After RAI - OK to stay in hotels???

Did anyone see this article?? A friend sent it to me. It's from the ASCO Post in March 2011. It talks about how to decrease exposure to others after RAI, but also says that staying in a hotel is "OK." WHAT???!!! When I read it, it sounds like the doctors are basically telling you to treat it like a cold or something (they say flu). "Stay at arms length away from people," etc.

http://www.ascopost.com/articles/march-1-2011/how-can-patients-who-receive- radioactive-iodine-treatment.aspx

Comments please...

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Glad I dont work in a hotel in their area!

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These are highly respected doctors, but in my opinion, it is not OK to stay in a hotel. You can expose unknowing young children and pregnant housekeepers/guests to radiation that can be harmful later in life. I could NEVER knowingly potentially cause harm to someone else's thyroid, could you? We wonder why thyca is growing and doctors tell RAI patients to stay in hotels??? My daughter was diagnosed at 15 - we stayed in a lot of hotels - I will always wonder. We had to travel for her RAI and the nuclear medicine department told us to get a hotel. We traveled an hour further to find someone who understood our concerns and she stayed in the hospital where they knew how to dispose of exposed sheets, etc, and how to protect others.

I'd rather give someone the flu than cancer - there is a world of difference!

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Teenmom wrote: I could NEVER knowingly potentially cause harm to someone else's thyroid, could you?

Absolutely not!!! That's why I was wondering about this article! As you mentioned, these are supposed to be highly respected doctors. Why on earth would they give such advice. I feel like they are really downplaying the affects of RAI. And yes... world of difference between the flu and cancer. Not even in the same ballpark.

~TERRI

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Goodness me, I'm being very contrary this morning! Maybe it's one of those days, and I'll go back to my charming self tomorrow!!

But do you really believe that everybody, or even most people, who undergo RAI observe the precautions correctly? You don't think that when you go to the mall, the movies, McDonald's, there's a possibility of exposure to an RAI patient?

I was impressed that the doctors in the quoted article recognise that there is a percentage of non-compliant patients, and are willing to undergo the cost of a hospital stay to decrease the likelihood of sending them out into the community! Although based on the time I worked in a hospital (112 years ago!), I'm not even certain that they are correctly disposing of linen and so forth. In those days, I saw many blood products not red bagged, TB patients not correctly isolated, heck, many hospital workers didn't even change their gloves correctly!!

That's not to say that we on this board shouldn't take personal responsibility to do things properly for our loved ones and our community. But look at it this way. Better an overseas patient be in his own hotel room, than on a commercial flight, which was the other option for these particular individuals.

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The comparison to the flu is so that people understand how it's transmitted and how long before you're no longer "contagious". I was told by a few Med. pros that although it's not a first choice, it's fine to stay @ a hotel if that's the only alternative. You have to keep in mind that many people travel outside of their state/country to receive treatments and the majority do not stay in hospitals since it's no longer a required practice in most hospitals (unless the dose is super high) and therefor will need a place to stay. It isn't realistic to believe that EVERYONE will/should stay @ home or someone else's home. A lot of us also have children & pets and it may not be feasible to send them & the spouse away. You have to do what's best for your situation and sometimes that's choosing the lesser of 2 evils.

I chose to stay away for 8 days because I have 3 kids. I stayed in one of my husband's corporate residential hotels. I took my own linens, pillows & towels and washed everything in hot water and thoroughly disinfected everything I came in contact with. By this time all significant levels of radiation had decayed. I still took trash home with me & kept it in the basement for another week before disposing. I basically followed the same protocol as if I were home.

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MSK indicates they go over additional precautions to these international patients to further help reduce I-131 exposure in these international patients.

ATA guidelines addresses the hotel issue directly:

Post-therapy living situations
Hotel/motel accommodations. A stay in a hotel or motel
is not recommended after treatment with 131I. Without specific
environment assessments and dose-rate calculations,
hotels and motels should be avoided for the periods of daytime
restrictions in Table 2A-1 and 2A-2. The RSO should be
consulted if a patient must travel a substantial distance after
treatment, requires additional follow-up imaging, or cannot
travel home without an overnight stay.

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I haven't read the article, but that sounds incredibly irresponsible. Hotel beds can be less than 6 feet away from neighboring rooms. I would be very upset to find out that the person in the room next to me was there after RAI treatment. Not to mention the exposure of the maids...

If a patient cannot safely travel home, they should stay in the hospital for at least the first 72 hours after RAI is administered.

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The article is in reference to MSK releasing international patients who undergo RAI treatment to hotels. MSK has decided this is ok.

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Yes, and I think that is highly irresponsible of MSK. No, patients should not be flying home after treatment either... they should be provided a hospital room to stay in for at least the first 72 hours (maybe less for a lower dose treatment).
Or maybe they need to designate a wing of a hotel nearby, or have something like the Ronald McDonald house. But the idea that it's okay for someone who was just given radiation to sleep in a bed less than 6 feet away (on the other side of a wall) from any unsuspecting traveler is just not okay. I'll be sure not to book any hotels anywhere near MSK...

