Paul's Heart

A Scary Story

Back when I was a young kid, I remember being scolded by my Grandmother, “don’t sit so close to the television! You’ll ruin your eyes.” That was the simplest way to warn a kid. However, my Grandmother had a bigger fear, and just did not want to scare me, radiation emitting from the television. If she only knew, proximity to the television was the least of my worries when it came to radiation.

So yesterday, I wrote a story about the latest issue to reveal itself to me, related to late developing side effects from my treatments for Hodgkin’s Lymphoma over three decades ago, osteopenia, a loss of bone density. Both radiation and chemotherapy are the culprits behind this diagnosis. And last week, my confirmed first injury related to that condition, a cracked rib.

But this post is not about osteopenia or my cracked rib. And I am going to try to avoid getting too nerdy or lost in the weeds with an explanation. This post is going to be about understanding, as easy as I can possibly make it.

First, likely all of us have been exposed to a minimal amount of radiation at one time or another, probably at the least, during a dental visit, having x-rays taken of the teeth. It is a tiny amount of radiation and does not last long inside your body at all. The actual time that it takes for dental x-ray radiation to leave your body is referred to as “half-life”, is so minimal, it is not even referred to as “half-life.” But when you are referring to the amount of radiation a person is exposed to either in a work environment or as a patient, “half-life” depends on the isotope and the exposure/dose.

There are a lot of different terms used to describe the exposure to radiation such as: sieverts, mrem, and grays. If I understand correctly, sieverts and mrem refer to the actual dose, while gray refers to the “absorbed” dose. Again, if I understand correctly, both end up meaning the same exposure. OSHA, the Occupational Safety and Health Administration, puts the annual dose limit exposure to radiation at 5,000 mrems. Just because I happen to be more familiar with the measurements in “grays,” that equates to .05 grays per year. The lifetime limit per the NIH, the National Institute of Health, is 400 mSv, or 40,000 Mrem, or .4 grays. Again these are lifetime numbers. Now hang on to your socks.

In February of 1989, I was treated with 4 grays (also described as 4,000 rads) of ionized radiation, or 400,000 Mrem, or 4,000 mSv. You do not need to be a scientist or math genius to know, the amount of radiation that I was exposed to, and similarly many other Hodgkin’s survivors from that time and beyond, was not safe. It was considered experimental, and it worked. The question is, at what cost?

Up until last week, bone density was the least of my worries, but with a simple cracked rib, the condition of my spine, and my susceptibility to an increased risk of fractures needs to be kept in mind now. The increased time for a broken bone to heal, or increased risk of bleeding to death (especially during surgery) are quite extreme. Combine this issue with my cardiac (3 heart surgeries and a carotid repair), pulmonary (pre-cancerous spots on both lungs and other issues), endocrine, musculoskeletal, and gastrointestinal systems, radiation may have saved my life from cancer, but the cure might just have been worse.

Which brings me back to the topic of “half-life.” Each year, my department at work was required to hold a “radiation safety training” session. To the average co-worker, this was as entertaining as watching paint dry. But for me, a fan of the Incredible Hulk, and carrying likely as much radiation as the Hulk, I was one of the few paying attention, for the question and answer portion at the end that is.

Part twisted sense of humor, and part hope for cure, I asked the same question, which I was able to do every year, because there was a different instructor. Every year, I would ask the same question.

“What is the half-life of 4 grays of ionized radiation?” It was a simple enough question, short, direct, to the point, simple math. But I knew the reaction, and the conversation that would follow.

Instructor: That’s impossible.

Me: Yes, I know (I said with a straight face, knowing what I was going to do to him). But what if it did happen? What would be the half-life?

Instructor: That’s impossible, no one would ever be subjected to that exposure. They would never lose that contamination.

Me: Well, I was exposed to that, back in 1989, treated for Hodgkin’s Lymphoma.

I had seen the look on his face before, disbelief. It was not that he did not believe me. He just could not believe that it had been done to me. I actually know several people who work with the Nuclear Radiation Commission, and one of them actually broke down in tears, because even their employees are not to be exposed to high levels of radiation.

Instructor: (in a shaken voice) You’ll never get rid of it in your lifetime.

Translation? Radiation will continue to wreak havoc on me for the rest of my life, even when it comes to repairs already done. This is why many of my survivors and I, call radiation, “the gift that keeps on giving.” It gave us remission, but it keeps giving us more than we asked for.

The truth is, there are many like me. At least until the turn of the century, this level of radiation was still being used. Many of my “older” or longer survivors, were exposed to even more radiation than I was, leaving most of us with some sort of late effect(s) to deal with. We may not interfere with television signals or be able to cook foods holding them in our hands, or in my case, possess the strength of the Hulk, but the truth is, there are many issues, some quite severe underneath our “shells.” I have written often about the issues with my heart from radiation damage.

There are now better treatment plans as far as radiation is concerned. Medicine learned they can do more with less. There are better protections such as face or body shields (as pictured), and doctors are now able to beam the radiation directly to the tumor, sparing surrounding areas, known as “scattered field” (this is why us long termers have so many issues).

This conversation is indeed quite scary. But it is a conversation that awareness is needed. If all goes as planned, remission will get reached, but surveillance once completed is critical to catch anything that develops sooner than later.