Illness, Part 1: I'm Not Using It Anyway...

I was sick this spring, and at the doctor for a diagnosis. As is normal procedure, he felt my neck.


"Wow, your thyroid is huge!" he said.


"Yeah. I know." We've been down this road before.


He glanced over my chart, then at me, with my thinning hair, fatigue, coarse facial hair and general roundness, and said, "We need a full blood workup."


"OK – but we've done this before."


The first time was so long ago that I had a different doctor, probably 18 or 19 years ago. The blood panel said that everything was fine. "We'll keep an eye on it," the doctor said.


Years passed. Pregnant with my fourth child, I inexplicably lost weight all through the pregnancy. When I had her, I was 45 pounds lighter than I was the day I got pregnant. It stayed off for a year. I was eating a lot of fresh fruit, since that was my craving with this baby (with my oldest it was salad and eggs; with my third it was ham fried rice.) Still, I was also eating an extraordinary amount of sweets, which I always crave. I was eating more of everything than I ever had before. With two adolescents, a preschooler, a toddler and a newborn, I was also getting very little exercise and craving naps even after I had them.


After almost exactly a year, I started to gain weight. I cut down on sweets, then cut down on all food. The weight crept up anyway.


My doctor – a new one this time –sent me to an endocrinologist to be tested for Polycystic Ovarian Syndrome, based on my difficulty getting and staying pregnant, and the fact that I'd never had regular periods before Baby #4. Suddenly, after the baby, they were showing up every 30 days or so. For someone who regularly went three months without a period, it was actually annoying. "Again? We just did this!"


The endocrinologist felt my neck."Your thyroid is quite enlarged," she said. "Has anyone ever told you that?"


"Yeah, a couple of years ago."


"Did they test it?"


"Yeah. Everything was normal."


She did an ultrasound of my thyroid, then sent me for a complete blood workup. I did not have PCOS, it seemed,and my thyroid function tested normal.


"I'm not convinced," she said. She wanted another test on my thyroid. My portion, after insurance paid out – and we have great insurance – was $500, for a single test. I don't even remember what it was for anymore, but I declined. My PCOS diagnosis was negative, we'd already run thyroid tests, and I was not interested, with 4 kids and one income, in forking over $500 on a possibly unnecessary test.


At least twice more in the intervening years, my doctor has noticed that my thyroid is enlarged, and become alarmed, especially given some of the rest of my history/symptoms. So, he'll again run blood tests, tests that will all say that I'm fine.


So, last spring, I was grumpy and miserable enough that I griped to the physician's assistant when he mentioned doing it again. "We do this every three years or so, and I'm just tired of doing it over and over."


"Well, yes, I can see how that would be annoying."


He flipped back through my chart. "Yeah, last time everything was normal," he said. "We'll just see what comes up this time." He also ordered an ultrasound of my neck.


I have long resigned myself to the idea that if something is wrong, a standard blood test won't catch it. I also don't enjoy getting blood drawn just to hear that I'm fine. I grumped, I procrastinated, but I got blood work done AGAIN, and had a new ultrasound done.


Unlike my endocrinologist, my GP doesn't have an ultrasound machine, so I went down to the huge testing facility in town, where I've had MRIs, mammograms and more.


The technician seemed slightly bored. "So, what makes you think that you have thyroid problems?" she wanted to know.


I was annoyed. I felt as if she had looked at me and was thinking, "Come on, lady, every fat woman in town decides after reading some magazine article that she has thyroid issues. Just lay off the potato chips." I'm not a nut about healthy eating, but I have never in my life, for instance, polished off  a carton of ice cream by myself, as an annoying number of people assume, after no more than looking at me. Besides, I was there under protest.


I answered neutrally, "My doctor has noticed that my thyroid is enlarged. He'd like some tests run."


She had me lay back while she prepped the ultrasound wand. I felt her attention sharpen as soon as it touched my neck. She took a full hour plus to scan my throat, hitting what I think of as the still photo button ever minute or so. When we were done, I was miserable– I hate having my throat touched, much less getting pressure put on it – and dizzy. I went home and commented to my husband, "At least she stopped treating me like a hysteric when she saw that it actually is enlarged."


