Expert: Ronald Levy, M.D. - 2/18/2007

Question
My husband is on Cardizem CD 360MG (one daily) Lisinipril-
HCTZ 20-12.5 (once daily) and Levothyroxin 100MCG (once daily) His blood pressure at home runs around 114/78, but when he goes to the doctors, specialists, or is in a stressful situation it is around 160/something.  I believe my husband's blood pressure goes up when he gets nervous, which I think is anxiety related, it always has. Even taking both blood pressure medications and the thyroid one, his nurse told me that the top number of his blood pressure was 160 when we were at the radialogist's for my husband's initial consultation for prostate cancer.  So, even with both medications it was still that high because he was very anxious that day. What I wanted to know was with the meds he is taking, what kind of general anesthetic could he have?  Also, would his thyroid medication interact with the seeds that will be transplanted into his prostate? I read on the Levothyroxin warning sheet that this medication should not be used with any type of iodine including radiologic contrast agents containing iodine.  However, his urologist had him get a CAT scan of his pelvis and one stomach with contrast after his prostrate biopsy came back positive for cancer. HE also had a radionuclide bone scan.  Do you think the Levothyroxin interferred with these tests? Also, he is into his fifth week of having 25 radiation treatments (IMRT).  Would the levothyroxin he is taking interfere with these treatments? His doctors know what meds he is on and never said anything about them.
Would appreciate any comments you might have.  I am concerned about the medications my husband's GP has him on.
My husband has lost 10 pounds this past year and hasn't been dieting.  I think it may be the thyroid medication that has caused this.  Thank you, once again.


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The text above is a follow-up to ...

-----Question-----
My husband is going to have a prostate seed implant and his radialogist usually does this with a spinal; however, my husband wants to be asleep.  Many men have this done with a general anesthetic also. First of all I would like to ask exactly how a spinal is done?  If it is painful?
and if there are any after effects from it.  Also, what kind of anesthetic would they give my husband instead of the spinal to put him to sleep?  My husband is 68 and has never had any kind of surgery before.   Thank you.
-----Answer-----
If you've ever had an epidural for childbirth, it's almost the same but actually easier and with a smaller needle. I have had one myself so I can speak from experience. It does not hurt (you may have some burning from the local anesthesia at the needle site but that goes away in seconds). It is done by having the patient sit up and lean forward. The needle is placed in the lower back and advanced into the spinal canal. The needle is smaller than an IV or blood draw needle. After the medicine is placed, everything from the waist down gets numb. It wears off in 1-2 hours. Other than occasional pain at the insertion site, there are no after effects. If he gets a general, there are numerous options which would depend on his medical history, etc.

Hope this is helpful,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

Answer
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What I wanted to know was with the meds he is taking, what kind of general anesthetic could he have?  

The meds he is taking don't really change the meds we would give for a general anesthetic.

>>>>>>>>>>>>>>>
Also, would his thyroid medication interact with the seeds that will be transplanted into his prostate?

You would have to ask this to the urologist or oncologist. I am not aware of any interactions

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I read on the Levothyroxin warning sheet that this medication should not be used with any type of iodine including radiologic contrast agents containing iodine.  However, his urologist had him get a CAT scan of his pelvis and one stomach with contrast after his prostrate biopsy came back positive for cancer. HE also had a radionuclide bone scan.  Do you think the Levothyroxin interferred with these tests?

I doubt it but again you would need to the nuclear medicine physician.


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Also, he is into his fifth week of having 25 radiation treatments (IMRT).  Would the levothyroxin he is taking interfere with these treatments?

Ask the oncologist.

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My husband has lost 10 pounds this past year and hasn't been dieting.  I think it may be the thyroid medication that has caused this.  

It might be but it could also be the cancer, etc.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston