RE: saftey of being in the proximity of someone on RAI therapy

["Philip Egidi" <phil.egidi@state.co.us>]

OK, I guess I should clarify by what I meant when I said the suits would

pay them a visit.

All the technical and regulatory comments are correct, the patient is

released from care and the stuff is not under license anymore.  That is

our world.  But the landfills don't have to take the material, some

cooperate and let the identification process occur on their property and

will bury it away from people and staff knowing about the short decay

time.   But other landfills don't cooperate.  One ends up with a truck

that is out of service (which costs the company money), staff time is

diverted to fill out the DOT exemption paperwork and conduct the surveys

(or a consultant has to be found who can do it quickly), the truck has

to go somewhere to have the load checked, and the offending material has

to go somewhere for the decay period.  When I said suits, I meant bean

counters more than lawyers.  These alarms cause expenditures of time and

money that may not be proportional to the risk involved, but

nonetheless, it happens.  The trash companies and the landfill operators

have their own liabilities and concerns that are not always congruent

with ours.



Enough on this thread.

PVE



>>> "Flanigan, Floyd" <Floyd.Flanigan@nmcco.com> 08/20/04 07:52AM >>>

The radiological half life of I-131 is only about 8 days. It should be

at unnoticeable levels in a relatively short period of time. Isotopes of

this nature are used for medical applications on a regular basis and to

my knowledge, once a patient is released from the hospital, there are no

regulations which place controls on the disposition of the resultant

contaminated waste which the patient generates. As an example of the low

level of concern for this particular isotope, cheese made from milk

contaminated with I-131 may be sold at market theoretically since the

aging process for cheese is longer than the time it takes for the Iodine

to decay to a low enough level to fly under the proverbial radar. I

would not be concerned in this case.



Floyd W. Flanigan B.S.Nuc.H.P.



-----Original Message-----

From: owner-radsafe@list.vanderbilt.edu 

[mailto:owner-radsafe@list.vanderbilt.edu]On Behalf Of John Jacobus

Sent: Friday, August 20, 2004 7:29 AM

To: Philip Egidi; kb1ipd@HOTMAIL.COM;

owner-radsafe@list.vanderbilt.edu;

radsafe@list.vanderbilt.edu; crispy_bird@YAHOO.COM 

Subject: Re: saftey of being in the proximity of someone on RAI

therapy





Philip,

Unless there is a regulatory state requirement, which

I doubt, there is no requirement to isolate household

trash.  It is a nice idea, but unless the hospital or

local authorities are willing to pick it up, patients

should not be required to do so.  Does Colorado have

such a provision?  



I have never heard of a private citizen being asked to

pay charges for contaminated waste. 



--- Philip Egidi <phil.egidi@state.co.us> wrote:



> And PLEASE have your friend follow the instructions

> given (hopefully) by

> the doctor/clinic/hospital as to disposal of wastes

> that may contain the

> I-131 after she is released from patient care.  Do

> NOT just throw paper

> towels or anything that may contain body fluid

> (feces, urine, sweat,

> vomit, etc), in the trash - it may set off alarms at

> the local landfill.

> Your friendly state regulator (or less friendly

> hazmat response team)

> may end up dumping the load looking for the

> offending trash in order to

> deal with it appropriately/  If the responders can

> trace the radioactive

> trash back to your friend, she may get a visit from

> the suits, and

> perhaps a bill for the effort.

> 

> Thanks,

> Phil Egidi

> Colorado

> 

> >>> John Jacobus <crispy_bird@YAHOO.COM> 08/19/04

> 07:42 AM >>>

> Steve,

> Your friend is being treated with I-131 to ablate

> any

> remaining thyroid tissue.  I-123 is an imaging

> agent,

> which was probably used during a diagnostic scan to

> assess her the extent of the cancerous thyroid and

> uptake of iodine.

> 

> Because she no longer has a functioning thyroid,

> various hormonal and physiological problems will

> develop.  Eventually, she will be put on a synthetic

> hormone that will have to be adjusted over time. 

> Too

> little, and the patient is lethargic.  Too much, and

> the patient is too hyper.  I assume they have not

> started her on replacement therapy because the want

> to

> ensure that all of the cancerous thyroid tissue has

> been destroyed.

> 

> Your friends sinus problem may be a side effect of

> the

> removal of the thyroid, or a totally unrelated

> effect.

