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Notes
Bad reactions to the anesthesia THYROIDECTOMYYour Body
The goal of a thyroidectomy is to treat your condition by removing all or part of thethyroid gland. This operation is an excellent way to treat, or begin treating, several thyroid problems.
 The thyroid is in the front part of your neck, just below your voice box (larynx). It's shaped a little like a butterfly. The butterfly's wings are the right and left lobes. The lobes wrap around your windpipe.  Nerves that control your vocal cords and voice box run alongside your windpipe. On the back side of your thyroid are the parathyroid glands. They control calcium levels in your body.
Bean-shaped things called lymph nodes carry a fluid called lymph as it moves through your lymphatic system, which runs all over your body.
What does the thyroid gland do?
The thyroid uses iodine from your blood to make a hormone that controls how your body uses energy (or your metabolism). So it helps control things like how many calories you burn, your body temperature, and menstrual cycles (or when you get your period).
Your thyroid hormone level needs to be balanced so your body works as it should. Too much or too little thyroid hormone in your blood can throw your system out of balance and cause all kinds of problems.
You can live without a thyroid gland.
Even if your entire thyroid gland is removed, taking daily medication can get thyroid hormone into your system. In fact, you may already take medicine to keep your thyroid hormone level in a healthy range. Your Condition
Some thyroid conditions are more likely to need surgery than others. But some of the most common conditions that need to be treated with this operation are:
Nodules
Nodules are lumps inside the thyroid gland. They're pretty common, and anyone can get them. Most of the time, nodules don't cause any problems. And if a harmless nodule is found, your doctor may decide to just leave it alone.
But you may need surgery if a nodule is:
If you have a nodule, before the operation, your doctor will most likely do something called a fine needle aspiration (also called an FNA or biopsy). In fact, you may have already had this.
Usually, a fine needle aspiration is done to remove a few cells so they can be looked at under a microscope to make sure cancer isn't there.
Goiter
When the entire thyroid gland gets bigger it's called a goiter. Like nodules, goiters don't always have to be removed. But if a goiter is causing problems with swallowing or breathing, or if it's big and your doctor thinks it should come out, surgery may be done to remove it.
Doctors often don't know of any one cause for goiters. But they may be caused by a combination of things, including:
HypothyroidismWhen the thyroid makes too little hormone, it's called hypothyroidism. Surgery is notneeded to treat this.
Hyperthyroidism
When it makes too much hormone it's called hyperthyroidism. Surgery may be done for this. Hyperthyroidism speeds up your metabolism and causes your body to use energy too fast, and this can make you feel jittery, irritable, lose weight, or have trouble sleeping.
The thyroid isn't always removed to treat hyperthyroidism. But when medication or other things like radioactive iodine treatments don't work to control hyperthyroidism, all or part of the thyroid may need to be removed.
Thyroid cancerAs you know, our bodies are made up of billions of cells. In a healthy body, cells grow, divide, and eventually die. And as old cells die off, they're constantly replaced by new ones. Cancer happens when abnormal cells continue to multiply. And a lump of tissue called a tumor can form.
The most common, and most treatable, type of thyroid cancer is something calledpapillary thyroid carcinoma. This kind of cancer tends to grow slowly, and usually is NOT life threatening. In fact, it has a very high cure rate. But there aren't many things scarier than cancer, no matter how treatable it is. So if you've been diagnosed with thyroid cancer, talk with your doctor about the type you have.
Before Surgery
Before surgery, you'll probably have a few more tests. You'll most likely have a physical exam that may include things like:
It's also very important for your surgeon to learn about your overall health and your health history. And it's up to you to fill her in. Think of yourself as a key member of your healthcare team. When you give your doctor the information she needs, you increase your chance for success.
Let your surgeon know if:
For your safety, make a list of everything you take. Be sure to include:
You may need to get some medications out of your system in the weeks before surgery.
For instance, your doctor may ask you to temporarily stop taking anything that can increase the risk of bleeding. This includes things like:
If you take a blood thinner like warfarin (also called Coumadin®) or drug called Plavix®, you'll need to talk to the doctor who put you on this drug to find out exactly what to do. But do not stop taking this kind of medication on your own. Your doctor needs to help you do this safely.
For a complete list of what to stop taking, and when, ask your doctor.
It's also important to know which medications you should KEEP taking. If you take medication now for things like high blood pressure, make sure you talk with your doctor about this.
Support
It's a good idea to ask a family member or a friend to be there with you for comfort and support. Think of this person as your partner in care. Doctors and nurses like to have one "go to" person for all communication. He or she should be able to speak up for you, ask questions, and give information about your health. Be sure to introduce this person to your doctors and your nurses so they know it's OK to share your health information with them.
The night before surgery
One thing that's VERY important, do NOT eat or drink anything after midnight. If there's anything in your stomach and you throw up during the operation, it can be very dangerous. So make sure your stomach is EMPTY, or your surgery may need to be rescheduled.
That said, if your doctor says it's OK to take some or all of your regular medications on the morning of surgery, just take it with a sip of water.
Your Procedure
Your surgeon will have a specific plan for your operation and recovery. But this will give you a general sense of how surgery will go.
First, an IV line will be placed in your hand or your arm. This is so you can receive antibiotics, medication, and fluids.
Then you'll go to the operating room. When you get there, you may be connected to:
Anesthesia
Then they'll start your anesthesia, which can be given a couple of ways.
You may have a combination of medicine to numb your neck, and medication that will make you very drowsy. This is called conscious sedation. The medicine won't put you to sleep completely. But you probably won't remember anything that happens during surgery.
General Anesthesia
Many times, this surgery is done under general anesthesia, which puts you into a deep sleep, so you're completely out.
The Procedure
When everything is ready, surgery can begin. It usually takes anywhere from 1 to 3 hours.
After Surgery
After surgery, expect to feel groggy and a little out of it. If you feel sick to your stomach or have the chills, just ask your nurse to help you get comfortable.
In recovery
You'll be hooked up to some monitors and your IV line for medication and fluids. After a couple of hours, a nurse will help you get up and walk. Moving around can help prevent blood clots from forming in your legs and helps you regain strength.
Most people are surprised by how well they feel right after surgery. In fact, a lot of people are able to walk around and eat normally the same day as their operation.
Going home
Some people go home the same day as their surgery. But many people stay for a night. Once your doctor thinks you're ready, you can go home. Just make sure you have someone to drive you home and stay with you.
In fact, you may not be able to drive for a while. If you have any questions about when it's safe for you to drive again, ask your doctor.
When I get home, will I be in a lot of pain?
Many people say the pain isn't too bad. But for the first few days after surgery you may have:
Your doctor will prescribe pain medication if you need it. But some people only feel like they need to take over-the-counter drugs like Tylenol® for their discomfort. In fact, some people don't need to take any medication at all. Just make sure you understand your doctor's instructions on how and when to take any medications.
Bathing
If you have any questions about this, ask your doctor.
Returning to work and other activities
You should be able to return to work in about a week. But it could be sooner or later. It just depends on how well you feel and what kind of job you have.
You'll most likely feel good enough to do many of your normal activities in a few days to a week. Just don't push yourself too hard in the first couple of days.
One thing you should do is move your neck from side to side. Rolling your shoulders is good, too. Gentle stretches like these should help prevent stiffness.
Of course, if you have any problems during recovery, please call your surgeon.
Call right away if you have:
Also call if you have:
It's normal to have MILD numbness and tingling in these areas. But if it's severe, call your doctor.
Or call if you experience anything unusual. If something just feels wrong, let your doctor know.
Thyroid replacement therapy
Depending on how much of your thyroid is removed, you may need to take medication after surgery that will do the job of your thyroid gland. This is called thyroid replacement therapy.
Thyroid replacement is typically a pill you take once a day that has the exact same chemical makeup as the hormone your thyroid makes. And you may have to take a pill daily for the rest of your life. Most of the time, people who need thyroid replacement pills start taking them soon after surgery. In fact, you may have been taking them before surgery to try treating your condition.
TSH test
It may take a little while before the hormone level in your system is right. So about 6 weeks after surgery you'll have a simple blood test called a thyroid-stimulating hormone (TSH) test.
A TSH test lets your doctor figure out how much thyroid medicine you need by seeing if there's too much or too little TSH in your blood. If your dosage is adjusted, your blood will be tested again in another 6 to 8 weeks to see if your TSH is balanced. If it is, you're getting the right amount of thyroid medication.
It may take a few adjustments before the hormone level is balanced. But once it is, you'll most likely have a TSH test once a year. With balanced hormone levels, you shouldn't have any problems with weight gain or low energy, but if you have questions about this ask your doctor.
Risks and Benefits
Benefits
How this surgery benefits you depends on your condition.
Risks
There is a risk of injury to the nerves that control your vocal cords. An injury may cause a hoarse-sounding voice, trouble swallowing, or trouble breathing. Any problems may go away in the weeks after surgery, but sometimes they can be permanent.Like any operation, a thyroidectomy has some risks. Below are some of the risks of this operation, but this isn't meant to scare you. Understanding what's involved is an important part of any operation. If you have any questions about how these risks relate to you, please ask your doctor. Also, there are some very unusual risks that will not be covered here. So please do not consider this list complete. Because your surgeon needs to work very close to the nerves that control your vocal cords, there's a risk a nerve in this area could be stretched or injured. This may cause a weak or hoarse-sounding voice. You also may not be able to project your voice as well, or hit high notes when you sing. Sometimes, it may be harder to swallow food, drink, or pills. And although seriuos breathing problems are rare, sometimes people get short of breath, have noisy breathing, or trouble coughing. So keep your doctor up to date. She may suggest other procedures to help with any problems. And of course, if you have serious trouble breathing, get emergency help right away. Most of the time, these problems are temporary and go away within 6 months. But in some cases, these problems can be permanent.There is a risk that the parathyroid glands may be injured or removed during the operation. In some cases, you may need to take calcium pills (possibly every day) for the rest of your life. Even though the goal of this surgery is to remove all or part of the thyroid gland, there is a risk that the parathyroid glands (which control calcium levels in your blood) may be removed as well. Or they may be injured. The parathyroid glands are very small, and are often difficult for the surgeon to see. So if the parathyroid glands are removed or injured, calcium in your blood may drop to a low level. If this happens, it may cause:
With any surgery, there's a risk of bleeding. Most of the time, your doctor will be able to control any bleeding or it will stop on its own. But bleeding may not happen until several hours, or even days, afterward. If you have bleeding in the days after surgery, in very rare cases, you may need another operation to treat it. It's common for a small amount of blood and other fluid to collect where the thyroid was removed. But sometimes a lot of blood can collect under the skin, and a hematoma can form. Hematomas are usually small and the body just absorbs them naturally. But in rare cases, a hematoma can be large and may block your airway. If this happens, you may have trouble breathing and you should call your doctor right away. Your doctor may need to drain the area, possibly with another operation. There is a risk of bad or allergic reactions to the anesthesia, medications, or materials that are used. While it's very rare, you can die from a serious reaction. Some people may have bad reactions to anesthesia. For example, they may feel sick to their stomach or throw up after their procedure. But an allergic reaction happens when your body tries to get rid of something it doesn't want. And it's your body's response that can be serious. Signs can include:
If surgery is done to treat thyroid cancer, there is a risk that this operation will NOT cure it. Even if the operation goes exactly as planned, there is a risk that cancer cells may still be in the body after surgery. Removing the thyroid gland often cures many kinds of thyroid cancer. But if cancer cells are still in the body after the operation, other treatments like radioactive iodine treatments may be done. In rare cases, chemotherapy may be needed after the operation. If surgery is done to treat thyroid cancer, there is a risk that cancer can return after the operation. If this happens, you'll need more thyroid cancer treatments. Your surgeon will do everything she can to remove all of the cancer. And even though it's uncommon, there is a risk that cancer will return (recur) sometime after surgery. If cancer returns, it can show up where the thyroid gland was, or in the lymph nodes. But very rarely, cancer can spread to other parts of the body like the lungs or bones. If cancer returns, you'll talk with your doctor about the best treatment plan for you. And this may include another operation. There is a risk of infection. In rare cases, more surgery may be needed to treat an infection. Although your surgeon will take great care to prevent it, you may get an infection in the area surgery as done, or in other parts of your body (like in your lungs or bladder). Signs of a wound infection include:
There is a risk of blood clots that, in rare cases, can be life threatening. Blood clots can form in your blood vessels during or after surgery. In rare cases, a blood clot can travel to the heart or lungs. This can be very dangerous and can even be life threatening. Signs of blood clots include:
There is an extremely small risk of a stroke, heart attack, or death. Although the risk of a stroke, heart attack, or death is extremely small, these and other risks are possible during your surgery or recovery. Things like your age, the condition of your heart, being very overweight, and past illnesses and surgeries can make the operation more difficult. As a result, you could become seriously ill or die. Alternatives
The decision to have a thyroidectomy is up to you.
