Using Big Guns to Hunt Radioactive Zebra

Today I attempted to explain to an old friend exactly why Chris experiencing extreme side effects from the radioactive iodine is a GOOD thing. It's counterintuitive and the conversation reminded me of something we've yet to address on this blog.

We are extremely blessed in our choice of doctors. Our care team is simply incredible.

That's not an accident though. We spent years going through doctors, trying to find someone who understood what Chris was experiencing. Finding our care team was the result of perseverance and patience.

There's a saying in the medical community: "If you hear hoofbeats, think horses, not zebras."

Chris is a zebra. Currently he's a radioactive zebra.

If someone could make me a design of a radioactive zebra I'd have a shop up on Zazzle and be selling radioactive zebra t-shirts by the end of the day.

But anyway...

Finding doctors who understood that they might be looking for a zebra can be incredibly difficult. Our breakthrough came in getting a very young and fresh family doc, convincing him that he was out of his depth, and getting him to send us to specialists. Then we just didn't quit until we got to the right specialist.

This is nothing new to me. In 2004 my youngest brother Tim, 30 years old at the time, suffered complete kidney failure. Most of the time dialysis patients are older, diabetic, and non-compliant. Tim is younger, has no other medical issues, and is incredibly OCD. Dialysis diets are written for the non-compliant. Tim might be the only dialysis patient in the country that almost stopped his heart from lack of potassium in his diet. Finding him a doctor who understood him took time and patience.

Finding a doctor who understands Chris ended up being incredibly difficult as well.

Chris got up to 300lbs overweight at one point. Most people that are that overweight 1. are diabetic, 2. have blood pressure issues, 3. lie to their doctors about their diet and 4. are past middle age. Chris is 36, normal blood sugar, normal blood pressure, and tells the doctors the truth. Finding a doc who understood all of that took some doing.

What finally did it for us was dealing with a new physician's assistant doing the intake at the group endocrinology practice. He didn't believe Chris either but he had a list of things he "had to do"in order to make the head of the practice happy.

The PA is the one who found the tumor.

Suddenly Chris got "upgraded" as it were. His case reached the ears of the head of the endocrinology practice, a man who graduated from medical school at Yale in 1969. He's one of the most respected endocrinology and metabolism researchers in the country.

This doc HAD to have Chris as his patient.

When we first met him we didn't jump through all the hoops or spend forever listing his symptoms to unbelieving ears. He came fully ready to believe that Chris was a zebra.

When Chris said "Endocrinology is weird and no-one understands it" the doc said, "Yeah, that's why I like it."

I'm fully convinced our endocrinologist's next research paper will heavily feature Chris.

Funny thing about doctors who "get it" and like odd cases; they know other doctors who feel the same way. That's how Chris ended up with an orthopedist who saw a man in his mid-30's with knee pain and treated him according to his age. Which meant Chris ended up with drugs that worked, not drugs that are safe for the vast majority of orthopedic patients.

Between these two doctors and their willingness to treat Chris as a zebra, they quite honestly saved his life. They reduced his symptoms, reduced his pain, and reduced his weight.

Most doctors are afraid to "bring out the big guns" as it were. Most doctors are afraid of lawsuits, malpractice claims, and non-compliant patients accidentally killing themselves. These doctors dived into Chris's case, took a good look at both of us, determined that we're educated and intelligent patients, and treated us accordingly. They brought out the big guns because we could handle it.

Which brings us to awesome doc number 3, our second (and final) surgeon.

There are no words for how much I love this surgeon. Mostly because of what he did the day of the surgery.

We'd met him at the consult and he'd gotten his measure of us. He knew who we were, he figured us out.

Right before the surgery he came to see us in the prep area. There he gave us the option.

"If I go in there and think that a lobe of the thyroid can be saved, do you want me to save it? That would reduce your chances of damage to the parathyroids and limit your risk. If I go in and I don't think it looks malignant, I can just take out the tumor and leave the rest alone, it's up to you."

We told him to take the whole thing, that we were pretty sure it was malignant (given the growth rate), and that we didn't want him going under the knife again if the pathology comes back with bad news. Also, with me being pregnant, we didn't want to take any chances.

He told us the surgery would take about an hour. It took 2 1/2 hours. Twice he had a nurse call me in the waiting room to update me and tell me everything was going okay, once during and once as they were closing up.

When he came to talk to me in the waiting area he walked up to me grinning like the cat that got the canary.

That's far more reassuring than it sounds. When a surgeon is wearing the "I fought a tough battle and I kicked its ass" grin, you know the world is okay.

He didn't withhold details from me. He'd already figured out that I could handle it.

He still didn't think it looked malignant, but he'd followed our wishes. Also, it was one of the largest masses he had seen, with the most extensive vascular network he had seen. He'd brought out the big guns.

Good thing too, as nine days later he's the one who delivered the bad news about the pathology (it was aggressively malignant; and without removal Chris could have been dead within a few months), and that Chris would be undergoing aggressive, high dose radioactive iodine ablation. He then passed the football back to our awesome endocrinologist.

Our awesome endocrinologist who, at the RAI consult, decided to keep bringing the big guns. He believed us when we told him we were already on a pretty low-iodine diet and had already stopped the thyroid supplementation in preparation for the treatment. He took us on our word, had a blood test run to confirm that Chris was ready, and had Chris booked for RAI by the end of the afternoon.

They usually wait six to eight weeks, just to make sure; but the doc understood how serious we were about nuking this bastard from orbit, and exactly one month after surgery Chris received his first RAI treatment. The minimum amount of time after surgery, the maximum dosage allowed for all but the most extreme life-threatening cases. We prepped to the max; not only did Chris adhere to a low-iodine diet, he went way past low-iodine requirements and made his body as desperate for iodine as possible.

It's not just the docs who get to bring out the big guns. Sometimes the patients can do that for themselves.

I can't state enough how unusual it is for doctors and patients to agree on going all-out, much less putting it into practice. It's almost unheard of. Usually both sides are much more cautious, would rather extend treatment than risk bad side effects or collateral damage.

Clearly Chris isn't a normal patient, and these aren't normal doctors.

Using the big guns does have a few drawbacks. Chris is incredibly sick; he's so hypothyroid and soaked up so much radiation that we weren't really prepared for how bad he'd feel.

Incredibly sick is a good sign. A sign that we maximized the amount of the RAI he'd soak up, and a sign that there's not much thyroid tissue left to cause a problem. This is one case where being really sick means you did something right.

In another week he'll undergo the full-body gamma camera scan to see where the RAI soaked up and identify any other masses that need to be removed. If that's clear or mostly clear (small spots will be cleared up over the next 6 months as the RAI clears his system) treatment will be considered successful. If there are a lot of specks remaining, large concentrations of specks, or any clear masses; they'll wait a few weeks for the remaining I-131 to clear his system, then dose him again, and scan him again.

They'll scan him again in six months to check for any other masses or concentrations of specks, and there's a chance he'll need to go for another treatment; but if the treatment was aggressive enough in the first place, it's unlikely (then he'll have to get a scan once a year for the rest of his life).

If treatment was successful the endocrinologist will start the thyroid hormone replacement regimen and start tinkering with dosages. He won't be starting at the normal "safe" starting point either; he's willing to calculate dosage according to what he knows about Chris and try to get the dose right the first time (400mcg per day; about four times the normal starting dose). He'll still be bringing out the big guns.

This is what happens when you're an educated patient, you find the right doctors, and you're willing to take some risks in order to get it done right the first time.

Being willing to take chances, using the big guns, and finding the right doctors is what it takes sometimes.

Especially if you happen to be a radioactive zebra.

Mel

Fallout Boy - Day two

So... basically today sucked.

As I have often said before in these pages, Cancer sucks, I highly recommend not getting it.

I'm not sure if it's the extreme hypothyroidism, the radiation, or the mixture of the two; but I pretty much feel like I've been stuffed into a burlap sack and severely beaten with medium sized hammers.

Why medium sized?

Because they hurt a lot, but don't break anything, and no one hit, is enough to distract you from all the others.

The nausea isn't actually bad (I've been able to eat, drink, and keep everything down), but the joint swelling, aches, headaches, muscle weakness, and general malaise... Not fun.

