Thyroidectomy Surgery: Have an Advocate

A thyroidectomy is a major surgery conducted in a hospital. Individuals having a full thyroidectomy will spend at least one night in the hospital. During this time, it is the patient's job to rest and heal. It is the hospital's job to take care of the patient. 

While you are likely to do an excellent job attempting to rest and heal, sometimes the hospital struggles with their responsibility. The nurse and staff have many patients, many responsibilities, and they don't have all the answers. It takes a long time to get some answers. The staff are humans who make mistakes, have difficult patients to deal with, and some unfortunately, care less than others. Dealing with all of this as a patient can be stressful. Again, a patient's job is to rest and heal, not deal with extra stress.

Therefore, I highly recommend appointing an advocate in advance. It could be a friend. It could be a spouse. It could be an adult child or another family member. Whoever it is, you should have a conversation with them in advance so they clearly understand the expectations. 

If you ask the nurse a question, for example, and an hour goes by without an answer, you expect the advocate to go find the nurse and get an update. If your dinner is two hours late, you want your advocate to get you food. If a doctor is talking to you at a hundred miles an hour, your advocate needs to take notes and help ask questions. If a monitor is beeping for thirty minutes, your advocate needs to find someone to check on it. Making sure you get your medicine on time, your blood tests on schedule, getting opportunities to walk, washing and/or bathing, etc. These are the kinds of things you need someone to deal with so you can rest and heal.

Set the expectations very clearly. Don't just say "Hey, can you be my advocate?" That will lead to a misunderstanding. You may want more control or less control. The advocate won't know what you want unless you tell them. Explain various scenarios and make sure they understand and are comfortable fulfilling the responsibility. 

It is best when the advocate is by your side, but that isn't completely necessary. The advocate can stay connected by regularly calling the nurse for updates (which you can arrange and grant such permission) and staying in contact with you. The advocate doesn't have to spend all day by your side, but they do need to be engaged and involved.

If your advocate is your husband? I am a guy, so, I am allowed to be frank about this. You need to set your husband straight that he is your defender and completely responsible for your advocacy. In many relationships, especially when involving health care, husbands tend to take the back seat. Be clear about the expectations. And not to be too gender specific.... if your advocate is your wife and she has a similar trait, the same applies. Be very clear.

I remember reading one story of a woman with several kids and the husband abandoning his wife at the hospital so he could focus on the parenting. When he did visit briefly, he brought the kids and they were acting crazy in the room, She expressed great disappointment with her experience and her husband. You don't want to have that kind of experience!

If your spouse can't be your advocate due to parenting responsibilities? Find a friend or another family member to lean on. Don't just assume that your spouse can double-up on parenting responsibilities AND do advocacy. If your spouse can? You should be very grateful. :-)  My wife was my advocate even with double parenting responsibilities and I feel I am a very lucky husband to have such an incredible wife.

Having an advocate allows you to play "good cop/bad cop". Nearly all the hospital staff will work hard and do their best. But that sometimes means long delays. The best way to approach this is with a positive attitude and a smile. Sometimes a positive attitude and a smile gets taken advantage of. The squeaky wheel gets the oil, so, the hospital staff may be busy with more difficult patients. Having an advocate allows you to be positive and smiles while the hospital staff can see the advocate as being the heavy. This approach has a better chance of resulting in nicer treatment than if the patient is required to develop an attitude.

So, find an advocate for your hospital visit. Make sure they understand the responsibilities. And then focus on resting and healing. 

Area Under Scar Part 2

Week 4 post-op and here is an update on the area under my scar (seroma). Click the video to watch.

Area under the scar

My hospital has a system where I can send messages to my doctors. So, today I sent the following:

I am 4 weeks post op for Thyroidectomy. I have an area below the incision that has been growing since after the operation. Is it anything to worry about or can it wait a few more weeks for my second follow-up? This picture is me laying in my back: 

The area appears to be very solid to the touch. It itches. It is easily irritated by a shirt collar. I am not running  a fever. It was perhaps half the size when I was in the hospital and at that time I was told it was fine.

