By February 2014 I had a lab slip for an ultrasound to check the lump on my neck from a thyroid goiter (enlargement) that hadn’t been checked in 8 years. Back then I knew enough to ask questions and seek out answers, but I definitely didn’t carefully evaluate every doctor, specialist, lab, clinic, or testing procedure provider. I didn’t understand the power I had to choose my care providers. I don’t remember where I had that ultrasound test done – who performed the test wasn’t significant to me at the time. I clearly remember the results though: my goiter had grown to 1.2cm.
A follow up visit with Dr. Elliott confirmed what I already knew: this was concerning. I needed a fine needle aspiration (FNA) – a test where a needle is inserted through the skin of my neck into the nodule (growth within my thyroid gland) and some fluid is removed for cancer testing. An Ear, Nose and Throat (ENT) specialist in the same medical group as Dr. Elliott was capable of performing this test, and because I trusted Dr. Elliott I trusted other doctors in his group.
I made an appointment with the ENT specialist, who I’ll refer to as ENT#1. He seemed pleasant, and began explaining to me how the FNA procedure would go. He would numb my skin, I would tilt my head back, he would insert the needle into my neck and extract the fluid from the nodule. He would repeat this process 5-6 times. The goal was to get as much nodule fluid as possible. He also explained the spectrum of possible results: benign (negative), undetermined, suspicious, or malignant (cancerous).
I explained that I am not a fan of medication and surgery, and believe those things should be used only when absolutely necessary. My goal was to keep my thyroid unless it was cancerous. As ENT#1 was explaining the possible outcomes of the test, he mentioned that some of his patients have their thyroid removed “just for peace of mind”. This was odd considering I had just finished telling him I only wanted surgery if it was necessary: if he was paying attention he would have known this information was irrelevant to me.
At the beginning of the appointment I told ENT#1 I had just come from the chiropractor because I was having some back and neck pain. He later told me about one of his patients who was having back and neck pain. She was seeing a chiropractor, and during a test to diagnose the neck pain (I can’t remember which test) a thyroid tumor the size of a grapefruit was found. This wasn’t exactly reassuring. If he’d been paying attention he would have known this would be very disconcerting to anyone with potential thyroid issues, let alone a person who had just been to the chiropractor.
I’d researched the testing procedures and read that often the FNA test was done with ultrasound guidance, where an ultrasound showed where the needle was going. ENT#1 planned to do the test without ultrasound guidance. I asked him about this, and he said there were some practitioners who used ultrasound, but he did not use that method. He assured me he knew exactly what he was doing and was “really good” at finding the exact spot necessary to extract the fluid. I was already there in his office, psyched up to have the test done, and with his reassurance that he was competent I went ahead.
I leaned on an upright examination table, then tilted my head back to expose my neck. ENT#1 conducted the test just as he’d described. He said he could tell by looking at the fluid that it was the fluid from inside the nodule. He was confident. When he was done with the test he returned the table to its normal horizontal position and left me sitting on it for a minute while he took the fluid samples to their rightful place. The test was complete.
While ENT#1 seemed pleasant enough, I felt an uneasiness. I was nervous about the test and the possibility of cancer, so I didn’t put much credit in that gut feeling. I put it down to nerves. In hindsight there were plenty of clues pointing to me being in the wrong place, but I hadn’t yet learned to rely on them.
Think about the medical providers you use right now. Are there clues that point to you being in the wrong place?