Thyroid cancerIf you've been diagnosed with thyroid cancer, a thyroidectomy is the only way to treat, or begin treating, your condition.
Watchful waiting for harmless nodules or goiters
For harmless nodules or goiters that don't cause problems, treatment isn't always done right away. This is called watchful waiting. Watchful waiting does NOT mean you or your doctor ignore your condition. Instead, physical exams or ultrasounds are done to keep a close eye on the nodule or goiter to see if it gets bigger or causes other problems. And if your condition becomes more serious later on, you and your doctor will decide if a thyroidectomy or other treatments are needed.
Other treatments
Other conditions like hyperthyroidism can often be treated with things like medication and radioactive iodine treatments. You may have even tried them and they didn't work. But most likely, you've at least talked with your doctor about these treatments already and decided that surgery is right for you.
This operation often works to treat, or begin treating, many thyroid conditions. And again, even though your body needs thyroid hormone to work well, there is medication to replace it. So even if your entire thyroid gland is removed, you can live a normal, healthy life.
Health Information Forms
After you print this summary, you can fill out the following forms. Keep a copy at home and take a copy to your next doctor's appointment.
    Emmi is an interactive, informational program offered by doctors to educate patients about risks, benefits, and potential outcomes associated with various medical treatments and surgical procedures. Your doctor has chosen to use Emmi to help you understand a health care procedure that he/she has recommended. To ensure that your doctor knows that you viewed this presentation, a record of your viewing will be sent to him or her as part of the informed consent process. By participating in this program, you are agreeing to allow Emmi to share the information you have provided to Emmi with your doctor. Emmi is provided for information and education purposes only. No doctor/patient relationship is established by your use of this program. Emmi provides no specific diagnosis or treatment for you. The information contained here is an educational supplement to your consultation with your doctor. While Emmi is intended to educate you about the procedure your doctor has recommended and the most common potential risks and complications of the procedure, it is not all-inclusive. There may be other complications, known and unknown, which result from the surgery. No guarantees or warranties are made regarding the surgery itself. Emmi is not intended to offer specific medical or surgical advice to anyone. It is also not a substitute for the informed consent process that your doctor will handle directly with you. Further, please be sure to discuss any questions or concerns you have regarding the information contained here, as well as the risks associated with refusing the treatment or procedure, directly with your doctor. By participating in this program, you are agreeing to allow Emmi to share the information you have provided to Emmi with your doctor. ©2011, Emmi Solutions, LLC. All rights reserved. | |||
2013年12月30日星期一
甲状腺切除手术 (THYROIDECTOMY)
2013年12月29日星期日
Free T guide post Thyroidectomy
What are T4 and T3?
T3 is the active thyroid hormone utilized in the body. The thyroid makes very roughly 20% of the T3 in the body though some people it likely makes way more than this amount. This is the portion that is not converted from T4. The rest of the active T3 comes from conversion from T4, this occurs in many places in the body though many places depend upon the liver and other places to convert it for them. The thyroid makes other things too, but mainly T4 or the storage thyroid hormone. T4 cannot be used anywhere in the body so it is considered inactive or storage only. It can only be converted to active hormone before being used. This is kind of like crude oil which isn't gasoline, and crude oil doesn't fire in the cylinders of the car, only gasoline does but of course we do need crude oil to get gasoline (called refining not conversion).
After thyroidectomy most doctors give T4 only despite knowing the thyroid made more than T4.
T3 is in a prescription called cytomel, this is synthetic T3. Cytomel is often sold in 5 mcg (low amount) or 25 mcg (high amount) pill forms so it is difficult to titrate a long term dosage. T3 is also in natural thyroid prescriptions (from animals). There are 9 mcg of T3 in each grain of natural thyroid. T3 has very rapid effects.
T4 is in a prescription called Levothyroxine, Synthroid, Tirosint and other names. These are the synthetic forms. It also is in natural thyroid prescriptions (from animals). In natural thyroid there are 38 mcg of T4 per grain of natural thyroid. T4 tends to change things slowly.
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
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General info on Free T’s (laboratory test):
One learns that Free t's, not TSH are the most critical thing to feeling well. It's not that we ignore TSH, because that is important for cancer prevention but TSH does not help you feel well. Free t's should be your guide to feeling well. Most doctors don't bother checking Free T labs carefully, they just look at TSH and assume you are ok even though the Free t's may be super out of whack and unfortunately you will be too.
One also has to look at vitamins, minerals, cortisol, iron, B-12, and others. Importantly, if T3 levels are good and Free t4 not too high that is a very important signal to look at reverse T3 and related issues such as iron.
Free t ranges are in a state of change. Free t4 ranges coming down, Free T3 ranges coming up over last 5 years. Ranges were designed around people with a thyroid, we need higher Free T3 post TT because we no longer have an on demand system and generally speaking the pituitary makes its own T3 from T4 so we want to be sure the rest of the body has an adequate supply in the post TT world where T3 issues cause most of the problems that happen because doctors take the T4 high making the pituitary supplied but the rest of the body not.
Because I use that as a method, I reference people carefully doing Free T labs at about midpoint from thyroid meds. Midpoint is not close to taking medications, and not too far from medications.
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Two common problem areas and some symptoms
High Free t4 – symptoms include mood changes and swings, irritability or a short temper, headache and migraine, body aches and pains
Low Free t3 – all the symptoms of hypothyroidism, but common are the brain fog or loss of attention span, feeling tired or no ability to do things like we used to, skin issues, hair loss, fingernail issues, inability to lose weight despite honest effort, and many more
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FREE T3 – Active hormone
A better Free t3 range in US (traditional units) post TT would be something like 3.0 to 5.0 pg/mL (roughly 20% added to a normal thyroid patient). One can get Free T3 related hypo symptoms well into the mid 3's particularly with no thyroid. If you are generally above 3.0 pg/mL and have no other issues such as vitamin, mineral, adrenal/cortisol and sex hormone related it is possible to feel ok. Official ranges vary but often much lower, an example range semi-updated would look like 2.4 to 4.4 pg/mL, but I would love to see the bottom raised. Definitely aim for above 3.0 pg/mL, and if you can get to 4.0 pg/mL that is better. Generally speaking if one optimizes all issues such as vitamin and mineral and other mentioned above, and the FT3 is low the only way to raise it is a long term cytomel prescription or natural thyroid containing T3.
For system international (SI) including Canada, or mostly non-US based labs: Conversion factor pg/mL to pmol/L is 1.5362. SI free t3 ranges, a suggested better range post TT as 4.5 to 7.5 pmol/L. Aim for a minimum of 4.5 but 6.0 pmol/L is better.
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FREE T4 – storage hormone only no merit to making it high.
Older Free t4 ranges in US often went as high as 2.0 ng/L but some places have taken the top down to 1.5 ng/L now, and if not that then maybe 1.7 or 1.8 ng/L. I don't like my Free t4 over 1.4 so I can let T3 do its job. I am fine at moderate Free t4, or 1.1 or 1.2 ng/L but people vary where they feel well and some like it a bit higher. If I had lots of Reverse T3 I would let my Free t4 go much lower because reverse T3 is made from T4. An example range reasonably updated would look like 0.75 to 1.5 ng/L. If you test above 1.4 the only way to reduce this number is to reduce your T4 medications, and if your TSH is not where needed you need a long term cytomel prescription or switch to natural thyroid.
For system international (SI) or non-US ranges: Conversion factor ng/L to pmol/L is 12.87. For SI look for ranges ending somewhere around 19.0 pmol/L but stay under that. Ranges might run 9.6 to 19.0 pmol/L. I personally would like my FT4 level about 15.0 if it were in SI ranges.
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Important lab based goals and supplements to discuss with your doctors:
Total Vitamin D (25-Hydroxyvitamin D): 70 ng/mL
B-12: 800 pg/mL
Ferritin male over 100 ng/mL, female 90 ng/mL but ferritin is just storage iron or one type of iron measure
One can take Selenium and Zinc to help the T4 convert to T3. Check all your vitamins before adding as you do not want to go too high. Suggested dose:
Selenium up to 200 mcg OR several Brazil nuts
Zinc 30 mg
Iodine 300 to 500 mcg a day
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When to get Free t labs:
If you test soon after taking your thyroid meds the levels on Free t’s will read too high, if you test the next morning before you take meds it might be too far out and will test low. I suggest a minimum of four hours but best perhaps at 9 to 12 hours out from taking thyroid medications, or the midpoint. Whatever you choose a consistent method not too close and not too far from taking your medications should be used to see if things are moving the right direction.
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Where to get Free t labs:
If docs won’t order, first look for a doc that does, but you can order your own:
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
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My doc doesn't want any of this, what should I do?
You can always look for another doctor, in the mean time all the issues mentioned under supplements and lab based goals section can be worked on with a primary care.
You can also switch around the T4's. Tirosint is perhaps the best T4 out there because it does not have the fillers that many get issues with in other T4's. There have been people who posted taking exact same amount (mcg the same) of synthroid and Tirosint yet the results for Free t3 improved on the Tirosint meaning the conversion was improved. So it is a good first choice to try to help improve things, but it may not always improve T3 for all people just certain ones. I have less side effects on Tirosint versus synthroid, but I need plenty of cytomel on either. Nevertheless, Tirosint many docs will give a prescription for, cytomel many docs won't, and since it can often help out it is a good start.
Your dose may need to lower on Tirosint since it is highly absorbed and Tirosint may cost you a lot more. You can try other T4's too. If nothing else most doctors would certainly agree to try these T4 options.
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But my endocrinologist said my numbers look "good"?
What an endocrinologist means when they say something like numbers are "good", means you are TSH suppressed for cancer recurrence prevention. TSH does NOT help you feel well, it has nothing to do with that. To feel well a person has to look at carefully timed Free T levels, plus vitamins, minerals, etc.
It is possible to have both cancer recurrence prevention and to feel well via well adjusted and timed Free T labs, vitamins, minerals, but don't expect that many an endocrinologist to do that for you though some might. The main lesson is you will have to be your own advocate and take your own initiatives, make your own requests. For the most part the vitamin, mineral and sometimes even the Free T's have to be worked out via your request and initiative with a primary care and sometimes a general endocrinologist can take over once the Free T level are adjusted properly.
Endocrinologists are paid to handle cancer recurrence prevention, not help you adjust Free T's, vitamins and minerals like iron or others. Some will do this free of charge essentially but don't expect lots for free. This is the mandate of the terrible insurance system in the USA. Though insurance varies, endocrinologists are paid for what medicare coding dictates and that relates to TSH suppression and checking for cancer. Other countries often just copy what the USA does even though medicare coding is a flawed system. None of that will help you feel well, though it may help you prevent cancer from coming back plus detecting it if it does starts coming back. Most people post thyroidectomy still do need the traditional care of looking at cancer recurrence.
=================
T3 is the active thyroid hormone utilized in the body. The thyroid makes very roughly 20% of the T3 in the body though some people it likely makes way more than this amount. This is the portion that is not converted from T4. The rest of the active T3 comes from conversion from T4, this occurs in many places in the body though many places depend upon the liver and other places to convert it for them. The thyroid makes other things too, but mainly T4 or the storage thyroid hormone. T4 cannot be used anywhere in the body so it is considered inactive or storage only. It can only be converted to active hormone before being used. This is kind of like crude oil which isn't gasoline, and crude oil doesn't fire in the cylinders of the car, only gasoline does but of course we do need crude oil to get gasoline (called refining not conversion).