Hopefully the surgeon responds and tells me it is fine and there is nothing to worry about. 

The Dangers of Opiod Pain Medicines

Revised

When I met with the surgeon we talked about pain management. I explained to him that I did not want any opium based pain medicine because they can be highly addictive and I don't want to use them and I don't want them in my house. He agreed and said that wouldn't be a problem. Fast forward to my leaving the hospital. The hospital pharmacy gave me a bag of pills filled with vitamins and opium based pain medicine to take home. I told the nurse I didn't want them. She said that so many people leave the hospital and then call the surgeon begging for pain medicine that now they just send people home with it. That got me thinking.... I don't want to be in pain... what if I need the pain medicine and I refused it and was in trouble at home? I agreed to take the pain pills home. I have a college student and two teens, so, I am concerned about having these pills in the house. I hid them in the back of a cupboard so that if I needed them during recovery, I could get to them. Fast forward one month later and I had completely forgotten about those pills sitting in the cupboard.

If you had a Thyroidectomy, there is a good chance you left the hospital with pain medicine too. Pain management is a personal choice. What someone uses to manage that pain is a discussion that should happen between the patient and the doctor. If you need to use the pain medicine? Then you should. I recommend discussing in advance with your doctor what the various options and risks are: Opiod and non-opiod based. I am in no way suggesting anyone should go without pain medicine. The point of this posting is make sure everyone is thinking responsibly about it.

The Opiod based pain killers include Morphine, Tramadol, Oxycodone, Fentanyl, hydrocodone, oxymorphone, and the list goes on and on.

While it is unlikely anyone will develop an addiction by taking Opiod based pain killers after a Thyroidectomy, extended use can lead to a dependency. According to the Office of National Drug Control Policy, there are 1.5 million chronic users of heroin, 75% of which started their addiction with prescription Opiods. If that concerns you? You should discuss it with your doctor.

Suppose you are sent home with pain killers. You either do not need them, or, you took what you needed. And now you have a bottle filled with left over pills. What should you do with those pills?

Part of the  heroin epidemic in the United States is due to prescription opiods that find their way to the streets. Perhaps it is a sweet loving child who finds some in a medicine cabinet and sells them for some quick money, or a child that trades them for something else, or a visiting relative pockets them. Here are some ideas on what to do:

1. Lock them away in such a way that children and visitors won't be able to access them. In my case, I have teenagers yet I don't have any lockable cabinets in my house.

2. Properly dispose of them. Check here and/or check with your pharmacist. In my region, we are told to take them to a police department. Your region may have different instructions.

3. Never flush an Opiod medication down the toilet unless the medicine comes with specific instructions allowing it.

4. Discuss the dangers of prescription medicines with your children.


What am I going to do? I'm taking the pain killers out of my cupboard this afternoon and driving them down to the police department for disposal. Then I am going to stop by the hardware store and purchase a lock for my medicine cabinet.

I hope this as an opportunity to make sure any pills left over from a Thyroidectomy surgery have been properly taken care of.


Want to read more about the problems with Opiod pain killers? Read Bob Lonsberry's experience.

How to take Synthoid

I can't believe how much misinformation there is and how many people are taking their Thyroid Hormone replacement medication incorrectly!

The directions are either printed on the bottle or in the paperwork that comes with the medicine. If you can't find it, get an app like Mango Health. Or read the directions on the web site: https://www.synthroid.com/what-is-synthroid/dosage

You should take the medicine on an empty  stomach    +/- 30 minutes of any food, and +/- 4 hours of any calcium. Otherwise, the medicine will be less effective. Do not take the medicine with food, but do take it with water.

Take the medicine at the same time every day. If you are off by a few hours on one day? OK. But then get back on schedule with your next dose.

Many people find it useful to set at alarm to take the medicine and then go back to sleep.

Remember: no calcium +/- 4 hours!

The online support groups are a dangerous place to get advice about taking the meds. Some people have been taking it incorrectly for a decade or longer and will swear that it doesn't matter, and many of those same people will be in the group with thyroid problems that would be fixed if they just took their medicines correctly. 

