How to prevent boredom while in isolation

The RAI treatment for thyroid cancer requires a patient to be isolated in an all leaded room for a minimum of three days if it is done inpatient.  I was hospitalized for three days and was instructed to stay in my own room not sharing toilets with anybody.  So, what did I do to keep myself boredome free during the isolation?

1.  Smart TV and wifi.  This is a perfect match.  Strong wifi is a ++.  There are a lot of things  to browse on the net.  Good thing, the American Hospital Dubai has a well-equipped ablation room.

2.  Movie marathon.  Watching one movie takes about two hours.  In 24 hours, one can watch about 12 movies without breaks ha ha ha.

3.  Coloring book.  Adult coloring book are IN now a days.  It is a stress reliever and it brings out the creativity in oneself.

4.  Books.  Read lots of books.

5.  Pray.  Do not forget the most important use of your time, a conversation with God.

Ablation day 2

Woke up at 2:38 a.m. because the autoflush of the toilet has been flushing every 15 seconds.  I had to stand up and walk to the toilet to check if thereg  is any ghost ha ha ha only to find out that the platic for my trash was being detected by th autoflush.  Afte taking the RAI pill, i had tp flush two to three times to totally flush the radiation.  Wide awake until 4 am.  Then slept again til 7 am ro take myThyroxine.

Now on day two.  Yesterday was a breeze.  No adverse effects except for the headache due to the extended fasting i did.  Last breakfast was 8:30 a.m. only with boiled white eggs and orange juice. 

My first meal was back to regular diet but still no seafoods. Fair enough.  I sipped lemons and finally ate a regular diet.  Nom nom.  The meal is placed in a box.  All are in disposables and there is a special refrigerator for my food trash. It's called the decay storage (see picture of the brown cabinet below). This is a freezer thta is covered in a brown cabinet.  And oh, did i tell you the room is all lead inside the walls.  The nurses also covered all handles with plastic cling wrap even the mobile phones.

I had breakfast as in bug breakfast.  I also changed my beddings and cleaned my toilet.  I was also able to chat with my family back home. After cleaning my room,  i took a long shower and sat down to watch but suddenly i felt my heart beating fast.  Palpitations? I called the nurse and she told me to takr a deep breath.  I was ok after a few minutes.

Ablation Day: Step 5 RAI

I am now in the ablation room ohee American Hospital Dubai.  After my second dose of Thyrogen earlier, this is it.  Three hours after the last dose of Thyrogen, bloods were extracted.

About 3:15 p.m. i took the RAI tablet. It is a white tablet sealed in a gray bucket all lead covered (see picture)  There is a tube like straw that the technician puts in the bucket to pick up the tablet.  But when picking up the tablet, i had to do it myself as the technician had to stay far away from me.

So i picked up the tube and put the other end of the tube in my mouth with tablet sliding through the tube to my mouth and with water i pushed it down my stomach. The dose was 105.2 mCi.

Dr. Yang, the technician and the nurse were all outside my room.
I was instructed to lie down for 10 minutes to measure my radiation level.

The level was 163 uSV wohoooo....

Second Thyrogen injection: Step 4 to RAI

Had my Thyrogen injection at 9:30 a.m. today.  This is my last of two injections.  So far, so good.  Continuously praising God for all of this as i await for another victory.

First Thyrogen injection: Step 3 to Radioactive Iodine treatment

I came early to the ENT clinic today for my Thyrogen injection.  Guess what? The original presciption of the Thyrogen is missng and Pharmacy refused to release the Thyrogen kit without the original prescription.  After waiting and praying,  the beautiful nurse from ENT called me to collect my Thyrogen kit. So i came running and took the kit from the Pharmacy and went back to the clinic for my injection.

The Thyrogen is in powdered form  kept in a vial.  This has to be mixed with saline to be ready for injection.  A little warming for the solution and the target has been set - the buttocks!  Waaaah.

Yes, Thyrogen is meant to be injected in the gluteus muscle (buttocks).   Thanks to my caring nurse it did not hurt much. I had to stay for 10 more minutes in the procedure room before they had to let me go.  After that, i went back to work normally.