Honestly, I'm having a hell of a time getting up, moving around etc... Seriously, I'm weak as a damn kitten right now. Grunting when I pick up my laptop, and needing to brace myself and push off with my arms just to get off the couch.

I'm kinda uncoordinated and fuzzy too. I presume thats from the hypothyroid.

One thing I KNOW is from the hypothyroid is that lovely combination of extreme fatigue with inability to sleep. I managed a not very solid 3 hours last night (or rather, this morning. 5am to 8am) even though I was exhausted. I tried to nap twice during the day, and managed to zone out for a half hour or so each time, but couldn't actually sleep.

I'm fuzzing out, and getting foggy, quite a lot.

So, that's all the subjective bad news. 

The good news, is that the radiation is falling off pretty fast. So much so that Mel will be able to sit in the same room with me tomorrow.

I'm going to graph out a couple doses here from today:

Date -- Time -- Delta -- Distance -- Dose uSv/h

9/14      0800      18          0                  >1000
9/14      0800      18          2                  360
9/14      0800      18          3                  65
9/14      0800      18          6                  26
9/14      0800      18          12                14


9/14      1200      22          0                  >1000
9/14      1200      22          2                  290
9/14      1200      22          3                  52
9/14      1200      22          6                  24
9/14      1200      22          12                13

9/14      1400      24          0                  >1000
9/14      1400      24          2                  260
9/14      1400      24          3                  45
9/14      1400      24          6                  23
9/14      1400      24          12                9


9/14      1600      26          0                  >1000
9/14      1600      26          2                  240
9/14      1600      26          3                  40
9/14      1600      26          6                  22
9/14      1600      26          12                9



9/14      2000      30          0                  970
9/14      2000      30          2                  210
9/14      2000      30          3                  34
9/14      2000      30          6                  17
9/14      2000      30          12                7


9/15      0000      34          0                  900
9/15      0000      34          2                  150
9/15      0000      34          3                  24
9/15      0000      34          6                  13
9/15      0000      34          12                6


You can see that I switched up to four hour data reporting, from 8am to midnight, with the notable (in bold) exception of the 1400 reading, that being 24 hours after my dose (I gathered every two hours, just because I had nothing better to do. It'll be in my spreadsheet and graphs at the end of the process)

Now, the first thing about this data is I can't say enough how strongly radiation falloff is correlated with frequency and volume of elimination. The more water I eliminated (actually mostly gatorade), the more radiation I eliminated. In fact I tested before and after, just to see the difference, and it was as much as a 10% in less than five minutes. Since all my previous measurements were post elimination, I decided to make all of them post elimination. Also it's clear that the longer you go between eliminations, irrespective of volume, the greater the dosage in the elimination.

A few things are notable about these results.

• The slope of change shallows out very quickly.  When you see the graphs, it's going to be a very peaky curve.
• On wakeup at 8am, general radiation levels had fallen about 20-30% from the 2am measurement; and were less than half what they had been 12 hours earlier at 8pm.
• At the 24 hour mark, I was still showing over 1000uSv/h touching my torso (I was at 1600 immediately after dosage); but otherwise the radiation  levels at 2, 3, 6, and 12 feet were all less than 15% what they had been after my first full measurement.
• Also, the 24 hour mark was where I first fell below 10uSv/h at 12 feet; the maximum recommended long term dosage for healthy non-pregnant adult; just barely, but below. Some time tomorrow I'll fall below 5uSv/h at 12 feet, the maximum for my pregnant wife; and below 10uSv/h at 6ft. 

My first full measurement was at 1600 yesterday, so comparing 24 hour intervals we see (0 is touching my torso, 2 is holding the meter at arms length):

Distance -- 9/13 ------ 9/14 ----- %change
0                 >1000       >1000     UNK
2                 >1000       240         UNK
3                 800           40           95%
6                 600           22           96.5%
12               480           9             98.1%

That's a very substantial, and very nonlinear falloff. It's also not directly proportional, not very close to inverse square, and not really on any kind of consistent or predictable trend line slope except "down".

Basically, from my own personal results, you can't make any linear regression analyses to plot future dose numbers with any kind of accuracy.

That said, it looks like it'll be safe for my wife to sit across the room from me early tomorrow (Saturday), and probably 6ft away from me late tomorrow. Unfortunately, it probably won't be 'til Monday or tuesday she can sit on the other side of the couch from me; and it probably won't be for a couple days after that she can sit next to me on the love seat.

As for sleeping together...

Well, I finally fell below 1000uSv/h touching my torso at about 8pm; but the slope of change is pretty shallow. We won't be able to sleep together until that dosage drops at least to 5uSv/h, and in theory it would be safer to wait til it drops below 1uSv/h (we tend to sleep pressed up against each other. Maximum exposure). At the slope I'm seeing right now... It's going to be at least a week... Probably more like two (the trend line is 12 days from dose to get under 5... but as I said above the trend lines are inconsistent).

Oh and you definitely want to be using your own toilet for at least a week as well. That change slope is very shallow too. At the 24 hour mark, I was still eliminating at over half the initial elimination dosage.

One thing that I've found the guidelines are overcautious on though, is your dishes, silverware, and disposable plates and cups. They're not taking on any significant radiation to dose back out; though admittedly it's only been a day, and dosages are cumulative. So with multiple uses over several days, it may build up. I'll test it. Same thing with the sheets, towels etc...

That isn't to say these items aren't picking up some radiation, they certainly are; but it's not a lot, and they don't hold on to it long once out of my immediate presence.

Metal objects however... If you carry change in your pocket during this process, you definitely don't want anyone taking it into a federal building for at least a couple weeks... maybe longer.

I'll have Mel do a residual test with me out of the room on m sleeping position, my laptop, the contents of my pockets etc...

And that was day two...

Fallout Boy - Day One

So, I'm radioactive.

 On purpose.

 ... Aint that a kick in the head.

My regular readers can skip ahead to the section after this, unless you'd like a recap of the course of the cancer. I'm writing this up for other thyroid cancer fighters, who will be coming to this page without having read me before.

So, once more unto the breach my friends...

The story so far...

For those of you just tuning in to our show, your humble narrator has been suffering from unusual health problems with endocrine symptoms since sometime in 2004 (or probably before, but it started being noticeable in '04).

By late 2005 it was very clear something was wrong, but we couldn't find any cause. Basically, I had lots of symptoms of diseases I didn't have; and they got progressively worse and weirder.

I also went from a healthy and strong 285-295lbs, working out regularly with under 15% bodyfat; to a damn near crippled 497lbs at 57% bodyfat; and most of that weight was gained about 4 of those 7 years

...and doesn't include the losing 70, then gaining 90, then losing 60, then gaining 100 see saw back and forth. Added up it was over 600lbs just in big swings of 40lbs or more.

Oh, and most of it was on a severely calorie restricted diet. At one point I was eating under 1200 calories a day, at over 400lbs, and I was still gaining weight; because my metabolic rate had fallen to well under 1/2 normal caloric burn per pound per day, and because I was retaining ever more water (eventually to the point it threatened my heart, breathing, blood pressure, and circulation in my hands and feet; never mind the great deal of pain it caused).

In early 2011, after 7 different doctors in 3 states over more than 6 years; we finally figured out what I had...

It was thyroid cancer.

Of course, I had been tested for thyroid problems, multiple times in fact; and my results were always inconsistent  Sometimes very high, sometimes very low, sometimes things that should be high when other things were high were low etc... etc...

But none of the blood tests were consistent with thyroid cancer.

I'd had head MRI, chest MRI, abdominal MRI, contrast on all of them, pet scans, cat scans, ultrasounds; in fact multiples of all of them... But because my blood tests weren't consistent with thyroid cancer, they'd never scanned for thyroid cancer, or even FELT my neck.

My endocrinologist saved my life, because he (and his PA) were the first to say "well, sometimes the blood tests are wrong, let's just check anyway".

They found what, at the time, was a potato sized tumor in my neck.

The other weird symptoms were side effects of the wild fluctuations in thyroid function, from paraneoplastic syndrome caused by the thyroid cancer, from microlesions all over my endocrine system making it nuts (which were also thrown off by the thyroid tumor); and from my body attempting to deal with all of it... very unsuccessfully.

Great, I finally had a diagnosis, and we knew how to treat it. Even better, there were ways to address the symptoms even before we got the cancer out.

