Monday, February 2, 2015

Radioactive Iodine Treatment, Part 1

I have google researched this treatment, and all of the information online is vague, or conflicting.  I think there may be slight variances in Canadian and US treatment procedures, and/or different hospitals or regions handle it differently.  I now have the paperwork from my very own Endocrinologist in hand and want to put it out there what is involved in radioactive iodine treatment at Sunnybrook in Toronto Ontario Canada, in 2015.  

Due to the risk of radiation exposure to my young female offspring, I have chosen to be admitted (committed??) to the hospital for the first three days of my treatment.  This will be in March, the Monday-Wednesday after March Break.  I will be permitted to go home after that, but still have to keep my hands to myself and my dishes, laundry, bed, and bathroom solely for my use for one week after (yahoo for my master suite already in the basement).  Not as bad as the original one month isolation period I was first told!  

Also it specifies I must not use disposable cups plates or cutlery, or paper towels etc, I must use and wash my own towels and dishes separately from everybody else.  Must wear slippers/shoes when out of bed, and have to flush three times after every visit to the toity. Glad my first three days will be at the hospital so I don't have all that flushing on my good ole' Meaford water bill!!

Some of this stuff I will copy directly from the wad of paperwork I was given to read, highlights include:
  • the purpose of radioactive iodine treatment is to destroy any remaining thyroid tissue following surgery
  • it will be a capsule I will have to take with water, then drink a tonne of water/fluids for the following days and weeks
  • radioactive iodine emits two types of radiation called "beta particles" and "gamma rays"
  • the beta particles irradiate and destroy the thyroid and/or thyroid cancer tissue, but travel only a few millimetres in tissue
  • gamma rays travel a much greater distance and can be used to image the distribution of radioactive iodine in the body
  • thyroid tissue takes up a small part of the radioactive iodine, but the majority is cleared from the body in the normal ways we expel things... saliva, perspiration, bathroom. The amount of radioactivity in the body decreases gradually over a period of weeks, both through excretion and through natural decay of radioactive material
  • I loved science classes in high school!  And I remember a presentation we had at an assembly in the gym where some animated presenter came to teach us about radiation.  We learned about Chernobyl, but also I seem to specifically remember him emphasizing that we are exposed to radiation in our everyday lives, not just from the microwave but through simple things like asphalt
  • the Canadian government mandates strict radiation safety precautions to ensure that members of the public are not exposed to significant amounts of radiation. In the case of this treatment radiation exposure to others can occur through two pathways 1) "contamination" via bodily fluids or 2) direct exposure to gamma rays emitted from the body. I can totally see myself with light beams shining out of my fingertips!
  • there are some restrictions I must observe in order to optimize the safety and effectiveness of this treatment, including but not limited to: no CT scan (with the injected contrast dye I always have) within six weeks of treatment (phew last weeks' CT scan scraped by with a 7.5 week distance to treatment). Also to be noted the instructions specify that "female patients must refrain from initiating a pregnancy for 6-12 months after treatment" !?! Men 3-6 months, just for the record.  LOL No worries on this one, I am pretty much against initiating a pregnancy for the rest of my life anyway!
There is a specific list of things I have to do to prepare for the treatment.  My medication for thyroid hormone replacement has already been changed several times since surgery, but now I am on one specifically until two weeks prior to the radioactive iodine treatment, apparently it has a shorter half-life in the body therefore is more easily stopped (inside the body) prior to treatment.  

I will also have to be on a "Low Iodine Diet" for two weeks prior to treatment, to make my thyroid tissue starving so it jumps all over the radioactive iodine bait capsule on treatment day.  Laymans terms. 

No salt, no dairy/products, no eggs, commercially prepared food, chocolate, soy products, foods containing FD&C red dye #3, or anything else that could contain iodine.  No problem, I am about due for a cleanse anyway - green smoothies and celery with almond butter it is! Ideally this could occur on some tropical resort juice cleanse yoga vacation?  But I digress..... 

I have to go to Sunnybrook for bloodwork on the Friday before, to ensure that I am appropriately hypothyroid.

After the treatment I will resume with a double dose of thyroid hormone replacement meds and be back to my no coffee for an hour after taking this pill first thing every day for the rest of my life.  If this sounds confusing, believe me you are not alone, I get so frustrated with the medication stuff, I just don't get it.  No wonder pharmacists make so much money!

On the day of treatment I will be admitted to a private room, from which I will not be permitted to stray until I am discharged on the Wednesday.  I can bring new baby laptop, stuff to read, toiletries, bathrobe and slippers, bottled water and favourite drinks (and you may be as happy as I am to know that beer, wine, and spirits ARE permitted on the low iodine diet hehe! It says so right on the brochure - now I am just scouring the hospital handbook to see if there is any rule against me sneaking some in in my suitcase - it DOES say bring your favourite beverages! And drink lots of them too)  ;-)

The Nuclear Medicine Physician will explain everything that day, get my signed consent form, and administer the glow-worm capsule.   The stuff is tolerated well apparently so I shouldn't be physically ill from it - other than the risk of getting cancer from it we're good to go.  I assured the Endocrinologist I am not too worried about getting another case of cancer, it's sort of with me for life now anyway.  He must have felt like an ass having to explain that to me right after our conversation about melanoma. It was definitely an uncomfortable moment to be remembered in my myriad of medical moments. *sigh*

One week later, back to Sunnybrook I will go for a full body scan in Nuclear Medicine (I already know where that is in Sunnybrook as I pass it all the time by the tunnel) to determine the level of radioactivity and/or radioactive tissue left in my body.  This will determine whether or not the treatment will have to be repeated, I do have one friend of a friend who has had this treatment every year since her diagnosis.  My oncologist says this is like a bone scan?  But I have not yet had that either so this will be a new medical test to add to my repertoire.  Let me know if you have had this done, maybe give me a more concrete heads up than google will?

Okay well I think that's it for notable information I have been given about my upcoming radioactive iodine treatment.  Any questions let me know... there is likely stuff I am missing, but I am getting reasonably good at going with the flow of doctors springing stuff on me.  Part of the territory - I'm not complaining... just glad I am getting it all in writing. LOL

Article © Natalie Richardson 2015

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