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August 17, 2025
Check-up from the neck up…and beyond
By Jessica Nohealapa’ahi
The Bandera Prophet
I don’t typically write in the first person. I think the last time I did was when I publicly shared my colonoscopy experience. I hope my story will help someone else, so in that same spirit of transparency and awareness, I’m again lifting the veil - albeit a little higher. Please pardon the adult language, they are mostly quotes.
It all began with a sonogram in May.
Not really, though that does sound kind of poetic. What did begin with that sonogram in May was months of quiet - and not so quiet - fear and stress. For context, I’ll turn back the dial.
The background
It was 2009.
After a while of feeling not quite right, I relented and made an appointment with my doctor. I told him I felt like I had the jitters, off-and-on chest tightness, a pendulum of mood swings, and an overall sense of just-not-myself. He warmed up his stethoscope, listened to my heart and lungs, then asked how things were at home.
My family was in the middle of a move after wrapping up a major new home renovation; we had two kids in school and a still nursing one-and-a-half year old; I was a full-time journalist juggling a breast pump and laptop. Things were good, I said, just really busy.
My doctor, a man who treated my children and me through years of colds, allergies and basic health needs, loaded a compassionate smile and spelled out an unexpected diagnosis. “You’re just hormonal, and you have a mild case of depression,” he said while proceeding to list a plethora of recommended prescriptions, all of which I declined.
On my drive home, a little befuddled, I called my dad and shared the news. His reaction, something along the lines of, “That’s bullshit. Get a second opinion,” emboldened me to not accept the diagnosis at face value.
A good friend referred me to her doctor, and I immediately scheduled an appointment.
Upon arrival, I barely made it past the front desk.
Three nurses checked and double-checked my vitals, before the doctor did it herself. My resting heart rate hovered at 190 beats per minute, and got faster when she said I may need an ambulance. The rest is a bit blurry, but I was allowed to go home as long as I agreed to start a beta blocker, wear a heart monitor for one week, and schedule a sonogram of my thyroid. I must admit, I didn’t even know where my thyroid was.
I was soon diagnosed with multi-nodular hyperthyroid disease, and it had been brewing. Within weeks, a biopsy revealed the largest and most suspicious of four nodules was benign. We left the nodules alone, my thyroid functions eventually returned to normal, and I have been in remission for 14 years.
It was not depression.
Fast Forward
My visits to the endocrinologist gradually decreased from weekly to annually, until 2018, when my insurance changed, and my visits were no longer covered.
I shifted annual labs to my new general practitioner, who didn’t recommend a sonogram since everything had been stable for so long. This year in May, as a preventative screening, and to get something current on file, we agreed we should take a look.
When I read the radiologist’s report that arrived digitally in my patient portal, my heart rate soared to a blinding, deafening pace. Trigger words like High Risk, Suspicious, Immediate Fine Needle Biopsy Recommended transported me back to 2009 at whiplash speed. Once my vision cleared, I remembered to focus on the real data - the nodules were not only relatively unchanged, they were a little smaller.
Thus began an Abbott and Costello administrative debacle.
Who’s On First
My GP asked the radiologist to compare the 2025 report to the 2009 report, which he said he did, but he didn’t (the 2025 report indicated my diagnosis was single-nodular; I was multi-nodular). The radiologist ordered another sonogram, but the insurance wouldn’t cover a second preventative screening within 12 months. My GP said to disregard the appointment.
After weeks of kicking dirt back and forth with the radiologist, my GP advised me to follow up with my endocrinologist, since he was most familiar with my case. My insurance company rejected the required referral as out of network. A second referral was issued to another endocrinologist. That doctor wasn’t accepting new patients. A third referral to yet another endocrinologist was declined, because I haven’t had a bone density scan.
Three strikes, and running out of endocrinologists, my GP’s referral manager came up with a different play. She tried pushing the first referral through again, on the basis of continued care. It seemed like that could bring us home, but the insurance company tagged it at the plate. Because more than two years had passed since my last visit, it was not considered continued care, and - you guessed it - a new referral was needed.
By August, it became apparent that we were caught in a rundown, and I was on the verge of falling through the administrative cracks. So, I launched a Hail Mary. Working with the referral manager, I scheduled my own appointment with my original endocrinologist as a self-paying patient, which we theorized would close the gap in continued care, and approved coverage could get back on the roster.