> 

> There are a number of Web sites dealing with thyroid

> cancer try

> http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=43 

> and

>

http://cancernet.nci.nih.gov/cancertopics/types/thyroid/ 

> 

> With regard to at home care, the precautions she is

> asked to take are to ensure that exposures to the

> public and family members as the I-131 decays.  She

> should have been given a date as to when she no

> longer

> needs to follow these precautions.

> 

> The precautions you discussed with probably provide

> minimal protect to you.  Potassium iodine would

> protect your thyroid from uptake of radioiodine. 

> However, patients do not excrete significant amounts

> of iodine.  It is bound to the remanant throid

> tissue;

> proper hand washing and sanitary activities, e.g.,

> using separate eating utensils, precludes the spread

> of contamination.  

> 

> The use of a leaded apron will provide no benefits

> to

> protecting yourself from radiation emitted by your

> friend. The radiation emitted by I-131 is high

> energy,

> and the leaded apron protects against low energy

> x-ray

> radiation.  The best way to protect yourself is to

> stand or some distance from your friend, e.g., 3 to

> 6

> feet, and not spend significant amounts of time.  I

> would avoid spending whole evenings watching TV with

> her.

> 

> It is also important to keep in mind that the

> recommendation are precautionary.  No harmful

> effects

> have ever been shown to occur to caregivers who have

> worked with therapy patients.

> 

> --- Steve Packard <kb1ipd@HOTMAIL.COM> wrote:

> 

> > Hello.   I realize that this board is not normally

> > concerned with nuclear 

> > medicine, but perhaps someone with a good health

> > physics background could 

> > help me.

> > 

> > I have a very good friend who a few years ago was

> > diagnosed with thyroid, 

> > throat and lymphoid cancer.   Her thyroid was

> > removed and since then she has 

> > been given radiation therapy approximately every 6

> > months.

> > 

> > Her therapy consists of direct gamma irradiation

> of

> > the neck region and 

> > ingestion of radioactive iodine.    I believe the

> > isotope is iodine-123, but 

> > she didn't know for sure what isotope of iodine is

> > used.    The iodine is 

> > administered in an attempt to eliminate any

> > remaining thyroid tissue.

> > 

> > The radiation therapy has the side effect of

> making

> > her very ill, 

> > immediately after it is administered, and has the

> > long term effect of 

> > causing her sinus problems.

> > 

> > Her sinuses are chronically clogged and painfully

> > filled with fluid that is 

> > impossible to drain.   She has sinus infections

> > frequently and has been on 

> > antibiotics so many times for sinus infections,

> that

> > they are losing their 

> > effectiveness.

> > 

> > I am not sure if it is the iodine treatment or the

> > direct irritation which 

> > has caused this damage to the sinus region.    

> > However, clearly there has 

> > been tissue damage from the radiation that is not

> > healing.    Does anyone 

> > know of any supplements, medications or techniques

> > that are effective in 

> > promoting the healing of radiation damaged tissue,

> > such as that in the 

> > sinuses?

> > 

> > 

> > And on a related note:

> > 

> > When my friend is given the radioactive iodine,

> she

> > is ordered to stay alone 

> > in her home for over a week.   She is told she

> > cannot be within 25 feet of 

> > anyone else and cannot closely interact in any

> way. 

> >   This is very 

> > difficult for her, especially because she becomes

> > ill and would benefit from 

> > personal care.

> > 

> > Would it be safe to spend time with her if I did

> the

> > following:  I Took 

> > potassium-iodine before being around her (incase

> > somehow iodine excreted 

> > entered the environment),  I wore a 1 mm thick

> lead

> > radiological apron, lead 

> > kilt, thyroid protector, gonad protector,

> > radiological lead-acrylic glasses, 

> > and .5 mm equivalent full-arm lead-rubber gloves. 

> 

> > I also would wear a 

> > digital alarm dosimeter to verify that my time

> would

> > stay within reasonable 

> > limits of safety.

> > 

> > If I took these protective steps, would I be safe

> to

> > spend a period of a 

> > couple hours a day with her?

> > 

> > . . .

> 

> =====

> +++++++++++++++++++

> "Everyone is ignorant, only on different subjects."

> Will Rogers

> 

> -- John

> John Jacobus, MS

> Certified Health Physicist

> e-mail:  crispy_bird@yahoo.com 

> 

> 

> 		

> _______________________________

> 

=== message truncated ===





=====

+++++++++++++++++++

"Everyone is ignorant, only on different subjects."

Will Rogers



-- John

John Jacobus, MS

Certified Health Physicist

e-mail:  crispy_bird@yahoo.com 





		

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