The theory was that once we got the big main mass out, the other issues would either be easily treatable, or may even go away on their own.

BUT... they wanted me to wait a while before we went after the big tumor.

Because I had gained so much weight, my care team wanted me to lose over 140lbs before we removed the big tumor; to reduce the risk of death or serious side effects on the operating table.

140lbs is a lot of weight to lose; and I had been GAINING weight for years even on diets...

Initially, they offered me a gastric bypass; but I wasn't really happy with that idea. I was pretty sure that with the right medications helping me control my hormones and water weight, I could do it.

So I did it...

Once we figured out what was wrong, we were able to get me on a BIG STUPID PILE of medications  (including biweekly hormone injections, and literally dozens of pills a day) that allowed me to get rid of a lot of my ridiculous water retention, and start getting my metabolic rate back into something approaching a reasonable range.

With the medications, I was able to lose 153lbs in about 14 months; but my weight wouldn't stabilize. I would fluctuate as much as 60lbs up or down in a week or two. So my care team debated what to do for a few months; my endocrinologist wanting to do the surgery as soon as possible, and my oncological surgeon wanting to hold off on more weight loss and my weight stabilizing.

Finally, my endocrinologist, the leader of my care team, decided to get another ultrasound on my tumor; and it's good that he did, because he found that it had more than doubled in size and volume in the 12 months since my previous ultrasound.

At that point, he asked my surgeon to operate, but she still insisted that we stabilize my weight... So we found another surgeon.

That was the end of June. I had my surgical consult in mid July, and got scheduled for surgery in mid-August (the first slot the surgeon was able to get me into).

August 13th I had my tumor, as well as my whole thyroid removed (though they were able to save both parathyroids), in a surgery that took more than twice as long as expected... Because the tumor had grown even larger just in the six weeks since the ultrasound.

When they finally took the tumor out, it was a 10.2cm rough sphere (about 4"); and with the blood and thyroid included, the total mass removed was almost SIX POUNDS.

They got the pathology report back after the surgery, and I met with my surgeon, who told me that it was very lucky they had got it when they did, because if they hadn't I would likely only have had a few months before it was critical (could have killed me).

According to the pathology, this was an extremely aggressive malignancy (which we suspected given the growth rate of course), and that while there appeared to be no lymphocytic involvement, there was extensive vascular infiltration. Given the size, mass, and nature of the malignancy; along with the other symptoms (microlesions etc...), I would need to undergo aggressive radiation therapy, and a full body scan to check for other masses etc...

I knew this was a possibility, so I was preparing for Radioactive Ablative Iodine (RAI) therapy from day one. I have been on a mostly low iodine diet, and have not taken any thyroid supplementation, since two weeks before my surgery.

As soon as we got the lab results back, I went on an ultra low iodine diet, and tested my thyroid levels...  (they look for a TSH of at least 30, and over 40 is preferred. 9 days after surgery I was at 40, 20 days after surgery I was at 70) such that I was ready to take my first radiation treatment one month from my surgery (the minimum time allowed by protocol).

The various and sundry details, setbacks, annoyances, discoveries and whatnot have all been written about in fairly great detail in these pages these past two years; and are roughly indexed in this link:

http://anarchangel.blogspot.com/search/label/Cancer

And now, you're caught up to present day, at 2pm

At just about 1400 pacific today, a very nice guy named Bobby, very carefully (and thankfully very patient in letting me take some pictures) unscrewed a small shielded vessel containing a small sealed bottle, which he then unsealed and stepped back from:

After letting me take my pictures, he then very carefully put a small bluish white capsule containing a 150 millicurie equivalent dose of Iodine-131 onto my tongue, and had me swallow it.

After I finished the paperwork, I just randomly stood in the room near his dose calibrator, and it showed 85 microcuries from about four feet away (I cropped in on it in this pic):

With the probe just over my gullet (but not touching), his calibrated dosimeter registered me at 160 millirems per hour (which is also 1600 microsieverts per hour).

That's 1.6 times the Nuclear Regulatory Commissions (NRC) dosage limit for non-radiation workers for entire YEAR,  as an hourly dose rate. So, Yay!

Remember, that's not what's inside me (which is much more), it's what I'd be irradiating someone else who was standing right up against me.

I'm really glad I took the opportunity to ride my motorcycle down to the clinic. It was an absolutely amazingly beautiful day; high 70's, breezy and clear... Just beautiful, especially on a bike. It makes the 75 miles actually enjoyable, rather than a chore.

It couldn't have been a more amazing day, and I took the extra long and scenic ways home; stopped by the lake a while, then rode off deep into the woods away from everything where I knew there was a view, and just enjoyed it; because that's likely the last chance I'm going to get to take a lovely ride on a nice sunny day for a while.

I did notice one thing though; the GPS on my phone lost track when I touched it. Not surprising since, the tiny GPS antennae in the phone isn't exactly robust, and a VERY small amount of interference is all it takes to glitch one. It was only while I was actually touching the case though, as soon as I left it alone in its mount it was fine.

I was hoping that there'd be enough beta excitation to make my watch hands glow brighter; but it certainly wasn't evident in daylight even holding my hands up around the face to darken it up.... I'll try it again later, and it doesn't take all the much beta for a phosphor reaction; but I'm guessing there won't be much if anything noticeable.

Yesterday we got our radioactive dosimeter (RADEX 1706), and calibrated it to our local daytime and nighttime background radiation, which varied from 0.12-0.16 uSv/h day, and 0.08-0.10 uSv/h night; depending on where we measured, what time of day etc...

Basically, across 10 long baseline measurements (long baseline being 4x the 26 second short baseline acquisition time; or 104 seconds each), across 12 hours day and night, the baseline background radiation here is 0.12uSv/h; which is almost exactly 1/2 the national average; and unusually, is 1/3 the statewide average of neighboring Washington state.

Of course, that's still damn near nothing; it's about the same dosage of radiation you get from eating a banana.

Wait what, bananas are radioactive? AHHHH WE"RE ALL GONNA DIE!!!!

Or not...

EVERYTHING is radioactive; it's just a matter of how much.

Bananas have a large amount of potassium. Potassium naturally has a small amount of radioactive potassium isotopes mixed in; enough to give you a 0.098 or about 0.1 microsievert dose of radiation.

So, for those geniuses who constantly spout off about non-ionizing radiation, and how "there is no safe dose of radiation" etc...

Yeah, you're an idiot. Sorry.

When I got back home, I had Mel go to the gate with the meter and check when it hit 50, and then 100 microsieverts per hour... Which was about 35 and 25 feet away respectively.

Then had her walk up to the main floor and scan as I went by down to the basement (so she didn't have to get any closer for any further exposure). From a few feet inside the house, it peaked at around 80 uSv/h as I walked about 15 feet from the front door.

You might note, all that weight I lost? The 153lbs? Yeah, with the hypothyroid and the being off the meds for now about two months etc... All but 50lbs of it is back.

I've gained 40lbs since the surgery alone (and that's after losing 20 in the few days after the surgery); most of that in water. I feel like an overfilled water balloon.

 I can't wait until I can get back on my meds, and get my thyroid supplementation up (400mcg... rather a big difference from zero); and start losing weight again. Oh, even with the nausea I probably won't be losing any weight during radiation, because of the thyroid thing. My metabolism is so suppressed I can't keep my hands or feet warm; and my water retention is through the roof.

So, the rest of the post I've decided we're better off without pics, and we'll be talking about some bodily functions....

About the time I got home, the headache and nausea started coming on; and have been steadily coming on since.

Also, I was drinking mass quantities (as I had been advised to do; and I decided to test out one of the things all the websites tell you is a big safety issue... Just how much radiation you "pass out with water" so to speak.

I was... shocked.

From the seat, my ...liquid elimination... showed an effective dosage of 300 uSv/h; and that was before the full uptake (apparently it's going to rise further during the night; and may continue rising til tomorrow). Even after one flush, it was 80 uSv/h, and two it was 24...

Damn...

The docs told me that the more I could eliminate, the faster the radiation would come down to safe levels, the fewer side effects I'd have. They say that once per hour is ideal, but I should be going for at least once every two hours (which is about what I've been doing).

