When to Disclose Host Parent Illness During Au Pair Match

by cv harquail on July 18, 2016

Recently we’ve discusses Au Pair illnesses, when an Au Pair ought to share this information with Host Parents, and how / when Host Parents can best respond.

Now, the shoe’s on the other foot, with this email from HostMomWithGoodPrognosis.

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Should this information be shared before matching with an au pair? Or later, once the au pair arrives?

As HostMomWithGoodPrognosis writes:

I suppose the answer is always going to be “it depends on the specific facts,” so here are my facts for consideration.

A month or so ago, I had a lump in my thyroid tested and received a diagnosis of papillary thyroid carcinoma. The good news is that the prognosis for this is generally excellent — without boring you with the details, the survival rates are extraordinarily high, and it’s likely that at most I will only need to have part of my thyroid out. I won’t need chemo or radiation so I’m unlikely to be debilitated for any significant period of time. I’ve been told repeatedly by doctors that “it’s the best cancer to have” (somewhat annoying in that I’d rather not have any cancer, but objectively speaking it’s highly treatable and highly survivable). The options on the table right now are either active surveillance or a partial thyroidectomy, to be determined after I get a second opinion from one of the leading experts at a major cancer center in a couple of weeks.

The way the timeframe is shaping up, though, is somewhat tricky vis-a-vis our AP candidate interviewing and matching schedule. Our current AP leaves in late September and we need to match with our next AP by mid-August.

We’ve recently made an offer to an au pair candidate we really like, but I did not disclose the diagnosis to her during the interview process, because the final treatment plan is still up in the air. For what it’s worth, pending getting the second opinions and formulating a treatment plan, I’ve only told my current au pair, my boss, my mom and my siblings, and two close friends, but not my kids or my larger social network.

The timing of the surgery, if any, is so completely up in the air right now that I can’t say anything more than “I might need surgery either soon-ish or maybe months or years from now.”

At what point do I need to tell our new au pair? I am really not comfortable telling her right now (when we have not yet officially matched) in part because (selfishly) I don’t want this to influence her decision, in part because it is not a huge health issue that’s likely to affect how I function in the household during her year here, and in part because it still feels very private.

Is it OK that I’m withholding this information until I know what treatment plan I decide on? And once I do know what the plan is, I hope in a couple of weeks, should I tell her before she arrives or wait until after she’s here?

Image: Curious by Liliana Saeb, on Flickr

{ 26 comments… read them below or add one }

Aupair Paris July 18, 2016 at 9:03 am

I don’t think you need to share this info with the AP until it becomes relevant – or think about anything right now so much as looking after your own health. I think if you *don’t* share the info and something changes dramatically, and you do end up more seriously out of commission than anticipated (seems so unlikely, and hoping not!) then you may have to rethink some childcare arrangements – fill in the extra hours somehow… But since this is so spectacularly unlikely, I don’t see much point in possibly scaring someone off, when you more than likely will be bouncing back really soon!

I am admittedly liberal, even about au pairs sharing their illnesses – but you are the employer and not the employee in this case, and it’s not really any of an AP’s business exactly what you’re doing while she’s watching the kids – as long as she’s not going over her hours. I watched my host kids while my HPs had all kinds of appointments, and I never considered it my right to know what they were all for. I think it’s only an issue if you do begin to find that you desperately need more childcare help… But that’s not a question for right now, in my opinion.

I hope you get better really soon. Good luck with whichever treatment path they end up advising for you!

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FormeraupairNowjustaMom July 18, 2016 at 10:48 am

I think you should absolutely tell anyone you entertain as an Au pair to allow them to make an informed decision. I understand that your prognosis is excellent, however, cancer is a tricky desease. Once may be week and in remission one month and bang! then become ill and require treatment next. I think it’s unfair to withhold this information and impose on a young girl who has nothing to do with your circumstances the risk of having to witness cancer treatment (possible chemo or radiotherapy) without allowing her to decide for herself how she would feel if it came to that.