Tomorrow, i will visit the clinic early to get my second Thyrogen injection.  I will come earlier because after the injectioni will be admitted for the RAI.

LID: Vegetable Manchurian

Ingredients:

carrots
cabbage
zucchini
potato
sprouts
green chili
capsicum

2 tbsp cornflour
1 tbsp pepper powder or chili powder
coconut oil for frying
non iodized salt if desired
1 tbsp sesame oil

Procedure:

1.  Chop all vegetables.
2.  In one bowl mix all vegetables, cornflour, sesame oil, pepper powder and salt.  mix very well.
3.  Form into balls.  do not add water as the vegetables have enough water to stick it together into balls.
4.  Deep fry in coconut oil.
5.  Make dip using white vinegar or balsalmic.

LID: Kimchi quickie

Ingredients:

Lettuce cut in bite size
garlic
onion

Seasoning:
1 tbsp non-iodized salt
1 tsp sugar
1 tbsp vinegar
pepper powder as desired
1 tbsp sesame oil

1.  Mix all the seasoning ingredients.
2.  Pour on lettuce and mix with hands.
3.  Store in a bottle and keep refrigerated.

LID: Garlic and tomato pasta

Ingredients:

One head of garlic chopped
1 tbsp of garlic powder
onion
spaghetti cooked aldente
lots of tomatoes
parsley
provence herbs
olive oil
salt (non iodized) if desired

Procedure:

1.  Cook pasta aldente.
2.  Boil all tomatoes in 3/4 cup water with provence herbs until soft
3.  Heat pan and add olive oil
4.  Add onion
5.  Ad garlic mixed with garlic powder
6.  Add the softened tomatoes
7. Add salt if desired.
8.  Simmer until tomatoes become sauce.
9.  Pour on pasta.

enjoy!

I forgot to take picture of this as I have eaten it already.  :)

ENT follow-up visit @2 months postop

I went to see my ENT surgeon yesterday.  He checked on my laryngeal nerves through the scope and it was fine.  The thyroidectomy wound is healing well.   The scar looks fine.  I also had blood test for calcium level to knoe if i still have to continue my calcium tablets.  Now im just waiting for the nurse's call to inform me if ill continue my calcium tablet.  . Four days to go and its RAI.

LID: Squashkra (squash okra) mash

Ingredients

any herb powder (provence, thyme, parsely etc)
mustard seed powder
ginger powder
garlic powder
a little bit of chili powder
pepper
okra
squash

egg white (if desired for keeping the squash together)

Procedure:

1.  Steam the okra/
2.  Boil the squash.
3.  Mash the okra and squash together.
4.  Add all herbs and powder etc.
5.  Add egg white to keep them together
6. Mix
5.  Heat olive oil in pan.
6. Scoop a spoon of the mixture and fry.

LID: Chicken lettuce wrap

Ingredients:

2 chicken breast marinated with LID sauce (using balsalmic) and cut into cubes
carrots cubed
bean sprouts
cucumber cubed
onion
garlic
chilli powder

iceberg lettuce

Procedure:

1. Marinate chicken overnight.
2.  Cut chicken into cubes.
3.  Cut the vegetables in cube or small size.
4.  saute onion and garlic
5.  add marinated chicken
6. simmer.
7.  add carrots
8.  add bean sprouts
9.  add a little chili powder
10. Simmer.

To enjoy:  Place the cooked chix and veggies on lettuc and top with cucumber.

LID: Pasta asparagus in balsalmic sauce

Ingredients:

one pack Pasta cooked aldente
asparagus
baby corn
carrots
tomatoes
chicken cut into cubes
dash of salt not iodized
garlic
onion
olive oil

For the sauce:
honey
balsalmic vinegar
olive  oil
chilli powder
garlic powder
pepper
provence herbs
parsely
fresh tomatoes

Procedure

1.  Mix all the sauce ingredients and stir very well.  The amount of each ingredient is as desired.
2.  Boil chicken with a dash of salt (not iodized) and some herbs.  Cut into cubes.
3.  Saute garlic and onion in olive oil.
4.  Put in the cubed chicken.   Stir fry with the sauce.
5..Add the rest of the vegetables one by one, add the asparagus last.
6.  Simmer for two minutes.

