|2010 - A Shot Across The Bows|
not a year I want to re-live. It's September
2010 as I write this
and 8 long months ago I was diagnosed as having cancer of
the thyroid cartilage [to the left of the Adams Apple].
Which, as with everyone no doubt that is diagnosed as having
cancer, came as a bit of a shock.
As a Brit living in Turkey my first reaction was to return to the UK for treatment, but a couple of checks revealed that my home country was not interested. Despite paying into the system for over 35 years, apparently all UK citizens lose their right to free medical care under the national health scheme after they have been out of the UK for a period of six weeks. I am not going to comment on this mealy mouthed state of affairs other than to say that it's in keeping with most governments policies of moving the goalposts when it suits them. Without doubt, if I had been living out of the UK when I was in my 20's and World War 3 was declared, then I would have been forced to put my life on the line for the good old UK.
My second reaction, having been rejected by the UK, was to consider the practicalities of the situation. I have lived in Turkey for a quarter of my life, my business is here, my family is here, so the logistics of returning to the UK would not have been at all practicable.
Thankfully the rules of the Turkish National Health system provide healthcare for the whole family providing either the husband or wife has a fully paid up national insurance account. My wife is Turkish and my treatment was completed under the Turkish National Health system, which doesn't cover everything, but it was a great help. I can without hesitation say that the standard of treatment, care and the performance of the medical staff was exemplary at every stage.
When they say that beating cancer is a fight, they are not kidding. Of course it's different for everyone unfortunate enough to be forced to do battle. And for some who find out too late that they are a victim, the battle is lost before it starts. Fortunately, an ear infection that just would not go away forced me to see a specialist in January 2010. A swollen lymph gland in my neck, which I associated with ear infection, alerted him to the possibility of an altogether more sinister cause. Four weeks later after umpteen CRT scans and biopsies, a final biopsy performed under general anesthetic came up positive. The Big C reared its ugly head.
Caught at a reasonably early stage, that is after 4 weeks of tests at a private hospital in Bodrum that all proved negative and a final biopsy under general anesthetic at a private hospital in Izmir [200Kms north of Bodrum] that proved positive the prognosis was that it was curable. Arrangements were made quickly for an appointment at the public Dokuz Eylul University Hospital in Izmir. That was when the fight started, seemingly easy at first, though the explanation of a plastic/rubber 'under the skin' serum/drug/transfusion port, six 2 week chemotherapy sessions and 35 radiotherapy sessions [including 2 more chemotherapy sessions in tandem with the radiotherapy] did seem a bit daunting.
Before the start of the treatment I underwent a series of tests which were necessary to check if there were any other cancer sites and to determine my general health. It turned out that the tumor on my Thyroid cartilage was the only cancer site and all other tests, including blood and vital organs, were normal. This meant that the doctors on the treatment review panel were able to recommend the highest dose of chemotherapy possible, thus reducing the length of the treatment.
[I am including the details below mainly for the benefit of those who are about to undergo chemotherapy and/or radiotherapy in the hope that it may be of some help]
Chemotherapy is the administration of some fairly 'heavy-duty' drugs that kill cancer cells. Unfortunately they have some nasty side effects mainly resulting from the fact that they also kill many healthy cells, particularly those cells that are replaced quickly such as in the mouth, kidneys etc.
The chemotherapy treatment room at Dokuz Eylul University Hospital is a light and spacious area with beds and easy chairs along two sides. Soft background music and efficient looking nurses tending infusion drips, completes an atmosphere of easy tranquility, an altogether pleasant experience masking the real battle that was about to begin.
Chemo Session 1 [2 weeks]
My initial treatment was the infusion of 'whatever' over a period of 6 hours after which a 'take-home' circular, 22 hour drug dispenser was plugged into my 'bionic' port. At this point the drugs have no apparent effect. Sleeping with the drug dispenser in place was no problem, wearing a tee shirt with a top pocket for the drug dispenser proved to be a practical way of keeping everything in place.
It was not until the day the drug dispenser was removed that the effects of the drugs started to become apparent, mainly as a feeling of weariness rather than tiredness, a feeling of sickness [though not actually sick because of the anti-sickness drugs] and a slight loss of taste. For the next five days following the removal of the drug dispenser an injection of some other drug was administered over a period of 5 days apparently to help my kidneys recover. The weariness increased over the five days and the feeling of sickness persisted. From then the side effects reduced to the point that everything returned seemingly to normal, no weariness, no sick feeling and a full appetite, with everything tasting normal.
Chemo Sessions 2 to 4 [4 weeks]
The next 2 chemo sessions were a repeat of session 1 except that the side effects were taking progressively longer to subside after the last of the 5 day injection course. My appetite was becoming progressively less mainly because of the lack of taste and the modification of taste.
During these sessions there was some difficulty with bowel movements which fluctuated between constipation and diarrhea, the latter being coupled with very excessive mouth watering an a feeling of dire sickness. Very debilitating.
During this time I was prescribed some energy giving meal replacements that also included fiber. These tasted good at first but later, as the lack of taste developed they were like drinking 'sump-oil' and tasted not much better, not that I've ever tasted sump-oil. I also supplemented my diet during this period with some liquidized meals, from banana milk shakes, porridge with salt or sugar with an egg added occasionally. Needless to say they all tasted much the same and getting them down was a real effort, usually in a concentrated 'down in one'.
Chemo Sessions 5 [2 weeks]
By now the side effects were really kicking-in, the respite time between the end of the drugs and the next session was down to 2 days at the most, so an almost constant feeling of 'un-wellness'.
Day 1 of session 5 and I was reasonably enough recovered to want to continue the 'fight'. However, by day three I was bed-ridden, had absolutely no appetite, felt really sick, cannot eat or drink and was physically weak from a combination of the drugs and the lack of food.