After thyroidectomy most doctors give T4 only despite knowing the thyroid made more than T4.
T3 is in a prescription called cytomel, this is synthetic T3. Cytomel is often sold in 5 mcg (low amount) or 25 mcg (high amount) pill forms so it is difficult to titrate a long term dosage. T3 is also in natural thyroid prescriptions (from animals). There are 9 mcg of T3 in each grain of natural thyroid. T3 has very rapid effects.
T4 is in a prescription called Levothyroxine, Synthroid, Tirosint and other names. These are the synthetic forms. It also is in natural thyroid prescriptions (from animals). In natural thyroid there are 38 mcg of T4 per grain of natural thyroid. T4 tends to change things slowly.
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
----
General info on Free T’s (laboratory test):
One learns that Free t's, not TSH are the most critical thing to feeling well. It's not that we ignore TSH, because that is important for cancer prevention but TSH does not help you feel well. Free t's should be your guide to feeling well. Most doctors don't bother checking Free T labs carefully, they just look at TSH and assume you are ok even though the Free t's may be super out of whack and unfortunately you will be too.
One also has to look at vitamins, minerals, cortisol, iron, B-12, and others. Importantly, if T3 levels are good and Free t4 not too high that is a very important signal to look at reverse T3 and related issues such as iron.
Free t ranges are in a state of change. Free t4 ranges coming down, Free T3 ranges coming up over last 5 years. Ranges were designed around people with a thyroid, we need higher Free T3 post TT because we no longer have an on demand system and generally speaking the pituitary makes its own T3 from T4 so we want to be sure the rest of the body has an adequate supply in the post TT world where T3 issues cause most of the problems that happen because doctors take the T4 high making the pituitary supplied but the rest of the body not.
Because I use that as a method, I reference people carefully doing Free T labs at about midpoint from thyroid meds. Midpoint is not close to taking medications, and not too far from medications.
----
Two common problem areas and some symptoms
High Free t4 – symptoms include mood changes and swings, irritability or a short temper, headache and migraine, body aches and pains
Low Free t3 – all the symptoms of hypothyroidism, but common are the brain fog or loss of attention span, feeling tired or no ability to do things like we used to, skin issues, hair loss, fingernail issues, inability to lose weight despite honest effort, and many more
----
FREE T3 – Active hormone
A better Free t3 range in US (traditional units) post TT would be something like 3.0 to 5.0 pg/mL (roughly 20% added to a normal thyroid patient). One can get Free T3 related hypo symptoms well into the mid 3's particularly with no thyroid. If you are generally above 3.0 pg/mL and have no other issues such as vitamin, mineral, adrenal/cortisol and sex hormone related it is possible to feel ok. Official ranges vary but often much lower, an example range semi-updated would look like 2.4 to 4.4 pg/mL, but I would love to see the bottom raised. Definitely aim for above 3.0 pg/mL, and if you can get to 4.0 pg/mL that is better. Generally speaking if one optimizes all issues such as vitamin and mineral and other mentioned above, and the FT3 is low the only way to raise it is a long term cytomel prescription or natural thyroid containing T3.
For system international (SI) including Canada, or mostly non-US based labs: Conversion factor pg/mL to pmol/L is 1.5362. SI free t3 ranges, a suggested better range post TT as 4.5 to 7.5 pmol/L. Aim for a minimum of 4.5 but 6.0 pmol/L is better.
----
FREE T4 – storage hormone only no merit to making it high.
Older Free t4 ranges in US often went as high as 2.0 ng/L but some places have taken the top down to 1.5 ng/L now, and if not that then maybe 1.7 or 1.8 ng/L. I don't like my Free t4 over 1.4 so I can let T3 do its job. I am fine at moderate Free t4, or 1.1 or 1.2 ng/L but people vary where they feel well and some like it a bit higher. If I had lots of Reverse T3 I would let my Free t4 go much lower because reverse T3 is made from T4. An example range reasonably updated would look like 0.75 to 1.5 ng/L. If you test above 1.4 the only way to reduce this number is to reduce your T4 medications, and if your TSH is not where needed you need a long term cytomel prescription or switch to natural thyroid.
For system international (SI) or non-US ranges: Conversion factor ng/L to pmol/L is 12.87. For SI look for ranges ending somewhere around 19.0 pmol/L but stay under that. Ranges might run 9.6 to 19.0 pmol/L. I personally would like my FT4 level about 15.0 if it were in SI ranges.
----
Important lab based goals and supplements to discuss with your doctors:
Total Vitamin D (25-Hydroxyvitamin D): 70 ng/mL
B-12: 800 pg/mL
Ferritin male over 100 ng/mL, female 90 ng/mL but ferritin is just storage iron or one type of iron measure
One can take Selenium and Zinc to help the T4 convert to T3. Check all your vitamins before adding as you do not want to go too high. Suggested dose:
Selenium up to 200 mcg OR several Brazil nuts
Zinc 30 mg
Iodine 300 to 500 mcg a day
----
When to get Free t labs:
If you test soon after taking your thyroid meds the levels on Free t’s will read too high, if you test the next morning before you take meds it might be too far out and will test low. I suggest a minimum of four hours but best perhaps at 9 to 12 hours out from taking thyroid medications, or the midpoint. Whatever you choose a consistent method not too close and not too far from taking your medications should be used to see if things are moving the right direction.
----
Where to get Free t labs:
If docs won’t order, first look for a doc that does, but you can order your own:
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
----------
My doc doesn't want any of this, what should I do?
You can always look for another doctor, in the mean time all the issues mentioned under supplements and lab based goals section can be worked on with a primary care.
You can also switch around the T4's. Tirosint is perhaps the best T4 out there because it does not have the fillers that many get issues with in other T4's. There have been people who posted taking exact same amount (mcg the same) of synthroid and Tirosint yet the results for Free t3 improved on the Tirosint meaning the conversion was improved. So it is a good first choice to try to help improve things, but it may not always improve T3 for all people just certain ones. I have less side effects on Tirosint versus synthroid, but I need plenty of cytomel on either. Nevertheless, Tirosint many docs will give a prescription for, cytomel many docs won't, and since it can often help out it is a good start.
Your dose may need to lower on Tirosint since it is highly absorbed and Tirosint may cost you a lot more. You can try other T4's too. If nothing else most doctors would certainly agree to try these T4 options.
----
But my endocrinologist said my numbers look "good"?
What an endocrinologist means when they say something like numbers are "good", means you are TSH suppressed for cancer recurrence prevention. TSH does NOT help you feel well, it has nothing to do with that. To feel well a person has to look at carefully timed Free T levels, plus vitamins, minerals, etc.
It is possible to have both cancer recurrence prevention and to feel well via well adjusted and timed Free T labs, vitamins, minerals, but don't expect that many an endocrinologist to do that for you though some might. The main lesson is you will have to be your own advocate and take your own initiatives, make your own requests. For the most part the vitamin, mineral and sometimes even the Free T's have to be worked out via your request and initiative with a primary care and sometimes a general endocrinologist can take over once the Free T level are adjusted properly.
Endocrinologists are paid to handle cancer recurrence prevention, not help you adjust Free T's, vitamins and minerals like iron or others. Some will do this free of charge essentially but don't expect lots for free. This is the mandate of the terrible insurance system in the USA. Though insurance varies, endocrinologists are paid for what medicare coding dictates and that relates to TSH suppression and checking for cancer. Other countries often just copy what the USA does even though medicare coding is a flawed system. None of that will help you feel well, though it may help you prevent cancer from coming back plus detecting it if it does starts coming back. Most people post thyroidectomy still do need the traditional care of looking at cancer recurrence.
=================
T3 supplement and FAQ’s, an addition to the Free T guide
- By BiomedEE · December 22, 2013 at 4:55 am · 14 replies
- In Using targeted therapies
- 0 Recommend Follow replies
- Shared with the public
T3 supplement and FAQ’s, an addition to the Free T guide
------
How do I add cytomel to my T4 prescription?
To keep things roughly the same TSH reduce t4 by 4 mcg for each 1 mcg of T3 added. That is rough, and people vary all over but it is always easy to add T4 back so I would reduce the T4 prescription by 4 mcg for each 1 mcg T3 added first.
For safety sake, if the TSH is already very low on T4 meds you should remove the T4 well ahead, such as a week before adding the T3 you plan on trying.
People needing larger amount of T3 often need to bring the amounts up slowly over time.
-----
How do I take T3?
Many people divide in two and take half of the daily dose first thing in AM and half in afternoon. That is to help with T3 run-out. If you take it once a day your alertness levels will swing too much.
-----
Can I take cytomel with food?
I would not take natural thyroid with food, but sometimes cytomel is taken with food by some people. So the food issue is complex. Basically yes you can take it with food, somewhat.... That varies all over and is person specific.
A few people can't take it with food at all or it does not absorb.
Other people do take T3 with light food to slow down the T3 rate, this is hard to understand until you understand what T3 run-out is, but taking it with food slows that down sometimes for some people. Taking it on an empty stomach and sometimes it gets "used up" too quickly or you are subject to T3 run-out.
So the answer is all over.
Just keep in mind once on any T3 for the long term, that Free t testing has to be done much more carefully timed than before being on anything with T3.
-----
Does T3 help me lose weight?
The way I describe cytomel and weight is, if you do a super hard diet and your T3 levels are poor you will fail. If you do a super hard diet and T3 levels are good you have a chance. But the super hard diet makes you lose weight; the T3 level if poor prevents it from working but does not cause weight loss as that is the role of the diet.
-----
Does T3 swing TSH around with lots of daily variation as I was told it will and I need my TSH suppressed due to thyroid cancer?
No. You can get what is called T3 run-out where the T3 gives a high alertness level after you take it and this often will fade as one gets to the afternoon, but the TSH would probably not change. Missing a T3 dose can cause the TSH to change small amounts. In my experience dropping a cytomel dose for a day only changed my TSH by 0.2 (from 0.1 to 0.3).
----
I switched to natural thyroid for my T3, can this change my Thyrogobulin (cancer marker)?
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
-----
Does T3 cause a-fib, irregular rhythm and heart rate problems?
TSH being highly suppressed is what generally might cause you to get a-fib, irregular rhythm and heart rate increases. Adding T3, which highly and quickly changes TSH, just has to be done with way more care that's all. Since both T4 and T3 both change TSH they both can cause these issues. It is just that one has to be done more carefully than the other one. T4 is slow to act, T3 changes things almost immediately. When they both cause TSH changes it is easier to just use T4 since it is slow to act, but does not mean T3 can't be used any more than T4.
Another major factor on these issues is cortisol levels (adrenal hormone). People with low or high cortisol levels, even if only subclinically low or high, are more subject to irregular rhythm and heart rate problems. Correcting cortisol levels can often help for those with these issues.
-----
When I add T3 to my regimen the TSH is so suppressed, why is this?
You may need to drop some T4 done after checking Free t levels, however most with good moderate Free t levels may have TSH/pituitary errors. Some of the TSH error sources are discussed on the National Association of Hypothyroidism website.
http://nahypothyroidism.org/
The pituitary is a feedback control system that wasn’t really designed around people doing thyroid cancer recurrence prevention and may not normally operate under these conditions.
The pituitary makes its own T3 supply from T4 via direct conversion for its own use though it measures the total thyroid hormone levels in the bloodstream it does not depend on the blood T3 levels apparently since it can convert its own supply. This often results in peripheral signs of hypothyroidism such as skin or hair issue even though TSH is suppressed.
Reverse T3 (rT3) counts against TSH yet supplies no benefit since even rT3 is a hormone that is measured as part of the total hormone level by the pituitary
In general the worse a T4 to T3 converter you are the less reliable your TSH reading may actually be.
----
Links to more info?