My blood tests - surprise, surprise–came back normal. My ultrasound, however, showed nodules on my thyroid. My doctor's office referred me to a surgeon. My PA remained puzzled during my follow-up visit to go over the test results – "Whatever they are, they're obviously not impeding function," he said.


I was still grouchy, but at least well enough behaved NOT to say what I thought – "Oh, yes, of course the gland that's been swollen for years and is now covered in unexplained growths must be functioning at its optimum." I just made an appointment with the surgeon.


The nurse ran through the now very familiar list of questions.


Fatigue? "Always."


Difficulty sleeping? "Yes."


Hair loss? "Since I was 16. This (riffling my hair) is all Rogaine."


Difficulty swallowing? "Yes. Even as a kid."


Digestive issues? "I was diagnosed with an ulcer at 20. It hasn't bothered me for years."


Joint issues? "I was just diagnosed with cubital tunnel syndrome." (It's like carpal tunnel, only in your elbow.) I also have knee issues.


Unexplained weight gain or loss? Depression or anxiety? I've been through all of this before. "But my blood work says my thyroid function is normal."


The surgeon felt my neck and dictated to his nurse, "REMARKABLY enlarged thyroid." I giggled. He had me swallow while he felt my throat. He felt all around my neck, then had me meet him in his office.


He was uninterested in talking about my normal blood test results, even when I brought them up. "The normal thyroid is about this long," he said, holding his fingers about an inch and a half apart. Mine, apparently, goes almost up to my jawbone, and down to my collarbone, and maybe even under the collarbone, "but I can't feel down that far." It spreads in the other direction almost ear to ear. "You have a minimum of 50 times the mass and volume that you should," he said. "Enlarged," indeed.


The original plan had been to look at removing the nodules, at least some of them, but he was not interested in trying that. Turning on his computer, he showed me the scans. The largest nodule is about 3 inches across, twice the normal size of the whole thyroid. He showed me more and more. "This one is over 5 centimeters. This one is over 6. This one is 3.5. So is this one." Things that were normally viewed in a single slide took two for me, on both sides of my neck.


I could keep it, he told me, but it was going to start encroaching on my voice box and windpipe. The best option would be to take it out entirely, and put me on daily pills for the chemicals it normally provides.


So, in a week, I go into the hospital. I have to stay overnight, which I am not at all thrilled about, but it's doable. I will leave without a thyroid. "Your operation will take twice as long as an ordinary thyroid removal."


He's making no promises for how I'll feel after it's gone, but the surgeon has made one promise about how I'll look. "You won't recognize your neck," he says.

How Does Your Garden Grow?

     We have finally hired professionals to do some long overdue work on our house - trust me, there will be essays, with photos, devoted to all those details. Right now, though, I want to talk about my garden.

     I knew that my plants would be trampled by workmen. They were putting stucco on the house, which necessitated scaffolding, which was up for weeks, and a lot of foot traffic right next to the house. It was important enough that I was willing to sacrifice everything in the two beds next to the house. I didn't even plant my vegetable beds this year, since they're against the back of the house.

     I was right - those two beds were trampled almost to oblivion. My yucca and two worse-for-wear chamomile plants survived. There's no trace of my daylilies or of my yellow and gold lantana. My lamb's ears survived, but they're pretty matted down.

     I knew it was coming, so it wasn't excruciating to let go. It's sad, and I'm hoping that some roots survived to send up new shoots. If not, OK. I just planted some annuals, including portulaca, one of my favorites, so it doesn't look too naked.

     I was not prepared for the wear and tear on the rest of my yard.

     Before I say this, don't get me wrong. The work these men did on my home is beautiful. I am very glad; I would have the work done again if given a chance for a do-over. We're happy, the neighbors are happy, and as far as I know, the workmen are happy.

     But for crying out loud, is it that tough to walk on the paths? We have a lot of gravel, since my husband and I are both allergic to grass. We also have quartzite flagstone, surrounded by pebbles. You'd think that walking on, and piling your materials on, gravel and flagstone would be easy. We're not going to whine that your lumber is killing our lawn - we don't have one.

