To read more about how Dimitrios' cancer was diagnosed during an abdominal scan following his aortic root replacement surgery, click here.
Radiation Treatment In a Pill
Transfixed on the long cylindrical stainless steel tube that the Penn medical staff had just pulled out of a large wheeled case, I took a deep breath and tried to make sense of the scene. Just a few short weeks earlier, I had been diagnosed by Dr. Susan Mandel with papillary carcinoma (thyroid cancer) and then had a radical thyroidectomy performed by Dr. Ara Chalian to remove my thyroid and some of my surrounding lymph nodes. If there was a silver lining, it was that I had the “right” kind of cancer, if ever such a thing could exist. Although my cancer was aggressive, having spread to surrounding lymph nodes, it was of the papillary variety, which has a high survivability rate.As the top of the container opened, a cool vapor came pouring out, revealing a small glass tube of capsules – a scene that could have been plucked right from a sci-fi thriller. A thin gown that struggled to cover my 6’5” frame was the only thing separating me from the radiation emanating from the glass-encased capsules. Ironically, radioactive iodine (RAI) is released in a nuclear meltdown. Thyroid tissues absorbs iodine, so here I was willingly swallowing this veritable poison in hopes that it would irradiate and kill any thyroid tissue remaining in my body. Instinctively, I placed the palm of my hand over my “bits.” Surely, I thought to myself, I should at least be wearing a lead apron or something?!
The Penn Nuclear Medicine staff, clad in full protective gear, was ready for anything, including cleaning up a radioactive spill if I were to vomit up the RAI pills. From the outset, I was warned that I might experience a wave of nausea and that I should fight the feeling to vomit as best I could. As serious as the situation was, all I could think about in that moment was that I hadn’t vomited since the 6th grade, a nearly 20 year record that I wasn’t about to relinquish without a fight … especially to the likes of a despicable disease like cancer.
With a determined gaze, I watched as the capsules were divvied up into several small paper cups, each with it’s own cup of water in tow. Preparing for my first “radioactive shots,” I listened intently as the nurse rattled off instructions:
“Swallow the pills two at a time.”
“Don’t let them linger on your tongue before swallowing.”
Crickets ... no one was biting. I had stalled long enough and it was time to get this show on the road. I picked up the first cup of pills and with as much precision as I could muster, tossed them into my mouth, aiming for the center of my tongue. Reaching for the obligatory water chaser, I paused as I felt an intense burst of coolness where the pills had landed, almost as if I had crammed an entire tin worth of Altoids into my mouth at once; the pills were all but frozen. As I leaned back and emptied the contents of the water cup into my mouth, I could feel a trail of cold propagating down my throat. I better slow down, I thought to myself, I wouldn’t want to give myself an RAI headache.
Fighting back fleeting waves of nausea, I managed to keep all of the RAI pills down: a small but nonetheless satisfying victory. Cancer had taken my thyroid, but I was going to be damned if it claimed my vomit-free streak (which might have survived another decade had it not been for some sketchy seafood from my former favorite Thai restaurant – but that’s another story....)
The next phase of treatment was actually the most difficult for me. I had enjoyed the support of my family and friends throughout my thyroid surgery, and I couldn’t even put into words the strength and courage they imparted to me simply by being there through it all. But the radiation swirling around in me meant that anything I touched or even breathed on became contaminated with radiation that was leaching out of my body. In one fell swoop I had become a walking radioactive meltdown. Destined for isolation from all human contact, it began to sink in how lonely radiation treatment was going to be.
During my week in isolation, I ate only with paper plates and plastic utensils. Not that I had much of an appetite – still bound to an extremely low iodine diet, I had to keep any food-based iodine to a minimum so it wouldn’t compete with the RAI that was attacking any remaining cancer cells. That meant lots of raw fruits and vegetables, nuts, and white rice and pasta. Newspapers, books, and magazines were allowed, because they could be easily disposed of after my isolation, but I quickly became saturated with trashy novels and Newsweek. Visits from family and friends were extremely brief, and intricately choreographed. I finally knew what it felt like to be a living breathing bubble boy.
After surviving one of the longest weeks of my life, I still had a long list of restrictions that I had to follow while the radiation began to dissipate. Travel by plane was out as I would potentially set off radiation detectors at airports; a decidedly unwise move in a post-9/11 world. I couldn’t be around pregnant people, which made things awkward at work. “Hi, I’m radioactive. By the way, you aren’t pregnant, are you? Because I could potentially harm your fetus!” Going to the bathroom meant sitting down for everything (to avoid unnecessary splashing) and flushing the toilet several times after use. Self-conscious about still posing some harm to others, I avoided people for several weeks.
The only bright spot was that I instantly became very cool to my young cousin, who was thrilled that I was radioactive and expected me to have all kinds of interesting powers (a notion that was unfortunately quickly disabused when I didn’t glow in the dark as he had hoped).
In the weeks that followed, full body scans looking for any remaining thyroid cancer found none; I had been given a clean bill of health. Looking back on the entire experience, I couldn’t help but wonder about how fortunate I had been to make it as far as I had, catching my thyroid cancer before it had gotten out of control. It was a fluke that they even caught it at all.
Learn more about thyroid cancer treatment at the Penn Thyroid Center.