Full blast Low Iodine Diet: Step 2 to Radioactive Iodine therapy (RAI)

In the past week, i have already prepared myself for the LID and this week I am going full blast low-iodine diet in preparation for my RAI-131 ablation therapy.  I will be receiving 100 mCu on 17 November 2015.

Why go on LID or low iodine diet?

For the radioactive iodine treatment (RAI) I-131 to be effective,  a low iodine diet is recommended two weeks before the I-131 administration.  RAI is iodine, so for this treatment to be absorbed by the remnant thyroid, the body should be iodine hungry.  Being on low iodine diet gives a  more successful treatment with radioactive iodine.

For more information, visit thyca.com:

Radioiodine therapy

The main instruction of my doctor is NOT to eat seafood mainly.  When I was told by the nuclear medicine specialist to research on the preparation, I searched the net and found that the following should be avoided when on low iodine diet:

• seafood
• egg yolk
• potato skin
• iodized salt
• dairy

Otherwise, be very careful with foods with added salt, not necessarily sodium.

Sugared cashews

Sugared cashews

Cup of Cashew nuts
cup of water
one tablespoon sugar

Procedure:

1.  Soak cashews in water.
2.  Remove water.
3.  Pour sugar and cover all cashews add more sugar if not enough or if desired.
4. Bake in oven at 250 F.
5.  Turn once in a while.

Enjoy!

LID veggie fritters

Low Iodine Diet Veggie fritters

Ingredients

1 medium zucchini
1 medium sweet potato
1 medium carrot
1 medium potato
2 egg whites
1/2 tsp ginger powder
1/2 tsp garlic powder
1/2 tsp onion powder
canola oil for deep frying

balsalmic vinegar + any herbs and pepper for dipping

Procedure

1.  Peel all the vegetables especially potato as potato skin is high in iodine.

2. Using the peeler, scrape all the vegetables and put them in one bowl.

3. Chop the parts that cannot be scraped with the peeler into small cubes.

4.  Mix together with egg, a little pepper, onion powder, ginger powder and garlic powder.  Alternatively, use onion, garlic and ginger.

5.  Heat canola oil and deep fry the fritters to your desired size or shape.

Enjoy with balsalmic dip.

Nuclear medicine counseling: Step 1 to Radioactive Iodine therapy (RAI)

Today, I had an almost one hour counseling session with the nuclear specialist of the American Hospital Dubai, Dr. Hua Yang.  She answered all my questions and discussed the plan for my thyroid ablation.

 Do's and don'ts

 Ablation plan

The treatment will start with Thyrogen injection on 16 November 2015 which is the first dose of two doses.  This is usually done on an outpatient basis.  The next day, after 24 hours, I will have another Thyrogen injection. 

Thyrogen is a recombinant form of human thyroid-stimulating hormone (TSH). It works by binding to TSH receptors on normal thyroid cells or on thyroid cancer tissue. This helps to determine if there are any thyroid cells or thyroid cancer cells remaining.

If Thyrogen is given before RAI (radioactive iodine), there is no need to stop the Thyroxine or other medications.  The low iodine diet is the only preparation needed.  

In the afternoon after the second dose of Thyrogen, I will be admitted.  It is important not to have any food before that admission, so breakfast is encouraged, so from lunch will be fasting.  At liunch time, I-131 will be given in capsule form.  Two hours after the capsule is administered, NO drinking and NO eating but can drink water only.

I will be admitted for three days, in isolation until the scan shows that I am in a safe radioactive level.  But after I come home, I still have to isolate my self in my own room, using my own bathroom and not preparing food.