So then I ran some distance tests; and again, the engineer in me is amazed at how little attenuation there is from my body, the couch, the table in front of me etc... They're nearly transparent. I knew they would be of course, on the general "nuclear" scale... but we're talking about some very small amounts of radioactive material, with a comparatively very low energy isotope.

When I first got home, and sat myself in my normal position in the basement, Mels normal position on the main floor was below 10 uSv/h, but only just (9); and that's with about a 30 foot slant range, a floor and ceiling, and a bunch of furniture in between.

Touching the meter, holding it out at arms length, I was over 1000uSv/h (the max detection on my meter in that ranging), so I didn't bother checking the rating touching my abdomen. 3 feet away at the other end of the couch from my normal basement seating position was at 800 uSv/h. Six feet away was 600 uSv/h, and 12 feet was 480 uSv/h.

Honestly, these numbers all really surprised me. I really wasn't expecting that high... and they actually are high enough that with a few hours exposure, they could measurably increase someones rate of cancer or having children with birth defects.

Of course, that also means they increase my chances of other cancers; but since I've already got cancer that could kill me if I don't do it... That's the way it works.

Oh and never mind the fact that they didn't follow inverse square all that well; life isn't a physics problem, and atmosphere isn't vacuum.

The good news, is that the numbers are going down fast.

A note on rounding:

For these measurement, my meter can display 3 digits (internally it calculates to four decimal places) however, unless obviously otherwise, I am rounding as follows (always rounding up):

• 1000+ is off the scale
• 26-1000 to the nearest higher 5
• 10-25 to the nearest higher 1
• 0-9.9 to the nearest higher .1

6pm

Two hours later at 6pm (four hours after the dose), I was still over 1000 uSv/h at arms length touch, but hopefully not too much, because it took 20 seconds to get there. 3ft was 400 uSv/h, 6ft was 200 uSv/h, 12 ft was just 40 uSv/h.

However, my second elimination test showed 600 uSv/h!!! yipes.

8pm

I ran another series at 8pm, (six hours after dose), and I was finally below 1000uSv/h at arms length touch (850 uSv/h), 3ft was 200 uSv/h, 6ft was 80 uSv/h, and 12ft was 30 uSv/h

Third elimination test, another 610 uSv/h.

At 8, I also had Mel run the floor test, and now her seating position is only getting about 3 uSv/h; which is well below the safe threshold for reasonably long exposures ( 5 uSv/h) for pregnant women. So we're good with our current arrangements of things.

10pm 

Now as I write this it's 10pm, and I've got to say, the nausea and wooziness/woogieness is a bit much... The fatigue and ache and lack of body temp control from being severely hypothyroid are just WAY worse... But I'm not losing it or anything. I had dinner an hour ago and I'm holding it down no problem.

Also, I've been sucking on candies, and drinking a lot of sports drink and OJ, as is recommended to help elimination and to avoid salivary gland problems.

Seems to be working.

Let me just run my next test series...

Ok, arms length touch was 600 uSv/h, but I was still over 1000 uSv/h at my torso. I have to move out 12" to get below 1000 uSv/h. 3 ft out was 130 uSv/h, 6ft was 40 uSv/h, and 12ft was 25 uSv/h; with elimination at 520 uSv/h

I'll probably be awake 'til 2am, and if I am I'll update at midnight and 2am as well; to get a 12 hour baseline on the radiation.

Tomorrow, once I wake up, I'm going to switch to a 4 hour measurement cycle. I may stick at 4 hour, or go to six hours on Saturday.  I'm spreadsheeting all this data, and at the end of this I'm going to graph out the radiation dosage and distance over time.

Midnight update:

Well, the rate of reduction is reducing; as would be expected of course, though the slope isn't particularly consistent.

It was still more than a foot from my torso to get under 1000 uSv/h; and the arms length measurement had only dropped to about 535 uSv/h. The 3ft dropped to 110 uSv/h, the 6ft to 35 uSv/h, and the 12 ft measurement dropped to 22 uSv/h. The elimination test showed 480 uSv/h.

12hr update:

So, 2am, 12 hours after the initial dose, and here we go.

It's still more than a foot from my torso to get under 1000 uSv/h; and the arms length measurement  dropped to about 485 uSv/h. The 3ft dropped to 90 uSv/h, the 6ft to 30 uSv/h, and the 12 ft measurement dropped to 18 uSv/h. The elimination test dropped to 320 uSv/h.

One thing I've noticed, is that once you drop down below 500-600 uSv/h, the radiation dosage is HIGHLY directional; with my sides radiating about 2/3 the energy of my front, and my back radiating about half... Interesting.

I'm sure folks have done this in labs many many times; but I couldn't find it online anywhere; and it's the kind of data I wanted to see and understand when I was doing my research on this cancer, and this therapy so... Here it all is.

Tomorrow etc...

I'll be doing the following days radiation measurements one post per day. Haven't decided if I'll post in the morning and update during the day, or I'll just post it at the end of the night.

Paging Dr. Bruce Banner

I am gamma hot. Registered 90 millicuries just standing there. Their dosimeter read me at 160mRem just after taking the pill.

Pics and details to follow, but I thought Id post that before I ride home.

I bet im the only radioactive biker in the northwest this afternoon...

Nuke-u-lar Wessels?

So, in a few minutes I'm off to the nuclear medicine clinic for my first radiation treatment.

They're letting me do my isolation at home at least, so I'm not stuck in the hospital for four or five days; but I do have to drive down there and back alone; since Mel won't be able to sit in a car with me for at least a week.

ACtually... It's a gorgeous day, and I'm probably not going to feel well enough for a while... maybe not 'til after the weather turns... I think I'm going to ride the bike down. It may be my last chance.

There's likely to be some unpleasant side effects, and I'm probably going to feel pretty sick for at least the next few days... maybe more... So don't expect much in the way of good content.

However, we have a geiger counter/dosimeter, and a couple of experiments to run; maybe some videos of me making watches glow very brightly etc... to post.

This is likely the only time I will get to be radioactive on purpose, and if you think I'm going to miss making the jokes, and running the experiments, and screwing with stuff over it... You don't know me too well do you?

Overnight last night

We hit freezing for the first time this season. Officially it was 34, but we saw 32 here.

... My instinct keeps saying "this year" not "this season"; but of course, the last time we were below freezing was in early April this year (looked it up; there was an overnight freeze april 14th, but it had been over freezing for most of a couple weeks before that)...

So, we put our first fire of the season in the fireplace this morning; cleared out the flu, took the chill off the morning, and then we let it burn down; before it hit a high of 73 today.

It's been unusually cold overnight for the last few nights, dropping from the high 40s (and even low 50s two weeks ago), to the mid-low 30s. It should be right around freezing (forecast is 33) tonight as well; then it should be back in the mid-low 40s overnight for the next couple weeks (the normal overnight temps for this time of year. It normally doesn't average under freezing overnight 'til late October).

Amazing that four weeks ago it was in the mid 90s. Seasons change faster here than they did where I grew up in New England. Probably something to do with the maritime climate, and the big thermal mass of the ocean there, vs. the mountains (the big lake can't quite match up to the north atlantic).

We've got two cords of two year seasoned birch out back waiting to be neatly racked and stacked by our upstairs and downstairs doors.

One or two small splits in our fireplace insert does a pretty good job of taking a 35 degree outside to a 75 degree inside.

If we have as mild a winter this year as we did last year, two cords should be more than enough for the winter without needing to use the oil heaters at all.

It's good them temps will be going back up, since I start sleeping in the basement tomorrow. Mel and I will both miss the body heat with each other.

Accountability, responsibility, risk, metrics, unions, markets... What about education?

Right now, Chicago teachers are striking, even though they already make an average salary nearly double that of the average Chicago family, and are being offered a 16% raise over four years.

I dunno about you, but as a free market partcipant in our economy today, that sounds like a pretty good deal.

Well, first thing is they're asking for a 30% raise over four years... but that's really just a negotiating point, and one they don't expect to get. If it were just about the raise, I'd guess they'd take the 16%.

It's not.

It's not really about the money; it's that the teachers new contract attempts, in even the tiniest way, to add some accountability and performance measures to the teachers contracts.

... and the teachers unions can't give even a millimeter on this issue. Not one millimeter, not ever. Because if they do, their rigid seniority system collapses, and they lose power.

