Four Grains of Rice

The above picture, taken peak-pandemic, circa April, 2021, finds your favorite gringo blogger struggling to wake up and greet the day. Post-morning fart, with noteworthy bedhead and spectacular beardage courtesy of local hair salons being shuttered due to coronavirus, I blearily imbibe coffee. I don’t recall what prompted me to stage this photo, but I remember those uncertain months and that very, very long spring, when hoarding toilet paper became a stock-in-trade and when hand sanitizer was seemingly more valuable than a pot of gold.

Fast forward a little more than five years, and no one talks about the pandemic anymore—almost as if it never happened. As for yours truly, I’ve moved to Knoxville and am five months into a new job with a company that genuinely values its employees. I still have that bathrobe and coffee mug, as well as the facial hair. The beard is less unkempt, though speckled with lots of gray. Beneath each eye: matching crow’s feet, or laugh lines, if you will.

Also, I’m two inches shorter than I was when this picture was taken.

A Wee Tumble

I don’t blog much anymore. One of my most recent entries, written last fall, details my 2024 Mount LeConte day hike-gone-wrong. It was almost one year ago, exactly one week before starting a new job, that I took a nasty spill on the way down from the summit of Mount LeConte, the third-highest mountain at Great Smoky Mountains National Park. The hike marked my fourth (I think) summit of LeConte, and my route was a loop trail that I had bagged once before. I tripped over a boulder embedded in the trail less than two miles from the bottom. The sun had gone down and I was flagging, though my headlamp and the lights of Gatlinburg below provided enough illumination for me to follow the uneven path. When I face-planted after a misstep, I miraculously avoided a concussion but suffered four broken bones and was ultimately air-lifted off the mountain. I had a metal plate inserted in my right arm the next morning.

Before anesthetizing me, doctors asked if I suffered from heartburn or a pronounced gag reflex. I answered “yes” to both and learned that a full-body x-ray revealed I had a moderate hiatal hernia, severe enough that one of the risks is choking to death while under anesthesia.

Yikes.

It explained the GERD-like symptoms I’d been feeling for the previous 18 months, and was something I had never gotten officially diagnosed because I didn’t have health insurance following a layoff. Can you afford $800/month in COBRA coverage? Neither can I…

Doctors performed the surgery anyway, and I’ll be forever grateful to Dr. Smith at UT for saving my arm, broken so badly from my fall that it was flopping back and forth like a beached salmon. I told myself that I would get that hernia officially diagnosed as soon as I was able to afford health insurance.

So Many Things

I went back to work in early 2025 and chose a PCP (primary care physician) in my insurance network. My first orders of business: a head-to-toe physical (it had been a while), a referral to a gastroenterologist regarding the hernia and acid reflux, and a couple of cortisone shots, one in each knee, those joints hurting from what I figured was thousands of miles of trail miles hiked. Remember: uphill hiking may be good for the heart, but downhill hiking is bad for the knees.

With a physical comes bloodwork, and for the doctor to call the results “concerning” would be an understatement. My calcium levels are dangerously high, he tells me, and it isn’t until then that I learn too much calcium is as bad as too little. Additionally, my parathyroid glands are malfunctioning. For one thing, these four tiny glands on either side of a person’s throat—four grains of rice, basically—are supposed to regulate calcium levels but instead are making my levels even higher. And for another thing, the ENT my GP referred me to suggests he’s never seen parathyroid levels so high before. And thus begins a supposition by the doctor that this could all lead, as well, to The Big C.

Holy shit.

Separate from my ENT referral, I was also referred to an orthopaedic specialist, a doctor who stated that I don’t have arthritis in my knees and that I just need physical therapy. He delivered a cortisone injection in my right knee at my request, though I don’t think he felt it was strictly necessary. So far so good, right?

Not so fast. The cortisone shot didn’t help at all, and my knees continued to ache. Stairs were becoming a real problem, and I was grateful that I prioritized finding a ground floor apartment when I opted to move to Knoxville. I requested an x-ray on my left elbow, which had recently developed a knotty bump I naturally assumed was a bone spur, similar to what pitchers and tennis players sometimes get, in my case from over-exerting my left arm after breaking my right.