Post ablation discharge instructions for Iodine-131 therapy:

During the first three days, you should

• not touch anyone, keep a distance of 2  meters at all times between you and the next person.
• not sleep with anyone else in the same bed.
• not travel by mass transit (planes, trains, ships, buses, etc)
• not be in public places such as cinemas, restaurants, malls, etc
• not travel in a car with children or pregnant mothers.
• not share a bathroom with anyone else.
• drink plenty of non-dairy fluids.
• flush toilet twice after each use.
• urinate frequently.
• take daily showers.
• brush teeth at least three times a day.
• eat meat with no bones
• eat small meals and try not to have leftovers.
• use separate disposable plates and utensils and rinse them thoroughly before dispensing.

During the first 7 days, you should

• not have any intimate contact with another person
• not be around children
• not be around pregnant mothers
• not share meals with anyone
• not prepare meals for anyone
• maintain a distance from others

Thoroughly clean the bathroom and bedroom in three days.

• wipe all surfaces of the bathroom with damp sponge or cloth twice.
• wash all sheets, towels, pillowcases and clothes together in a washing machine twice.

You may return to work after

• three days if you have your own office or cubicle and i your work involves contact with adults only
• seven days if your work involves contact with children and pregnant mothers.

I have also signed the consent for the ablation therapy.

Continuing on low Iodine diet.

Low iodine (LID) Butternut squash and string beans in coconut milk

Ingredients

Butternut squash (half)
string beans (about 10 strands)
coconut milk one cup
onion
garlic
rock salt
olive oil
pepper

Procedure

1.  Cut squash into cubes.
2.  Cut string beans into 1-2 inch size.
3.  heat olive oil
4.  Saute onion and garlic
5. Add coconut milk.  Bring to boil.
6.  Ass salt and pepper to taste.
7.  Put the squash.
8.  Simmer.
9.  Put the beans.
10.  Simmer until desired tenderness.
11. Serve with rice.

Beans and basil (LID)

Ingredients:

2 cups Bean sprouts
1/2 cup green beans
chili powder
ginger powder
rock salt (not iodized)
onion
garlic
olive or canola oil for sauteing
1/2 cup water
basil leaves fresh

Procedure
1.  Wash bean sprout and beans.  Cut beans into three parts.
2.  Heat olive or canola oil.
3.  Saute onion then garlic.
4.  Add chili powder, ginger powder and rock salt.
5.  Add green beans.
6.  Simmer.
7.  Add bean sprouts.
8  Simmer.
9.  Remove from heat.
10.  Add basil leave on top.

Preparing for my low iodine diet

In few weeks' time, I will be having my radioactive iodine treatment.  Before this, I have to eat a low-iodine diet.  I have been searching and researching about LID or low-iodine diet.  I have through many websites and some are contradicting.  So, I gathered most of what i have read and came up with my own personal LID do's and dont's.  But there is one very helpful site the thyca.org with recipes that I will be trying soon.

LOW IODINE DO NOT EAT!!

1. Seafoods.
2. Milk and dairy.
3. Milk chocolate
4. Egg yolks
5. Cheese

LOW IODINE ALLOWED FOOD

1.  Pasta and rice.
2.  Camote and potatoes
3.  All fresh fruits and vegetables
4. Unsalted nuts
5.  Fresh meats

For flavoring, I will be using rock salt and different herbs and spices.

One week post completion thyroidectomy

I just came from my checkup after one week of completion thyroidectomy.  It's a good news for my histopathology of the left thyroid is negative of cancer.  Praise God.  The next step will be the RAI or radioactive treatment.  Hopefully, injectables will be approved by the insurance.

Dr. Carmelo was so happy of the result.  He also said, "you have a lot of friends."  He also said that it is important to have a lot of friends for support.

He also discussed with me the preparation before RAI.

What to do before RAI?

1.  Five weeks before, all medicines will be stopped.
2.  Low Iodine diet, so no seafoods!
3.  Expect weakness and tiredness because the drugs have been stopped.

During the RAI, i will be inpatient for three days with all the amenities in the hospital including wifi so he told me to bring my gadgets.

The stitches have been removed and I feel well.  Actually, gained weight ha ha ha.