We’re waiting to hear from the insurance company. Regardless, it was a home run for me, and the best $200 I’ve spent this year.
Welcome Back
I really, really like my endocrinologist. He said he wondered where I’d been, and was visibly dismayed when I explained the whole insurance and radiology fiasco. He read the reports, reviewed my case, examined me, and optimistically said, “I’ll see you in six months.”
He also wrote a letter to my insurance company.
I set my appointment for 2026, checked out, sat in my hot car for a hot minute, and cried.
In addition to being a low-key-but-managing nervous wreck, I’m also a little superstitious. Post cancer, I was afraid to celebrate, for fear of tempting the cruelty of fate. A friend convinced me after two years to attend Relay for Life, and it remains one of my more memorable experiences.
Two weeks ago, I made plans to get together with a friend after my appointment, and momentarily questioned whether I was waving my middle finger in fate's face. I considered cancelling, just in case the visit didn't go well, but instead decided to keep our date - not as an act of defiance, but rather a leap of faith. I’m so glad I did.
Facing Fear
I’m a firm believer in preventative screenings, because I know early detection saves lives - it saved mine. Unfortunately, that logic never eliminates the momentum of panic and anxiety that builds before every mammogram, sonogram, blood test and procedure. Multiple times a year, I move forward into that fear. Frankly, it’s exhausting.
This year is especially poignant, because I’ve always had my dad to figuratively hold my hand. Whether by humor, good advice or paternal tone, he’s been my solid. While I was preparing for a colonoscopy in 2021, he was scheduled for the same thing four states away. Who knew our mutually candid bathroom humor would give me the courage and strength I desperately needed (that story at https://www.banderaprophet.com/210417colonoscopyjournal.html).
My dad passed in February, and I’ve felt a little lost. I have leaned heavily, while trying not to be obvious, on my family. My aunt, a retired RN, is my voice of calm, reason and explanation. My best friend has an uncanny ability to talk me out of the trees. And I can hear my god-sister telling me to get my “ass to the doctor,” which is surprisingly propelling.
But here’s the bigger problem - what’s up with our healthcare system?
Flawed And Fractured
I fully recognize and give thanks to the grace of God, and my healthcare. I’m alive because I’ve had wonderfully attentive doctors, swift and thorough procedures, and an amazing family.
But not everyone does.
I’m lucky that I could afford to pay my endocrinologist cash out of pocket. I’m blessed to have a job and a support system.
But not everyone does.
I’m fortunate to have health insurance - flawed though it is. My employment doesn’t offer that benefit, but I’ve had help navigating the marketplace, which can be confusing. Because of that guidance and because of that service, I have maintained seamless and continuous life-saving coverage.
But not everyone does.
Je Ne Sais Pas
I don’t know what the solutions are. I can only advise and give advice based on my own experience. So here goes.
Don’t be afraid to get second opinions.
If I had listened to my doctor in 2009 - who stopped being my doctor in 2009 - I would have likely had a stroke and possibly died.
It is time for open, honest conversation about women’s healthcare.
I was dismissed. Reread my previous paragraph.
Advocate for yourself.
Don’t give up if you hit a roadblock, whether with your insurance or medical provider. Listen to your body and your little inside voice, and keep asking out loud for what you need.
Know your thyroid (and where it is, which is the front of the neck).
This is a mighty mouse of an organ that regulates metabolism, bone growth, brain function, heart rate, the nervous system, and so much more. Nodules are common, and the vast majority are okay. See an endocrinologist if you have even the slightest concern, or just want to be screened.
Private-pay
If you don’t have health insurance, many physicians will offer a discounted cash rate. Some may bill later, allowing more flexibility. Be mindful of labs, as those can really add up.
Low-cost and free medical care
The Arthur Nagel Community Clinic provides low-cost or free medical services to Bandera County residents who qualify. See more at https://nagelclinic.org/
Watch for mobile mammogram screening services, which are low-cost, sometimes free and local. Go to https://www.universityhealth.com/services/breast-health/mobile-mammography
If you’re afraid, know that you’re not alone. Push through the fear and move forward - one step, one phone call, one appointment, one procedure at a time. You’ve got this.
Be kind to yourself, and be kind to others. I know it sounds preachy and cliché, but you truly never know what someone is quietly - or not so quietly - dealing with.