Easy graphic - posted by MtDenali on this list:
http://www.thehealthyhomeeconomist.com/thyroid-disease-as-a-psychiatric-pre tender/
Dr Mercola on using Free t’s instead of TSH as primary labs (Dr Mercola is not addressing thyroid cancer patients but lays out case for Free t's):
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
Posted by silverem
http://www.dearpharmacist.com/2013/01/29/how-you-measure-thyroid-hormone-it -matters/
Thyroid help - general
NAH – National Association of Hypothyroidism - great graphics.
http://nahypothyroidism.org/
Dr Holtorf related links
http://www.holtorfmed.com/
http://www.hormoneandlongevitycenter.com/thyroidtreatments1/
Mary Shomon – outstanding author
http://thyroid.about.com/
Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/
T4 to T3 really good summary:
http://www.naturalendocrinesolutions.com/articles/do-you-have-a-t4-to-t3-co nversion-problem/
Reverse T3 links
http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-T hyroid.htm
http://health.groups.yahoo.com/group/RT3_T3/
http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/
Order your own labs!!
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
Links to doctors that may help
http://thyroid.about.com/cs/doctors/a/topdocs.htm
Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx
Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2
------
How do I add cytomel to my T4 prescription?
To keep things roughly the same TSH reduce t4 by 4 mcg for each 1 mcg of T3 added. That is rough, and people vary all over but it is always easy to add T4 back so I would reduce the T4 prescription by 4 mcg for each 1 mcg T3 added first.
For safety sake, if the TSH is already very low on T4 meds you should remove the T4 well ahead, such as a week before adding the T3 you plan on trying.
People needing larger amount of T3 often need to bring the amounts up slowly over time.
-----
How do I take T3?
Many people divide in two and take half of the daily dose first thing in AM and half in afternoon. That is to help with T3 run-out. If you take it once a day your alertness levels will swing too much.
-----
Can I take cytomel with food?
I would not take natural thyroid with food, but sometimes cytomel is taken with food by some people. So the food issue is complex. Basically yes you can take it with food, somewhat.... That varies all over and is person specific.
A few people can't take it with food at all or it does not absorb.
Other people do take T3 with light food to slow down the T3 rate, this is hard to understand until you understand what T3 run-out is, but taking it with food slows that down sometimes for some people. Taking it on an empty stomach and sometimes it gets "used up" too quickly or you are subject to T3 run-out.
So the answer is all over.
Just keep in mind once on any T3 for the long term, that Free t testing has to be done much more carefully timed than before being on anything with T3.
-----
Does T3 help me lose weight?
The way I describe cytomel and weight is, if you do a super hard diet and your T3 levels are poor you will fail. If you do a super hard diet and T3 levels are good you have a chance. But the super hard diet makes you lose weight; the T3 level if poor prevents it from working but does not cause weight loss as that is the role of the diet.
-----
Does T3 swing TSH around with lots of daily variation as I was told it will and I need my TSH suppressed due to thyroid cancer?
No. You can get what is called T3 run-out where the T3 gives a high alertness level after you take it and this often will fade as one gets to the afternoon, but the TSH would probably not change. Missing a T3 dose can cause the TSH to change small amounts. In my experience dropping a cytomel dose for a day only changed my TSH by 0.2 (from 0.1 to 0.3).
----
I switched to natural thyroid for my T3, can this change my Thyrogobulin (cancer marker)?
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
-----
Does T3 cause a-fib, irregular rhythm and heart rate problems?
TSH being highly suppressed is what generally might cause you to get a-fib, irregular rhythm and heart rate increases. Adding T3, which highly and quickly changes TSH, just has to be done with way more care that's all. Since both T4 and T3 both change TSH they both can cause these issues. It is just that one has to be done more carefully than the other one. T4 is slow to act, T3 changes things almost immediately. When they both cause TSH changes it is easier to just use T4 since it is slow to act, but does not mean T3 can't be used any more than T4.
Another major factor on these issues is cortisol levels (adrenal hormone). People with low or high cortisol levels, even if only subclinically low or high, are more subject to irregular rhythm and heart rate problems. Correcting cortisol levels can often help for those with these issues.
-----
When I add T3 to my regimen the TSH is so suppressed, why is this?
You may need to drop some T4 done after checking Free t levels, however most with good moderate Free t levels may have TSH/pituitary errors. Some of the TSH error sources are discussed on the National Association of Hypothyroidism website.
http://nahypothyroidism.org/
The pituitary is a feedback control system that wasn’t really designed around people doing thyroid cancer recurrence prevention and may not normally operate under these conditions.
The pituitary makes its own T3 supply from T4 via direct conversion for its own use though it measures the total thyroid hormone levels in the bloodstream it does not depend on the blood T3 levels apparently since it can convert its own supply. This often results in peripheral signs of hypothyroidism such as skin or hair issue even though TSH is suppressed.
Reverse T3 (rT3) counts against TSH yet supplies no benefit since even rT3 is a hormone that is measured as part of the total hormone level by the pituitary
In general the worse a T4 to T3 converter you are the less reliable your TSH reading may actually be.
----
Links to more info?
Easy graphic - posted by MtDenali on this list:
http://www.thehealthyhomeeconomist.com/thyroid-disease-as-a-psychiatric-pre tender/
Dr Mercola on using Free t’s instead of TSH as primary labs (Dr Mercola is not addressing thyroid cancer patients but lays out case for Free t's):
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
Posted by silverem
