Hospital Stay Schedule
1. Check in was 10:00 AM on Monday. Orientation, do's and don'ts, menu selection for the entire stay.
2. IV installed by doctor. Amino acids IV drip started at about 11:00AM at 200 ml/hr. Zofran tablet placed under the tongue for possible nausea control.
3. After one hour, went to floor 01 (basement) and received the isotope injection by the doctor. (My wife sat about 3 meters away from me.) No nausea, or vomiting. Didn't really feel anything. The injection is only a few cc's and happens quickly. (Blood counts won't drop for a week or more, and then will require about 6 more weeks to recover.)
4. By 12:30PM I was back in the shielded room with my roommate and eating lunch. There are six treatment rooms and seven beds allowing for 14 patients/week in this nuclear medicine ward.
5. Lounged around about three more hours until the 1000 ml amino acid bottle was empty. IV then removed.
6. 3:15 PM, kidney baseline scan. Took only 5 minutes. (The injection has a little bit of 111-In to give off gamma rays so they can see where the Y90 isotope went.)
7. Post treatment pancreas swelling is usually not much of an issue. If there is a high liver tumor load, liver swells in its encasement and can possibly/will cause pain from the treatment.
8. My wife was allowed in the hospital room, but she stayed behind the protection wall.
9. Second Day – Tuesday. 8:45AM 360 degree abdomen scan. 10:00AM full length body CT scan (no contrast fluid used) and 2nd kidney scan.
10. Met Dr. Müller (Department Head) and Dr. Flavio Forrer (Attending physician) at 3:45PM. They gave me the first impressions of the treatment.
11. Third Day – Wednesday. Breakfast at 7:30AM. Last kidney scan at 8:45AM (another 5 minute process). Met with Dr. Forrer at 9:45 AM. Discharged at 10:00AM.
Notes:
1. You will be told to stay at least 3 meters from any contact with children under age 12 and pregnant women for a few days after leaving the hospital. (editor note - please check with clinic this is not the case at Bad Berka)
2. They will give you a letter to explain the treatment to airport security. I didn't get caught until Chicago. Then all the pocket-sized detectors on every Customs and Immigration official went off within 15 feet of me. They thought the letter was nice, but they used their own equipment to scan, identify the isotope, type of emission, and grade (medical, commercial, or military). It was very routine with minimal delay. I think they welcome us as a test of their equipment.
3. You may walk around the hospital grounds as long as long as you stay 3 meters away from other people and go back to your room to use the restroom. (They catch and contain everything – even shower and lavatory water -- and hold it in tanks for three months.) (editor note - Please check with the clinic you are at this is clinic by clinic policy)
4. They expect you to keep your room clean, and minimize throw-away stuff. They will clean and decontaminate the room after you leave in preparation for the next patient coming a few hours later.
5. I was told by the University of Iowa nurses to Dr. O'Dorisio to be really well hydrated before the PRRT. Do this to minimize nausea and kidney issues from the amino acids drip and the isotope injection. It worked for me. Do it.
6. Since I take an oral medication for hyperglycemia and my tumor exhibits some characteristics of a glucaganoma, I was told to take insulin and Sandostatin on the trip to control blood glucose levels after treatment. There was some possibility of a "glucagon release" from the PRRT. It didn't happen for me, but you might want to check with your physician.
7. I took all my normal drugs with me from home, plus those extra ones in item #6. I kept on taking them while in the hospital. I also took Imodium and Senekot along just in case the bowels caused some irregularities, as you understand. Nothing out of the ordinary happened.
8. Dr. Forrer requested blood counts and creatinine level every two weeks after I got home, to be faxed to Brigit Avis. No CT scan was needed between the first and second treatment scheduled 9 weeks later. (I have the CBC and metabolic panel done locally in Kansas City.)
My Side Effects from the PRRT
1. No nausea or vomiting or pain (I have a low liver tumor load, 10-15% estimated.). Maybe, just a little bit of light-headedness for 10-15 minutes after the injection.
2. My fatigue was certainly noticeable, but not debilitating. We made short walks from the hotel to the Marketplatz to eat, etc. The tram passes were a big help.
Second Treatment Comments
Since we had done the tourist bit on the first trip, we shortened the stay for this last treatment. We arrived late Sunday night, checked into the hospital on Monday morning, released at 9:00 AM on Wednesday, and headed home on Friday. The process worked as smoothly as the first treatment. The doctor offered an appraisal of the results from the first treatment.