There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:
Disasters are about people and planning, not nature’s pomp.” ~The Economist
Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post
The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.
We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.
The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.
I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.
The risk of using KI far exceeds any benefit right now.
Potassium iodide is an over the counter commercially available medication. Don’t let it’s “over-the-counter” status confuse you into thinking it’s a harmless substance; ingesting KI can be dangerous. KI should always be stored up and out of reach of children.
Radiation Effects In Children, Use of KI, And Calming Down:
- What you’ll read here will echo what you’ll read elsewhere. I am learning from health leaders in the Department of Health and from the American Academy of Pediatrics; both will help us understand more as time goes on. Further, I never received much training about potassium iodide or remember learning much about its use in children during med school or residency. So I’ve been doing a lot of reading, listening, and learning about this topic to help advise my patients. If your pediatrician is also learning in the moment, I wouldn’t be surprised.
- What Is Radiation? “We live in a radioactive world–humans always have,” says the American Nuclear Society. We get radiation from natural and man-made sources every single day. It comes from as far away as outer space, and from as near as the foods we eat and the water we drink. There are two kinds of radiation events that can cause noted negative health effects in children: First, gamma rays and neutrons from a nuclear weapon. Fortunately, the exposure decreases as distance from the bomb increases. This type of radiation can hit the body unless you are protected by a wall. Secondly, internal radiation from fallout of radioactive elements (like that from Japan) that can enter the body via inhalation and ingestion. After a nuclear event, radioactive iodine can enter the air and be inhaled. It also can land on produce or feed for animals. After ingestion, some elements can concentrate in parts of the body. For example, radioiodine, one of the substances released from reactors in Japan, can concentrate in the thyroid, a gland in your neck, and have dangerous effects. After Chernobyl, we learned a significant source of fallout is often in cow’s milk that children (and adults) drink. We know now to avoid this particularly dangerous ingestion. Read a summary on radioactive fallout by The National Cancer Institute.
- Is Radiation Worse For Kids? Yes. After studying the effects of the A-bomb in Japan and the fallout from Chernobyl, we know that children are much more vulnerable to the effects of radiation, partly because they absorb and metabolize substances differently and because they are closer and interact more with the ground, where fallout would settle. Further, because of high concentrations in cow’s milk, children (big milk drinkers) are at increased risk. Ultimately, radiation can damage cells in the body. Therefore, we always want to reduce any radiation exposures, particularly in kids.
- What is Potassium Iodide (KI) And How Does It Work? In 1982, the US FDA approved potassium iodide (KI) to protect the thyroid gland from radioactive iodine arising from radiological or nuclear emergencies. In a radiation event like in Japan or in attack on a nuclear power plant, or in nuclear bomb fallout, volatile fission product (radionuclides and radioactive iodine) can be released. Once in the air, we can ingest or inhale this dangerous iodine. KI works by preventing radioactive iodine from reaching the thyroid. By saturating the thyroid gland with a source of stable iodide (KI, for example) prior to any exposure to these radioactive iodines, the ionizing radiation tends to be excreted from the body instead of being absorbed. The protective effect of KI dose lasts approximately 24 hours. The CDC reviews KI and discusses proper dosages for infants, children, pregnant and breast feeding moms. I’m not spending a lot of time on dosing and use right now because I don’t think we need to use it. If we do, I’ll write a more detailed post.
- Does KI Protect The Entire Body? No. KI neither protects against radiation poisoning elsewhere in the body nor can it provide any degree of protection from bombs producing radionuclides other than radioisotopes of iodine.
- Do Americans Need KI? Typically, no. However, if you live within 10 miles of a nuclear reactor, you should have doses available for all family members, especially children. For the rest of us who don’t live in proximity of a reactor, No, we don’t need it now due to events in Japan. Further, take a look at this graphic from NYT showing the moving plume. By the time that the radioactive particles from Japan reach the West coast, they are largely dispersed. Also, note that it takes about 6 days for the plume to reach the west coast. The half life of I-131 is very short, only 8 days. This means every 8 days, its dose is reduced in half. Therefore, much of the plume that arrives has already lost its intensity just because of time. In addition to time, wind dispersal reduces its potency. After 80 days, less than 1% of radioactive particles will remain.
- Radiation Levels Now: As of writing this on March 18th, no increase in radiation levels have been detected here. Federal and state agencies are monitoring radiation levels and detect no noted changes. And detection efforts have been increased. Further, samples taken 50 miles from the reactors in Japan are currently not at harmful levels. In Washington state, as of today, follow radiation levels online.
- Is This Radiation The Same As Radiation From A Doctor Ordered X-ray? Yes and No. Both diagnostic x-rays and the radiation plume from Japan are ionizing radiation. However, the bulk of the fission products in a nuclear fall out are I-131 type radiation. Most particles produced by this type of radiation travel a very short distance. In contrast, in the clinic or hospital, I-131 is used only in rare circumstances, typically in the detection and treatment of thyroid cancers.
- How do the radiation levels near the nuclear site compare to a chest x-ray? Not well. Although the standard unit of measurement for ionizing radiation is a millirem (mrem), it may be difficult to compare effects in Japan to a chest x-ray here. A chest x-ray or a CT scan gives you a set amount of radiation over a very short period of time (seconds). Radiation levels in an around the nuclear plant in Japan are measured in radiation/hour. Only in a very complicated interventional radiology procedure would a patient be exposed to an hour of ongoing radiation. Physicians work hard to reduce time of x-ray exposures, ie a campaign called Step Lightly. FYI: I got a little help with these last few points from my husband, a radiologist. Read more about reducing radiation exposure for your kids in his guest blog.
