Paul's Heart

You Mean There Is More?

I have survived cancer, Hodgkin’s Lymphoma, over thirty-one years. I guess that would qualify me to refer to myself as a “long term cancer survivor.” But if you talk to me about my survivorship, while I acknowledge my longevity, when I use the term “long term cancer survivor,” like many others, the term has a much different meaning because as it turns out, our battle never really ended.

I was done with my treatments on March 3, 1990. This is the date that I officially recognize as being “done” with cancer. I was actually declared in remission several months early, barely half way through my treatment regimen. As far as the date any of us survivors use, it is one’s preference.

In April of 2008, eighteen years later, I discovered that my battle was not over yet. Though I had seen others battling what is described as “late term developing side effects” from their treatments, up until that point, I had none, at least I was unaware of any. And why would I be? I was long not being followed up by my oncologist for anything. But on April 17th, 2008, a near fatal heart condition was not only discovered, but the cause revealed so much more.

When you get a sunburn, that is from radiation. Soon after you notice it, it may start to blister, and eventually peel. And that is just what you see. The sun’s rays do not penetrate deeply into the body to the best of my knowledge, so we only get to see what happens on the outside.

Radiation used to treat cancer however, that does penetrate into the body. It has to in order to destroy the cancer cells.

You can see from the photo above, a burn from radiation treatment, and this is likely very early on, the only way to tell that this is not “sunburn” is because of the skin pattern. Pictures of radiation burns from treatments only get more extreme and difficult for most to view. My point is, just like the sun’s burns, radiation burns are visible on the skin. But unlike the sun, radiation treatments reach below the skin. And of course, below the skin, we cannot see what is “cooking.”

Sunburn usually resolves itself in a short period of time, likely a week (unless you are a skin cancer risk). But treatment radiation is a different situation. Because of the dosage of radiation used, a term called, “half-life” comes into play. Simply put, “half-life” is how long the radiation will last in the body once exposed. Because of the massive amount of radiation used to treat cancer, unlike that from the sun, which skin has a chance to recover quickly, if you are a cancer patient treated with radiation, no matter how many years out it has been, you likely are still dealing with the impact of your radiation treatment. That is why many of us refer to radiation as the “gift that keeps on giving.” Radiation gave us the gift of the cure for our cancer, but is also giving us so much more.

The problem, in my case, and like many before me, those of us treated before the turn of the century, medicine was either not aware of, or did not learn about the late effects from the progressive and cumulative nature of radiation damage.

For me, once my “widow maker” blockage was discovered with my heart, almost too late, it was also discovered why it happened, radiation damage. Because of my involvement with other survivors who up to this point, were “different” than me, because I was “healthy” and they were not, I was encouraged to seek out the opinion and care of a particular doctor who had studied this issue, for decades.

Long story short, after two years of visits, multiple tests and procedures, many more issues were discovered with my body and the damage from radiation therapy, as well as the toxic chemotherapy that I was exposed to. My doctor used to joke “it would be so much easier just to be able to do some sort of full body scan.” But after all this time, issues were discovered with my lungs, spine, upper body muscles, endocrine system, gastro intestinal system, and additional issues with the cardiac system (keeping it simple).

For thirteen years now, during a time I always believed I was supposed to not even have to think about my cancer, late developing issues have been followed so that doctors would know when they had to be repaired. The obvious question is “why wouldn’t they just be repaired now if you know they are there?” And that is logical. The problem is another issue for us lymphoma survivors, we have a problem with bleeding and healing. Therefore, doctors do not like to do anything with us, until they must. Think of us as human ticking time bombs.

The list of issues I deal with, more than a dozen long is more than enough. But is it everything?

That is what made me think of the quote from a professional wrestler I watched in my youth. Just when you think you have all the answers, the question gets changed.

Recently, a fellow survivor just underwent a surgery for a a major blockage, in another major artery that most of us in the non-medical world likely have never heard. But yet, this is what was happening to her. Not being followed up for the condition, it was not only discovered, but doctors had roughly no experience with the combination of the repair and the damage from radiation damage, which clearly is what cause the blockage.

In my survivorship circle, no one has heard of this particular artery, also sharing the name with a dietary disease, Celiac, but I assure you, this artery is a big one. Obviously we do not give it much thought because it is not immediate to the heart. As it turns out, there are a lot more arteries that we should be concerned about, especially if we have been exposed to radiation therapy.

It is hard enough not to have the world of medicine 100% on board with dealing with late side effects from treatments. But the rarity of issues beyond heart bypasses and valve replacement has now put a question at the top of my list next time I get to visit with my doctor. With all that is known about my health history and what I must deal with, what about the Celiac artery? But also what about the renal artery, the mesenteric arteries, gonadal artery, and iliac arteries? And will I be lucky to find the doctor who will know how to handle these issues if they come up? For those of us treating in the last century, our scattered radiation fields have left us with this possiblity.

I am waiting to hear about the recovery from my fellow survivor. Ironically, she had just gone through another major cardiac procedure less than two years ago, and clearly, though it should have been on the radar, it was not even a blip. There had been no reason to look for it. But a happen-by-chance, led to its discovery, and for her family, they could not be more grateful as serious as this was, that it was caught and dealt with before it was too late.

There is a reason I never put the challenge “what else?” out there. I do not need the challenge. I have enough on my plate, all the while balancing what is important in my life, watching and experiencing my daughters grow up.