And finally, when in doubt, if you have questions, if you have symptoms, if you have unease… just get your ass to the doctor.
Here’s a song that lifts my spirit and helps ground me…
It all began with a sonogram in May.
Not really, though that does sound kind of poetic. What did begin with that sonogram in May was months of quiet - and not so quiet - fear and stress. For context, I’ll turn back the dial.
The background
It was 2009.
After a while of feeling not quite right, I relented and made an appointment with my doctor. I told him I felt like I had the jitters, off-and-on chest tightness, a pendulum of mood swings, and an overall sense of just-not-myself. He warmed up his stethoscope, listened to my heart and lungs, then asked how things were at home.
My family was in the middle of a move after wrapping up a major new home renovation; we had two kids in school and a still nursing one-and-a-half year old; I was a full-time journalist juggling a breast pump and laptop. Things were good, I said, just really busy.
My doctor, a man who treated my children and me through years of colds, allergies and basic health needs, loaded a compassionate smile and spelled out an unexpected diagnosis. “You’re just hormonal, and you have a mild case of depression,” he said while proceeding to list a plethora of recommended prescriptions, all of which I declined.
On my drive home, a little befuddled, I called my dad and shared the news. His reaction, something along the lines of, “That’s bullshit. Get a second opinion,” emboldened me to not accept the diagnosis at face value.
A good friend referred me to her doctor, and I immediately scheduled an appointment.
Upon arrival, I barely made it past the front desk.
Three nurses checked and double-checked my vitals, before the doctor did it herself. My resting heart rate hovered at 190 beats per minute, and got faster when she said I may need an ambulance. The rest is a bit blurry, but I was allowed to go home as long as I agreed to start a beta blocker, wear a heart monitor for one week, and schedule a sonogram of my thyroid. I must admit, I didn’t even know where my thyroid was.
I was soon diagnosed with multi-nodular hyperthyroid disease, and it had been brewing. Within weeks, a biopsy revealed the largest and most suspicious of four nodules was benign. We left the nodules alone, my thyroid functions eventually returned to normal, and I have been in remission for 14 years.
It was not depression.
Fast Forward
My visits to the endocrinologist gradually decreased from weekly to annually, until 2018, when my insurance changed, and my visits were no longer covered.
I shifted annual labs to my new general practitioner, who didn’t recommend a sonogram since everything had been stable for so long. This year in May, as a preventative screening, and to get something current on file, we agreed we should take a look.
When I read the radiologist’s report that arrived digitally in my patient portal, my heart rate soared to a blinding, deafening pace. Trigger words like High Risk, Suspicious, Immediate Fine Needle Biopsy Recommended transported me back to 2009 at whiplash speed. Once my vision cleared, I remembered to focus on the real data - the nodules were not only relatively unchanged, they were a little smaller.
Thus began an Abbott and Costello administrative debacle.
Who’s On First
My GP asked the radiologist to compare the 2025 report to the 2009 report, which he said he did, but he didn’t (the 2025 report indicated my diagnosis was single-nodular; I was multi-nodular). The radiologist ordered another sonogram, but the insurance wouldn’t cover a second preventative screening within 12 months. My GP said to disregard the appointment.
After weeks of kicking dirt back and forth with the radiologist, my GP advised me to follow up with my endocrinologist, since he was most familiar with my case. My insurance company rejected the required referral as out of network. A second referral was issued to another endocrinologist. That doctor wasn’t accepting new patients. A third referral to yet another endocrinologist was declined, because I haven’t had a bone density scan.
Three strikes, and running out of endocrinologists, my GP’s referral manager came up with a different play. She tried pushing the first referral through again, on the basis of continued care. It seemed like that could bring us home, but the insurance company tagged it at the plate. Because more than two years had passed since my last visit, it was not considered continued care, and - you guessed it - a new referral was needed.
By August, it became apparent that we were caught in a rundown, and I was on the verge of falling through the administrative cracks. So, I launched a Hail Mary. Working with the referral manager, I scheduled my own appointment with my original endocrinologist as a self-paying patient, which we theorized would close the gap in continued care, and approved coverage could get back on the roster.
We’re waiting to hear from the insurance company. Regardless, it was a home run for me, and the best $200 I’ve spent this year.
