The Hidden Side Effects of Radiation

by GregP_WN

Radiation is a standard part of treatment for a large group of cancer types. Sometimes combined with chemotherapy, sometimes used on its own, and even sometimes with a mixture of other traditional treatments, surgery, and drugs. There are several hidden side effects that you may or may not be told to expect. Some of them show up quickly, but many wait years to show up. Some can be life threatening. 

Radiation Mask

You will find many people that say radiation was much easier to take than chemotherapy was, I am in that group also. 29 years ago, I was diagnosed with Hodgkins Lymphoma for which I was prescribed chemotherapy followed by radiation treatments. 28 to be exact. Followed 18 years later by 25 more in the same area for a third diagnosis for head and neck cancer. These are the side effects I have endured. 

After having gone through the 6 months of chemo treatments, I found the radiation treatments to be non-eventful. The initial set up was a little time consuming, but after that, the daily treatment was only 15 minutes or so total. That includes walking into the room, taking off my shirt, and laying on the table to get lined up with the radiation marks, then receiving the treatment, putting a shirt back on and walking back down the hall. After I done this for a few weeks I got into a routine where I would be taking my shirt off while walking in, I wouldn't wait for them to tell me to get on the table, I knew the routine, so I just jumped up there and laid down and waited. 

Compared to a routine chemo treatment these days, there is no comparison as to which is faster, of course, they are different animals too. Chemotherapy can last as long as 8 hours or more for a treatment. 

Radiation side effects come in two types, those that show up fairly quickly, say 2 weeks after radiation starts and continue to show up through the rest of the treatment schedule, and delayed side effects that are hidden. In other words, they are not what anyone might expect, sometimes we are not told about the possibility of these even showing up. Some of these side effects can be prevented or at least minimized during the treatment process if the treatment facility plans for them. Not all facilities do. 

Initial side effects that will show up quickly are going to depend on where you are getting the treatments. My radiation was given in the throat/neck/jaw/chest area during the first round of radiation that I received 29 years ago, I later went through another regimen of radiation 18 years later, in a more precise area of the neck/jaw. The initial side effects that started showing up were a dry mouth due to loss of saliva gland activity, initially. A sore throat followed that, along with the inability to swallow without great pain. Eating was becoming more and more painful and resulted in a loss of about 45 pounds. 

You learn to eat things based on the "burn factor" and the "slide factor". How much if any will it burn my throat as it goes down, and how easily will it slide down my throat. Swallowing, one of the most basic, almost involuntary acts we do hundreds of times a day becomes very painful and difficult. Some people are encouraged to have a feeding tube put in before the treatment ever starts, as the Radiation Oncologists often know based on the type of cancer and location and strength combined with a number of treatments given may cause swallowing problems. 

Fatigue is another expected side effect from radiation, and most of us have it after a couple of weeks. It felt to me like I just had to go take a nap each afternoon. Going to sleep at night was not a problem either.

A severe "sunburn" or radiation dermatitis is usually the next immediate side effect that will show up. It can often be controlled with special creams that can be obtained from your Radiation Oncologist. 

Radiation Burn

Nausea and extreme pain in the throat were my most severe side effects that were immediate. These side effects while very tough to deal with were temporary. The hidden side effects are those that sometimes come quickly and never go away, or don't show up for years. Here are some that I have experienced.

Hidden Side Effects From Radiation

Loss of Saliva Gland Function - The first hidden side effect that I didn't expect was a total loss of saliva gland function causing dry mouth, which in turn caused total loss of teeth. We don't realize how much saliva (moisture) the body produces each day until you don't have it. Sort of like not missing the electricity until a storm blows it out. 

Rapid Tooth Decay or Loss - Radiation that is directed to the neck/jaw area will either reduce saliva gland function, which returns later or it will completely kill them off and you will have no moisture in your mouth. This moisture keeps your mouth clean, keeps your teeth bathed in moisture and enzymes that help clean. Without it, your teeth immediately will start to decline. In my case cavities started to show up, followed by fillings falling out that had previously been put in. I have talked to many head and neck cancer patients that were not warned that their teeth could be lost completely. In my case, I was simply told to get all of my teeth checked, and any problems fixed before the treatments started, they do not want to risk you having a dental procedure during treatment as it's a risk of infection during your compromised immune system. 

Some two years after radiation was completed and I had recovered from most of the side effects, my tooth loss became so bad that I consulted an Oral Surgeon for advice on removing all teeth. It had gotten to the point that my teeth were not worth saving as any work done to them would most likely just be lost in the near future. The teeth just were wearing down, decaying and causing severe pain. 

At first, the Oral Surgeon didn't want to pull any teeth for a fear of my developing Osteoradionecrosis, a condition where the jaw bones will not heal due to the radiation treatment damaging the tissue which decreases the healing ability. 

See a previous article on Osteoradionecrosis

Osteonecrosis Of The Jaw

One of the usual treatments to offset the possibility of osteoradionecrosis is Hyperbaric Oxygen Treatment. This is a procedure where the patient is placed inside a plastic tube, and pure oxygen is put into the tube under some pressure. This oxygen is absorbed into the body and encourages healing and more rapid cell growth. A friend of mine even grew hair back on his head after he was previously bald even before treatments. 