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Dorsi July 19, 2016 at 11:15 am

That is a popular conception of cancer, but not really true. For someone with gall bladder disease, they can be well one week and then require treatment the next. Cancer is not a special illness that is more likely than many others to suddenly knock you down. Of course, some cancers are more aggressive, more difficult to treat.

However, if this mom had Crohn’s disease (inflammation of the intestines, autoimmune related), should she disclose? It could put her in the hospital. It could kill her. It is very unlikely to do either of those things, just like thyroid cancer is unlikely to do those things.

Any of us could be hospitalized next week and be seriously ill. But the risk is about the same as it is for the HM asking the original question.

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FormeraupairNowjustaMom July 18, 2016 at 10:49 am

*one may be well

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TexasHM July 18, 2016 at 10:50 am

I think it’s fair to wait on the conversation until you have more details/a plan. Right now if you bring it up she likely will have lots of questions and you will have no answers so it might come across as – not sure how to say this without sounding insensitive because cancer regardless of situation is a big deal – a bigger deal than it may be.

I would, however, tell her in a couple weeks (well before she comes) because it doesn’t matter what you wait to tell her until she arrives she will likely feel misled and you could get off on the right foot. If it truly is something that will be unlikely to impact her and her experience then there is no reason to withhold until she arrives unless you are trying to prevent her from reconsidering her match with you (which she is likely to do if she arrives and then finds out something was deliberately withheld). Plus right now like you said you aren’t even officially matched and you don’t have a second opinion so there isn’t anything to talk about – yet. If you officially match and then in a couple weeks get a second opinion and plan then I think you give her a high level heads up. Like with kids, if you don’t make it a big deal and you have a plan she will likely roll with it no problem. If she doesn’t then honestly she isn’t the AP for you anyway and better to learn that when you still have time to find another candidate than to wait and end up in rematch because she feels misled (worst case scenario of course).

I think a lot of HFs dread having all sorts of conversations with their APs or candidates in interviewing and a lot of the time when they finally do have the conversation they are surprised that it’s a non-event for the AP. I’ve known HMs that have agonized for weeks over telling an AP something they think is a dealbreaker only to have the AP say “Ok!” and walk off like nothing happened. I guess my long winded point is don’t assume that this news will at all change her mind about matching with you and your family. The conversation will likely be much more stressful to you than to her (assuming you approach it in the manner discussed above). If anything it could potentially strengthen the relationship because she will (hopefully) appreciate that you shared that news with her and your plan when theoretically you didn’t have to (agency profile I don’t think requires you to disclose and even if it did you did not have official diagnosis until after you were already interviewing anyway).

Prayers for quick healing and you and your family! Hopefully this will quickly pass, new AP will be a rockstar and you can get back to being you and doing what you do without having to worry really soon.

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NoVA Twin Mom July 18, 2016 at 2:04 pm

I agree with TexasHM (not a big surprise to me :))

Technically, until you have that second opinion, you don’t know much of anything to share. If you wanted to share ANYTHING at this point, you might talk through what would happen on a day you’re sick (with a stomach virus or something similar – something that would put you out of commission for a day or two) and what you expectations for an au pair during that time would be.

When you do bring this up with your au pair, you may want to lead with an “apology” – “I know it may seem like we should have told you sooner, but I wanted more concrete information before sharing this news with anyone, including our kids.” Then be open to the idea that she may want to rematch once she’s here and it’s nothing personal (though it will feel personal) – some people just don’t do well with “sickness.”

Some of this may be influenced, though, by the fact that I’ve had friends with thyroid cancer and you wouldn’t have known they were being treated for it, the effect on their (outside) life was so minimal. If this were a different type of cancer, my advice could be different.

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HappyHM July 18, 2016 at 12:32 pm

I think you should tell her now, before you match. I understand that it feels very private and that you’re still seeking 2nd opinions, and you say that you don’t want it to influence her decision of whether to match with you. However, by virtue of the fact that it COULD influence her decision, it’s better to tell her now–when you have TIME to find a replacement, rather than waiting to tell her when her arrival date draws closer or she’s with you and you might have to go into rematch. Those situations might leave you without childcare at a time when things are already becoming more stressful because of your treatment.