Countless bone scans, MRI procedures, CT scans, and radioactive dye injections revealed the bump on my elbow to be a Brown’s tumor, a side effect of hyperparathyroidism. That bump, it would seem, isn’t going anywhere, and I learned two weeks ago that although benign, the unfortunate location will cause my elbow to snap unless surgery is performed…surgery that leaves me with a plate in my left arm, this one to match the plate I already have in my right!

Lo and behold, my parathyroid levels are so elevated that they’ve given me osteoporosis and caused me to lose two inches in height. Something (I may never know what) has caused my condition to escalate at an alarming rate over the past few months. Alas, I’ll never know how or why I developed hyperparathyroidism, nor how long I’ve had it. Knowing that it is making my bones slowly break down, though, I’m certain I’ve had it since at least last fall, considering how badly I injured myself on the Bullhead Trail from Mount LeConte. As for the knee pain that is not arthritis; it was explained to me by my second orthopaedic doctor, this one a proper oncologist, that the hyperparathyroidism is causing my bone marrow to act abnormally, and that this, not the osteoporosis itself, is the source of my physical pain. That doesn’t sound good at all.

Still, it’s a relief to finally have some answers, and a game plan: I am being referred to Vanderbilt, in Nashville, for surgery. For per my ENT: If I don’t have parathyroid surgery posthaste, my bones will collapse and I will be dead before the end of the year.

Next Steps

Okay, so my ENT didn’t say I would be dead by the end of the year. But he did say that this disease will kill me, and that my bones will rapidly begin to break down. Starting with my left elbow, it appears. Can you imagine plopping down on the sofa a bit too hard and your tailbone snaps off? Or tripping on an untied shoelace and breaking both wrists as you instinctively extend your hands to cushion your fall? This is my reality unless surgery is performed. And because I feel so bad, most of the time, I feel before-the-end-of-the-year is an accurate self-assessment. Today was a good day, but that’s not often the case lately. This past Thursday, for example, my arms felt like a ton of bricks, and it took me five trips to carry five grocery bags, each with only a few items apiece, from my front door to my kitchen counter.

Normally, parathyroid surgery can be a minimally invasive, outpatient procedure, with a few weeks of general malaise during recovery and a small scar on either side of one’s neck.

Not for me, though. As if my extreme hyperparathyroidism isn’t enough, a CT scan has uncovered a lesion on my neck adjacent to the thyroid and parathyroid glands. A nuclear medicine test tomorrow will determine if the melanoma is localized or if it is spreading. It sounds like they may now have to remove all four parathyroid glands as well as my thyroid itself to get all of the lesion. I imagine that removal of all four parathyroid glands—all four grains of rice—will necessitate calcium supplements for the rest of my life. But what about thyroid removal? The thyroid regulates metabolic functions in the human body. Heartbeat…weight…hormones…body temperature…sexual performance. Does this mean that I’ll gain a lot of weight, or that my voice will change, or that I’ll be unable to rise to the occasion, so to speak?

Once again, it seems I still have more questions than answers. Vanderbilt has a reputation as one of the best hospitals in the world, and I know I’ll be in good hands for my surgery, as yet unscheduled. My consultation with the otolaryngology surgical staff is on Thursday, and I’m told I’ll be given as much time as I need to get the answers I’m looking for. That being said, I’m terrified.

I’m terrified about having surgery done in the general vicinity of my throat. I’m terrified about a long recovery, which is said to include tingling in the extremities, as well as whole-body weakness. I’m terrified of further ingratiating myself at work, where I haven’t worked long enough to be eligible for FMLA, and where I’m still “junior” enough to be seen as expendable. I’m terrified about the financial impact, as my insurance will cover some, but not all, of the cost, and as I’ve already used up my employer’s generous PTO allotment for doctor visits leading up to this apparent inevitability. But mostly, I’m terrified of what will happen if I don’t get this done. Who knew that a person’s tiny parathyroid—just four grains of rice, really—can do so much damage? Fuck, I’m terrified. The alternative, though, is Death. It waits for us all, but judging by how I feel, methinks my name is written (hopefully in erasable ink) near the top of its list.

So really, what choice do I have?