Week 8: Recovery Phase 1

When I met with my oncologist last week, she was as normal, very upfront. I paraphrase, a lot, but it was something along the lines of “Next week will be hard. One of the hardest yet. But you will turn the corner in 10 days or so, so focus on that”.

I’ve learned to trust everyone involved in my treatment, and she was of course correct. The first week after radiation therapy ends – last week - is fucking hard. I allow myself to swear here, as it has been shown by UK researchers that swearing helps reduce pain, the discovery even winning the researchers the Ig Nobel Peace Prize in 2010 😃

To manage the pain, I upped my Oxycodone to 20 mgs every 4 hours, and like last week, all nourishment and drugs are being administered through my peg tube. I’m getting really efficient at use the tube now, I can literally do it while on the move.

As mentioned last week, the pain became focussed in my throat. It’s hard to describe, but maybe it’s like having your tonsils out and then it’s like the pain one feels after the anaesthetic has worn off? But all the time. 24/7. What made this worse was the constant build up of glutty green phlegm on my throat that has to be cleared every 30 minutes or so with a retch, which is pretty disgusting. And the thick, mucous-like saliva that builds up all the time has to be wiped away constantly. For the first 6 days I had to lie on towels every night as I literally could not stop drooling this stuff 🤢.

Then when one pain grew more intense and subsided, a new pain would develop, especially in different parts of my mouth. What I think both David and I found fascinating was why is the pain developing in different parts, so long after the treatment has ended. A quick scroll through google found that it is linked to the radiation treatment itself

The radiation I’ve been exposed to over the last 7 weeks damages the DNA in the cells that are actively growing. That DNA is crucial to how those cells grow. Over some period, from hours to years, different cell types just get on with doing what they need to do, acting as the bricks and mortar of our bodies. However, most cells will want to go through a cycle of growth, and this occurs in different phases. At some point they divide, and so start to make certain proteins and other stuff that then allow them to create the DNA for new cells. Making the proteins and then the DNA can take between one and two days each. After that, there’s another phase which creates the bits and pieces that will ensure a successful cell division. In the final phase, the cell splits, creating a copy of itself.

Radiation is more effective on cells that are going through the division process. So those cells like cancer cells (or hair follicles), that grow quickly, are most affected by the radiation. The radiation messes up the DNA, and the cell division process, so the cells hit by radiation basically just die. But because different cells are going through their own cycle, this affects different cells at different times. This means that the radiation continues to have its effect long after it’s no longer being zapped through you.

That’s why the couple of weeks after radiotherapy can feel the worst. At this point, I’ve had the maximum dosage of radiation, so all those cancer cells are hopefully dying away, but so are all the normal cells my throat needs to function: the skin cells lining my throat, making saliva, making the glands that make saliva, basically, just keeping my body working. And each of these will have different growth rates, hence the different symptoms at different times.

As time goes on, the healthy cells that haven’t been damaged begin to grow again, and my body will recruit resources from all over the place to do this. The cancer cells will, however, hopefully have died away!!

So for pain management, we know that there will be severe pain, but for each person it is different because the radiation will have affected different tissues and cell types to different degrees. And that is the uncertainty we have to deal with.

However, to manage this, we strengthened my feeding and drugs schedule, which David took on board too keenly for my liking.

And it worked; when anything went wrong having a strict schedule meant that that elusive balance of managing pain could be restored as quickly as possible.

There are few hours in the day when I don't have to so something

But as off this morning, maybe I’ve turned that corner a couple of days early. I’m looking at David’s food jealously for the first time, and weirdly I’ve even taken to day-dreaming about biting into and chewing cakes, and mimicking the actions!!!

Time will tell if my crisp obsession will come back, or if that has dissolved away with the cancer too.