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Interesting reading. I'm sure there is a lot of people that do stay in hotels. I was even told by a stranger I should do that. I guess if you get yourself a kitchenette and be really organised for the week, not have anyone in to clean. It probably is fine. I would do my own cleaning though and bring my sheets and cultery, plates etc ... Obviously you would know ahead of time. It sure would be a pain though.

Smileyhappy

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After going through RAI and realizing that it is water soluable, I think as long as you took precautions such as taking your own bedding and utensils and got a kitchette room I don't think you would expose anyone anymore than you did when you took RAI and walked out of the hospital. You exposed each of those people you were near on you way out to RAI. Everyone has a different set of circumstances and I am happy that some people have a nice big home and can stay away from their family with a seperate bathroom, but not everyone has that luxury or that option and they have to do what is safest for themselves and their family.

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Walking by someone is not the same as sleeping next to someone on the other side of the wall. 100% irresponsible on the part of the docs suggesting this is ok. Insurance bs at its finest.

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No matter what precautions you take in the hotel room, if you don't move the bed to the center of the room or make sure that you're facing a closet behind your bed (or bathroom, etc - not another person's bed, which would be the layout in many hotels), the gamma rays that you are emitting will travel through the wall of the hotel room and expose the person sleeping on the other side of the wall. You can wash everything all you want - the concern isn't about exposing people from what you are excreting, but exposing people from what you are *emitting*, which is the entire point of isolation in the first place.

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This is what the article says about it:

"We tend to discourage people from staying at hotels, although when we look at the data, it seems perfectly fine for them to do so," Dr. Tuttle said. "Many patients don't have a choice because they are flying in for their treatments. If we treat them, they are usually not going to be able to fly for 2 or 3 days," because of precautions to keep at least an arm's distance from others and possibilities about setting off alarms. "We have carefully looked at this because we have lots of people flying in. When we set up these outpatient rules, we asked the question, 'Should we just admit people if they have to stay at a hotel?' Our physicists and nuclear medicine people very carefully went through all the data, and we are absolutely comfortable that it is safe for these patients to be in a hotel," Dr. Tuttle said.

Staying in a hotel "can be done safely and reasonably," Dr. Kloos agreed, but physicians need to discuss with patients some additional risk-reduction strategies. These measures include checking in before treatment so they can go directly to their room afterwards and avoiding interactions in the lobby. ■

and I guess the wall thing is something no guidelines ever discuss because they assume everyone has a bedroom that does not share a wall with another bedroom...and those two beds are not directly across from each other, divided by a wall.

I've never read this wall concern in exposure reduction guidelines, so it would be nice to know the source of this information.

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Yes, I did read the article... a hotel is a better alternative than getting on an airplane, but why won't the hospital provide a bed for these patients?
As far as the wall, the rule is 6 feet away... 6 feet regardless of if there is a wall or not, as walls do not stop gamma radiation.

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yes, the rule is 6 feet away but no agency address walls. there must be a reason for it.

what do people in apartments do? are we assuming that people in apartments never share walls with neighbors?

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not sure how much insurance could have to do with it, since it pertains to international patients.

no idea how that works.

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That was my point as well, at the start of my investigation and prior to RAI. I know quite a few folks who've had RAI & live in either an Apt. or Townhouse or those who've stayed @ home with their kids in the next room, etc. Also, hospitals don't offer hot cells (radiation-proof rooms) to patients. So even when they're "isolated" you have to wonder about neighboring patients. Unless EVERY wall & floor was made of lead (still not 100 proof), there's just no way of truly knowing how far/ how much radiation is traveling. The point is whether you're @ home, hospital or hotel, you should be careful & follow protocol to the T. I do believe insurance has a lot to do with why most hospitals no longer require patients to stay.

Interesting article btw- http://www.usatoday.com/news/health/2007-11-18-thyroid-cover_N.htm

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I truly can't help but think insurance has their hands in it, as cflo said. With so many different living conditions, I can't see why they would send people home (except to reduce expenses). I think everyone who has ablation RAI should be in hospitals. And after all, once you get into a hospital, they won't let you out until you read below a certain measurement on a geiger counter. Why? Because they deem you not safe for the public. Hmmmmmm... makes you think.

~TERRI

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Personally, I don't care to blame insurance.

I think it is a quality of life issue and am darn happy I didn't have to stay in the hospital for RAI ablation.

I don't know what kind of insurance international patients have, a lot of countries supply healthcare to their citizens. I'm not sure if that coverage translates to care out of country, or more specifically at MSK in NYC.

Who knows, maybe these international patients have to pay out of pocket for these services in NYC.

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