Others may say "my Endocrine Doctor never told me I needed to take my medicine any certain way." That isn't surprising because Endocrinologist  are doctors, not pharmacists. 

I have provided the link above. Whether you take the generic version or the brand name, it doesn't matter. Read the website for yourself. Take the medicine correctly for it to be most effective.

First Endocrine Appointment

As expected, my appointment with the Endocrine doctor occurred 3 weeks post-op.

I arrived and checked in at the receptionist. Shortly thereafter, a nurse took my vitals (blood pressure, weight, ect). The nurse then took my back to one of the examination rooms.

After a short wait, my doctor arrived with a student doctor. She listened to my lungs, heard, stomach, checked for swelling, checked my reflexes, and shined a light into my eyes. They then left and said they would return with the resident doctor to have discuss my treatment.

A short while later, the first two doctors plus a third came into the room. She explained several things that were already on my list of questions and then asked if I had any further questions. I sure did! And I will get into those answers in a moment.

Apparently my condition is very good. They are waiting for one more blood test (hemoglobin?) to return and if that looks good? They won't see me for another 6 months, at which time they will do blood work and an ultrasound. If it doesn't look good? They'll do a radioactive scan to see what is going on. As a last resort, they might do RAI. However, they explained that aggressive treatments using RAI have not proven to improve outcomes, so, the direction any more is to avoid the RAI unless there is a reason for it. I was told there will be one more blood test at the end of this month so they can compare the results.

OK, now my questions:

MEDS

At what point do we cut back on calcium? Immediatly

Move my scripts from Hospital Pharmacy to my pharmacy? done

Same manufacturer for thyroid meds? They didn't really understand this question. I was saying that if I get generic, I want the same generic manufacturer. They said the way the guaranty that is by going with a name brand.

Are name brands more stable? Yes. But they haven't had problems with generics

All the vitamins I take OK? Yes

What are the different kinds of thyroid replacement medicines? She said there is one that comes from a pig and they don't recommend that because the contents of live free hormone can very.

How to request prescription refills? Contact the doctor

How will this impact my depression & depression meds? It won't

Long term effects of Thyroid Replacement medicines? None. Just don't miss a dose

RAI - Cross that bridge when we get to it. It is unlikely I will need it.

BLOOD WORK

Stop the calcium blood work? Yes, stop it now

When will the parathyroids kick in? Pth test says they already have

Will my calcium sky rocket when it kicks in? It did not

How often will I have blood work? Every six months unless there is a problem

What will the blood work check for? Can I get everything checked? Just TSH and T4free unless there is a problem

Damage from thyroid levels being too high or too low? Long term or short term? Long term. Could lead to growths which could lead to more cancer.

If I feel great but my levels are off, is that OK? Levels must be within range

TEST RESULTS

What symptoms should I watch for that would tell me I need a medicine adjustment? They will know because they are monitoring my blood test results.

What does the Intact Pth test tell us? Pyrathyroid test. Tells if the pyrathyroids are active

RECURRENCE

What are the chances it will recur? 1-3 %

What are the symptoms of recurrence? They will know because they are monitoring my blood levels

In what body parts do recurrences appear? Neck

Is there anything that can be done to reduce the chance of recurrence? Keep levels in ranges

WEIGHT LOSS

Is weight loss different for me now than before? No, it is the same

Do I have to be careful about eating too much calcium unexpectantly? I will just pee it out, but, I could end up getting kidney stones.

Could I have a tums overdose? No. I will just pee it out.

NEXT STEPS

How often will I see you? Depends on the results of the hemo-globin test. If the test is good? Every 6 months for 1 year. 

What role does my primary physician play? He will do everything except the thyroid

Follow up activities and timelines: rai & body scans? Next test is a 6 month ultrasound if the hemo-globin comes back OK

GENERAL

Where do I call if I have a serious problem? Call the Endocrine doctor

How has thyroid treatment changed in the recent years? They have become less aggressive

Alcohol consumption? OK

Books or websites to learn more? If I have questions I should contact the Endocrine doctor