One drawback to the treatments is that some insurance plans won't cover it, and their cost can be as much as $2,000.00 per treatment. It was suggested that I have 30 of them. And no, my insurance wasn't going to cover any of it, so that was out!

Baramed Hyperbaric Chamber Xd Sm1

In the end, the Oral Surgeon agreed that our only option was surgical removal of all teeth, but on a slow program. He removed two and waited for them to heal before any more were taken out. Two more, and wait to see how the healing went, and so on. After all of the teeth were removed, I did heal just fine and eventually had dentures put in. The cost of having all teeth removed, in the $8,000.00 range, along with $3,000.00 for a pair of implant posts to hold the lower plate in place. As you can see, this was a very expensive "hidden side effect" that I didn't expect.

Carotid Artery Damage -  In my case, my interior carotid artery on the right side of my neck was occluded. Basically fried from the radiation. The possibility of this happening was never mentioned, perhaps it was buried in the book of paperwork and releases that I signed prior to treatment, but I certainly didn't expect this. If not for the having stroke like symptoms one day,(called a TIA), which led me to go to the ER, I wouldn't have known. I had 80% blockage in my carotid artery and I was lucky to have not had a full blown stroke. I spent a few nights in the hospital followed by a procedure to insert a stent in my carotid artery to improve blood flow. 

Heart Damage - Heart damage and artery damage around the heart and chest area is possible for those patients that are receiving radiation to the chest area in a broad pattern. Many of the new radiation procedures use precisely directed radiation beams targeted to the tumor area, in many cases the radiation beams do not hit any other areas other than the tumor. But, the risk is there, I have a friend that suffered a heart attack years after having had radiation to the chest/abdomen area. 

Swallowing/Choking Issues - In my case, the radiation was directed at my throat, from both sides. This radiation combined with scar tissue from a surgery to remove my right tonsil have combined to cause severe difficulty in swallowing. On several occasions, I have choked on food or while trying to take a prescription drug. I was able to get it expelled and breath, but it was a very scary event. Now, I eat everything based on how easy it will slide down. I also have a condition where liquids tend to partly go down the wrong way and cause me to choke and cough for several minutes until it is all expelled. These conditions were not explained or expected and I had to learn to deal with them, there is no cure for the narrow, scarred throat area that causes this choking. 

Whenever my Wife and I go out to eat with some people that don't know my history, I jokingly tell them that I will apologize in advance for any strange noises you hear coming from me during supper, and also disregard any food that might come out of my nose. Yep, it happens. Food will find it's way in that "in between" area in the throat where your nasal passages meet the throat, a little tickle happens and boom...chicken comes flying out of my nose. It's embarrassing if this happens in a crowded place, but thankfully that hasn't happened much while eating out. 

The strange noises are just what those of us with throat problems learn to do in order to swallow. Grunting, twisting and contorting my neck in different directions helps any food go down. 

Loss of Voice - Through the last year or two, I have experienced increasing periods of a rough/hoarse voice. When I wake up in the morning I really don't know if I'm going to be able to talk today or not. A good amount of hot coffee helps to get it started, and then whether or not the voice is going to work today depends on the weather, how much allergy reaction I have going on, how much coughing I have done over the last day or so, and how much mucous I have in my throat. 

It's a compounding problem, allergies cause me to have a sniffling/running nose, which causes a lot of coughing, which in turn causes a sore throat, which ultimately causes a ragged voice the next day. Compound that with scar tissue from two surgeries in the throat where they cut out my malignant tonsil, then cut a 3" hole in the through my throat to get clean margins. That was patched with some sort of space age bio-plastic patch. Follow that up with radiation treatments hitting both sides of my neck and presto, you have no voice as you remember it.

The Doctors tell me that it may be fine....just drink lots of water, that's what they tell the singing stars when they have a sore throat and can't sing. I think I've reached another level or two above a "sore throat". In reality, I think I am on a downhill path to eventually not having much of a voice at all. Again, this possibility was never mentioned and I don't get much reaction or interest in talking too much about it on my annual check up visits. The good news is...I'm alive! The bad news is, I may not be able to talk in a couple of years. Still, I would do it all over again if faced with the same decision.

Swallow studies can be done on people that have swallowing issues which sometimes lead to either re-learning to swallow or in some cases a procedure can be done to stretch the throat.

Here is a list of some other late side effects from radiation:

Dry mouth.
Permanent hair loss.
Problems with thyroid or adrenal glands.
Slowed or halted bone growth in children.
Decreased range of motion in the treated area.
Skin sensitivity to sun exposure.
Problems with memory or ability to learn.
Secondary cancers such as skin cancer.

While not every patient will have these side effects, they are all possible, it's a good idea to ask detailed questions about not only the immediate side effects that you may experience but also the possibility of long-term or hidden side effects of radiation for your type of cancer. This post covers the experiences of a head and neck/ Hodgkin's lymphoma patient. Other types of cancer will have some similar experiences and some that don't even come close. I will say that my first experience with radiation 29 years ago wasn't as bad. It was primarily the last round of 25 radiation treatments that done the bulk of my damage. 

Have you had some unusual or hidden side effects that showed up years after your treatments were over? Please comment about them below and let others know what to look out for. 

Also, if you have had some "hidden side effects" with radiation for a different type of cancer and would like to share them, drop us an email.

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