http://www.dearpharmacist.com/2013/01/29/how-you-measure-thyroid-hormone-it -matters/
Thyroid help - general
NAH – National Association of Hypothyroidism - great graphics.
http://nahypothyroidism.org/
Dr Holtorf related links
http://www.holtorfmed.com/
http://www.hormoneandlongevitycenter.com/thyroidtreatments1/
Mary Shomon – outstanding author
http://thyroid.about.com/
Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/
T4 to T3 really good summary:
http://www.naturalendocrinesolutions.com/articles/do-you-have-a-t4-to-t3-co nversion-problem/
Reverse T3 links
http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-T hyroid.htm
http://health.groups.yahoo.com/group/RT3_T3/
http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/
Order your own labs!!
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
Links to doctors that may help
http://thyroid.about.com/cs/doctors/a/topdocs.htm
Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx
Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2
2013年12月28日星期六
要等候耶和华
要等候耶和华，当壮胆，坚固你的心；我说再，要等候耶和华。’(诗二十七章十四节)。
‘你当默然倚靠耶和华，耐性等候他。不要因那道路通达的，和那恶谋成就的，心怀不平。当止住怒气，离弃忿怒；不要心怀不平，以致作恶。因为作恶的必被剪除，惟有等候耶和华的必承受地土。’(诗三十七章七至九节)。
‘我的心默默无声，专等候神，我的救恩是从他而来。惟独他是我的磐石，我的拯救；他是我的高台，我必不很动摇。......我的心哪，你当默默无声，专等候神，因为我的盼望是从他而来。惟独他是我的磐石，我的拯救；他是我的高台，我必不动摇。’(诗六十二篇一至六节)。
‘我等候耶和华，我的心等候，我也仰望他的话。’(诗一百三十五篇五节)。
‘你不要说，我要以恶报恶；要等候耶和华，他必拯救你。’(箴二十章二十二节)。
‘耶和华必然等候，要施恩给你们，必然兴起，好怜悯你们；因为耶和华是公平的神，凡等候他的都是有福的。’(赛三十章十八节)。
‘你岂不曾知道么？你岂不曾听见么？永在神耶和华，创造地极的主，并不疲乏，也不困倦，他的智慧无法测度。疲乏的，他赐能力；软弱的，他加力量；就是少年人也要疲乏困倦，强壮的也必全然跌倒。但那等候耶和华的必从新得力，他们必如鹰展翅上腾，他们奔跑，却不困倦，行走，却不疲乏。’(赛四十章二十八至三十一节)。(本段经文中的‘雕’字中文译本作‘鹰’，误。)
‘等候我的必不至羞愧。’――――赛四十九章二十三节。
‘凡等候耶和华，必里寻求他的，耶和华必然施恩给他。人仰望耶和华，静默等候他的救恩，这原是好的。’(哀三章二十五，二十六节)。
‘至于我，我要仰望耶和华，要等候那救我的神，我的神必应允我。’(弥七章七节)。
‘等候神’是圣徒必须学习的一样极重要的功课，但它也是最难学习的一门功课。就因为我们学习不好这门功课，我们受了极大的害。吃了极多的亏。许多很好的信徒不会等候。许多很热心的信徒不会等候。许多很忠心服事神的信徒不会等候。这些人知道罪恶害他们，他们却不知道‘不等候神’这件事同样的害他们。他们不知道因为不等候神，他们便会犯许多的罪。他们更不知道魔鬼会在他们忙忙乱乱的时候，把他们引到许多的罪亚和祸患中。人在慌忙之中最容易失去鉴别力，以致受人的欺骗。魔鬼就是在信徒遇事慌忙的时候引诱他们走入歧途，引诱他们去作许多在他们心思安静头脑清楚的时候绝对不肯去作的事。有三种境遇最能使我们因为不等候神以致犯罪。第一种境遇就是在我们遭遇危险患难的时候，第二种境遇就是在我们受人欺侮苦待，或是看见一些不公平的事摆在我们面前的时候，第三种境遇就是在我们渴望得一样什么好处，却是总得不着的时候。圣经里有几段顶清楚的记载证明这个真理，容我们引证这几段在下面。
‘扫罗照着撒母耳所定的日期等了七日，撒母耳还没有来到吉甲，百姓也离开扫罗散去了。扫罗说，“把燔祭和平安祭带到这里来。”扫罗就献上燔祭。刚献完 燔祭，撒母耳就到了。扫罗出去迎接他，要问他好。撒母耳说，“你作的是什么事呢？”扫罗说，“因为我见百姓离开我散去，你也不照所定的日期来到，而且非利士人聚集在密抹，所以我心里说，恐怕我没有祷告耶和华，非利士人下到吉甲攻击我，我就勉强献上燔祭。”撒母耳对扫罗说，“你作了糊涂事了，没有遵守耶和华你的神所吩咐你的命令。若遵守，耶和华必在以色列中坚立你的王位，直到永远。现在你的王位必不长久。耶和华已经寻着一个合他心意的人，立他作百姓的君，因为你没有遵守耶和华所吩咐你的。”’(撒上十三章八至十四节)。
‘后来摩西长大，他出去到他弟兄那里，看他们的重担，见一个埃及人打希伯来人的一个弟兄。他左右观看，见没有人，就把埃及人打死了，藏在沙土里。第二天他出去，见有两个希伯来人争斗，就对那欺负人的说，“你为什么打你同族的人呢？”那人说，“谁立你作我们的首领和审判官呢？难道你要杀我，像杀那埃及人么？”摩西便惧怕，说，“这事必是被人知道了。”法老听见这事，就想杀摩西。但摩西躲避法老，逃往米甸地居住。’(出二章十一至十五节)。
‘亚伯兰的妻子撒莱不给他生儿女。撒莱有一个使女，名叫夏甲，是埃及人。撒莱对亚伯兰说，“耶和华使我不能生育，求你和我的使女同房，或者我可以因他得孩子。”亚伯兰听从了撒莱的话。于是亚伯兰的妻子撒莱将仗女埃及人夏甲给了丈夫为妾，那时亚伯兰在迦南已经住了十年。亚伯兰与夏甲同房，夏甲就怀了孕。他见自己有孕，就小看她的主母。撒莱对亚伯兰说，“我因你受屈。我将我的使女放在你怀中，她见自己有了孕就小看我。愿耶和华在你我中间判断。”亚伯兰对撒莱说，“使女在你手下，你可以随意待她。”撒莱苦待她，她就从撒莱面前逃走了。’(创十六章一至六节)。
扫罗王从一种极好的地步堕落到极深的地方，再不能起来，真是一件极令人惋惜的事。但他第一步的堕落并不是犯了什么其他的大罪，只是因为不会等候神，便没有遵从撒母耳的话，自己去给神献祭。扫罗明明知道他不应当献祭，但他因为惧怕非利士的军兵，便作了这件愚昧的事，被神所废弃。其实他再等不多时候，撒母耳便来到了。我们岂不也是常作这种愚昧的事么？一遇见什么危险祸患，便吓得心惊胆战，手足失措。在这时候魔鬼最容易欺骗我们，引诱我们去作神所不喜悦的事。当我们遭遇危险，惊慌失措，手忙脚乱的时候，最容易失去平日所有的鉴别力，纵使不失去鉴别力，我们也会因为逃避危险的缘故，去作我们明知道不当作的事。要想逃避这种危险，只有学习等候神。无论遇见什么可怕的事，一点不要惊惶忙乱，只要安安静静的进到神面前，仰望他，求告他，等候他。他决不会忘记我们，更决不会遗弃我们。从来没有一个圣徒因为等候神吃了亏，受了害。可是有许许多多属神的人因为不等候神，便受了极大的损害，吃了极多的苦头。不用说危险在前的时候我们去作神不喜悦的事是得罪神，就是我们遇见危险不投靠神，却去投靠人，向人求援助，这已经是藐视神，不信靠神，得罪神了。古时犹太人遭遇巴比伦人的攻击，他们不呼求神的拯救，却到埃及去求救兵，神为这事深深的责备他们说，‘祸哉这悖逆的儿女！他们同谋，却不由于我，结盟，却不由于我的灵，以致罪上加罪，起身下埃及去，并没有求问我：要靠法老的力量，加添自己的力量，并投在埃及的荫下，所以法老的力量必作你们的羞辱，投在埃及的荫下要为你们的惭愧。他们的首领已在琐安，他们的使臣到了哈内斯。他们必因那不利于他们的民蒙羞，那民并非帮助，也非利益，只作羞耻凌辱。’(赛三十章一至五节)。又说，‘主耶和华以色列的圣者曾如此说，“你们得救在乎归回安息，你们得力在乎平静安稳，你们竟自不肯。”你们却说，“不然，我们要骑马奔走”；所以你们必然奔走。又说，“我们要骑飞快的牲口”；所以追赶你们的也必飞快。一人叱喝，必令千人逃跑，五人叱喝，你们都必逃跑，以致剩下的，好像山顶的旗杆，冈上的大旗。’(赛三十章十五至十七节)。按我们看，犹太人因为受巴比伦人的迫害，派人到埃及去求救兵，这并不是什么不合理的事，这里面更没有什么罪。神为什么这样严严的责备他们，重重的咒诅他们呢？但我们详细玩味这些话，便看出来他们这样作是轻看神，侮辱神，不信靠神，看神还不如埃及人可靠，看神的能力还不如埃及人的能力大。并且神曾告诉他们说，‘你们得救在乎归回安息，你们得力在乎平静安稳，’这明明是告诉他们说，只要安静等候神，便可得着拯救。但这些悖逆的百姓却说，‘不然，我们要骑马奔走，我们要骑飞快的牲口。’从这两句话中可以看出来他们是怎样轻看神，侮慢神，悖逆神了。全能的神应许要拯救他们，他们不肯等候他，却到不认识神的外邦人那里去求援助，请想这是不是罪？是不是极大的罪？他们为这事遭遇神的打击，是不是应当的呢？可是神的慈爱异常浩大，在他们因为不倚靠神而倚靠人遭遇打击以后，仍然向他们施恩典，对他们说，‘耶和华必然等候，要施恩给你们，必然兴起，好怜悯你们，因为耶和华是公平的神，凡等候他的都是有福的。’(赛三十章十八节)。神在他的百姓因为不等候他以致遭遇失败以后，再教训他们应当如何等候，并且清楚应许他们说，‘耶和华是公平的神，凡等候他的都有福的。’
可叹！可叹！今日许多信徒就是像犹太人一样，遭遇了危险困难，不知道仰望神，等候神，只是一味忙乱奔跑，到他们看为可靠的人那里去求援助，求拯救。如果他们去投靠属神的人，还可加以原谅，最可叹的，就是他们竟到不信的人那里去求拯救，他们所得的结果也是与那些犹太人相同，不但没有得着拯救，反倒蒙了羞辱，遭了祸害。这种情形我们听见看见的已经不知道有多少了。
摩西也曾因为不等候神惹出来一场祸患，险些丧了性命，神实在早已定规要藉着他拯救以色列人，但是他性情急躁，不等候神的日期临到，一看见他本族的人受埃及人的虐待，便怒不可遏，凭着自己血气的勇敢，把那个埃及人打死，埋在沙土里。他一点不想希伯来全族的人都伏在法老和埃及全国人的手下，打死一个埃及人能有什么用处。他更不想想因着打死这一个埃及人会酿出什么祸患。果然，希伯来人还一点没有得着解救，他自己倒几乎死在法老的手下。我们岂不也是常作这一类愚昧的事么？一受了人的欺侮苦待，便忿忿不平，想要以恶报恶。或是看见别人的恶谋成就，就心怀不平，以致自己也想去作恶。还有时候我们看见别人受恶人的欺压，便凭着血气之勇起来去攻击恶人，结果总是和摩西所遭遇的相同，还没有救了别人，自己倒先陷在祸患中，如果我们能忍耐些时候，等到神的日期临到，他一点不费事，就把一切不平的事都翻转过来，正如同他击打法老，将以色列全族的人都从埃及领出来一样。他目见我们的软弱和愚昧，所以他教训我们说，‘你当默然倚靠耶和华，耐性等候他。不要因那道路通达的，和那恶谋成就的，心怀不平。当止住怒气，离弃忿怒；不要心怀不平，以致作恶。因为你恶的必被剪除，惟有等候耶和华的必承受地土。’又说，‘你不要说，我要以恶报恶。要等候耶和华，他必拯救你。’
亚伯拉罕的事便是我们上文所提的第三种情形了。他渴望得一个儿子，好承受神的应许。但他的妻子已经绝了生育的盼望。他无法再等候下去。他听了他妻子的话，纳了夏甲为妾。结果是什么呢？神的应许到底还不是藉着他的方法成就，以撒仍是从撒拉生出来。纳夏甲为妾的结果，不过是使一个快乐平安的家庭变成了战场，夏甲与撒拉不和，以撒与以实玛利相争。直到今日，几千年来以实玛利的后裔――――亚拉伯人――――总是与以撒的后裔――――犹太人――――互相残杀，没有宁息的日子。我们也常常作这种愚昧的事。盼望得着一样什么好处，但总得不着，我们不能等候神，我们用自己的方法去得。我们也明明知道这些方法不是神所喜悦的，但我们为达到我们的目的，便不能不这样作。结果是什么呢？我们所希 望的好处也许可以得着，但不久便有许多的痛苦和祸患临到我们身上。许多信徒为求财产，走了神不喜悦的道路。许多信徒为求尊荣，取了神不喜悦的步骤。许多信徒为求子嗣，用了神不喜悦的方法。许多信徒为求成功，择了神不喜悦的手段。他们这样作，也许暂时得着一些功效，可是后来却因此招来无穷的祸患痛苦与损失。他们将要因此懊悔，因此自恨，因此哀哭号泣，想挽救已往的失败，但是大错已经铸成，再没有方法挽回了。
如果我们不愿意蹈上文所说的这些人的覆辙，就需要在每日生活中的大事小事上学习等候神。这并不是说我们应当一昧的懒惰不去作什么，也不是说我们要放弃自己的本分。不，我们应当随时随地善用机会，去作一切摆在我们面前的本分和工作。但我们决不可跑到神的旨意之外去作一件事。在遭遇危险祸患的时候，一点不要惊惶忙乱。不要作神不许可的事。不要投靠不属神的人。在看见恶人行强暴的时候，不要心怀不平，以致作恶。不要以恶报恶。不要用神所不喜悦的方法，去求什么尊荣、利益、成功，也不要用自己属肉体的方法，去帮助神作什么事。等候神和懒惰是完全不同的两件事。 懒惰是不肯去作摆在前面的本分和工作，等候神是不作一件出乎神的旨意以外的事，同时却在神的轨道中殷殷勤勤的去作每日每时应当作的事工。许多殷勤的信徒需要学习等候神。许多热心的信徒需要学习等候神。有些最热心的信徒是最不会等候神的人。他们忙着要去作工，要去办事，要去服事神，要去帮助人。可是他们凭着血气，用人的方法，去作这些事。结果不但未曾成功，倒遭了失败，不但未曾使神得着荣耀，使人得着益处，倒使神受了羞辱，使人受了亏损。不按着神的旨意去奔跑劳苦，还不如不奔跑劳苦更好。
有一件事与等候神是紧紧相连不能分开的，这件事就是信靠神。惟独会信靠神的人才会等候神。我们所以敢等候神，就是因为我们信靠他。我们信他决不失信，所以我们敢等候他。我们信他决不误事，所以我们敢等候他。我们信他能作一切我们自己不能作的，所以我们敢等候他。我们信他比世上的任何人都可靠，所以我们敢等候他。我们信他决不忘记我们，所以我们敢等候他。我们信他们所作的都好，所以我们敢等候他。我们信他的眼睛看顾一切仰望他的人，所以我们敢等候他。我们信他听我们的呼求，所以我们敢等候他。我们越能信靠神，我们也就越敢等候他。但信靠神多少与认识神多少有正比例。我们多认识神，才能多信靠他。无怪乎先知何西阿教导以色列人追求认识神了。他对他们说，‘我们务要认识耶和华，竭力追求认识他。他出现确如晨光。他必临到我们像甘雨，像滋润田地的春雨。’(何六章三节)。
