GOOD MORNING DOCTOR Prof. John Kurakar (a heart touching experience of cancer treatment) authored by Prof. John Kurakar CHAPTER 5 NUCLEAR MEDICINE & THYROID TREATMENT

                                        GOOD MORNING DOCTOR

Prof. John Kurakar

(a heart touching experience of cancer treatment) authored by Prof. John Kurakar

CHAPTER 5

NUCLEAR MEDICINE & THYROID TREATMENT

Following Dr.Subramanyam Ayyar’s recommendation, we went to the nuclear medicine department. Nuclear medicine is a cutting-edge branch of science. Here, radioactive substances are introduced into the body, which emit invisible rays during chemical reactions. Using these emitted invisible rays (gamma rays) and modern technological advancements, hidden cancers and other conditions can be detected and treated. Many conditions that cannot be identified through other diagnostic methods (such as CT scans and MRI) can be detected through nuclear medicine. It is a medical specialty that involves the use of radioactive materials in both diagnosis and treatment.Nuclear medicine involves imaging techniques that capture radiation emitted from within the body, as opposed to the external radiation sources used in X-rays. This is why it's described as "radiology happening inside." Unlike traditional radiology, which focuses on anatomical imaging, nuclear medicine emphasizes functional imaging, making it a physiological imaging modality. The most widely used techniques in nuclear medicine are Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) scans.

For evaluating thyroid cancer, an Iodine-123 whole-body scan is performed. This study is conducted after withdrawing thyroid hormone medications, along with total thyroidectomy and TSH stimulation. The scan reveals small residual thyroid tissue in the neck and metastatic thyroid cancer lesions in the mediastinum. Observed increases in the stomach and bladder are considered normal physiological findings. The capability of nuclear medicine to visualize disease processes arises from its ability to detect variations in metabolism.Nuclear medicine is a medical specialty that utilizes radioactive substances for diagnosing and treating diseases. Unlike traditional radiology, which relies on external radiation sources like X-rays, nuclear imaging records radiation emitted from within the body, effectively making it "radiology done inside out." Furthermore, while traditional radiology focuses on anatomical imaging, nuclear medicine emphasizes functional imaging, which is why it is referred to as a physiological imaging modality. The two most common imaging techniques in nuclear medicine are Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) scans.

This diagnostic method helps in detecting malignant diseases, such as cancer, that may be hidden anywhere in the body, even in the very early stages. Nuclear medicine is also used to treat conditions like thyroid cancer, lymphoma, and blood cancers. The head of the nuclear medicine department is Dr.Shanmugham. Prior to our arrival at the department, Dr. Subramanyam Ayyar had already informed Dr.Shanmugham in detail about the matters concerning our case.We had an extended discussion with Dr.Shanmugham. He informed us that, since the A.P.R. surgery was scheduled by the Gastroenterology Department for March 22, 2022, it was crucial to quickly elevate the T.S.H. hormone levels. Therefore, he advised administering two injections promptly, emphasizing their significant importance. He mentioned that each injection would cost approximately fifty thousand rupees. Dr.Shanmugham recommended coming back for the injections after four days. With this in mind, we returned to our home in Kottarakara for the four-day interval. On the evening of March 6, we arrived again at the guest house of Amrita Medical College. On March 7, we underwent an RTPCR test, and on March 8 and 9, we received the TSH injections.

Thyrotropin alfa injection is a form of human thyroid-stimulating hormone (TSH) used to test for the presence of thyroglobulin (Tg) in patients with thyroid cancer. Thyrogen (thyrotropin alfa) helps identify thyroid disease by measuring thyroglobulin levels in the blood, particularly during the follow-up of patients with well-differentiated thyroid cancer. This injection may be used with or without a radioactive iodine imaging test.Following the thyrotropin alfa injection, a radioactive iodine scan is performed for therapy. Radioactive iodine (RAI) is a treatment for hyperthyroidism and certain types of thyroid cancer. Despite the term "radioactive," RAI is a safe, well-tolerated, and effective treatment that specifically targets thyroid cells, minimizing exposure to other body cells.Radioiodine therapy employs radioactive iodine to shrink or destroy thyroid cells and is used to treat various thyroid conditions. The thyroid gland, located in the front of the lower neck, produces hormones that regulate metabolism. Iodine, essential for thyroid function, is obtained from food, and excess iodine is excreted in the urine.Radioiodine therapy is administered by specialists in nuclear medicine. Depending on the dosage, you may be able to go home the same day, but higher doses may require a hospital stay in a specialized room, where your urine will be monitored for radioactive iodine excretion.

Radioactive elements are substances that emit intense, invisible radiation as a result of their inherent chemical properties. These elements are utilized in the treatment of various diseases, including malignant conditions like cancer. This method of treatment falls under the field of nuclear medicine. A key radioactive element used in the treatment of thyroid cancer is Iodine-131. It is a very effective and safe treatment method for thyroid cancer, as it is both painless and non-invasive. When radioactive iodine is ingested, it is absorbed by the thyroid gland, where it targets and destroys thyroid cancer cells. The radioactive particles emitted from the iodine destroy the cancerous cells within the thyroid gland, thereby providing a highly effective treatment option.A person who has received radioactive iodine treatment will emit high levels of radiation from their body. This radiation can be harmful to the general public, especially to children and pregnant women. Therefore, it is essential for the patient to undergo isolation in a hospital for 2 days immediately after the treatment. Following this, the patient should continue self-isolation at home for an additional 7 days to minimize exposure and ensure safety for those around them.

On March 9, I was admitted to Amrita Hospital for iodine therapy. That same night, I received a high dose of radioactive iodine and was moved to a complete isolation room for two days. This room was designed for total isolation, with no contact with anyone, ensuring a complete separation from other people. The room had a small hatch through which food was passed to me. For two days, I remained alone in this isolated environment, akin to being locked in a cage or cut off from the world.There were four patients, including myself, in separate isolation rooms. Three of the other patients were women. On the second evening, we were all taken for a scan, dressed in yellow uniforms. The elevator used for our transport was restricted to ensure no contact with other patients or visitors due to radiation concerns. The scanning took about 30 minutes, after which we were returned to our respective cells. By night, we were discharged, and our family members came to pick us up.No hospital staff or assistants came close to our isolation rooms or the adjacent hall, further emphasizing our complete isolation. The experience felt like a significant turning point in my life, marked by intense solitude and separation. It reminded me of the severe isolation experienced by Malayalees in the Gulf during the early days of the coronavirus pandemic.By 7 PM, my wife Molly arrived at the nursing room to take me home. The sense of relief after such prolonged isolation was palpable. Upon arriving at the Amrita guest house, I spent another week in a different isolation room, continuing my period of separation.

Mental isolation can significantly diminish a patient’s willpower and overall resilience. When individuals are isolated not only physically but also emotionally, they may experience heightened feelings of loneliness and despair, which can undermine their motivation and ability to cope with their illness. Emotional support is crucial for patients, as it fosters a sense of connection and belonging that can bolster their psychological strength. Without such support, patients may struggle more with their treatment and recovery processes. Therefore, it is essential to ensure that patients remain emotionally connected, receiving encouragement and companionship from loved ones and healthcare providers, to help maintain their morale and improve their chances of recovery.