It was at this point that I went to the private hospital in Bodrum and was given 2 serum drips over a period of 3 hours. This helped a lot, though I did resolve at this point to forego the planned 6th Chemotherapy session, I am sure it would have killed me.
The doctors at Dokuz Eylul Hospital respected my decision and arranged for an 'end of chemo' MR Scan. Thankfully the resulting scan showed no sign of the tumor. Nevertheless the doctors decided to continue with the planned radiotherapy program which though only 20 minutes or so every day from Monday to Friday for 7 weeks, did require me to stay in Izmir from Monday to Friday each week.
Radiotherapy starts out as a simple, no pain, 30-30 minute session, that seems like it's going to be easy. A few days prior to the commencement of the treatment I visited the hospital to have a 'mask' made, this is a made to measure plastic grid that is heated to make it pliable. In a lying on your back position the warmed plastic grid is molded to your features and stretched downwards so that it can be clamped to a base. This mask is necessary so that the head and neck can be re-positioned on the radiography machine in exactly the same position each day.
My planned treatment schedule is five daily sessions each week for seven weeks, a total of 35 'fractions' as they are called of the whole radiation 'dose'. A drive of 250Kms each way to the hospital in Izmir is not really an option so it is necessary to stay in a hotel Monday to Thursday returning home after the Friday session for a weekend of supposed 'recovery'.
The effects of Radiotherapy treatment creep up on you, as I said it seems easy at first but the side effects of tiredness, nausea and lack of appetite become ever more severe. To the point where by week four it is an effort to do anything. Even watching television takes a lot of effort, and in any case everything on TV including otherwise good movies seem futile. By week 5 and six even eating becomes an extreme effort. Swallowing is difficult and nothing tastes good anymore so with mouth ulcers, a lack of appetite, nasty tasting food and nausea, eating just does not seem to we worth the extreme effort required. But, having lost 15 kilos since the beginning of Chemotherapy, not to mention the 15 kilos I lost several months before being diagnosed, I was now back to the weight I was at 22 years of age. So eating, while very difficult was becoming a necessity.
Early in the treatment my specialist prescribed some dietary replacement drinks that supposedly gave the body all the nutrition and fiber required. These tasted delicious during week one, coming in a variety of flavors including strawberry, banana and coffee, but by week five they were bland and akin to drinking waste sump oil. It took at least 30 minutes to pluck up enough resolve to down a bottle [just 33cl] in one quick 'down the hatch' movement. Despite the almost permanent feeling of nausea from week two to a couple of weeks after the treatment was finished, thankfully there was only one occasion when the 'down-the-hatch[ technique resulted in vomiting it straight back up.
By week five I was counting the days left like some prisoner, except my approaching final day was marked on a little card rather than on a cell wall. The last two weeks of Radiotherapy were purgatory. Making the daily journey from the hotel to the Hospital was a marathon that had to be run every day on the now infamous number 554 bus. It is July and the daily temperatures in Izmir are a steady 35c.
By week five there is a constant flow of catarrh like fluid draining from the back of my nose somewhere that tastes foul. It is difficult to swallow because of throat pain and its viscosity, much easier to occasionally take into a tissue. The days blur into each other and Fridays come round ever more quickly. Life has become a zombie-like routine.
Each day it takes a great deal of mental effort to prepare for being clamped down, unable to cough or swallow properly with the constant trickling of catarrh.
It's now November 2010, 12 weeks after the last radiography session and many of the side effects are still with me, the most inconvenient being the lack of saliva, reduced taste and numbness in the soles of my feet, toes and fingertips. My original understanding was that the chemotherapy would be the worst of the two cures, as it has turned out radiography is by far the worst. As far as I can make out recovery from the side effects of the chemotherapy was just 2 weeks.
AND THANKFULLY ONWARD
Update April 2011. Well it seems the after effects described above may be either a result of either the Chemotherapy or the Radiotherapy, or both. All are quire 'normal', the Internet is full of reports of similar after effects. The severity of the after effects are much the same now, some 4 months after my last entry. Saliva production does seem to be improving along with possibly 90% recovery of taste, but it's very slow. Certainly not enough yet to be able to eat without some sort of liquid available. Another side effect comes and goes, it's a feeling of an electric shock running down the front of my legs when bending my head down too quickly. I have to say that the side effects are 'livable with' and certainly preferable to the alternative.
Don't get me wrong, I'm not complaining.
My specialist, at my three monthly check-up at Dokuz Eylul Hospital in March 2011 was pleased with progress, my next check up is in four months.
It is just over two years since my last update and I'm still here.
It is now 3 years since my treatment ended and the after effects are still with me, though I can report that there has been some improvement.
1. The 'electric shocks' down my body when bending forward have gone altogether, which means something has repaired itself.
2. I am producing enough saliva to moisten my mouth during the day, however at night, when everyone's saliva production slows down, mine seems to stop, so a glass of water by the bed is essential. I cannot swallow any form of dry food without water, the saliva glands at the point of 'swallow' don't work at all, [not surprising since they are located right where the radiation was blasted].
3. My feet still feel like I have sand in my socks, there has been some improvement, but I have gotten used to the sensation now, so it is not really a problem.
4. From time to time, itchy spots appear from nowhere, on my back, chest, arms or legs. Just 2 or 3 which run whatever course nature decides, only to be replaced several months later with a new batch. I have no idea what causes them [my 'no-alcohol- months seem to have no effect so it could be from the Chemo, but after 3 years, that does seem unlikely].
And that's it, no other after effects and all 'liveable-with'.
Hospital check-ups are now every 6 months, my bionic blood-port is still in place.