会等候神的人真是有福的。别人想他们要耽误许多的事，其实他们所成就的比任何人更多。别人看他们走的太慢，其实他们跑的比任何人更快。别人看他们软弱无能，其实他们比任何人更有力量。他们必‘从新得力’，他们‘如鹰翅展上腾’，他们‘奔跑却不困倦，行走却不疲乏’。他们不轻易作什么事，可是作起来就必成功。他们不轻易举足前行，可是举足以后就必走到目的地。他们不轻易应许人，可是应许了就必实践。他们不呜则已，可是一呜就必惊人。他们不飞则已，可是一飞就冲天。他们不像其他的人说了极多的话，却办了极少的事，开了很多的头，却收了很少的尾，轻易开始，轻易中辍，轻易举足，轻易止步。他们有一种从天上来的智慧和能力，能成别人所不能成的功。能作别人所不能作的事。他们所处的境遇看着是很危险，其实是很安全。他们所走的路途看着是很崎岖，其实是很平坦。没有别的人比等候神的人更刚强，更稳妥。没有别的人比等候神的人更快乐，更有福。等候神是最难学最艰深的功课，可是学好了这门功课，比学好了任何其他的功课更有用。
‘要等候耶和华。当壮胆，坚固你的心；我再说，要等候耶和华。’
‘你当默然倚靠耶和华，耐性等候他。不要因那道路通达的，和那恶谋成就的，心怀不平。当止住怒气，离弃忿怒；不要心怀不平，以致作恶。因为作恶的必被剪除，惟有等候耶和华的必承受地土。’(诗三十七章七至九节)。
‘我的心默默无声，专等候神，我的救恩是从他而来。惟独他是我的磐石，我的拯救；他是我的高台，我必不很动摇。......我的心哪，你当默默无声，专等候神，因为我的盼望是从他而来。惟独他是我的磐石，我的拯救；他是我的高台，我必不动摇。’(诗六十二篇一至六节)。
‘我等候耶和华，我的心等候，我也仰望他的话。’(诗一百三十五篇五节)。
‘你不要说，我要以恶报恶；要等候耶和华，他必拯救你。’(箴二十章二十二节)。
‘耶和华必然等候，要施恩给你们，必然兴起，好怜悯你们；因为耶和华是公平的神，凡等候他的都是有福的。’(赛三十章十八节)。
‘你岂不曾知道么？你岂不曾听见么？永在神耶和华，创造地极的主，并不疲乏，也不困倦，他的智慧无法测度。疲乏的，他赐能力；软弱的，他加力量；就是少年人也要疲乏困倦，强壮的也必全然跌倒。但那等候耶和华的必从新得力，他们必如鹰展翅上腾，他们奔跑，却不困倦，行走，却不疲乏。’(赛四十章二十八至三十一节)。(本段经文中的‘雕’字中文译本作‘鹰’，误。)
‘等候我的必不至羞愧。’――――赛四十九章二十三节。
‘凡等候耶和华，必里寻求他的，耶和华必然施恩给他。人仰望耶和华，静默等候他的救恩，这原是好的。’(哀三章二十五，二十六节)。
‘至于我，我要仰望耶和华，要等候那救我的神，我的神必应允我。’(弥七章七节)。
‘等候神’是圣徒必须学习的一样极重要的功课，但它也是最难学习的一门功课。就因为我们学习不好这门功课，我们受了极大的害。吃了极多的亏。许多很好的信徒不会等候。许多很热心的信徒不会等候。许多很忠心服事神的信徒不会等候。这些人知道罪恶害他们，他们却不知道‘不等候神’这件事同样的害他们。他们不知道因为不等候神，他们便会犯许多的罪。他们更不知道魔鬼会在他们忙忙乱乱的时候，把他们引到许多的罪亚和祸患中。人在慌忙之中最容易失去鉴别力，以致受人的欺骗。魔鬼就是在信徒遇事慌忙的时候引诱他们走入歧途，引诱他们去作许多在他们心思安静头脑清楚的时候绝对不肯去作的事。有三种境遇最能使我们因为不等候神以致犯罪。第一种境遇就是在我们遭遇危险患难的时候，第二种境遇就是在我们受人欺侮苦待，或是看见一些不公平的事摆在我们面前的时候，第三种境遇就是在我们渴望得一样什么好处，却是总得不着的时候。圣经里有几段顶清楚的记载证明这个真理，容我们引证这几段在下面。
‘扫罗照着撒母耳所定的日期等了七日，撒母耳还没有来到吉甲，百姓也离开扫罗散去了。扫罗说，“把燔祭和平安祭带到这里来。”扫罗就献上燔祭。刚献完 燔祭，撒母耳就到了。扫罗出去迎接他，要问他好。撒母耳说，“你作的是什么事呢？”扫罗说，“因为我见百姓离开我散去，你也不照所定的日期来到，而且非利士人聚集在密抹，所以我心里说，恐怕我没有祷告耶和华，非利士人下到吉甲攻击我，我就勉强献上燔祭。”撒母耳对扫罗说，“你作了糊涂事了，没有遵守耶和华你的神所吩咐你的命令。若遵守，耶和华必在以色列中坚立你的王位，直到永远。现在你的王位必不长久。耶和华已经寻着一个合他心意的人，立他作百姓的君，因为你没有遵守耶和华所吩咐你的。”’(撒上十三章八至十四节)。
‘后来摩西长大，他出去到他弟兄那里，看他们的重担，见一个埃及人打希伯来人的一个弟兄。他左右观看，见没有人，就把埃及人打死了，藏在沙土里。第二天他出去，见有两个希伯来人争斗，就对那欺负人的说，“你为什么打你同族的人呢？”那人说，“谁立你作我们的首领和审判官呢？难道你要杀我，像杀那埃及人么？”摩西便惧怕，说，“这事必是被人知道了。”法老听见这事，就想杀摩西。但摩西躲避法老，逃往米甸地居住。’(出二章十一至十五节)。
‘亚伯兰的妻子撒莱不给他生儿女。撒莱有一个使女，名叫夏甲，是埃及人。撒莱对亚伯兰说，“耶和华使我不能生育，求你和我的使女同房，或者我可以因他得孩子。”亚伯兰听从了撒莱的话。于是亚伯兰的妻子撒莱将仗女埃及人夏甲给了丈夫为妾，那时亚伯兰在迦南已经住了十年。亚伯兰与夏甲同房，夏甲就怀了孕。他见自己有孕，就小看她的主母。撒莱对亚伯兰说，“我因你受屈。我将我的使女放在你怀中，她见自己有了孕就小看我。愿耶和华在你我中间判断。”亚伯兰对撒莱说，“使女在你手下，你可以随意待她。”撒莱苦待她，她就从撒莱面前逃走了。’(创十六章一至六节)。
扫罗王从一种极好的地步堕落到极深的地方，再不能起来，真是一件极令人惋惜的事。但他第一步的堕落并不是犯了什么其他的大罪，只是因为不会等候神，便没有遵从撒母耳的话，自己去给神献祭。扫罗明明知道他不应当献祭，但他因为惧怕非利士的军兵，便作了这件愚昧的事，被神所废弃。其实他再等不多时候，撒母耳便来到了。我们岂不也是常作这种愚昧的事么？一遇见什么危险祸患，便吓得心惊胆战，手足失措。在这时候魔鬼最容易欺骗我们，引诱我们去作神所不喜悦的事。当我们遭遇危险，惊慌失措，手忙脚乱的时候，最容易失去平日所有的鉴别力，纵使不失去鉴别力，我们也会因为逃避危险的缘故，去作我们明知道不当作的事。要想逃避这种危险，只有学习等候神。无论遇见什么可怕的事，一点不要惊惶忙乱，只要安安静静的进到神面前，仰望他，求告他，等候他。他决不会忘记我们，更决不会遗弃我们。从来没有一个圣徒因为等候神吃了亏，受了害。可是有许许多多属神的人因为不等候神，便受了极大的损害，吃了极多的苦头。不用说危险在前的时候我们去作神不喜悦的事是得罪神，就是我们遇见危险不投靠神，却去投靠人，向人求援助，这已经是藐视神，不信靠神，得罪神了。古时犹太人遭遇巴比伦人的攻击，他们不呼求神的拯救，却到埃及去求救兵，神为这事深深的责备他们说，‘祸哉这悖逆的儿女！他们同谋，却不由于我，结盟，却不由于我的灵，以致罪上加罪，起身下埃及去，并没有求问我：要靠法老的力量，加添自己的力量，并投在埃及的荫下，所以法老的力量必作你们的羞辱，投在埃及的荫下要为你们的惭愧。他们的首领已在琐安，他们的使臣到了哈内斯。他们必因那不利于他们的民蒙羞，那民并非帮助，也非利益，只作羞耻凌辱。’(赛三十章一至五节)。又说，‘主耶和华以色列的圣者曾如此说，“你们得救在乎归回安息，你们得力在乎平静安稳，你们竟自不肯。”你们却说，“不然，我们要骑马奔走”；所以你们必然奔走。又说，“我们要骑飞快的牲口”；所以追赶你们的也必飞快。一人叱喝，必令千人逃跑，五人叱喝，你们都必逃跑，以致剩下的，好像山顶的旗杆，冈上的大旗。’(赛三十章十五至十七节)。按我们看，犹太人因为受巴比伦人的迫害，派人到埃及去求救兵，这并不是什么不合理的事，这里面更没有什么罪。神为什么这样严严的责备他们，重重的咒诅他们呢？但我们详细玩味这些话，便看出来他们这样作是轻看神，侮辱神，不信靠神，看神还不如埃及人可靠，看神的能力还不如埃及人的能力大。并且神曾告诉他们说，‘你们得救在乎归回安息，你们得力在乎平静安稳，’这明明是告诉他们说，只要安静等候神，便可得着拯救。但这些悖逆的百姓却说，‘不然，我们要骑马奔走，我们要骑飞快的牲口。’从这两句话中可以看出来他们是怎样轻看神，侮慢神，悖逆神了。全能的神应许要拯救他们，他们不肯等候他，却到不认识神的外邦人那里去求援助，请想这是不是罪？是不是极大的罪？他们为这事遭遇神的打击，是不是应当的呢？可是神的慈爱异常浩大，在他们因为不倚靠神而倚靠人遭遇打击以后，仍然向他们施恩典，对他们说，‘耶和华必然等候，要施恩给你们，必然兴起，好怜悯你们，因为耶和华是公平的神，凡等候他的都是有福的。’(赛三十章十八节)。神在他的百姓因为不等候他以致遭遇失败以后，再教训他们应当如何等候，并且清楚应许他们说，‘耶和华是公平的神，凡等候他的都有福的。’
可叹！可叹！今日许多信徒就是像犹太人一样，遭遇了危险困难，不知道仰望神，等候神，只是一味忙乱奔跑，到他们看为可靠的人那里去求援助，求拯救。如果他们去投靠属神的人，还可加以原谅，最可叹的，就是他们竟到不信的人那里去求拯救，他们所得的结果也是与那些犹太人相同，不但没有得着拯救，反倒蒙了羞辱，遭了祸害。这种情形我们听见看见的已经不知道有多少了。
摩西也曾因为不等候神惹出来一场祸患，险些丧了性命，神实在早已定规要藉着他拯救以色列人，但是他性情急躁，不等候神的日期临到，一看见他本族的人受埃及人的虐待，便怒不可遏，凭着自己血气的勇敢，把那个埃及人打死，埋在沙土里。他一点不想希伯来全族的人都伏在法老和埃及全国人的手下，打死一个埃及人能有什么用处。他更不想想因着打死这一个埃及人会酿出什么祸患。果然，希伯来人还一点没有得着解救，他自己倒几乎死在法老的手下。我们岂不也是常作这一类愚昧的事么？一受了人的欺侮苦待，便忿忿不平，想要以恶报恶。或是看见别人的恶谋成就，就心怀不平，以致自己也想去作恶。还有时候我们看见别人受恶人的欺压，便凭着血气之勇起来去攻击恶人，结果总是和摩西所遭遇的相同，还没有救了别人，自己倒先陷在祸患中，如果我们能忍耐些时候，等到神的日期临到，他一点不费事，就把一切不平的事都翻转过来，正如同他击打法老，将以色列全族的人都从埃及领出来一样。他目见我们的软弱和愚昧，所以他教训我们说，‘你当默然倚靠耶和华，耐性等候他。不要因那道路通达的，和那恶谋成就的，心怀不平。当止住怒气，离弃忿怒；不要心怀不平，以致作恶。因为你恶的必被剪除，惟有等候耶和华的必承受地土。’又说，‘你不要说，我要以恶报恶。要等候耶和华，他必拯救你。’
亚伯拉罕的事便是我们上文所提的第三种情形了。他渴望得一个儿子，好承受神的应许。但他的妻子已经绝了生育的盼望。他无法再等候下去。他听了他妻子的话，纳了夏甲为妾。结果是什么呢？神的应许到底还不是藉着他的方法成就，以撒仍是从撒拉生出来。纳夏甲为妾的结果，不过是使一个快乐平安的家庭变成了战场，夏甲与撒拉不和，以撒与以实玛利相争。直到今日，几千年来以实玛利的后裔――――亚拉伯人――――总是与以撒的后裔――――犹太人――――互相残杀，没有宁息的日子。我们也常常作这种愚昧的事。盼望得着一样什么好处，但总得不着，我们不能等候神，我们用自己的方法去得。我们也明明知道这些方法不是神所喜悦的，但我们为达到我们的目的，便不能不这样作。结果是什么呢？我们所希 望的好处也许可以得着，但不久便有许多的痛苦和祸患临到我们身上。许多信徒为求财产，走了神不喜悦的道路。许多信徒为求尊荣，取了神不喜悦的步骤。许多信徒为求子嗣，用了神不喜悦的方法。许多信徒为求成功，择了神不喜悦的手段。他们这样作，也许暂时得着一些功效，可是后来却因此招来无穷的祸患痛苦与损失。他们将要因此懊悔，因此自恨，因此哀哭号泣，想挽救已往的失败，但是大错已经铸成，再没有方法挽回了。
如果我们不愿意蹈上文所说的这些人的覆辙，就需要在每日生活中的大事小事上学习等候神。这并不是说我们应当一昧的懒惰不去作什么，也不是说我们要放弃自己的本分。不，我们应当随时随地善用机会，去作一切摆在我们面前的本分和工作。但我们决不可跑到神的旨意之外去作一件事。在遭遇危险祸患的时候，一点不要惊惶忙乱。不要作神不许可的事。不要投靠不属神的人。在看见恶人行强暴的时候，不要心怀不平，以致作恶。不要以恶报恶。不要用神所不喜悦的方法，去求什么尊荣、利益、成功，也不要用自己属肉体的方法，去帮助神作什么事。等候神和懒惰是完全不同的两件事。 懒惰是不肯去作摆在前面的本分和工作，等候神是不作一件出乎神的旨意以外的事，同时却在神的轨道中殷殷勤勤的去作每日每时应当作的事工。许多殷勤的信徒需要学习等候神。许多热心的信徒需要学习等候神。有些最热心的信徒是最不会等候神的人。他们忙着要去作工，要去办事，要去服事神，要去帮助人。可是他们凭着血气，用人的方法，去作这些事。结果不但未曾成功，倒遭了失败，不但未曾使神得着荣耀，使人得着益处，倒使神受了羞辱，使人受了亏损。不按着神的旨意去奔跑劳苦，还不如不奔跑劳苦更好。
有一件事与等候神是紧紧相连不能分开的，这件事就是信靠神。惟独会信靠神的人才会等候神。我们所以敢等候神，就是因为我们信靠他。我们信他决不失信，所以我们敢等候他。我们信他决不误事，所以我们敢等候他。我们信他能作一切我们自己不能作的，所以我们敢等候他。我们信他比世上的任何人都可靠，所以我们敢等候他。我们信他决不忘记我们，所以我们敢等候他。我们信他们所作的都好，所以我们敢等候他。我们信他的眼睛看顾一切仰望他的人，所以我们敢等候他。我们信他听我们的呼求，所以我们敢等候他。我们越能信靠神，我们也就越敢等候他。但信靠神多少与认识神多少有正比例。我们多认识神，才能多信靠他。无怪乎先知何西阿教导以色列人追求认识神了。他对他们说，‘我们务要认识耶和华，竭力追求认识他。他出现确如晨光。他必临到我们像甘雨，像滋润田地的春雨。’(何六章三节)。
会等候神的人真是有福的。别人想他们要耽误许多的事，其实他们所成就的比任何人更多。别人看他们走的太慢，其实他们跑的比任何人更快。别人看他们软弱无能，其实他们比任何人更有力量。他们必‘从新得力’，他们‘如鹰翅展上腾’，他们‘奔跑却不困倦，行走却不疲乏’。他们不轻易作什么事，可是作起来就必成功。他们不轻易举足前行，可是举足以后就必走到目的地。他们不轻易应许人，可是应许了就必实践。他们不呜则已，可是一呜就必惊人。他们不飞则已，可是一飞就冲天。他们不像其他的人说了极多的话，却办了极少的事，开了很多的头，却收了很少的尾，轻易开始，轻易中辍，轻易举足，轻易止步。他们有一种从天上来的智慧和能力，能成别人所不能成的功。能作别人所不能作的事。他们所处的境遇看着是很危险，其实是很安全。他们所走的路途看着是很崎岖，其实是很平坦。没有别的人比等候神的人更刚强，更稳妥。没有别的人比等候神的人更快乐，更有福。等候神是最难学最艰深的功课，可是学好了这门功课，比学好了任何其他的功课更有用。
‘要等候耶和华。当壮胆，坚固你的心；我再说，要等候耶和华。’
2013年12月21日星期六
加拿大华人- 甲状腺癌
http://blog.wenxuecity.com/myblog/10060/201111/25.html
我 2010 年诊断出甲状腺癌, 之后一直瞒着朋友们. 上周写信给他们分享了我这两年的经历.
