Fly Well

All of us were shocked and saddened to see the awful loss of life and widespread destruction from Japan’s earthquake, tsunami, and the ensuing nuclear reactor issues. Email correspondence from pilots en route when disaster struck described critical decision-making when destination airports were closed and no alternative seemed possible, illustrating the wide-ranging effects such natural disasters may have. Although there is no current impact on the United States, such catastrophes might occur elsewhere, so I think it timely to address one medical impact of radiation—thyroid cancer.

Radiation harms biological tissues (like us) by “ionizing” or damaging cells at the most basic level. Snakes are either venomous or harmless and some wax lyrical on how to tell the difference. My philosophy is, keep the heck away from all snakes! I feel the same about radiation.

When a nuclear reactor has problems of the kind seen in Japan, radioactive materials such as iodine and cesium may leak and enter the atmosphere, water supply, and food chain. The thyroid, a butterfly-shaped organ located in the front of the neck wrapped around the windpipe, is very sensitive to radiation. It produces hormones that regulate how fast we metabolize and use energy—think “human throttle.” To function properly, iodine is taken up by the thyroid after consuming items rich in the substance such as shellfish, iodized salt, or kelp. Radioactive iodine released in a nuclear accident is problematic as the thyroid cannot differentiate between “good” and “nasty” iodine; the bad stuff is absorbed into the gland, where it might cause cancer—a risk more pronounced in babies and children, lessening after 40 years of age.

This may present with a lump, but most thyroid nodules are benign. Other symptoms include neck, jaw, or ear pain; hoarse voice; or enlarged lymph nodes. A full medical history and exam are necessary, as thyroid cancer may be associated with other malignancies. As this condition tends to be more common in women, a male with a nodule or a younger (less than 20 years old) or older (over 70 years old) patient favors a malignant process. There are four types: papillary, follicular, medullary, and the most aggressive, anaplastic (the type Chief Justice Rehnquist succumbed to). Tests include measuring blood thyroid hormone levels, an ultrasound to ascertain if the lump is solid or fluid-filled, a special scan to determine whether the nodule is composed of active (“hot”) or inactive tissue (“cold”), and a biopsy taken with a very fine needle. Surgery is the bedrock of thyroid cancer treatment, often followed by the administration of, wait for it…radioactive iodine! This is given at a high dose to kill any remaining cells. The patient must take oral thyroid supplements thereafter. With the exception of anaplastic tumors, the outlook is pretty good.

After the 1986 Chernobyl accident, the incidence of thyroid cancer climbed, estimated to affect an additional 3,000 people, most of whom had been youngsters in Russia, Ukraine, or Belarus when the incident occurred. The United Nations stated in 2002 that another 10,000 people remained at risk of developing the illness. However, Poland, next door to the affected area, saw no such increase. Why? Simply put, the Polish government distributed potassium iodide to its citizens. Widely available in the United States, this substance, when taken a few hours before radiation exposure, satisfies the thyroid’s craving for iodine, effectively “filling it up” so that the nasty glow-in-the-dark iodine cannot get in.

In the event of a nuclear accident in the United States, the authorities would purportedly distribute the drug if radioactive iodine had been released. However, there are some who recommend having a supply on hand, especially if one lives in close proximity to a nuclear power plant.

Dirty bombs have entered our lexicon—conventional explosives packed with medical or other radioactive isotopes—and thankfully none have been detonated, but in the event of an explosion iodine may not be released and local health officials would hopefully provide advice. I do not want to be a scaremonger, but as pilots we talk about staying ahead of our aircraft, so in the wake of the Japanese tragedy this is a good time for emergency planning for the home, just like we plan in flight.

I encourage everyone to develop an emergency plan—how to contact family members and loved ones remembering that when disaster strikes, phones, text, and email may not be available, so consider an agreed upon location to gather. Think about supplies for home, hangar, airplane, and car. There are plenty of good resources in libraries and on the Internet.

I want to stress that I am not endorsing the purchase of potassium iodide; that is a matter between you, your doctor, and family. If you do, make sure you purchase from a reliable source. One facet of Japan’s apocalyptic events that deserves mention is how calmly and gracefully this proud nation has borne its suffering. Most pilots know what to do in the unlikely event of an engine failure or cockpit fire. Learn how to deal with events that may be even more widely catastrophic and do what we as pilots are trained to do. Take charge.

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