THYROID WARD RELEASE INSTRUCTIONS:

Radiation Safety Officer:   Dr. Stan Carlin, Office: 501-328-3344 / Home: 501-450-7225

TO THE OWNER:       __________________________________

                                                      (cat’s name)                                               (owner’s name)

The following rules must be followed, without exception, if your animal is to be treated with radioactive iodine. Read them carefully. If you agree to follow these rules and request that your animal be treated, sign below.

OWNER’S STATEMENT OF CONSENT FOR TREATMENT

I have read the rules that must be followed if my animal is treated with radioactive iodine, agree to follow them carefully, and request that my animal be treated.  I fully understand that once treatment commences, that my cat cannot and will not  be released from this Clinic until it meets certain Radiation Safety Release Criteria, which will cause my cat to be held (in our radiation safety ward) for up to 14 days (typically 6-8 days) post injection with radioactive iodine.   [Please Note:  all of the above is distinct & separate from the 14 day home quarantine which occurs after release from our Clinic].   (and in the rare case of a cat that becomes deceased while in the Clinic for radioactive iodine treatment, I understand that the cat will not be released to me for up to 90 days).

                     _______________________________                                            _____________    

                                 (Owner’s Signature)                                                                 (Date Signed)

   THE FOLLOWING RESTRICTIONS APPLY UNTIL___________________(Date to be entered):

            [Except for the 90 day rule explained below]                                     (ie., the 14 day date)

1.   Leave the collar on your pet warning others about the radioactive iodine until the date noted.

2.   Except for persons excluded from any contact with your cat (paragraph “3.” below), caregivers shall stay at least three feet away from the pet, except for brief periods for necessary care.

3.   Children under 18,  pregnant women,  nursing mothers, and women of child-bearing age must not have any contact with your cat or its urine, feces, saliva, or litter; and, they must stay at least three feet away from the cat at all times!  (six feet is better).

                        4.   You must keep your pet strictly confined to your premises during this period.

 5.   The radioactive iodine which your pet has received is beneficial to it, but

        it is desirable that other persons not be unnecessarily exposed to radiation.

 

To keep such exposure as low as possible:

a.         You should minimize close contact with your pet, including arranging to

       have your pet sleep in a separate room until the date noted.

b.        Your pet is still excreting low levels of radioactive iodine in its urine, feces, saliva, & sweat glands (foot pads).   Make sure your cat urinates and defecates in its litter pan.  Wear disposable latex/plastic gloves to minimize skin contact with litter & excretions.

                              c.    For a period of two weeks post-discharge of your pet from our hospital,  you will be required
                                     to place all litter and waste from your cat in plastic bags and store it in a secure area for ninety
                                    days in a properly marked metal can outside of your home.  At the end of the ninety days of
                                    storage this debris will be safe to send out with your normal trash to the landfill.   Note: If you
                                    send this waste to the landfill too soon you will set off alarms and be subject  to a major fine. 
                                    Note also, after your cat has been home for two weeks, its urine and feces (excreted from that
                                    time forward) will be as safe as normal;  it is just the waste from the first two weeks that must be
                                    stored for ninety days.

d.   Wash your hands carefully after handling your pet, its food dishes, &/or its litter pan.

Note:  If your cat needs veterinary attention or if your cat should die prior to the date noted, or if you have any emergency associated with your cat, please contact Dr. Stan Carlin, Office:  501-328-3344 / Home: 501-450-7225.   Alternate Emergency Numbers:  Syncor Nuclear Pharmacy (Cardinal Health): 800-933-3446; or UAMS Poison Control Center: 800-376-4766.   Please always try Dr. Carlin first.  Thank you.

OWNER AGREEMENT AT TIME OF RELEASE

I have read and understand the radiation safety precautions, and will follow them.

____________________________                                                                _________

        (Owner’s Signature)                                                                                 (Date)

RELEASE STATEMENT by RSO:   I certify that your cat has this date met the radiation safety hospital release criteria as established by the Arkansas Department of Health. ___________________ (signature, Dr. Stan Carlin)

REMINDERS to Cat Owners:

1.   Remember the wet paint analogy, urine and feces.  (to be discussed upon admission to Clinic)

2.   Remember the candle flame analogy.  (to be discussed upon admission to Clinic)

3.   Do not use bleach to disinfect   (may release iodine into the air).

The TWO WEEK Rules expire on__________________.  (date to be entered)

The NINETY DAY Rules expire on__________________.  (date to be entered)

Please schedule the NEXT VISIT WITH YOUR VETERINARIAN the week of ___________________.

      [Request that your Doctor measure Total T-4, Creatinine, BUN, & other appropriate tests]