我 2010 年诊断出甲状腺癌, 之后一直瞒着朋友们. 上周写信给他们分享了我这两年的经历.
珍惜生命 – 给我的朋友的一封信
你也许能察觉到我和朋友的交往少了; 即使是聚会的时候说话也少了; 你可能注意到我脖子上的疤痕; 注意到我原来就不多的笑容更难得一见了.
过去的一年对我来说是风风雨雨, 沉浮上下. 现在和你分享一下, 一是消除大家可能的不解, 二是我自己该淡然面对, 不必苦苦隐瞒的时候了. 另外, 也希望你能得到一些珍惜生命, 健康养生的启示.
(一) 第一次手术
2009 年我处于极其郁闷的状态, 尤其是在 7 8 月期间, 人几乎崩溃, 身心具疲. 11 月时 接受了朋友的建议去做体检.
检查显示有轻微的脂肪肝和数枚胆结石, 都是到了这个年纪可能遇到的普通问题. 需要跟踪的是甲状腺. 家庭医生一摸, 感觉右侧甲状腺肿大. 于是约超声波; 发现肿块; 转专科医生; 排队做穿刺活检, 约到的是次年的 4 月.
当时, 家庭医生说是癌的可能很小. 即使是癌, 甲状腺癌也是最容易的癌, 很好治愈. 毕竟癌症对于我来说是太遥远了, 父母往上三代也没有一个的癌症的. 听他这么说就更没有在意, 于是就等了4 个多月做穿刺 – 在超声波的导引下, 用针刺入取组织. 癌细胞需要用显微镜观察,其外观与正常细胞不一样.
5 月 4 日得到结果, 显示右侧甲状腺乳头状癌和淋巴结转移. 我听了有些沮丧, 但也没有觉得天塌下来, 因为家庭医生事先提示过.
专科医生转我去专门的肿瘤医生那里, 预约的是 5 月 18 日, 但手术最快排在两个月以后了. 晚上, 打电话给国内做过癌症药物研究的同学,他说癌症这东西应该争分夺秒, 尽快手术, 何况已经转移了. 我自己也觉得不能耽误, 因为以前听说过不少加拿大医疗制度导致病人等到死.所以很多人回国或去美国治疗.[mbl: 看来这位"做过癌症药物研究的同学"不知道, 比起其它癌症来,甲状腺癌是 slow growing and highly treatable.所以他的"应该争分夺秒, 尽快手术"的说法并不准确.]
于是 5 月 10 日飞到北京. 中间在阿联酋转机, 折腾了 24 小时. 因为托了关系, 下飞机的当天就做了 CT. 次日早晨等结果的那十几分钟才第一次感到紧张, 如果扩散了这么办? 如果不能手术了怎么办? 好在除了颈部淋巴结, 没有其他转移了. 看片子的人说这差不多是他们医院的最轻的了, 但是也不能掉以轻心, 毕竟是癌症.
5 月 14 日在北京医科学院肿瘤医院做了手术, 切除了右侧甲状腺和右颈部的淋巴结. 依然记得手术医生在我脖子上面用笔划来划去, 说话间就失去了知觉. 醒来时已经被运回病房, 依稀听到亲戚朋友们的说话声. 手背上插着吊針, 鼻子通着氧气, 右手臂上套着自动量血压的套子,几分钟就测一次. 手术刚完的24 小时里非常难受, 不是疼, 说不出的感觉.
这是中国最好的肿瘤医院, 手术医生也是比较权威的医生, 但这次手术有不少后遗症, 现在右侧颈部脸部还有淤积的淋巴液, 右肩膀无知觉,嗓音也变得低哑, 说话费力. 伤疤从脖子中间一直到几乎右耳的后面. 手术医生说手术完了就算治好了, 定期复查就行了.[mbl:这位手术医生的经验不够!]
恢复的其实比较快, 回加拿大前的一周里, 自己坐地铁去北海玩; 和朋友吃饭等等. 走在北京交通混乱的街上, 想着: 好不容易治好了, 可别被撞死了.
6 月 1日飞回多伦多. 5 月离开多伦多和孩子们告别的时候, 心中一丝忧虑, 怕自己再也回不来了. 航班号是 xx4, 座位号是 44, 候机的地方一个巨大的黑色的园棚, 就像中国老式的坟墓. 我吓得从它旁边绕过去. 人脆弱的时候, 就容易迷信. 然后用理智告诉自己, 不用为没有到来的事情担心, 难过. 现在, 三周之后, 终于回来了, 看到了毫不知情, 依然快乐的孩子们.
(二) 第二次手术
我决定不把这事告诉朋友和同事, 因为不愿意看到那么多同情的眼神和好心的询问.
回加拿大以后, 又通过家庭医生约了一个甲状腺专科医生 Dr. Zahedi, 便于复查, 7 月 18 日见到了她. 一见面, 她就问我, 怎么左边的甲状腺没切呢? 对她来说这是一个非常低级的错误, 她对此非常不满. 因为甲状腺癌手术后需要做碘131 治疗. 在西方医疗体系里面, 这是必须的后续治疗, 可以杀死残留的微小甲状腺癌细胞组织, 大大降低复发的可能. 于是她给我约了甲状腺手术医生 Dr. Goldstein, 把左侧甲状腺也切除. 另外, 她说肿瘤这么小 (1-2cm)就转移到淋巴结, 说明你的癌细胞很 aggressive.
附:碘131治疗的原理:
甲状腺细胞会吸收碘, 甲状腺癌细胞也有这个特性. 而碘131是碘的同位素, 是放射性的碘. 人吃进去后, 体内残留的甲状腺细胞(正常的或者癌细胞)就会吸收碘131. 碘131放射伽玛射线杀死甲状腺细胞, 也就是说甲状腺细胞自食其果. 吃下去后要隔离几天. 药效几个月的时间, 但两周后不需要隔离了.
另外, 有效期间做全身扫描. 检测到有放射性浓聚的地方就是癌细胞存在的地方. 以此可以判断手术切除是否干净, 或者有没有身体其他地方的转移.
因为我的左侧甲状腺没有切除, 如果吃了碘131, 就会都浓聚在左侧甲状腺, 残留的癌细胞反而吃不到了. 所以, 必须切除全部的甲状腺才能用碘131治疗.
这是非常好的有标靶性的放射治疗, 副作用很小. 可以说是甲状腺癌患者的福利, 其他癌症的放疗没有这么好的, 都是好细胞和坏细胞一起杀, 人很受罪.
2010 年 7 月初的十天, 按原来的计划去了 Banff National Park. 这在得知诊断结果前就定好了. 虽然刚刚完手术一个多月, 但身体还行, 就去了. 果然风景宜人, 觉得很值得.
7 月下旬, 公司有一个转全职( Employee )的机会. 同时, 我的颈部新长出来好几个突出的淋巴结, 所以我担心复发了, 毕竟术后复发率是40% 以上. 万一癌扩散, 自己不行了, 对家庭还需要一个保障. 全职有保险 (Short/Long Term Disability), 不能上班也有 60-70% 的工资. 于是就同意转全职. 税后收入比做合同 (Contractor) 减少了一大半, 但就算是买个保险吧. 另外, 很多时候可以在家工作, 减少精神的压力.
2010 年10月, 在多伦多 women’s college hospital 做了第二次手术, 切除了左侧甲状腺. 这次手术很小, 没有那么难受, 术后第二天一早就出院. 休息了两周就回去上班了.[mbl: 这次加拿大手术医生的技术看来比北京的手术医生要好.] [我们来做一次马后炮复盘:如果不匆匆忙忙赶回北京,就坚持留在加拿大做全切除,是不是效果会更好一些?]
一个月后, 病理显示左侧甲状腺没有癌. 这消息令人振奋. 接下来就是做碘131, 清除残余癌细胞.
(三) 碘131 治疗和扫描
2011 年2 月 14 日, 做了碘131治疗. 治疗前需要无碘饮食两周, 以确保可能残存的癌细胞处于对碘的饥饿状态, 所以, 不能去饭馆吃饭,不能用普通的含碘盐. 日本震后, 中国人抢购碘盐就是这个道理, 让甲状腺吃饱了碘, 就不会吸收碘131. 正常的甲状腺细胞吸收到碘131 的放射, 可能癌变. 而癌细胞吃了碘131 会自己被杀死.
在 women’s college hospital 的一个隔离房间里面吃了100mCi的碘131 胶囊. 在那里住了两个晚上. 每天在电脑上看看电影, 看看小说,吃着没有任何味道的饭. 护士送饭送水也放到门口, 她们离开了, 我才开门拿进来.
一周后做了WBS(whole body scan 全身扫描), 但到了4月再见甲状腺医生的时候, 才知道结果.[mbl: WBS的结果不需要等那么长,自己应该主动询问.你下面说到,7/15做CT7/21就知道结果了.] 她告诉我的扫描显示右颈部和中部, 以及左纵隔(胸腔上部, 气管,食管,淋巴总管交会处)有浓聚. 她说她不知道纵隔的是什么, 也许就是淋巴结转移. 她打算等半年再做碘131 扫描, 看看这些残余有没有被碘杀死. [mbl: 结果没有按照这位医生计划,半年后再做一次WBS.反而在9/27大动干戈做开胸手术,才知道纵隔上的肿瘤不是癌,是一个良性的支气管囊肿(Bronchogenic Cyst). 现在要问一个问题,如果先做一次WBS,是不是可以避免这个开胸手术?] 我从医院出来, 发现自己的车还被拖走了, 因为到了 rush hours.