That being said, I echo TXHM above in that if you present it the way you’ve presented it here, the AP will likely said, “OK no problem.”

On the small chance this would be an issue for her, it’s appropriate to give her the chance to decide that for herself when you still have time to make other arrangements.

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Frankfurt AP Boy July 18, 2016 at 2:11 pm

From an au pair perspective, I would have no problem with the prospective HM keeping this private. It seems normal to me that you would only share it when you know the AP better.

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HRHM July 18, 2016 at 3:05 pm

I may have a unique perspective, as I am a surgeon. But I think the way to reframe the question is this – You may need surgery during her year – do you need to warn her this is possible? The answer is no. You also might need an ACL repair or to get stitches during her year, but you don’t warn her about that, right?

Yes you have a cancer diagnosis, but you’ve also heard about the treatment options and know that this is a relatively easy treatment course. Even if you get your thyroid out, you’ll be an outpatient or at worst, overnight. If you had late stage breast cancer with recurring trips to the radiation onc center and debilitating chemo and repeat surgeries scheduled, then a warning would only be fair. As long as your medical condition and it’s treatment won’t materially change the job description as she already understands it, there is no reason to disclose this to her.

Your health is a very private matter and only you can decide what you are comfortable sharing with a stranger. Unfortunately, sometimes even with an AP in your home, you don’t want them knowing your personal business. I certainly did not share my multiple miscarriages and D&Cs with our APs, even the ones I like a lot. I just said, “I have to have a procedure” or “I’m not feeling well” and left it at that. As long as you’re not violating hours, it’s all you owe them.

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Mimi July 18, 2016 at 4:17 pm

I have an autoimmune disorder and am on injectables for it. We disclose this with APs that we are serious about matching with so that they understand that they will see medication in the refrigerator, that there are syringes in the house, and that although my condition is very well managed, I have some physical limitations and I can have flare ups that incapacitate me. We have never had anyone reject us as a HF citing this as a reason (because there are so many more with 4 HK!), but I prefer to have it out there because there is often judgment where there is ignorance.

Although there are many things up in the air about your diagnosis and prognosis, establishing a good relationship often starts before they arrive and I see how an AP could see it as a breach of trust if they learn about this after the fact. Even with a good prognosis, there are many ways in which illness affects families and the psychological impact of a cancer diagnosis affects different families in different ways. Depending on your children’s ages, you may find them looking to the AP for emotional support and it would be better to know now if the AP is up for the task. Even if that’s not the case, it is helpful to know in advance how an AP might handle the idea of “sickness.” As TexasHM says, if this is a deal breaker for a potential match then that’s not the AP for you. I think that if you have told your current AP and you expect to have a family relationship (rather than employer/employee) with your next AP then you should disclose it to a prospective AP if you’ve proposed matching.

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TexasHM July 19, 2016 at 9:26 am

This is a great point – you may handle the situation differently based on the type of relationship you desire with your AP. Ours are completely integrated true blue family therefore I would approach as stated above. But, if you are seeking a more professional relationship and that’s what AP wants/expects as well then HRHMs approach would likely be better.

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WarmStateMomma July 19, 2016 at 7:34 am

Health is such a personal matter, but so is living with a new family. To the extent you think it may impact her experience, I’d disclose that you have some health concerns and it may impact her in XYZ way. I’d give thought to whether your family is going to be stressed out, cancelling the vacation plans your AP thought she’d be joining you for, etc. Just as we think APs don’t fully appreciate the ways their health problems can impact the family, we should consider whether ours impact them. And then let her decide.

This doesn’t mean sharing private details, just whatever you expect the impact to be on her. She is probably imagining a happy-go-lucky adventure and to be greeted with that scary word “cancer” might feel like a bait and switch. Managing expectations to the extent you can is key in all aspects of the AP program. Just tell her whatever you would tell her if she were living with you – as HRHM says above, this can be vague.

