RadioActive Iodine (RAI)


I went to the dentist yesterday for a routine check up and cleaning.  (I’m happy to report that I have no cavities!)  As the days got closer to my appointment, I found myself thinking about the dental x-rays and wondering about radiation exposure.  As a cancer survivor, the last thing that I want or need in my body is more radiation.  The RAI (Radioactive Iodine  – also known as I-131) was more than enough for me, thank you.  I know that there is radiation in the x-rays, but didn’t know how much. 

Knowledge is Power!  I have the means to find out and educate myself on radiation.  And that is what I did.  I started with the FDA site and found an article called “Reducing Radiation for Medical X-rays” that had tons of information.  I didn’t know the specifics about x-rays until I read it in the FDA article.  It said “X-rays are a form of electromagnetic radiation that can penetrate clothing, body tissue, and internal organs. An X-ray machine sends this radiation through the body. Some of the radiation emerges on the other side of the body, where it exposes film or is absorbed by a digital detector to create an image. And some of it is absorbed in body tissues. It is the radiation absorbed by the body that contributes to the “radiation dose” a patient gets.”

The FDA also had this short video on their site about radiation and x-rays:

The more research I found, the more concerned I got.  Advancements in technology are leading to new kinds of scanners, like the cone-beam CT scanner used at many dental offices.  According to the NY Times article Radiation Worries for Children in Dentists’ Chairs, “Some states have in effect no inspections of dental X-ray units,” said Dr. G. Donald Frey, professor of radiology at the Medical University of South Carolina and a past president of the American Association of Physicists in Medicine. While inspectors generally evaluate machine performance, few attempt to measure the overall radiation risk to the patient’s organs.  “States tend not to want to regulate the practice of medicine or dentistry,” Dr. Frey said.

The real “jaw dropper” was the video called “The Price of a Smile” posted by the NY Times.   This video digs a little deeper into some of the new technology embraced by some dentists and orthodontists.  It really makes you wonder if money has become more important than health.  Here is the video:  http://video.nytimes.com/video/2010/11/22/us/1248069363524/the-price-of-a-smile.html

My vision for this post was to share information on radiation and x-rays used in the dental profession as well as other medical professions.  However, after reading a few articles and watching a couple short videos on the dental industry’s use of x-rays and scans, I found more than I expected.  It was more than I wanted to be “exposed” to. 

As for my dental visit, I was never even asked to have any x-rays done.  I had them over a year ago, but they did not see the need for them during my visit.  Go figure!  (Oh and I’m happy to report no cavities.) 

A couple of weeks ago I had a painful reminder from my salivary gland that the RAI (radioactive iodine) treatment is starting to take a toll.  Almost two years ago, I took RAI (I-131) to kill any remaining cancer cells lurking around in my thyroid tissue.  This was done a couple of weeks after my thyroidectomy.  I didn’t have any issues with my salivary glands during that time.
If it’s not one gland, it’s another.  Instead of my thyroid gland being diagnosed with cancer, now my parotid gland has been diagnosed with sialadenitis.  Oh joy!  At this point, it is hard to say if my sialadenitis of the parotid gland is a direct result of the RAI or not.  There is not too much research on the long-term effects of RAI to date.  However, I did find a case study in the JADA called Salivary Gland Injury Resulting From Exposure to Radioactive Iodine that was very informative.  According to this study, “In the majority of cases, when a patient receives therapeutic doses of 131I, the patient develops an asymmetric radiation sialadenitis. Obstructive symptomatology is to be expected. Oral dryness occurs less often and is related directly to high dosages and the passage of time. Clinicians should be aware of the condition to avoid unnecessary diagnostic and therapeutic measures.”
Back to my story…
The pain and swelling continued for several days.  I finally went to the Otolaryngologist (Ear, Nose and Throat (ENT) doctor) last week and was told to drink a lot of water, suck candies, massage the salivary gland area and put a warm compress on it. The goal is to keep the saliva flowing and wash away any blockage. I did all of those things and it got better. I went a couple of days without swelling or pain. Then this morning I had a few bites of breakfast and the pain came back with the swelling. Nooooo! Not again!! I took Advil, massaged the area and put on a warm compress. It helped. But a girls gotta eat, so by lunch time I tried again.  It didn’t go too well. I called and left a message for my ENT and am waiting to hear back. This is very frustrating. I’m trying to keep it in perspective. Things could always be worse. I’m grateful that the thyroid cancer is in remission. Since that is the reason the RAI was even done, I need to remind myself that it did work.
My life is really good! However, eating is kind of important, so I’m hoping my parotid gland gets better soon!  Until then, I will be massaging away, chain chewing gum and sucking candies, drinking lots of water and sharing my journey with all of you.
~ I’m grateful to be a ThyCa survivor ~ I’m grateful to be a ThyCa survivor ♥ ~ I’m grateful to be a ThyCa survivor ~ ♥ ~ I’m grateful to be a ThyCa survivor ~ I’m grateful to be a ThyCa survivor ~ My parotid gland still hurts when I eat from the RAI (RadioActive Iodine). I get small bits of food caught in my throat at times. My vocal chords are still a little damaged from the thyroidectomy. My fear wakes up every 6 months when I go for follow-up scans and blood work. I get hot flashes and chills now more than ever. My memory is not was it was before. So I need to remind myself, despite it all. I FOUGHT THE FIGHT. I AM A CANCER SURVIVOR and THRIVER!!!  AND FOR THAT, I AM SO GRATEFUL!!