Here's a fun fact; a lot of younger teachers don't mind the idea of performance standards, and they actually LIKE the idea of merit pay, performance bonueses etc... It's not a foreign idea for them, because all their friends who live in the real world market economy have that sort of thing.

Recently, in Idaho, the commissioner of education managed to get teacher tenure eliminated, and performance based bonuses (note, not performance based salaries or hiring or firing, just bonuses) passed as commission regulations, and then when they were challenged in lawsuits, via statute approved by public referendum.

In response, the teachers unions sponsored an unsuccessful attempt to have the commissioner (who is now serving as one of the two lead advisors on education to the Romney campaign) recalled. So unsuccessful in fact the numbers indicate basically no-one voted for the recall but teachers and their immediate families.

This year, they managed to get enough signatures together to get a repeal effort on the merit pay rules on the ballot as a referendum; polling on which indicates it will fail miserably. Meanwhile, the teachers unions are both suing to prevent the policies from being implemented AND SIMULTANEOUSLY suing to force the department of education to distribute the bonus money, but on a seniority basis.

Trying to have their cake and eat it too.

I don't understand how much more clear it could be that this has nothing to do with the wellbeing of our children, or about good teachers; it's about protecting union rules, and union rule...

BUT, there are certainly good, well meaning people, who really do believe that we shouldn't put performance standards on teachers... That it's somehow "unfair" or impossible, or just not a good idea etc...

"You can't hold teachers accountable for the performance of their students, there's too much they can't control. Their home lives, their parents, poverty... Good teachers could be penalized simply for having bad students). It's not fair"

Common refrain from teachers, and from those who support their position in this... After all you wouldn't want to be evaluated on someone elses efforts and abilities right?

Well... I am. Most likely you are too.

In the free market, we are held accountable for other people performance and decisions etc... all the time.

As an individual contributor, my performance is measured not only by my own efforts, abilities, and success; but that of my group, my manager, and my company as a whole.

As a manager, I am held entirely accountable for someone elses performance. I have tools to motivate them, help them perform better etc... But still, I have to deal with the performance that other people give me. I have to have the skill to use that performance in the best possible way.

"But you can fire your low performing employees".

Really?

Ever worked in corporate America? Or had a real job of any kind?

So long as my employees meet bare minimum standards, and don't actually commit a crime (or violate major HR policies), I'm not getting rid of my low performers. It's up to me, to make them meet the standards I need for my group to be successful.

In sales, you are held accountable for other people actions, decisions, and performance as well. You don't get to control your customers decisions, and how much they buy from you is dependent more on their performance than yours.

Yes, a skilled salesperson with a good support team will sell more than an unskilled one; and that's as it should be... but its still entirely dependent on someone elses performance and decisions. A good sales guy can't get a customer who doesn't have the money for the product, to buy the product... or at least not more than once.

Good sales managers understand this. They set account and territory sales expectations based on a reasonable evaluation of the possible performance of those accounts. If they don't then they won't get any decent sales people to work for them, and they'll constantly churn sales people making these accounts and territories perform even worse.

What matters in evaluating your ability as a salesperson isn't your absolute sales, it's your performance in comparison to other sales people with a similar situation. IF you perform well, then good managers will put you on difficult accounts that have the potential to perform better, and reward you if you make them perform up to potential.

At least if you have a decent management team.

At that point you're at the mercy of having a good boss, who understands that relative performance is a better judge of your capability than absolute performance...

Just like teachers.

Holding teachers accountable, doesn't mean that all teachers should be held to arbitrary and universal standards. Teachers that teach all "remedial" students can't be held to the same standard of performance as those who teach all honors students...

And NO-ONE IS SUGGESTING ANYTHING LIKE THAT.

Or at least no-one serious, with credibility, who should be listened to.

Calling for "standardized testing and accountability" isn't calling for teachers to make poor students perform at the level of honors students. It's calling for teachers of all levels of students to perform no worse than average against other teachers of similar levels of students; and to measure improvement in those students over time, compared to other teachers of the same level of students.

How is that unreasonable?

Only those with the irrational... even stupid... belief that teaching is some kind of special "calling" performed only by special people who must be protected from the market forces that the rest of us must cope with; could possibly justify that sort of thinking, with any kind of intellectual honesty.

They generally apply the same sort of thinking to artists, who must be protected from the horrible taste of the masses etc...

Yeah... If we did that, then teachers would be at the mercy of having competent managers, who knew how to evaluate performance.

Just like the rest of us.

In fact... The only time I ever see a serious proposal that teachers should be evaluated by absolute and arbitrary standards... It's coming from lefties or teachers; because they are trying to "avoid bias" or "avoid subjectivity" etc... etc... etc...

Holding teachers accountable also means holding administrators and school systems accountable. It means making them participate in the market that the rest of us are forced to.

If you have a poorly managed school, good teachers won't go there.

IF good teachers won't go there, then good students won't go there... IF they're given the option that is...

Oh... wait a second... Hey... that might just be...

And of course, if we allowed that, then the unions would lose...

Oh... hey, that might just be...

Ya think maybe...

Teaching is a job, just like any other. It's a job that has more benefits than most. These days, it's even a job that pays more than most. It's a job that has a lot more security than most. It's a job that has more garbage and BS and heartbreak than most. It's a job that's harder than most. It's a job that's a lot more important than most...

Great teachers can do more to help children be successful than anything other than great parents...

But it's still a job.

Teachers aren't superheroes, they aren't artists, they are workers... just like the rest of us.

Teachers don't need to be protected from the real world, they need to be a part of it, and accountable to it... just like the rest of us.

Maybe if they were, there would be a lot more good teachers, and a lot less bad ones.

Maybe if they our were, our children would be a lot better off.

Recipes for REAL Men: "Making do" sometimes means "making great stuff"

The best thing about a restricted diet, is that it makes you do the things you wanted to do anyway, but were "too convenient not to/you were too busy to/you were too lazy to" do anyway.

One of Mels favorite things to do in the entire world, is to bake fresh homemade bread.

So a couple days ago, for the first time all year, Mel made a sourdough starter. Last night, she used that starter to make up a couple starter sponges for a slow condition and first rise*, when she woke up she used the sponge to make up a couple of loaves; and now as I write this, a couple loaves of homemade sourdough are on a secondary rise.

In 45 minutes or so, my house will be filled with the glorious smell of fresh, hot, homemade sourdough bread baking.

* A sponge left conditioning overnight and a slow rise, are one pretty easy way to get spectacular bread with great texture and flavor; without the use of commercial dough conditioners that give you a quick rise, but use things like soy and iodate, which I can't have on my restricted diet

One of MY favorite things in whole world is a nice roast beef sandwich, on sourdough.

No commercial bread allowed? No problem.

No commercial cold cuts allowed though... is a problem. Commercial cold cuts use "flavor enhancers"and "freshness stabilizers", including brines and injections, which can contain iodine.

Or rather, it WOULD be a problem, if we didn't know how to do our own. That's why we've got a meat slicer after all.

Besides, doing it yourself is FAR cheaper, and far tastier, than commercial cuts.

Last week, while we had friends from The Guncounter forums visiting, we smoked a whole 15lb turkey, a 5lb pork loin, and a 10lb brisket point.

The whole pork loin and about 1/3rd the turkey and brisket were scarfed that night, but we have been eating the leftovers ever since.

Let me tell you, a home smoked turkey, rubbed with BBQ rub and slow smoked for 8 hours at 220 degrees... You will NEVER have a better turkey sandwich in your life.

I don't need to tell my readers how great a BBQ brisket sandwich is.

Monday afternoon, we took a 10 pound top round roast ($3.29 a pound), rubbed it down with our favorite spice blend (mostly salt, pepper, and garlic powder, but also paprika, cumin, hot mustard, and a bit of powdered chili pepper); and slow roasted it at 250 degrees until the center hit just over 125. Then we shut the heat off in the oven and let it rest for 20 minutes.

We cut the small ends of the roast off and had thick sliced roast beef with sautéed scallopped potatoes for dinner; leaving us with about 8 pounds of big, thick, rare roast beef to stick in the chiller.

We're going to shave a lot of that nice and thin for sandwiches for the next week or so; freezing what we don't eat fresh, to make fried steak sandwiches from later.

Some of it we'll cut into 1/4" thick slices and simmer in homemade gravy for open face sandwiches, or to serve over smashed potatoes.