I can’t imagine what a punch in the gut it was to receive that diagnosis. I wish you the best with your recovery.

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Jennc July 19, 2016 at 12:47 pm

I’m in the medical field , and in my opinion it is not necessary for you to share this information . If you decide to have surgery , there is no apology that needs to be made , you give her the information she needs and just let her know more assistance maybe required while you recover , but recovery from post partial thyroidectomy isnt awful and won’t put you out of commission long. It is also not horribly painful. Anyone of us can have something occur during an Aupair year that requires surgery you never know

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CanadianAuPair July 19, 2016 at 5:25 pm

First of all– get well soon OP, all of my best wishes to you. I think the best way to approach this is the golden rule– share with your au pair what you would expect him/her to share with you. If the situation was reversed would you be mad at your au pair for not disclosing this condition pre match? In this situation I think you’re totally fine keeping it to yourself until necessary.

Personally I never disclosed a kidney condition that I was born with to my host family, mostly because I had surgery years ago and manage it with little to no effort now. HOWEVER I do acknowledge that I live in and au paired in countries where I have basic healthcare if I need it (I did use it as an au pair…. but for a broken foot not a kidney). It came up sometime throughout the year as the kids saw my scar, and was nooooo big deal.

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Taking a Computer Lunch July 19, 2016 at 10:12 pm

I’d like to throw something into the mix here. You’ve told your current AP – and chances are she’s had an official or even ongoing conversations with the candidate. So, the candidate might already know. Better for her to hear it from you: 1) it’s a minor form of cancer with a high cure rate, and shouldn’t involve chemo or radiation; 2) the fact that relatives or DH will cover care for the children during and after your surgery so that she’ll stay within her 10 hours a day and no more than 45 hours per week; 3) you’re matching with her because you feel that she’s the best candidate to care for your children during your recovery from surgery when you won’t be able to pick them up but you will be able to cuddle.

Everyone brings preconceived notions to the table. Personally, I believe more you are open with a candidate the more equipped they are to rise to the occasion.

And yes, sometimes the situation changes. Within three weeks of AP #6’s arrival, DH’s father collapsed and died 6 weeks later. Our AP was ill equipped to handle the grief and stressed out about it. However, when The Camel (our beloved child with special needs for you new moms) required major surgery, I took time to sit down and tell the AP just how important she would be to the family (she thought she might be able to take a long vacation – ha!). My honesty about her role paid off. She was very vested in our family during The Camel’s surgery and recovery (it wasn’t clear The Camel would survive – she was on life support for 10 days and at one point DH and I had to raise the question of withdrawal of support). The AP gave The Camel, child #2, and us 100% of her support (while still being able to have her mandatory time off). We were all disappointed when her nomination for Au Pair of the Year did not go far.

I know that everyone has their personal barrier when it comes to privacy, but in my experience, a little honesty goes a long way. IMHO – set your AP up for success with your family – because even if your cancer “is nothing” it will be very tense in your house when you undergo surgery – and you’ll need a caregiver for your children who can step up, empathize with their grief and help them understand that your surgery and recovery is temporary in their lives.

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ChiHostMom July 19, 2016 at 10:35 pm

I agree with Taking a Computer Lunch since your potential AP should here it from you.

I’m hypothyroid and have been for 20+ years now and I will say that sometimes it takes a while to get all the dosages figured out with thyroid stuff. When my medications have been off I can have symptoms ranging from depression/anxiety/insomnia to almost ADHD levels of attention and energy and the weight gains/loss to go with. I don’t share with APs until they get to our house because if they’re off, within a month or so I’m back to normal (after the blood tests reveal that I need a dosage change).

