Friday, November 11, 2005

Thyroid/Lung Cancer: Treatment with Radio Active Iodine I 131

by Shirley W. Madany

Talking with a nurse at the Cancer Center of Ingalls Hospital, Harvey, IL, where I was having a follow-up visit with the radiation oncologist Dr. Sharkar Sanwalani, we got around to what I thought were possible symptoms earlier in this year (2005). One always looks back to see if there weren’t some signs. She suggested that I write an article for a magazine or our blog site, as it is a subject which interests everyone. I know, myself, that ever since being diagnosed with cancer I have had an avid interest in the entire subject.

After having a CAT Scan because of some irregularities noticed on an X ray, I received a phone call from my doctor the following day. I should see a pulmonologist right away. I got an appointment and we were shown the results. There were visible nodules on both lungs. I should have the more intensive PET Scan right away and a lung biopsy at the hospital the following day. Another sober phone call, again on a Friday. There was no doubt about it. I should find an oncologist and go on from there. It was definitely cancer.

Dr. Mark Kozloff was recommended as oncologist. And that first phone call to make an appointment with him, gave an inkling of a very different kind of doctor. The receptionist said, “Hold on, he’ll want to speak to you”. That was a surprise. His words were a surprise also: “As you have to wait a week to see me, please call if you have any emotional problems during the week.” At our first meeting he explained that he always takes phone call from his patients immediately, so one accepts the inevitable interruption during an appointment, because that is how he operates.

Next I phoned our Pastor to tell him the sober news. I will always remember his words: “Shirley, you know that God is not surprised.” How true. Think about it. From the minute I heard I had cancer I had experienced a remarkable gift of peace. Like most new cancer patients I also had that acute sense of the shortness of life and a wish to tidy up loose ends. I saw my life taking a turn down an unknown and unexpected road, but not for one minute did I think that I had strayed from following Jesus This was all part of God’s will and God’s plan for my life..

Thus began a remarkable summer punctuated with appointments and tests. Sometimes things seemed to be moving too slowly but our doctor son urged patience, because when cancer appears in two locations it is absolutely imperative to locate the “starter”. Once that was finalized the cancer would henceforth go by that name. The lung biopsy gave definite results. The next thing then was an ultra-sound and biopsy of the thyroid.
After carefully studying the two sets of cancer tissues Dr. Mark Kozloff announced “If you have to have cancer, then I have good news for you. You don’t have lung cancer but rather thyroid cancer and that makes you eligible for targeted therapy, Radio Active Iodine!”

Before describing my adventures in the nuclear field of medicine let me go back to those supposed symptoms.

For months I had been extremely bothered by excess phlegm which made me almost lose my voice each evening and caused all kinds of coughing and clearing of the throat in order to answer the phone let alone carry on a conversation. About March a friend noticed that I was “wheezing”. I could feel it and hear it myself. So, I begged my primary care doctor to think of a solution to what I called a “condition”. He recommended that we try allergies first and I did get some relief from the product Zyrtec. However, he wanted me to see a specialist and it was then that I totally failed my first experience with a spirometer. I simply couldn’t exhale properly. The allergist said he was going to recommend that I see a pulmonologist because I obviously had an obstruction in my lungs. He ordered an X ray and the rest of the story followed when the X ray showed irregularities and a CAT Scan was prescribed.

Searching the Internet, I found that coughing and wheezing could be signals of cancer. And I regretted that the annual X ray had gone out of style. It was just fortunate that I had recently had a chest X ray prior to cataract surgery. Thus it was possible to compare and see that something was not right in the lungs.

It seemed another blip in the road when I didn’t qualify for a full-body Thyroid Scan. Dr. Kozloff suggested that we go the route of surgery immediately. By August 25th I was having thyroid surgery and recovering very quickly. A mass was found attached to one nodule and removed and most of the thyroid removed as well, with the comment from the doctor that he wondered how I had been swallowing all this time. The trachea had been displaced considerably.

Finally by September 19th I was given that full-body thyroid scan. It proved positively that the diagnosis of thyroid throughout the two areas was correct. I was ready to have the exceedingly remarkable “one time does all” full dose Radio Active Iodine I 131.

Since that treatment a physician friend wrote the following: I'm sure that most of your friends in the congregation have heard of the more common cancer treatments that were like mine (surgery followed by six months of chemotherapy) and not so much about the ones that are like yours (surgery followed by a single shot of I131). Maybe it would help them to know that in the case of a functioning thyroid, the situation is virtually unique among body organs in that the thyroid concentrates iodine in its cells; no other organ in the body does that, so we can "target" active thyroid cancer nicely, even the distant metastases, by giving it a "poisoned" form of iodine. In essence, you poison the "food" (the iodine) that only the thyroid has to have, then the thyroid cells take it up, and die. It's the same sort of principle that some people use for rats, slugs, termites, ants and mice--they put poison out disguised as food, and when the little creatures eat it, they die. In your case, your thyroid gland was still using iodine to make thyroid hormone, so all your doctor had to do was use the radioactive form of iodine to deliver a "bomb" to each thyroid cell, and boom! They all died. Fried. Gone! Since no other cells in the body use iodine like that, they weren't harmed. Since you can't live without thyroid hormone, you are probably on Synthroid or some other kind of thyroid replacement.

A graphic description!

The administration of the dose was unique. It was done by swallowing three capsules which were transported in highly insulated carrying cases and which could not be touched by anyone’s hand. They were lifted carefully with long tweezers into a paper cup, one at a time and an audience of three watched me do the successful swallowing of this highly dangerous material. The private room had been prepared against radiation and I would remain there until a high tech instrument showed a reading that declared me safe to be out in the public! The only way to wash the radiation out of my body was to drink large quantities of water. This became one’s main occupation during the almost 4 days I spent in that little “cell”. Certain precautions had to be taken by each nurse who entered my room and food trays were stored until I checked out. Finally, at noon on day four I was pronounced safe to go home, with certain precautions and instructions. . I had absolutely no ill effects and only that special instrument could tell that I was filled with radiation. (No. You don’t glow in the dark!)

I had brought several of Jan Karon’s “Mitford Series” to read again and a radio to provide good music. So it was a time for contemplation and meditation and rest. A time to thank God for the marvels of modern science and for real hope of a cure.

Later X rays and scans will tell us just how effective this treatment has been.

November 2005

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