自己尽量保持镇静, 但在去取车的路上, 霎时间天地再次被翻转. 原来以为已经可以恢复正常的生活了, 现在一下子又被拖回到反抗病魔的状态.
回到家, 上网研究了很久. 甲状腺癌纵隔转移 5 年生存率是 50%, 其中 80% 会有肺转移, 生存率就更低了. 这个生存率对于其他癌症来说是高的, 但是对于一个从没有面对死亡的人来说, 如同是被置于绝地. 本来恢复了看房, 准备换房的行动现在又一次终止. 股票也不跟踪了,避免情绪的波动. 生活的中心再次转移回到对抗疾病的状态.
于是, 开始到处寻访, 后来经人推荐买了一本书, 是一个法国的医学博士写的, 叫David Servan-Schreiber. 他十七年前得了脑癌, 切除后,一年后复发, 再手术化疗, 放疗等. 于是他开始研究如何通过健康的生活方式避免癌症, 或者得了以后防止复发. 汇集了他很多年研究和收集的材料, 写了一本书畅销书 <Anticancer, a new way of life>. 里面具体的东西很多, 这里简单地做概要, 希望对你也有用:
- 减少动物性食品, 尽量素食
- 不吃垃圾食品, 快餐, 如麦当劳
- 尽量吃有机的食物
- 注意 Omega -3 的摄取, 每天 1 克
- 注意维生素 D的摄取
- 保持愉快的心情
- 锻炼, 每天 30 分钟, 每周 5 次的快走.
- 参加支持小组 - support group, 和其他病人分享和讨论病情和感受
- 做冥想:如瑜伽, 气功, 太极等
他讲座的 video 在youtube 上有, 即使身体健康的你, 也不妨看看:
另外还结合了不少其他的实例和文章, 我开始调整饮食, 吃营养品, 锻炼身体等等. 家里用了好几年的玉米油, 其实对癌症是火上浇油. 因为其Omega 6 的含量太高, 会促进血管增生, 帮助癌细胞生长. 换成橄榄油. 白米, 白面换成糙米等五谷杂粮. 经常打鲜果汁等等. 生活不再那么简单方便, 好在经常在家工作, 有时间折腾这些东西.
看了这么多资料, 并且和rolia 抗癌之路的网友的交流, 我增加了很多健康养生的知识,成了这方面的小专家. 心情从刚刚得到消息时的沮丧也转为平静. 毕竟自己做了自己能做的, 最后的结果只能交给老天了.
(四) 纵隔转移
2011 年5月见手术医生的时候, 跟他讲了我对碘131扫描报告中纵隔有浓聚的顾虑, 他劝我不必担心, 给我约了CT.
6 月回国看了父母. 他们还不知道我得病的事. 好在他们眼神也不是很好, 没有注意到我颈部的疤痕. 给他们的照片都是经过处理, 消除了疤痕的. 然后去九寨沟, 黄龙, 西安, 一共玩了一周. 7 月1日我独自从上海回到了多伦多.
回来后, 发现家门口的树没有了. 原来, 那颗树大半变黑枯死, 管理公司怕风大吹倒, 砸到人或车, 就锯掉了. 这对我的震动很大, 因为听说家门口的树死了, 这个家就完了.
小时候, 姥姥给我讲过不少她以前的故事. 她父母有五个孩子, 加上老人佣人, 都靠他父亲从外面寄钱回来养活, 也算是富足之家. 一次他父亲离家做生意后, 家门前的大树自己枯死了, 原来几百只树上做窝的鸟也飞走了. 邻家说: 这家是要败了. 果然, 她父亲再没有回来. 没有了经济来源, 我姥姥不得不从大学辍学, 去小学教书, 都来又从政, 一路坎坷.
7 月15 日做了上身的 CT 扫描. 21 日见了医生得到结果.
- 纵隔食管旁一个 2.1x1.6cm的肿瘤;
- 肺部末端轻微的纤维化;
- 肺部 7 个小结节.
医生说高度怀疑是纵隔转移, 他想做穿刺活检, 确定是癌症后再手术.
回来后, 心情急落, 纵隔转移 + 肺转移, 印证了碘131 的结果. 活过5 年的可能性小于 50%. 不仅如此, 网上得知碘131可能导致肺纤维化,那个更加要命. 本来甲状腺癌靠碘131能得到很好的治疗, 如果因为纤维化不能用碘131, 治愈的可能性就更加微乎其微.
北京肿瘤医院十几年收治了 70 多甲状腺癌纵隔转移的病人, 可见它不是很常见, 大部分甲状腺癌手术完了就好. 而且纵隔转移发生是术后1.5-20 年间. 我的情况还不到一年, 长得太快了. 想起来当初 Dr. Zahedi 说我的癌细胞很 aggressive, 担心自己的癌细胞生长过快, 人生也就很快结束了.
7 月23 日那一两天, 我完全陷入了绝望之中. 真正地去想那些面临死亡的问题. 即便如宗教所说人有灵魂, 无论是上天堂/下地狱, 还是投胎转世, 和亲人的隔绝却是永远的了. 如果看<人鬼情未了>中, 爱人阴阳两隔会感动落泪, 现在它却摆在自己的面前.
孩子还小, 不能看着他们长大, 永远不能拥抱他们. 这对我来说, 无力面对. 觉得自己无力承担这许多, 想着只能去教堂, 托付给这个我多年来努力想信, 又无法想信的上帝. 不过, 最终还是没有去.
邻居+朋友+同事 M, 2008 年得了癌症, 大手术, 化疗, 放疗, 各种新药都无济于事. 现在被放弃治疗, 在家. 从他夫人那里得到这个消息,我心情无比沉重. 我甚至没有勇气去看他. 生怕看到他的今天, 就变成我的明天.
之后和医生的交谈中, 他们都说这个肺纤维化不是碘131 引起的, 不会影响碘131 治疗. 肺部的结节也不一定是甲状腺癌转移, 很可能是污染, 感染引起的. 让我稍许安心.
痛定之后, 我进入更加严格的生活方式. 更严格控制饮食; 天天去跑步; 吃中药调理肝火; 种小麦草榨汁喝; 参加素食班学习素食理念和方法; 参加有机耕种班准备来年大干一场, 等等.
值得一提的一件事. Eddy 是在6 月抗癌之路聚会时第一次见到的, 那时他刚刚诊断出肺癌, 7 厘米了, 无法手术. 穿刺活检把他折腾得很虚弱, 总咳嗽. 医生几次跟他说要准备好后事. 当时真为他捏把汗. 9 月再次聚会时他和老婆又来了, 人胖了不少, 精神很多. 他还在经历化疗, 好在他身体素质不错, 所以人没有虚弱, 肿瘤也缩小了. 他对我说: 这次来就是看看你. 他看到我发的帖子有些沮丧情绪, 所以特意来给我鼓励. 我是不善表达喜怒的人, 当时就感谢他的鼓励. 事后想想,很感动, 他自己已经面对死亡, 虽有好转, 但依然在和死神搏斗, 但还想着来给我鼓励. 抗癌之路的组织者和另外的几名女队员也都邮件, 电话, 给我鼓励, 难能可贵. 还有很多事例, 一时也说不完.
(五) 第三次手术
几经尝试, 超声波无法到达那个肿瘤, 没法穿刺活检. 甲状腺癌的血液指标是 TG, 但是我血液有 TG抗体, 所以测得的TG值不起作用. 唯一契合的是 2 月的碘131 扫描报告, 显示左纵隔的浓聚. 在我的要求下, 甲状腺医生, 手术医生和另外一个专家会诊, 觉得转移的可能性很大(highly suspected), 同意手术.
2011 年 9 月27 日, 在 Toronto General Hospital 进行了第三次手术.
换好衣服一进去，医生对我说, 他重新看了 CT，肿瘤位置比预期的要深，所以可能要劈开胸骨。他已经联系了胸外的专家. 我想，既然来了，就接受吧。上了案板，一个不认识的医生和我打招呼，他就是负责砍断我的胸骨的医生。然后，Dr. Goldstein开始对着摄像机介绍，看到我还没有昏迷，对着麻醉师说：再加麻药。
醒来时, 已经在监察室，24 小时护士监护. 奇怪的是感觉不如在北京手术时难受，其实那次手术要小很多。第二天，医生来看我，说已经做了快速病理，那个肿瘤不是癌。我并没有欢呼雀跃，一是因为事先有侥幸心理，觉得那可能不是癌；另外，肺部的多个小结节其实是更大的顾虑。
下午，转到了普通病房，因为公司保险cover 80%, 就要了一个单间。很幸运的得到一间，两面墙都有大窗户，而且能看到 CN tower。头三天不能吃喝，因为动了食管（那个肿瘤是附在食管上的），怕漏东西到胸腔，那是及其危险的。三天后, 开始吃流质：果汁和果冻等. 护士看到送来的饭，说这是什么午饭啊！
被要求每天走动, 加快恢复. 一次出去走动，看了一会儿电视，足球场上奔跑的球员，无数喊叫的观众. 我很走运地看到曼联一个及其漂亮的，充满自信的配合进球. 感觉把我拉回到这个世界. 曾经看着这些充满热情的人们，我觉得我在离开他们而远去，我将不再属于这个世界.现在，我至少已经一条腿跨回来了。
还有一件有意思的事, 每次去照X-RAY，都有人来用轮椅把我推去推来。我说我可以走，他们说这是医院的政策必须坐。结果就看到我一个大个男人被个小个的女护士推着。 想起来去年在北京肿瘤医院，一个大妈来说带我去做超声波，走了几步，她就说：我告诉你再哪里，你自己去吧。结果我用了 20 多分钟，问了N个人，才在一个犄角旮旯找到.
没有让孩子们来看我, 因为我还没有勇气告诉他们我的病, 没有勇气让他们看到我病重躺在床上的样子. 所以, 他们到现在还不知道, 尽量敏感的老大有些知觉.
一星期后，出院了。和出狱的感觉差不多, "不自由，勿宁死”. 回家就抓了一把零食吃. 住院一周，最大的感触就是"千万别犯罪"，犯罪了也千万别被抓。 原来以为监狱生活规律, 有人做饭, 可以读书, 修心养性，而且, 据说(seinfeld)探监的SEX是最好的, 现在看来还是算了。我没熬到探监一定已经疯了。
之后又见了几个不同的医生. 医生 Dr. Thomas Waddell, 他打开我的三根肋骨, 取出了肿瘤. 他告诉我那其实是一个支气管囊肿(Bronchogenic Cyst). 可能天生的, 只是最近进了液体, 所以大起来了. 如果早知道, 就不用手术, 观察就行了. 如果实在太大, 只需要用针进去吸出来液体就行了. 现在已完全切除了, 但不排除再生, 3-5年复查一次.
另一个权威甲状腺医生 Dr Tsang, 他说如果纵隔的肿瘤不是癌，只需要做一个小剂量的碘131扫描，看看肺上的是不是甲状腺癌细胞。如果是, 才需要大剂量治疗。 回家路上心情轻松了很多，从今年四月开始担心的问题似乎有了最好的结果。现在看来肺转移的可能性较小。 人生的计划从 3-5 年变成了30+ 年.
下周就去见 Dr. Zahedi, 商量做碘131 的事.
过几天就术后一个月了, 现在状态都好, 恢复不错. 前几天还参加了抗癌之路10月聚会. 胸口还疼, 背部肩胛骨疼, 需要每天服用止疼药. 这次恢复是几次手术以来最慢的一次。不过没有什么不好的症状，只是需要时间。
医生给了六个月的假, 我要好好利用. 这些天在家看1080p的电影, 另外准备发展点爱好. 不过如果在家无聊的话, 也可能会提前回去上班.
2011 年 10 月 20 日, 我的朋友 M 在重症监护室去世. 他和我年纪相仿, 还有一个十几岁的女儿. 我已经去参加了他的葬礼.