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Schnitzelpizza July 20, 2016 at 2:34 am

As somebody who has thyroid issues running in the family (grandpa had ‘thyroid cancer’ of some type, grandma and aunt had thyroid removed due to Hashimoto’s, my younger cousin had papillary thyroid carcinoma – gross disease that had spread to the lymph nodes with a total thyroidectomy, a second surgery as well as radioiodine therapy – she has been cancer free seven years this year, I have Hashimoto’s… my MIL had what DH and I assume was follicular thyroid carcinoma) a) all the best to you and b) you want your prospective AP candidate to hear it from you and not your current AP.

You don’t need to go into any details when telling her.
Tell her you might need to have your thyroid removed and there might be a time period in which you might be less than fun to be around while your medication is being adjusted (my cousin has to stay slightly hypothyroid on recommendation by her doctors which is not ideal concerning weight and other possible symptoms, as described by ChiHostMom).
Yes, of course you might tear your ACL and need surgery for that… but there is a difference between acute and chronic issues. And I usually feel that it is fair to disclose chronic issues to an AP before arrival (says the AP who ended up in a HF with a child with Ehlers–Danlos and life threatening allergies that had not been disclosed during matching, even after I asked for health issues).

“The options on the table right now are either active surveillance or a partial thyroidectomy”

Not a doctor. But from my experience (and I was heavily involved in my cousins treatment as my aunt always wanted somebody else at the appointments, as a second set of ears and somebody who isn’t star struck by “a doctor”)?
Get it done and over with. You might not even get a choice but the prognosis for papillary thyroid carcinoma is so excellent if it’s fully removed that you are basically considered cured after surgery.
Do get a second opinion on part or total thyroidectomy (it’s often multifocal so don’t throw the idea of a total thyroidectomy out of the window early) and if you will need radioiodine therapy after surgery but as it usually is with cancer – the earlier you catch it, the earlier you get rid of it, the smaller it is, if you get it all out and if it hasn’t spread… the better the prognosis (and it has a 5-year survival rate of 100% for stages I and II and the 20-year survival rate is somewhere up there as well).

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Schnitzelpizza July 20, 2016 at 2:36 am

This was not supposed to be a reply to ChiHostMom… I just clicked “add reply” above. Oh well.

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Chicago Host Mom July 19, 2016 at 11:09 pm

I was in an almost identical situation two years ago (except for location of the cancer, but it was also very manageable). I did not disclose this to our prospective Au pairs in the matching process because I was still adjusting to the situation myself and am generally very private about health issues. When I had scheduled surgery and knew what would play out, I emailed our new match to let her know the details she needed to know — basically about the same info that OP provided. I did not want her to worry unnecessarily and I did not want to raise questions I could not answer yet. She was totally fine and mature about everything. The only impact it had on her was that I was in the hospital for three days and then I was l off work for 8 weeks during the summer, which did not actually impact her schedule, but I wanted to help her understand when she is “on duty” while one of us is home and develop some strategies to help the kids look to her and not me while I was recovering and she was on duty.
Anything could happen during an au pair’s year, and so long as you do not have a chronic condition or know that treatment and recovery will affect your au pair’s experience, disclose what you feel comfortable with, at your own pace, and in a way that explains how it will affect her. I also suggest talking to your LCC to hear her thoughts.

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Seattle Mom July 20, 2016 at 5:57 pm

After reading this post and through most of the comments, I think the OP has a lot of advice and a variety of opinions and perspectives! I honestly don’t know what I would do in her shoes, but the discussion here sure is helpful. I bet that certain ideas resonate with her feelings and values more than others, and whichever way she goes she’ll know that it was well thought out.

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German Au-Pair July 20, 2016 at 7:08 pm

Here’s what I think you should disclose so you are on the same page:
1. You currently are seeing a doctor for some condition that may require you to undergo surgery during her stay with you.
2. You already have an alternative childcare plan in place which looks like xy so she will not be required to work more than what is allowed (but, depending on your regular schedule, maybe more than during the rest of the year).
3. You will probably need her to be supportive to the kids and your family in this case.

All of which can happen without knowledge during her time there so her response SHOULD be that she’s okay with it. If she’s not, you really don’t want her around for it anyway.