Some of it will get that same 1/4" thick slicing; but be griddled to get a seared edge on, and served as hot seared beef, with hot mustard and steak sauce.

When it starts to get a little gray, we take the rest, dice it up into little cubes, and simmer it in barbecue sauce, to make some nice loose meat barbecue.

Next week, as our last smoke of the season, we'll probably corn our own brisket ($4.19 a pound), for corned beef, then smoke half (or all) of it to make our own pastrami (which lasts a few weeks in the fridge... if we don't eat it all first of course).


Oh and dairy free gravy isn't too much of a problem; even without margarine.

Last week, when we smoked the whole turkey, we collected all the drippings (not very much actually because slow smoking preserves a lot of moisture in the bird... Mostly just rendered fat). We used all that liquid and rendered fat, (and of course the carcass and the skin) to make a couple gallons of stock.

Once the stock was done we refrigerated it, which gelled it (and pushed a good half pound of turkey to the surface), we skimmed that smokey turkey fat off the top and salted it.

To make soups and gravies without butter, we use salted rendered smoked turkey fat; and finish out the creamy texture with riced smashed potatoes instead of cream.


And of course, there's the pork...

Saturday, we picked up a 15lb pork butt ($1.79 a pound), and broke it down into 2.5lb chunks.

One chunk went to italian sausage. One to asian sausage (which we'll use to make dumplings, pork buns, fried wontons, and potstickers). One to chorizo. They're all in the fridge or freezer now.

One chunk went to carne adobada with black beans and rice for Sunday dinner (and Monday lunch).

In the next few days, we'll probably do some as BBQ pulled pork. We may do some tacos or burritos with home made tortillas, rice and black beans.

So yeah, going without butter, or eggs, or cheese, or milk; or all those commercial products; is a pain...

....But it's not like we're stuck eating granola.

September 11, 2001, 8:46am Eastern Daylight Time:

4017 days, 9,500 dead
and we will continue
until the mission is complete

Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe, in order to assure the survival and the success of liberty. This much we pledge—and more. -- John F. Kennedy

We Will Never forgive

We Will Never Forget

We Will Never Stop

Nuke it From Orbit

It's the only way to be sure...

Right now, I am in the process of de-iodizing myself

Iodizing is the process of adding Iodide (usually in the form of potassium or sodium iodide), a critical trace mineral for human thyroid function, to food (usually to table salt); to prevent Iodine deficiency.

Iodine deficiency is the leading cause of preventable mental retardation worldwide; through the suppression of thyroid function...

And I'm doing it to myself intentionally.

As I wrote a few weeks ago, I will be undergoing high dose radioactive iodine treatment for my cancer.

We are literally going to nuke my remaining cancer; though from internal circulation, not from orbit.

So, we've been preparing for the process for the last few weeks.

To prepare for the process, you cease thyroid hormone supplementation for up to four weeks; which causes your body to flood your system with the hormones that tell your thyroid tissue (in this case, the small specks of cancerous thyroid tissues floating around my blood stream, and implanted in my other endocrine glands) to make more thyroid hormones; which in turn causes that tissue to take up as much iodine as possible (which it needs to make said hormones).

At the same time, you go on an ultra low iodine diet, to starve your remaining (cancerous) thyroid tissue  of the iodine it is desperately trying to take up.

Once your remaining cancerous tissue is trying to suck up as much iodine as it possibly can, they give you a dose of Radioactive Iodine-131.  This tissue then sucks in all that iodine you just flooded your system with, which hopefully kills it.

My thyroid was removed four weeks ago today; and I haven't had any thyroid replacement therapy, since we wanted to be able to do the radiation as quickly as possible after the surgery (four weeks is the minimum).

I was already hypothyroid before surgery (and experiencing a lot of the nasty effects thereof), and have been at a "subclinical" level for a long time (they didn't want to supplement me for fear of it worsening the cancer); but I at least had SOME thyroid hormones being produced.

The dosage of levothyroxine supplementation my docs calculated I would need would be 400mcg per day. Now of course, no thyroid, no thyroid hormones without supplementation; and no supplementation in order to prepare for the radiation.

As I said above, hypothyroidism causes some rather unpleasant symptoms and side effects. You can see the full list here, but I'm just going to list the ones I'm dealing with at the moment:

• Cold intolerance
• Poor temperature regulation
• Low basal body temperature
• Weight gain
• Water retention
• Puffy face, hands and feet
• Bradycardia
• Decreased sweating
• Muscle cramps
• Joint pain 
• Dry, itchy skin 
• Fatigue
• Impaired memory
• Impaired cognitive function (brain fog)
• Inattentiveness
• Sluggish reflexes
• Increased need for sleep 
• poor sleep regulation and disturbed sleep cycles
• Irritability 
• Rapid thoughts (or worsening of ADHD)
• Elevated serum cholesterol
• B12 deficiency
• Decreased sense of taste and smell
• Decreased testosterone synthesis
• Decreased libido
• Poor muscle tone (muscle hypotonia)

That's a big list... And yeah, we're deliberately making it worse.

And yes, it sucks.

But hey, I'm alive, and getting better; and once the cancer is gone, and we can get my hormone medications balanced, hopefully there's nothing in that list that either can't be treated, or won't get better on its own.

So, as I said, I have been sans thyroid for four weeks... And according to tests taken last week, my body is now as starving for thyroid hormone (and therefore iodine) as it's going to get.

So, because I'm ready now, and to get the radiation going as soon as possible; the docs scheduled me into the soonest available slot after my minimum four weeks...

...and I begin my first course of radiation this Thursday.

I've also been on a generally low iodine diet for a while (we don't eat processed foods for the most part, we don't use iodized salt, we don't eat a lot of seafood etc...); but I hadn't gone whole hog with the full restricted iodine regime.

Why?

Because a full low iodine diet SUCKS.

This is what you can't eat at all:

• Iodized anything (obviously)
• Dairy of any kind (no milk, cheese, eggs, butter)
• Soy products of any kind
• Seafood
• Sea salt
• Any product derived from the ocean in any way (seawater has lots of iodine)
• Most processed or commercially produced foods (soy based or seaweed based additives)
• Any red bean or legume
• Potato skins (the skins collect iodine, but the starch is fine)
• Commercial bread (dough conditioners and additives have soy, seaweed, and iodates)
• Cured meats or cured foods of any kind (commercial curing agents have trace amounts of iodine)
• Any brine injected meat (the brines may contain iodide or iodate)
• Much of the meat at supermarkets (because of the injecting) particularly pork and chicken
• Any product with added salt (unless you can verify that it's not sea salt or iodized salt)
• Any restaurant food (unless you can verify they don't use iodized or sea salt)
• Certain food colorings
• Preserved or concentrated foods (often have iodine in their stabilizers and preservatives)

And you need to limit:

• Chicken (unless it's free range, organic, and not feed supplemented, animal feeds contain iodine)
• Beef (unless it's grass fed raised in a low iodine soil area)
• Pork (unless it's organic, and not feed supplemented, from a low iodine area)
• Other meats and poultry
• Rice
• Certain nuts
• Pasta
• Processed grains (except organic grains, grown in low iodine soil, which includes local soil here)
• Products with high or added potassium (small amounts of natural potassium iodide or iodate can be in them

Ever notice EVERYTHING HAS SOY NOW? Seriously, it's in frikken everything.

All the "natural" and "organic" stuff, that you would hope would be OK? Yeah they all use sea salt.

You'd be amazed at how many products out there have soy, or sea based additives, or iodine based additives... It's really best to just avoid commercial food products of any kind.

Oh and I can't take the potassium supplements that I require (because of my other medications), though I can at least replace that with orange juice.

So... what CAN I eat?

Pretty much I can eat home baked bread (which we do love anyway), black beans, peeled potatoes, most fruits and vegetables; and any condiments that I can verify don't have iodized salt or other iodine containing additives.

In theory I need to limit my meat intake to two servings of four ounces per day, and my grain servings (including rice) to four ounces per day.

I would starve to death. That would be something like 800 calories per day. After a couple weeks I'd be severely malnourished (especially since I can't take most supplements... sea products, soy products etc...).

My docs are fine with me eating more than the standard guidelines, since the guidelines are calculated for a 140lb woman; so long as I am careful about avoiding all direct iodine sources etc...

