On Monday I was admitted to Medway Maritime Hospital to undergo the first of my planned radiotherapy courses. After much debate among the consultants it was decided to do this treatment first, rather than the external beam radiotherapy. The reason was that my lung metastases are giving the main symptoms, my shortness of breath and coughing. If I had gone straight into the external beam then it would not have been until November that they could start to hit the lungs with anything. So I-131 it is. This is ablation, that is the use of a radionuclide to attack only the remaining thyroid cells left after surgery, and any cancerous thyroid cells, wherever they may be in my body. Hopefully hitting those in the lymph nodes and lungs. In order for it to work I had to go through the liothyronine withdrawal and low-iodine diet, see previous post.
So Monday 7th September into the nuclear medicine department, for standard blood tests, checks, and paperwork. They were a little concerned that my blood pressure was lower than usual and pulse was running fast. A second BP measurement a little later showed a slight improvement, temperature was fine so they were satisfied that I was fit enough. For this adventure I chose my plain brown kilt and ecru socks. I had previously called ahead to the Sister in charge and explained that I was a man who preferred wearing skirts and dresses, and would it be ok for me to do that. Her reply gave me a lot of confidence, that I could wear whatever I felt comfortable in. Result. A kilt, even though plain gathers few second glances and is an easy option for the first few times out.
Eventually down to Lawrence Ward room 9 where all the patients who have this treatment go. It is an isolation ward with strict radiation protection principles applied. I was to bring a change of clothing which was disposable, in fact anything that went beyond the red barrier would be contaminated. So my mobile phone was placed inside a plastic ziplock, in order to charge it I had to don rubber gloves in order to handle the charger. Last hugs for a while and then to get changed. I had chosen a light green safari shirt dress that is very comfortable.
The time had come to ingest the radioactive capsule, 5.9 GBq activity of I-131. It is the beta radiation that causes the damage to the cancerous cells, but also emits gamma radiation which causes the proximity issues for radiation protection. The small pellet was stored in a lead pot. It was extracted with a long perspex rod which I had to upend which sent the pellet down my throat, washed down with plenty of water. My initial measurement was 57 (arbitrary units), but close enough to represent 5.9 GBq if multiplied by 10^8. Sit and wait for 45 minutes for the capsule to break down before I could eat. Lunch. A couple of hours after which I got bad diarrhoea. It eventually settled as did I to suck lemon drops - recommended to promote salivation to wash the radioactive iodine from the salivary glands, which could be damaged otherwise. In room 9 there was TV, DVD player, DAB radio, CD player, books, puzzles, magazines, a comfy reclining chair, a periscopic window that allows you to see out but others cannot see in, though for the most part this meant a view of a brick wall and some drainage pipes. Tea and coffee making facilities. An en-suite loo and shower room - though the shower did take about 5 minutes to get hot, and the drain was marginally higher than the surround! So comfortable enough - I have stayed in worse hotel rooms.
The readings came and went, I was plotting them out and it became a game to see if I could predict the exponential fall in the readings, 46, 35. Tuesday I felt awful. A bad head, a swollen and painful neck. Eventually I was given some painkillers and was put on steroids for the swelling. 15, 13, 11. Wednesday morning, the first reading was 6, below the level of 8 that represents the 800 MBq upper limit for safety, so I could be discharged later in the day.
Chloe the physicist who had been administering the I-131 and monitoring my levels had calculated that at my time of discharge at 2pm I had 487 MBq remaining. Most of the reduction in activity is by excretion, so I had to try and squeeze out a wee before each measurement. All my bodily secretions are radioactive, so hygiene is paramount. I was given a list of restrictions on how close I was allowed to be to people for how long over what period. The half life of I-131 is just over 8 days, so I will remain marginally radioactive for some time to come, enough to set off radiation detectors at security check points at airports and the like! Then my meds. I get to go back on Levothyroxine - yay! but only a low dose to start with. Hopefully that will build up my energy again.
Home time, I had to sit diagonally opposite the driver as one of the 1m restrictions. When I got home I am not allowed to have close contact, less than 1m for any more that 15 minutes per day, until after Friday. I have to sleep downstairs. The cat has gone on holiday for a week while I am still radioactive. I felt completely wiped out.
Thursday, a day of rest, I make the most of it as I am back to the hospital tomorrow for another scan. Gorge on fish and dairy now!!
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