- Anxiety: As I said earlier, fear of the unknown is unsettling, particularly when our senses don’t back us up in detection of harmful substances. The most damaging effect of these tragedies for many of us here may likely be psychological. Do your best to turn off the TV when possible. Access information daily as opposed to hourly. Explain to your children what you see and what it means. Reassure them that you’re doing everything you can to prepare for unexpected events in your household and community. Build a 3 day emergency kit and make a communication plan for your family. Do this now. Your anxiety will only diminish…
What did I miss? What questions do you have?
I’m so embarrassed to admit that I heard about the PI hysteria from you first. There is so much happening in Japan still that it didn’t occur to me to think about the rate of travel of the plume or its density as it dispersed across the pacific. Giving a child in West Coast PI just doesn’t make sense to me. Yes, it protects the thyroid. Great. Except if your child is exposed to enough radiation to damage their thyroid, they will probably also sustain systemic damage that PI doesn’t protect against. It doesn’t sound like a cure-all radiation antidote. So, if you have 6 days notice, why would you sit there and watch a noxious fume come your way? Why only protect the thyroid? Get the hell out of Dodge and protect the whole child! Should that plume become a serious threat to the USA, we would probably evacuate rather than medicate. Wouldn’t you?
My husband works for a Japanese company and the scene at his office has been a different sort of devastation and heart break. I hope people put their excess energy and resources in what is actionable and before us: helping Japan.
I didn’t see you mention this, but a lot of people don’t realize that there are other radioactive components of much more concern than I-131; specifically, cesium, which is of much greater concern for the people in Japan than I-131, due to its longer half-life and systemic distribution through the body.
Includes a great graphic explaining how the damage to the plant occurred, too.
What type of radioactive material has escaped?
“There are reports of radioactive isotopes of caesium and iodine in the vicinity of the plant. Experts say it would be natural for radioactive isotopes of nitrogen and argon to have escaped as well. There is no evidence that any uranium or plutonium has escaped.”
I also think that many Americans are over-reacting to the danger posed to us in America.
I am also disappointed to hear/see so little on a global effort to help the Japanese people recover from this tragedy. We all know Japan as a thriving western society (albeit in the East), but this disaster will probably go down as the worst economic disaster in world history and no country’s citizens deserve to be alone in recovery from this, so I encourage your readers to see how they can help:
thanks for the great article.
Orion Turner says
You did miss some stuff, Like Cs 137. In the end it will be significantly more important than I 131. Cs 137 has half-life of 30 years. I 131has a half-life of 8 days. Much of the Iodine will become harmless before it reaches Seattle.
In the end I expect that more contamination from Fukushima will reach the USA than on most of Japan. THERE WILL NOT BE HARMFUL LEVELS IN THE USA. This would change if there was a Chernobyl type explosion, which is highly improbable now.
My wife teaches at a US Navy base in Japan. We live just south of Tokyo on the western edge of Yokohama, about 200 mi south of Fukushima. I do keep tabs on the situation and watch Japanese TV so I don’t know what is happening in Libya. To field questions from local friends I started a FB group, Shaken not stirred:
Should probably be read from the bottom. It does build. It is long. I post as new items are reported, usually from Japanese TV and try to address the report from a Nuclear Hazards & Protection point of view. Like your page, mine tends to talk about our local area.
Right now things are safe and getting better, but dose rate readings will get higher for everyone, (not harmful) Generally the harmful effects will be limited to the 30 km exclusion zone around the plant.
The price of sushi is going up.
concerned parent says
My daughter was given Potassium Pills by her radiation paranoid stepmom. She came down with Flu symptoms the next day and was ill for a week, headaches, body aches, low grade fever and extremely tired. Her muscles hurt so much she could hardly stand. We took her to the ER her blood work was ok…two days later she starts her period. She is 10 years old. Can messing with her Thyroid and her Endocrine system with 200mg of Potassium cause her to start her period early and flu like symptoms?
Wendy Sue Swanson, MD says
It is conceivable she could have had flu like symptoms from excesses in potassium iodide. But more likely, she had an intercurrent illness, a cold that caused flu-like symptoms.
In regards to pubery–no one knows what turns it on and no one knows exactly the trigger for the 1st period, so again, it’s most likely a coincidence. I’d talk with her pediatrician about your concerns next time you’re in the office.
So glad to hear that she checked out well in the ER. Thanks for sharing your story here.
I have been unable to find information on children ingesting CS-137 that has been found in the fallout from Japan in seattle. The reference to x-ray equivalents is concerning as the ingestion of such a particle would be different from outside bombardment. Having a newborn, we are wondering how to protect our baby.
Yvette R. Gorrell says
My son at the age of 11 and a half had to have radiation treatment to the head and neck. Why did the doctors suggest using this to protect his thyroid? Now he has to use levoxyl for the rest of his days on this earth. I believe they could have given it to him.
Yvette R. Gorrell says
why don’t they give children who have to have radiation treatment potassium iodide?
Concerned Parent says
Are temporary side effects from KI worse than having your thyroid removed due to cancer? No. The US Surgeon General commanded that hospitals DENY providing KI after the Fukushima radioactive explosions and Triple Meltdown in March 2011. These (4) “hydrogen” explosions most definitely carried massive quantities of radioactive isotopes into the jet stream and upper atmosphere; then straight to Seattle. This is a FACT! Learn the truth. Fukushima has caused, is causing, and will continue to cause a HUGE increase in childhood cancers of all types. Not just in Japan either. Publish the statistics to prove my claim wrong and I will delete this posting. Facts prove my argument is true. The French nuclear regulatory agency stated “at least 73 different radioactive isotopes were detected in airborne radiation monitors”. That was in France. Seattle was at 40,000x normal background radiation levels on March 17/18, 2011!!! Don’t be a lemming. Protect your children please.