One of the members (Peter Crane) of a thyroid cancer support group listserve I belong to posted an article in USA Today Thyroid radiation protections revisited. This is something I’ve been trying to figure out ever since I got my diagnosis and learned that RAI meant that I shouldn’t be near my children for at least a week. Every Dr. I talk to has a different set of instructions on how to protect my children from harmful exposure. The Thyca listserve is full of people who have been through the process and most everyone there agrees that you should send your children away for at least a week if not two. The precautions suggested are to basically pretend you are infected with bubonic plague and isolate yourself from everything and everyone for as long as possible. The Drs I’ve talked are far less uptight. My Nuclear Medicine Dr. said that there is no problem with going home to my family. I can hold my baby the day of my dose, according to him–as long as I don’t hold her for more than 5 minutes. I haven’t met with the nuclear safety officer yet but the Nuc. Dr. warned me that they will be a lot more paranoid. Back in 1997 the Nuclear Regulatory Co mission ended mandatory hospitalization for patients receiving I-131 doses. Before then, patients would stay in isolation in the hospital until a nuclear safety officer determined that they were “safe” to enter the public again. Now we take the dose and go home. Or go into a hotel. Think about that next time you stay in a hotel. There could be someone radiating in the room next to you. I really don’t know how paranoid we should be about this. According to Dr. Ain, Director of Thyroid Oncology UKMC

COMMON SENSE REGARDING RADIATION SAFETY AFTER
RADIOACTIVE IODINE TREATMENTS

Radiation safety precautions are based upon a very
reasonable consensus public policy that individuals,
who do not require exposure to radiation for their own
health, should have the least exposure to radiation as
is reasonably achievable. The acronym that is
commonly applied is “ALARA” (As Low As Reasonably
Achievable).

Such precautions have been designed because of this
PUBLIC POLICY and NOT because health professionals
expect radioactive iodine patients to be dangerous or
harmful to anyone else. In fact, I can conceive of
only three examples of situations in which a
radioactive iodine therapy patient could “endanger” or
cause “harm” to someone else: 1) If a cannibal should
chance to devour the patient immediately upon
discharge, this cannibal might experience dysfunction
of their thyroid gland; 2) If someone would try to
drink all of the urine produced by a patient for the
two days following discharge, they might also expect
dysfunction of their thyroid gland; and 3) If a
patient would breast-feed a child within two weeks of
such a therapy the radioactive iodine might be likely
to damage the infant’s thyroid gland. Lactation
during therapy would also provide excessive radiation
to the patient’s breasts and is an additional reason
why lactation must be discontinued for a couple of
months prior to receiving radioactive iodine
treatment.

Besides the three situations listed above, it is NOT
CONCEIVABLE that any MEASURABLE HARM could result from
a radioiodine therapy patient.

I find Dr. Ain’s “common sense” funny and comforting. But I think when you are going through this yourself there is a level of fear and paranoia about exposing your children. After all, nobody wants thyroid cancer to be revisited upon their children. The fear is that the guidelines changed in 1997 because insurance companies didn’t want to pay for hospitalization. From the USA Today article

But Crane and other thyroid cancer survivors say it will take more than voluntary guidelines to persuade insurance companies to cover hospital care.

“The NRC’s guidance is a useful interim step, but it doesn’t go nearly far enough,” Crane says. “This country is out of step with international standards for protecting children from radiation, and the NRC now recognizes it. The NRC is asking doctors and insurance companies to be more generous in hospitalizing patients, but the guidance has no legal force whatever.”

I am sending my children away for a week. But there is part of me that wonders if that is long enough. I am going to be so afraid to kiss them and hug them when they get back. My baby girl is so kissable I find myself unconsciously kissing her face and the top of her head all the time. It would be nice to feel confident that the guidelines we are given to protect our children aren’t influenced by insurance companies need to make money…