Welcome Back
I really, really like my endocrinologist. He said he wondered where I’d been, and was visibly dismayed when I explained the whole insurance and radiology fiasco. He read the reports, reviewed my case, examined me, and optimistically said, “I’ll see you in six months.”
He also wrote a letter to my insurance company.
I set my appointment for 2026, checked out, sat in my hot car for a hot minute, and cried.
In addition to being a low-key-but-managing nervous wreck, I’m also a little superstitious. Post cancer, I was afraid to celebrate, for fear of tempting the cruelty of fate. A friend convinced me after two years to attend Relay for Life, and it remains one of my more memorable experiences.
Two weeks ago, I made plans to get together with a friend after my appointment, and momentarily questioned whether I was waving my middle finger in fate's face. I considered cancelling, just in case the visit didn't go well, but instead decided to keep our date - not as an act of defiance, but rather a leap of faith. I’m so glad I did.
Facing Fear
I’m a firm believer in preventative screenings, because I know early detection saves lives - it saved mine. Unfortunately, that logic never eliminates the momentum of panic and anxiety that builds before every mammogram, sonogram, blood test and procedure. Multiple times a year, I move forward into that fear. Frankly, it’s exhausting.
This year is especially poignant, because I’ve always had my dad to figuratively hold my hand. Whether by humor, good advice or paternal tone, he’s been my solid. While I was preparing for a colonoscopy in 2021, he was scheduled for the same thing four states away. Who knew our mutually candid bathroom humor would give me the courage and strength I desperately needed (that story at https://www.banderaprophet.com/210417colonoscopyjournal.html).
My dad passed in February, and I’ve felt a little lost. I have leaned heavily, while trying not to be obvious, on my family. My aunt, a retired RN, is my voice of calm, reason and explanation. My best friend has an uncanny ability to talk me out of the trees. And I can hear my god-sister telling me to get my “ass to the doctor,” which is surprisingly propelling.
But here’s the bigger problem - what’s up with our healthcare system?
Flawed And Fractured
I fully recognize and give thanks to the grace of God, and my healthcare. I’m alive because I’ve had wonderfully attentive doctors, swift and thorough procedures, and an amazing family.
But not everyone does.
I’m lucky that I could afford to pay my endocrinologist cash out of pocket. I’m blessed to have a job and a support system.
But not everyone does.
I’m fortunate to have health insurance - flawed though it is. My employment doesn’t offer that benefit, but I’ve had help navigating the marketplace, which can be confusing. Because of that guidance and because of that service, I have maintained seamless and continuous life-saving coverage.
But not everyone does.
Je Ne Sais Pas
I don’t know what the solutions are. I can only advise and give advice based on my own experience. So here goes.
Don’t be afraid to get second opinions.
If I had listened to my doctor in 2009 - who stopped being my doctor in 2009 - I would have likely had a stroke and possibly died.
It is time for open, honest conversation about women’s healthcare.
I was dismissed. Reread my previous paragraph.
Advocate for yourself.
Don’t give up if you hit a roadblock, whether with your insurance or medical provider. Listen to your body and your little inside voice, and keep asking out loud for what you need.
Know your thyroid (and where it is, which is the front of the neck).
This is a mighty mouse of an organ that regulates metabolism, bone growth, brain function, heart rate, the nervous system, and so much more. Nodules are common, and the vast majority are okay. See an endocrinologist if you have even the slightest concern, or just want to be screened.
Private-pay
If you don’t have health insurance, many physicians will offer a discounted cash rate. Some may bill later, allowing more flexibility. Be mindful of labs, as those can really add up.
Low-cost and free medical care
The Arthur Nagel Community Clinic provides low-cost or free medical services to Bandera County residents who qualify. See more at https://nagelclinic.org/
Watch for mobile mammogram screening services, which are low-cost, sometimes free and local. Go to https://www.universityhealth.com/services/breast-health/mobile-mammography
If you’re afraid, know that you’re not alone. Push through the fear and move forward - one step, one phone call, one appointment, one procedure at a time. You’ve got this.
Be kind to yourself, and be kind to others. I know it sounds preachy and cliché, but you truly never know what someone is quietly - or not so quietly - dealing with.
And finally, when in doubt, if you have questions, if you have symptoms, if you have unease… just get your ass to the doctor.
Here’s a song that lifts my spirit and helps ground me…