In general, if there are health issues that are likely to cause a lot of distress on the family situation, I would absolutely disclose this to an AP. I started my AP year after I had been heavily involved in a relative’s care before his death and I know I would not have been up to living through this again if I’d known before matching. (Nor would I abandon a fmaily had it occured during a stay. It just seems fair to let someone know what awaits them.) In this specific case though it seems less distressing which I why I would disclose what I mentioned above and whatever makes you feel comfortable on top of it.

Good luck to you!

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txmom July 20, 2016 at 9:24 pm

Haven’t yet read the previous replies, but wanted to reply quickly myself. I’m an oncology RN, and have see this many, many times. I have never seen a patient hospitalized more than a night – and that is only if their surgery is late in the day. It is a minor procedure with a generally short recovery time. Many patients take nothing stronger than tylenol after the first night. No reason to say anything to your au pair. The procedure will likely be done and over with depending on when/if you schedule it. Your doctor is right, if you’re going to get cancer, this is the one to get. Good luck.

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EsqHM in DC July 21, 2016 at 11:46 am

Here’s my personal experience, which isn’t quite in the matching context. I was diagnosed with an advanced and aggressive breast cancer a couple of years ago (though thankfully stage III and not stage IV). My diagnosis came about a month after my new au pair arrived, so there was nothing to disclose at matching time, which was several months before that anyway. As most people realize, and has been noted above, after a cancer diagnosis, it does take several weeks to figure out the extent of disease and the treatment plan. For me, it did ultimately include a very aggressive chemo and a few surgeries (seven so far) and radiation and I’m actually still not finished, really.

Anyway we waited until the treatment plan was set to tell our then-current au pair, and I was kind of nervous she would want out (which I would have understood but which would have been devastating to us because we needed her more than ever). She was so great about it, though. We kept her hours and schedule pretty much the same, but things like my being home in bed recovering from chemo infusions was different than she would have expected her job to be. For example, she had to keep our 2 year old away from me when he wanted to come climb on me and be with me, which she did pretty well. We were really grateful for her help that year. It was a very stressful year, and her taking it all in stride will always mean a lot to me.

And as you may have gathered, my health concerns and treatments do persist to some extent beyond that au pair’s year. I knew I was going to have a couple of surgeries the next year, so it was actually in our family letter during the matching process. I will always keep some form of it in our letter. It says something like “I was diagnosed with breast cancer in 2013. We expect the hardest part is behind us, but I do sometimes have medical things come up, and you never know. We were so grateful to have an au pair willing to help us through our medical challenges so far, and we are looking for an au pair that is will and able to handle this situation.” The idea is, I want to warn them up front that they may have to deal with medical issues, and if they don’t want to–fine, then we are not a match.

Anyway, I have gone on too long. Just my 2 cents. Or maybe 4 cents.

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German Au-Pair July 21, 2016 at 3:55 pm

I hope you find a wonderful new au pair who will help you as much as you need. I wish you all the best! Keep fighting.

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CO Host Mom July 22, 2016 at 5:22 pm

First, as others have said, I wish you all the best and hope for a speedy and full recovery.

Secondly, I vote for the suggestion from German Au-Pair – you should share that you have a heath concern and that the outlook is very positive. I don’t think you need to share all the details but you should acknowledge the situation. Worst case, you could match with someone that has a recent issue with cancer in his/her own personal life and this may be a distraction to your relationship. I would at least mention the basics before you match because you need you AP to be supportive even if it’s for a short and quick recovery.

Also, if it were me, and I found out the host mom knew before we matched, I’d be somewhat upset that it wasn’t mentioned, at least at some level.

Good luck and let us know what you decide to do.

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HostMomWithGoodPrognosis July 23, 2016 at 1:05 pm

Thanks, everyone, for your thoughtful comments and your well wishes.

