Dr. Guttler's Newsletter

September 7, 2004

Hello to all my subscribers,

Outpatient Radiation Therapy
with Radio-iodine for Thyroid Cancer
No more hospitalization, and no more Thyroid
hormone withdrawal symptoms

The days of suffering through thyroid hormone withdrawal, and then going into the hospital for isolation after receiving radiation therapy for thyroid cancer is over. New California rules allow me to treat you as an outpatient. There are strict rules to follow to allow this change. My staff physicist, James Gonzalez and I have obtained all approvals to start up in September. Mr. Gonzalez will calculate to safe release rate after you receive the therapy dose in my thyroid center. If the dose is <500 millirems, you can go home. The dose is almost always less than 500.

However, there are important questions to answer first.

1. You must be in good health.
2. You must be able to comply with safety instructions.
3. You must exhibit urinary continence.
4. You must have normal kidney function.
5. Females must not be pregnant, exhibited by negative blood pregnancy testing.

You must answer these questions:

Work:

1. Can you take off work for one week?
2. If not, can you work part time and sit 12 feet from others?
3. If not, can you work in a room by yourself?
4. If you do work, can you use disposable utensils, cups, etc, wash your hands with soap and water after you flush the toilet several times, and use protective paper on the toilet seat?

Home:

1. Can you sleep in a separate room?
2. If not, can you sleep in a separate bed?
3. Do you have access to a separate bathroom?
4. If not, flush the toilet several times, and wipe off the seat. Wash hands in soap and water.
5. You will not breast feed a child.
6. No contact with children for one week.
7. Contact with adults for 1/2 hour at six feet.
8. No travel in cars, bus, boat or plane for one week.

If you can qualify for outpatient therapy, then we can treat you, without entering a hospital.

How does it work?

First you need to see me for a thyroid cancer consultation. I will determine what your prognosis is, and if you need none, low, or high dose therapy. If you are moderate or high risk I will consider you a possible candidate. If it is decided you need therapy, we need to decide if you want the standard withdrawal method, with it's morbidity, or the off label method. This allows you to stay on your cancer suppressing dose of thyroid hormone throughout the treatment. The protocol includes 2 shots of Thyrogen to boost iodine uptake for scanning and therapy. The shots are expensive, but you have no lingering symptoms of hypothyroidism for weeks associated with the old method. After the preliminary uptakes and scan, your therapy pill will be checked for accuracy by my dose calibrator. Mr.Gonzalez will measure exposure rate at 1 and 2 meters from the therapy dose. These numbers will be used to calculate the conservative dose to the general public. If this is < 500 millirem, then you can go home. Prior to going home I will measure your dose rate at one meter from your body. I will give you a release instruction sheet with your dose rate listed.

I give you these instructions for the first 2 days:

1. Maintain a prudent distance from others. Sleep alone.
2. No traveling by air, boat, bus or mass transit.
3. Sole use of bathroom. Flush toilet 3 times after each use.
4. Drink plenty of fluids, including lemonade, and suck on lemon drops.

Additional instructions include:

1. No sexual activity for one week.
2. Rinse the sink and bathtub thoroughly.
3. Shower daily. Use separate towels. Launder your clothes, bed linen separately.
4. The restrictions are over after 7 days, you can return to normal activity.

No More:

Nurses running to get out of your hospital room. Expense of 2-3 days in a private hospital room. Expense of a hospital nuclear medicine doctor, in addition to me.

Dr. Richard Guttler
Thyroidologist

Call 800-408-4909 for consultation, billing, and details.

Yours truly, and goodbye,

Richard Guttler M.D., F.A.C.E.
The "Doctor Reporter" for
The Thyroid Home Page:
www.thyroid.com founded in 1997.
25 Million Hits/year - 600,000 visitors/year
Sole Thyroid Physician:
Santa Monica Thyroid Center, Founded in 1974
Clinical Professor of Medicine:
USC/Keck School of Medicine - 1974-present

"You are the thyroid patients.......
I am the thyroid doctor"

Thyroid Disease Opinions from the desk of
Richard Guttler M.D., F.A.C.E.

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