Worse, I have to stay on the diet until I'm done with the radiation (2-6 months from now); because we're compressing it as much as possible; and if I need a second or third dose, I need to minimize the iodine taken into my body, and maximize the amount I'm flushing out of my system (thus maximizing my recovery speed).

Ok, now, what about the radiation?

Clinical doses of radioactive Iodine vary from as little as 8 millicuries, to as high as 200 millicuries. They rarely use dosages over 150 millicuries, because the incidence of negative side effects are very high (including sterility, and damage to salivary glands).

I-131 has a half life of 8 days, and an effective dosage of under 5 millicuries is considered effectively zero. Also, your body can flush out some of the iodine itself, so the dosage will go down faster than its half life; because of this, the average effective halflife in clinical testing is 6 days.

Because of my bodymass, and the aggressive malignancy and vascular infiltration of the cancer, my care team are going to be as aggressive as the cancer is; we really are going to "nuke it from orbit, because it's the only way to be sure", so they're hitting me with 150 millicuries.

Given the six-eight day halflife in the body of I-131, and the 150mCi dosage, I will need to be in isolation for 4-6 days; and it will take 30-42 days to flush the radioactive iodine out of my system to a clinically insignificant level (and I'll likely set off radiation detectors for 60-90 days).

Normally that would mean I could be around people for short periods of time after a week or so, and "normal" routines after three to four weeks... But there's a complication with my wife being pregnant.

I have to be in total isolation, until another persons effective received dosage standing near me is less than 50uSv/h. I can't be around other people for any length of time, until they would be receiving under 10uSv/h. I can't be around my pregnant wife at all (more than six feet away, preferably with a wall between us) until her effective received dosage is under 5 microsieverts per hour; and we can't sleep together until it's below 1 microsieverts per hour.

NOTE: This is a ridiculously conservative number. There is no detectable increase in health risk at dosage rate less than 100 uSv/h, and that requires a 10,000 hour exposure. 

Eat 10 bananas, you get about 1 microsievert dosage. An airline flight gets you between 2.3uSv/h and 4.0uSv/h. The worldwide average background radiation dosage is 0.23-0.27uSv/h to, so just being alive and on the earth for a day, you get about 6-7 microsieverts of effective dosage. The Washington state average (I couldn't find the numbers for Idaho) effective background radiation is about 3,600 microsieverts per year, or about 10 microsieverts a day. 

The standard for pregnant workers is under 5,000 microsieverts over the entire course of the pregnancy. Given the 200 or so days remaining, we would have to be in bed together all day every day of that entire time period to even meet the occupational safety limit (and we still wouldn't exceed it) which in and of itself is designed to have huge safety factors. Non pregnant workers are allowed up to 50,000 microsieverts a year occupational exposure; 10 times as much, and that has a 10 times safety factor from what is known to be harmful long term. 

Given the variables of my bodymass, the dosage, and the flushout rate, this could take anywhere from 3 days, all the way to four weeks, and the only way to know, is to measure.

And of course, that's for each dose; and it may take up to three doses over six months.

There is no way I'm not going to come within six feet of my wife for six months...

So, we're going to measure it:

A friend bought us a dosimeter in exchange for some gunsmithing work; a Radex RD1706. That way we can measure background counts, surface counts and spot counts; and know fairly conclusively when my wife and I can sit together, and when we can sleep in the same bed again.

A few weeks after my dosage, they'll body scan me. Based on what they see then, they'll calculate a time when I should have no live cancer cells left, and have the I-131 flushed out; then they'll give me a tracer dose, and scan me again.

If that scan shows clear, GREAT

If not, which again given my size, the size of the cancer, the vascular infiltration, the type and pathology of it (it was a poorly differentiated cancer which responds poorly to iodine, but it was also follicular, which responds better to iodine), there is a pretty good chance of; I get to wait two to four more weeks (to re-starve the body of iodine) and then another dose.

They'll generally do this for a maximum of three dosages; at which point over 96% of patients will have no detectable cancer.

If I still have cancer at that point... There's something else going on; a non-thyroid cancer, or a poorly differentiated metastasis (which is a much more serious issue).

Once we have finished the final radiation treatment, it will take a month to six weeks to completely flush out my system; and another month or so to fully recover, and to get my medications adjusted properly.

So, at a minimum, a bit less than three months from now, to at a maximum about six months from now; I'll be good to go.

Unintentional Truth from Biden

"Barack and I, we've been through a lot together these last for years, and one thing I've learned... I've learned about the enormity of his heart"

-- Joe Biden, speech in front of the 2012 Democratic National Convention

To quote my favorite film (and one of the internets most overused quotes):

"That word.... I do not think it means, what you think it means"

Enormity...

I realize a lot of folks might be making the same error that Biden did:

e·nor·mi·ty   [ih-nawr-mi-tee] noun, plural e·nor·mi·ties  

1. outrageous or heinous character; atrociousness: the enormity of war crimes.

So, Biden was telling the truth, through malapropism.

UPDATE: For those who go to certain dictionary websites and say "Wait, it's not a mistake it's an alternate definition", no, actually, it isn't. Some dictionaries have started listing it as such because so many people mistakenly use it.

Got a blow on

Massive windstorm in north Idaho right now, bad enough for red advisories. In the little valley in which we live we're seeing sustained 30kt winds with gusts to 50kts.

We're gonna see some damage out of this most likely. I've already heard some trees and branches giving out there, never mind the stuff being blown around.

Hey look, there's my baby

Anybody want to see the first photograph of our placental stage spawn?

No, no matter how much it looks like it, that's not a kidney bean inside a chili pepper; that is our baby.

As she posted earlier, Mel had some spotting and other symptoms, so they had her do an early ultrasound today.

He (Mel is mortally certain of it, and the early indicators, as unreliable as they are, point that way) is currently 1.76cm long, exhibiting normal development and heart rate (both size and heart rate are at the high end of the normal range for the timeline, which is slightly more likely to be male).

We were also able to confirm the timeline, our estimate matches the OB/GYN estimates within 3 days. Due date is confirmed at April 15th -7/+14 days.

We go back for the second ultrasound in four weeks, at which time we should be able to confirm boy or girl then.

Well That's a Relief

1 baby, in correct spot, 1.76cm, original due date is correct.

What a Difference 9 Years and Another Country Makes

This afternoon Chris and I will be in the OBGYN's office for a short-notice ultrasound.

At my first prenatal visit yesterday the RN doing the medical history listened to a few of my symptoms, pieced a few things together, and said, "I'm getting you in for an ultrasound THIS WEEK."

So... that should be interesting. It's most likely nothing, but it might be something.

Her reaction panicked me a bit until this morning, when I realized...

The last time I was pregnant was 9 years ago and at the time I lived and received my medical care in Canada.

In Canada 9 years ago, it took at least 4 weeks of advance notice to get the single ultrasound for the entire pregnancy. I waited in the waiting room with a woman who waited 8 MONTHS to get an MRI for her debilitating migraines. The only place I could get an ultrasound was the local hospital.

Now I'm back in the US, covered by incredible heath insurance that we chose. We've maxed out our out-of-pocket for the year (the deductible is a distant memory). Our insurance covers all diagnostic tests the OB orders and all prenatal visits. Our insurance covers pretty much ANYTHING that's actually a good idea medically. Our insurance company does not have a history of Monday-morning-quarterbacking the doctors. We knew this when we chose our insurance coverage.

In Canada the medical system was (and is) run by bureaucrats. Bureaucrats more concerned with keeping medical costs in check than actually providing good healthcare. Bureaucrats more concerned with power than keeping people alive. Bureaucrats who don't invest in preventative care because preventative care is a cost they have to account for now. Preventative care doesn't make good statistics because you can't tie preventative care to a lack of bad consequences. When people die from lack of care it doesn't affect the bureaucrats one bit, other than "well obviously we'll pay for the hospital because you really need it." Never mind the fact that the hospital could be completely avoided in the first place. The hospital is easy to justify.

Our health insurance company thinks about costs differently. The health insurance company invests huge amounts of money in tracking patient outcomes. They figured out a long time ago that, as a whole, preventative care costs much less than handling avoidable outcomes. For this reason our health insurance covers "elective" surgeries like Lap Bands. The costs of treating obesity now are lower than treating the effects later.

