Monday 24 July 2017

Dear Dr Nina: Will I still be able to mind my grandkids after radiation?

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Photo posed

Nina Byrnes

Dr Nina Byrnes answers your medical queries in her weekly column.

I have recently been diagnosed with breast cancer. I had a mammogram that showed a small growth that proved to be malignant when biopsied. My doctor has told me that I don't need chemotherapy but will be treated with radiation and, subsequently, Tamoxifen for a few years. I was so confused that I didn't really take in what he - or the lovely nurse that saw me subsequently - was saying. Can you give me any indication of what the radiation therapy will be like? Will I have many side effects? I know my prognosis is good but I'm more worried about my quality of life for the next few years. I am in my mid-60s and mind my young grandchildren. Will I be able to continue?

A Radiation therapy is a form of cancer treatment that is used to kill, stall or shrink cancer cells.

Depending on the type of cancer being treated it may be used alone or in conjunction with surgery or chemotherapy. External beam radiation involves receiving beams of radiation from an external machine. Internal radiotherapy involves placing radioactive implants in or near tumours. The doctors who specialize in radiation therapy are called radiation oncologists. You will have been referred to one of these by your surgical team. Prior to starting radiotherapy you will meet with this team and they can answer any specific questions you have. It is always helpful to jot down any questions you have in advance and to bring someone else with you to act as a second pair of ears on the day. Other members of the radiation team include specialist radiotherapy technicians, physicists and nurses.

Before starting treatment you will have a simulation visit. During this attendance measurements will be taken. Specific x-rays will be taken and your skin will be marked to define the area requiring radiation.

Treatment is usually five to six days a week for several weeks. You do not need to stay in hospital overnight. It will take place in a treatment room. You will lie on a hard bed and will be instructed as regards the exact position in which to stay. The actual treatment only last a few minutes. During this time you will be in the room on your own but you will be able to communicate with the radiotherapist if required.

The most common side effects of radiotherapy treatment are fatigue and skin changes. Skin can become red, tender and even occasionally blister and peel. Those who have breast radiotherapy also sometimes notice tenderness or swelling of the remaining breast tissue. Most of these changes settle within several weeks of stopping treatment. Changes of pigment in the skin may last indefinitely. Radiotherapy itself is not painful.

Be kind to your self during radiotherapy. Get plenty of rest. Eat well and drink plenty fluids. Don't wear bras if possible. If you do need a bra wear a soft sports one to avoid irritating the skin.

Wear loose cotton clothes that are easy to put on and take off. Only use skin lotions approved by your medical team.

Last but not least keep emotional support close. Being treated for cancer is a daunting process but remember this is a process you will go through and the goal is your future long-term health. Your disease was localised and you are receiving very effective treatment. It is likely you will be quite tired for several months after treatment and the emotional impact of cancer diagnosis often only hits once treatment is over. There is no reason why you shouldn't be able to get back to caring for grandchildren, but I would advise not rushing back to this. You should take time to heal mentally and physically and only return gradually to normal activity. You will get there. It just takes time. The outlook is bright. Let others care for you for a while until you are fully back on your feet. Good luck and stay strong.

What exactly is bloating of the stomach? Is it fluid or air and where exactly does it occur?

A Bloating of the stomach is a subjective symptom and may be due to many things but the most common would be excess gastrointestinal gas. Burping and passing gas may be embarrassing but it important to remember these are normal bodily functions. The gut is a long tube with two openings, one at the mouth and the other at the anus. When gases are produced as a by-product of digestion they have to eventually pass out one end or the other. The average person passes wind up to 14 times daily.

Gas in the digestive tract occurs in two ways. The first of these is when we swallow air. This can occur when eating or drinking quickly, chewing gum or smoking. Most swallowed air is removed from the stomach by burping. The rest travels on through the intestines. Gas may also be produced due to the break down of undigested food by bacteria in the large intestine.

Excess gas is not dangerous but it may make you uncomfortable. You may experience large amounts of burping and farting. Abdominal cramping and bloating can be particularly problematic.

For simple excess wind try looking at your diet. Keep a food diary it will help you identify which foods trigger symptoms of excess gas. Avoiding obvious trigger foods can help. To reduce gases eat food more slowly. Take time to chew properly before swallowing. Avoid beer or carbonated drinks. Avoid chewing gum. Smoking causes you to swallow air so avoid this to reduce gas. Stay active. Exercising encourages gut motility making it less likely that food can stagnate and ferment. Cut back on high fibre foods or increase these slowly if they are new to you diet. There are a number of over the counter remedies that may help reduce intestinal gas. Peppermint tea may also soothe.

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