There were so many bills from doctors, hospitals, pharmacies and on and on after all of the medical visits and procedures.  I am so grateful to have health insurance.  The two shots of Thyrogen alone was over $2,000!!!  Just check out this bill…Thyrogen receipt.  Even my doctor was surprised that it was covered by my insurance at 100%. 

Then there was the bill for the Thyroidectomy from the hospital, which was over $6,000!!!  Here it is…Thyroidectomy bill.  After going back and forth, it was all covered by insurance except for $275.  I was more than happy to pay that portion.

There were other bills of course, but those were the big ones through my thyroid cancer journey.  If I didn’t have insurance, I would owe over $8,000.  It just makes me think about all of the people who don’t have health insurance or who have plans with really high deductibles.  I can see how easy it would be to get into major debt due to medical bills.  I’m very blessed that mine was covered.  My heart goes out to all of the people going through there own journies with cancer or other illnesses who can’t pay the medical bills.

The iodine radiation treatment worked.  Oh yeah!  I got the follow up results from my bloodwork and thyroid ultrasound today.  It looks good and the blood levels were close to perfect.  Some extra unexpected good news was I lost about 8 pounds since March. I could tell by how my clothes fit, but the confirmation was nice to hear.

So if you’re about to go on the LID (Low Iodine Diet) to prepare for the iodine radiation, I’m cancer-free proof that it works.  Stay positive, replace fear with faith and keep walking through that storm.  There is lots of light on the other side.  I know because I’m taking it all in today!

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After 18 days on the low-iodine diet, my taste buds were sure looking forward to the freedom of tasting normal food again.  I had been fantasizing about sushi for days and that was my first post-LID meal. 

sushi

Little did I know that my taste buds were affected by the radioactive iodine.  Loss of taste? Are you kidding me?  The sushi was good, but not great.  The low iodine diet was already bland enough, but at least I could taste the food then.  What is going on now?

As the days went on, I noticed my sense of taste became worse!  I had the yummy taste of metail in my mouth.  Mmmmm. Mmmmm.  As a bonus, it felt like had burned my tongue.  But the loss of taste was mostly on the front part of my tongue and the soreness was on the back of my tongue.  I had read that this was a possible side effect from the RAI.

So now I’m off the LID.  I can have my cake now and eat it to.  I just can’t really taste it!

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So the day has finally arrived for the iodine radiation pill.  I’m glowing with anticipation.  After 18 days of the LID (Low-Iodine Diet), my remaining thyroid tissue/cells are starving for some iodine.  It has been hard to stick to the LID, but I did it!

Before Dr. Ladenson came in, we met with his Assistant, Marge and discussed my questions.  So I cannot be within 3 feet of anyone for 3 days.  (Frown)  I can have visitors over, but they just have to stay at least 3 feet away.  Well that is good to know!  Marge went on to let me know that I might set off some radiactive detector alarms. What? No way!  She gave me a letter that I need to carry with me for the next month just in case an alarm goes off.  These alarms are in airports, government buildings and other buildings.  Check out the JH Radiation Letter for the interesting details.

 And now for the big moment.  I was in the room with my Mom and in walks Dr. Ladenson and his 5 interns.  He explained that once I took the pill with the iodine radiation, it would make me radioactive for a few days.  The radiation will kill any remaining thyroid cancer cells and reduce the remaining layer of thyroid tissue.  It will go through my digestive system and come out in my urine, saliva and persperation.  (That is why I’m supposed to flush twice and put the toilet seat down, which made me think that some men might have a tough time remembering to put the seat down.)The actual thyroid area will be radioactive for a few months, but it will not be harmful. (Um, okay?)  Some of the radiactive iodine will go into my saliva glands which may cause soreness over the next few days, so sucking on hard candies is recommended to keep the saliva flowing. (Very interesting – huh.)

The room got very quiet.  Dr. Ladenson looked at me and asked, “Are you ready?”  I said “Yes I am.”  A few silent seconds went by as the intern was getting the pill out of the container.  Yes, a container that was within a container.  This is radioactive stuff and so that one little capsule of radioactive iodine was housed in layers of containers.  See the pic below…

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I then said, “It is so quiet in here.  We need some music for this.” Within a half a second my Mom’s (bless her soul) cell phone started ringing in the form of a song.  Perfect timing Mom!  So she jumped up and left the roon to answer the call. 

The intern brought over the capsule with a cup of water and gave it to me.  Everyone watched as I took the capsule.  Down it goes!  Then my Mom came back in.  She missed the big moment.  And just like that I became radioactive.  Let the 3 feet for 3 days begin.

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