It’s the beginning of February and our mild winter is morphing into proper winter. We have storm warnings that we should actually expect for this time of year. Even so the newspapers are full of apocalyptic warning. Batten down the hatches and prepare for Armageddon.
I’ve had a bit of a storm myself.
Episode 1 A sore throat that I couldn’t get on top of had me scurrying to Dr Banner a month early. I thought I was getting better at this “panic at every symptom phobia” but seemingly not yet 😦 Bless him, he was full of assurance that I wasn’t wasting his time and that he would rather look at an apthous ulcer than a cancer. He had a really good look round with the scope and I could feel it wiggling around all over my pharynx……nice!……not!
Episode 2….the saga of my dental care has finally culminated in a proper appointment …..on the NHS, yippee !!!! to sort out two teeth to crown and this week I had my problem wisdom tooth out….very skilfully at The Morriston. A non healing socket and infection were discussed but no mention was made of Osteoradionecrosis. Perhaps we overthink this and the risk is not as great as we imagine.The tooth was in the maxilla (good news, the top jaw has a better blood supply than the bottom), the gum looks OK and the small hole left behind looks healthy enough.
Osteoradionecrosis is a severe complication of radiation that can occur either spontaneously or as a result of injury to the jaw and the most likely injury is extraction of teeth. The end result is that the bit of bone dies and worst case scenario the jaw can break and have to be reconstructed.
The Acupuncture story continues in a rather exciting way. After three sessions my saliva is improving so well that I can go nearly a whole day without recourse to either sips of water or chewing gum. By the evening, though, things are beginning to dry up a bit so I still pop in the gum to keep my mouth moist. We discussed things yesterday and the plan is to keep going with weekly visits for the time being. I might actually ask Alison to give me a monthly once over as part of a general boost when this is all over. I happened upon a research paper on acupuncture for Xerostomia that seems to show that treatment is more effective during radiotherapy than after it. If he has time I shall see if Dr Banner has the inclination to maybe explore this and maybe suggest to the head and neck nurses that it might be a useful additive to the info patients get. I can only try. I must be careful though, as I’ve mentioned before I bet doctors absolutely hate Google…… This is the paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757250?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=120619 And this is a slightly more understandable description https://www.ascopost.com/news/december-2019/acupuncture-may-reduce-radiation-induced-dry-mouth-for-patients-with-head-and-neck-cancer/
Last week I visited my GP with a shopping list; Fluconazole for the thrush that appears rarely now; I like to keep some handy, and Lanzaprazole for occasional reflux as I find it works better than industrial quantities of Gaviscon. I also wanted to discuss longer term care of my cardiovascular system and my thyroid. Patients who have had neck irradiation need to be aware that X-rays can damage the thyroid so that it either stops working or starts to operate sub-optimally. The thyroid gland is a vital hormone gland: It plays a major role in metabolism. It helps to regulate many bodily functions by constantly releasing a steady amount of thyroid hormones into the bloodstream. It’s probably worth having an annual or even biannual blood test for levels when you are maybe 18 months out of treatment. Radiotherapy also causes damage to your carotid arteries. Arteries frequently receive significant doses of radiation by way of collateral damage in the treatment of Head and Neck cancer. Vascular injury following treatment may result in stenosis due to atherosclerosis and increased risk of stroke and transient ischaemic attack. The increased risk can be as high as 12% over non irradiated necks. It’s a not insignificant risk which I want to mitigate. To this effect we discussed control of blood pressure and cholesterol together with maybe an ultrasound in time to come. My blood lipids are up a little though my “good cholesterol” levels are high but, ever circumspect we decided on statins for the rest of my life. Add a decent low fat diet, which I’m already on, and I should be laughing. 🙂
I must say that nearly 13 months after treatment finished I feel I seem to be turning a corner, either that or I can feel spring round the corner…..or maybe it’s both