So when our insurance company looks at prenatal care their default position is "diagnostic testing is good and useful." The entire point of diagnostic testing is to catch problems early when the issues are much easier (and cheaper!) to resolve.

When insurance companies understand this (and pay their bills properly) the doctors are encouraged to use new technology. The doctors KNOW they will get paid. The doctors know approximately how often they'll use different types of testing. The OBGYN's office decides its worth it to buy and keep their own ultrasound equipment and keep techs on the payroll.

So when a nurse sees something that worries her, she doesn't need to clear it with a bureaucrat. She just walks up to the scheduler and asks for the next available opening.

Thus how I ended up with an appointment for an ultrasound the next day.

We don't think about this is the US because we're so used to it. Can't anyone see their doc and get an appointment for a diagnostic test in a short amount of time? Aren't there enough imaging clinics and specialists around that the wait is never long?

The only reason I can get an ultrasound on short notice, and Chris can get an ultrasound within an hour (the case when the tumor was first discovered) is the high availability of the equipment and the people qualified to use it and interpret the results. The only reason we have high availability of diagnostic equipment is the absolute certainty that, once bought (and this stuff ain't cheap), the specialty equipment will be used and they will be paid for that use.

The moment you make it necessary to go through a bureaucrat to get a procedure approved and paid for, you take away that certainty. It becomes risky to invest in expensive equipment and new, more accurate, less invasive tests. If you're not sure you'll be reimbursed, why would you invest?

Which is why in Canada 9 years ago I could only be scheduled for one ultrasound, with a 4 week wait. Lots of demand but no ability (or desire) to invest.

Now my OB's office in a small rural town has its own diagnostic equipment, the people on staff to use it, and next-to-no waiting.

Now, when the nurse sees something that worries her she can put her (and my) mind to rest within 24 hours.

That's a big deal.

There is an even bigger deal here though, that I haven't mentioned. The reason the short-notice ultrasound was ordered is because I might have an ectopic pregnancy. The chances are low, but one major symptom is there and my chances are increased due to being on birth control at the time of conception.

If I was at all in pain I wouldn't have even waited one day. They would have sent me straight to the hospital. Since I'm not in pain, we're just going to verify that the fetus is in the uterus.

The chances are low, but ectopic pregnancies can be life-threatening if not caught early. My RN decided that the signs warranted immediate investigation so she made it happen.

Oddly enough, the same symptoms might mean twins, for which I'm also showing other possible symptoms. Immediate investigation is still warranted.

Either way, my RN made it happen.

My RN can do that. She doesn't need to call anyone. She doesn't need to check the list of "approved procedures" and "approved reasons." She can make it happen just by checking with scheduling.

Why the hell do we want government run healthcare again?

Mel

They Really Will Put a Flashlight on Anything

I LOVE mascara. Absolutely adore mascara. I also hate most formulas and most applicators. Eye makeup is difficult to formulate right, doubly so for mascara. So when I stumble upon a formula I like I tend to hold on to it and start testing the rest of the manufacturer's products.

Too Faced's Lash Injection is one of my never-fail, always dependable mascaras. Doesn't clump, doesn't dry out, doesn't give me spider eyes, doesn't have me pulling at my eyelashes in frustration, and looks really good to boot.

It's also really expensive. It seems all of the good mascaras are and Too Faced is no exception.  Oh I've tried the cheaper mascaras but they never really work out for me. The Too Faced ended up in my collection as a birthday present and I absolutely adore it. I just can't justify buying more.

We've been looking for a good reflective mascara for me for what seems like forever. Reflective, light-catching mascara is the holy grail of the mascara world. Lots of mascaras claim to be reflective but turn out to be regular mascara mixed with glitter (seriously). And, of course, good premium reflective mascara is expensive.

So when I saw Too Faced's Lashlight on sale for 60% off I had. to. have. it. I'd been lusting over it for months.

This is the first bit of the description:

Our innovative thickening and lengthening mascara formula contains millions of microscopic mirrors that bounce light off lashes for a super-glossy, jet-black finish for whiter, brighter looking eyes.

I figured it was the same formula and same packaging that I researched 6 months ago. I really should have kept reading. No, scratch that. It was better being surprised.

My mascara arrived today. I'm opening up the shipping box (with Chris doing something else next to me) and I pick up the mascara.

And it's heavier and bigger than I expected. That's odd. Normally a tube isn't that heavy...

I read the box...

My mascara comes complete with blue-light LED's for "precise application".

My mascara has a flashlight button.

Actually there's a huge bonus to having lights and a battery in the applicator end. The applicator stays up by itself. This may actually be the first time in history that adding a (mostly) arbitrary light source to something ended up making the design better.

Does the light source work as promised? Yes, yes it does.

Shiny...

Chris initially didn't believe me when I told him. His remark? "They really will put a flashlight on anything." For once a package arrived with a new LED flashlight and I'm the one geeking out over it.

I wonder if this counts as a secondary backup light source...

Mel

Much as I love McGee...

I always forget how FRIKKEN DEPRESSING they are.

Seriously, the Travis McGee novels make Leonard Cohen look positively perky.

Incredibly well written, incredibly characterized, incredibly atmospheric... And darker than Tarantinos nightmares.

I'm seven books through, and I've got to take a break; read something mindless and fun.

I think I'm going to re-read the Conrad Stargard series (Leo Frankowski, I've written about the books before here). Utterly and completely Marty Stu, but fun.

Bwahahahahahahahahahahahaha

Sorry, this is just too amusing:

BOISE, Idaho (AP) — As Idaho voters decide on a sweeping education overhaul this November, teachers opposing the reforms may find themselves in a bind at the ballot box: By rejecting the changes, they could also be turning down a performance bonus after years of reduced or stagnant salaries.  

Idaho introduced merit pay under the reforms approved in 2011 and teachers worked toward those financial incentives last year. But the bonuses won't be paid out until Nov. 15, nine days after the referendum, and state officials say they can't distribute the money if the laws are repealed.  

The timeline is prompting outcry from the state's teachers union, which is fighting to overturn the reforms authored by Idaho schools superintendent Tom Luna.  

"The state Department (of Education) is holding this money hostage," said Idaho Education Association President Penni Cyr. "The teachers earned it, the legislature appropriated it last year and they intended it to be used for teacher compensation."  

Luna's office counters that the bonus payout plan follows the law and the only barrier to handing out the money would be the referendum spearheaded by the union.  

"It's not fair for them to say we're holding them hostage, they're the ones that put the referendum on the ballot, which is the only reason why these bonuses couldn't be paid," said Luna spokeswoman Melissa McGrath said. "We did not ask for there to be a referendum."  

If the laws are voted down, McGrath said, the state won't have the legal authority to distribute the funding.

So let's recap for those outside of Idaho. Tom Luna, Superintendent of Education for Idaho, drafted a plan for education reform in Idaho, which passed the legislature. Among the reforms were loss of tenure for new teachers, merit pay for all teachers, and bonuses for teachers who elect to lead extracurricular activities or go to needy school districts. Oh, and restricted bargaining rights for the unions.

First, they tried to get Luna recalled, with a ballot initiaitive. They got enough signatures to get it on the ballot, but it failed miserably... Basically the only people who voted for it were teachers and their immediate families.

Then they attempted to get the law repealed, which last year failed for lack of signatures (and included a huge scandal where teachers were encouraging 18-year-old students to get involved in the effort). However, partial repeals are referendums on this years ballot. Evidently they had enough time to get the signatures. One of those repeals regards restricted bargaining rights (yeah, like that's gonna pass) and the other regards merit pay.

Yeah, this is going to get interesting... As it is, the number of parents opposed to the reforms wasn't exactly high to begin with. Plus with all of the new educational choices that popped up, including free public virtual high schools, it's not like the kids have exactly been suffering.

In other news, Tom Luna is being floated as a possible pick for Romney's Education Secretary. He's already a member of Romney's Education Policy Advisory Group.

He's evidently also sharp as a tack, that one.

I can hear the handwringing already...

Mel

Edited to add: Evidently there's also a third referendum on the ballot that would repeal the requirement for all high school students to take at least 2 online classes (with state-issued laptops and computers no less) in order to graduate. Seriously, what is the union smoking and could it be more blatant in its attempt to save itself?