Just FYI for those in the know about thyroid issues — I am already hypothyroid and have been for years, so I’m used to the testing/treatment merry-go-round on that front. No Hashimoto’s though and I’m on a great regimen with a great doctor who does extensive testing every three months to keep me on track. She’s the one who palpated the nodule and sent me for the US and eventually fine needle aspiration. My PTC is Bethesda Grade VI (i.e. malignant) but is only 1.4 cm with no evidence of vascularity or extra-thyroidal extension on US. No US evidence of lymph node involvment either in central or lateral compartments. Genetic testing is negative for all genes/gene fusions associated with the more aggressive forms of papillary thyroid carcinoma.

I’m very lucky to have great health insurance and easy access on the East Coast to the top cancer centers in NYC, Baltimore, and DC, so I’ve been doing my due diligence on locating the best doctors for second opinions. I just saw one of the top specialists in the US (at one of the top national cancer centers) yesterday. He’s one of the lead authors on the American Thyroid Association 2015 guidelines for this condition. Based on all of my test results, diagnostic, etc. he told me that I have two perfectly reasonable choices: surgery or active surveillance (i.e. ultrasounds every 6 months). It really is a matter of my comfort: if I want to have surgery now, that’s fine, and if I want to wait and have surgery later if the nodule gets larger or if I have lymph node involvement, that’s fine too. Survival and prognosis are the same either way. I’ve decided to go the active surveillance route (as his patient). So the plan is that there is no treatment plan right now — I will go back for another ultrasound and consult in January, and make a new decision then based on what the results show.

I am not inclined to talk about this with our new AP — certainly not at this point, and maybe not even in January if it’s still appropriate to maintain the active surveillance protocol after that check-in. It seems to me it’s like telling her I might or might not need rotator cuff surgery during her time here — an example I use because I am having minor rotator cuff issues for which I’ve just started PT. I might need rotator cuff surgery down the road if the PT doesn’t work, but surgery is not at all on the horizon. If I did have to have thyroid surgery during her year here, it would be far less dramatic on my ability to function in the household than rotator cuff surgery — far less pain, very little time off work, minimal recovery time, no physical therapy afterwards, and no impacts to the childcare schedule as my husband can easily cover whatever extra hours over 9 hours in the day we have during the week. My kids will be ages 9,12, and 14 while she’s here, so they are not care-intensive like babies and toddlers are.

Honestly, it feels like I might scare my new AP for no reason if I bring it up since there is no plan for treatment between now and January. Similarly, we’re not telling the kids — there’s just nothing to worry about until there is something to worry about. Right now, this condition has no impact on my daily life, physical stamina, or emotional resilience. I know it’s a very fortunate position I’m in to have such an indolent and highly treatable cancer, but one of the challenges post-diagnosis has been having to become an instant lay expert so I can educate and reassure everyone around me (husband, current AP, siblings, their spouses, my mom, my in-laws, my boss, my closest friends…) Everyone tends to freak out when they hear the C-word so I have had to do a lot of emotional caretaking of other people with respect to my diagnosis as well as doing the research on my own to figure out what the best available evidence says, who the top experts are and scheduling appointments with them, pulling together all my test results and records to send to each new doctor I consult with, and so forth. Now that I have chosen the active surveillance route, I’m really looking forward to putting this down for a while and getting on with the rest of my life.

To be clear, if I had a different form of cancer or a more serious chronic or acute illness, I would be proactive about warning a new AP ahead of time and making sure she was as prepared as possible and had the option to back out if she thought it would be too much. My thinking here is very much shaped by the specific facts of this cancer and not by an extreme aversion to sharing personal details with an AP. We do value close family relationships with our APs and have relied on past APs heavily for emotional and logistical support during a couple of health issues we’ve had during their time with us. I did tell our current AP what was going on pretty quickly after the initial diagnosis here but have asked her to keep it confidential. She’s a very private person herself so I am confident she will not disclose the information.

I very much appreciate all the thoughtful responses and perspectives. In particular, to EsqHM in DC — I hope you are doing well in your cancer treatment and recovery. I’ve had friends and relatives go through breast cancer and I know treatment can be brutal.

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