     Why, then, did wood end up in the flower bed, tossed right on top of my shrubs? SHRUBS - I mean, they're tall, they're lumpy - how convenient can it be to set your stuff on top of them? Now my shrubs are matted and broken.

     I don't know what these shrubs are; they're something that tolerate poor soil and low water and produce lots of blue flowers that attract bees. I bought them because they were on end of season clearance years ago, 2 for $5. (I bought 4.) Still, I love them, and they're clearly not a walkway.

     Areas that were clearly flower beds, filled with blooming things and edged in stone, became thoroughfares. I'm not talking "occasionally stepped in," I'm talking "the main walkway through the yard." My phlox are trampled into the ground.

     Some of my flagstones were broken, I'm assuming while bearing the weight of the scaffold. I'm OK with that. They're not set in concrete or in any pattern, so it's easy to move them around a bit and make it look OK.

     There's gobs of dripped and dropped cement all over everything, though. The workmen cleaned up a lot, I cleaned up a lot, and you can still find it in my flower beds, on my gravel and on my rocks. On the rocks is the worst - you can leave it, or you can expend considerable energy chipping it off. I'm peeling the cement and the plasticized final color coat of stucco off of my spiky yucca leaves.

     Still, there is much to be happy about in my garden.

     My entire theory of landscaping is to make it totally neglect proof. I'm not talking "benign neglect," I'm talking about, "I haven't even thought about you for weeks" neglect. I love masses of flowers (my favorite colors are purple, lavender, blue and white) spilling out of overcrowded beds. I love succulents, vines, veggies and trees. I do not, however, want to baby anything. I hand water once a week; it takes between 15 and 30 minutes. If something can't survive that, I don't want it.

     I know that there are places where you can plant anything, and expect Mother Nature to provide all the water it needs. I do not live in one of those places. I live in the high mountain desert, with snow and low temperatures in the winter and blistering heat and lack of rain in the summer.

     I have four different colors of bearded iris. I love how they look, I love how they smell, but most of all, I love that neglect makes them actually happy. I once had some in between two outbuildings, and I didn't water them for literally a year; they bloomed and multiplied happily.

     In the last house my daughter rented, the landlord wanted a nice looking yard, and my daughter wanted to avoid yard work. I got permission to plant things, and put transplanted iris from my yard in her front yard. My daughter hasn't lived there for years, and the house spent more than a year vacant. We still drive by occasionally, dropping my son off at work. Now, with new owners, little remains of much of the original landscaping. The lawn is gone, the tree is gone, even some of the weeds are gone. Most of the yard is dead. The iris are thriving. Even when the house was vacant, there they were, a bigger and bigger mass, flowering like there was no tomorrow. Their exuberance makes me happy.

     In my yard, we also have grapevines that we frequently have to cut back, Virginia Creeper that is spreading and raspberry bushes that are multiplying. We have fruit and shade trees. I do not water any of them, ever.

     Besides the iris, I have two kinds of sedum, a succulent called "hen and chicks," something blue that I got as a hand-me-down transplant, lilies, daylilies, lamb's ears, honeysuckle, roses, a burning bush, chamomile, phlox, yucca, those shrubs, lavender, several kinds of bulbs, a butterfly bush, yarrow, some corkscrew-looking plant whose name I don't know (the tag said "donkey tails), euonymous bushes, creeping myrtle, two kinds of mums, and strawberries. All those get watered once a week. I chose most not because I adore them, but because they're tough and look great in rough conditions. (My soil, for instance, is not great.)

     I did not count on my hoses being removed from my house during the stuccoing. I also did not count on having limited access to my yard, even away from the house. I am not about to try to cart out a watering can for my entire yard, even if I could reach it all. Nothing got a drop of water for over a solid month. Of course, it's summer, with temperatures in the 90s and 100s.

     Everything looks great. Except for the stuff that was crushed (and I pruned those), you'd never know that anything less than ideal had happened. Even strawberries that had only been transplanted three weeks before the process began are happy. Even the crushed stuff, inclding my poor phlox, is blooming. Not every plant, but certainly every variety that's normally in bloom right now.

     Success! I have mastered the neglect proof landscape! There is, alas, no trample proof landscape.

     To thank everything for looking so great with no water, I watered as soon as the stucco hardened and the hoses could be reattached.