Friday, April 25, 2014

Blog 26 - Phew


Blog 26 – Ultrasound - phew

I only mentioned it to a couple of people: I had an ultrasound scan done on my neck yesterday. I’m more than happy to say there was nothing of consequence to be found. I’d noticed a very small lump under the left side of my chin, no corresponding lump under the right side. I had a vague notion that I’d come across the lump before, but you know I then began to imagine that I was false remembering it so as to make it unimportant. But over the week my hand kept making it’s way to my neck to see how it felt. Some days I could almost feel that it was larger. So on my last checkup on 10th April, I mentioned it. A finger of shock pinged my heart when the consultant said he wanted a scan done and he wanted to see me again for the results in two weeks time.

The ultrasound department in Lister hospital has moved up from the cellar to the main floor and is now clean and bright and, well, clinical. With a bright orange reception desk. It could be Ryanair. It has six ultrasound rooms. I wondered if there was Jazz in one, Classical in another. Perhaps White Noise in the third (Anyone remember the late 1960’s, cough, experimental band). My dad hated that music. I went into room 4. It was dim, and quiet. The nurse was welcoming. The doctor stood playing the keyboard of his laptop on the work counter. Like Rick Wakeman. But with the sound turned down. Pity. 
You lie on the couch and he squirts lubricant on your neck. Then uses his ultrasound wand to rub over the skin and watches the images on a screen that you can’t see. Every so often he presses a button and a still image is captured. “That’s fine” he says “Nothing to worry about”. But continues to check around the ear, across to the other side of the neck, down to the Adams apple. And back to the lump. “It’s your salivary gland that you can feel”. “Nothing to worry about”.

The question that formed would not come out.

Ah well, I can write it down and take it to the consultant next Thursday.
Do salivary glands change size?

I had another question about ultrasound. But the ultrasound doctor didn't seem particularly engaging. See the end of this tract to see how lucky I was not to ask it.

As you have come to expect, I've done a bit of reading....

Salivary glands (in humans) secrete stuff. Mostly the stuff just lubricates: Without lubricant you can’t swallow. But some stuff (amylase) begins the process of breaking down starch – so you can eat chips! Amylase is also used in home-brewing, converting starch into sugar, which is then converted into alcohol. The third stuff, from the Von Ebner glands on the tongue, dissolves food particles so that you can taste them. There are three pairs of main glands, by the ears, under the tongue and under the chin and up to 1000 further glands in the mouth.

The salivary glands of some species, however, are modified to produce enzymes; salivary amylase is found in many, but by no means all, bird and mammal species (including humans, as noted above). Furthermore, the venom glands of poisonous snakes, Gila monsters, and some shrews, are modified salivary glands. In other organisms such as insects, salivary glands are often used to produce biologically important proteins like silk or glues, and fly salivary glands contain polytene chromosomes that have been useful in genetic research.

Many anti-cancer treatments may impair salivary flow such as chemotherapy and radiation therapy. Radiation therapy may cause permanent hyposalivation due to injury to the oral mucosa containing the salivary glands, resulting in dry mouth or xerostomia, whereas chemotherapy may cause only temporary salivary impairment.


What is ultrasound. I hear you ask. Tee-hee.

Courtesy of Wikipedia.



Ultrasound is an oscillating sound pressure wave with a frequency greater than the upper limit of the human hearing range. Although this limit varies from person to person, it is approximately 20 kilohertz in healthy, young adults. Ultrasound devices operate with frequencies from 20 kHz up to several gigahertz.
Ultrasound is used in many different fields. Ultrasonic devices are used to detect objects and measure distances. Ultrasonic imaging (sonography) is used in both veterinary medicine and human medicine. In the non-destructive testing of products and structures, ultrasound is used to detect invisible flaws. Industrially, ultrasound is used for cleaning and for mixing, and to accelerate chemical processes. Organisms such as bats and porpoises use ultrasound for locating prey and obstacles.

My ultrasound question?

I remember having ultrasound treatment when I was recovering from a dislocated ankle. 6 weeks after my plaster came off. I was fortunate (I thought) to have private health care and so BUPA provided the physiotherapy. They used ultrasound to break down the internal scar tissue that formed when the torn muscles and stretched tendons repaired themselves. So I was going to ask the doctor if ultrasound should be used to break down the scar tissues in my neck that formed when the muscle, lymph nodes, nerve and vein where excised.
I've just been doing some research into ultrasound and physiotherapy. Here are a couple of quotes.

The frequently described biophysical effects of ultrasound either do not occur in vivo under therapeutic conditions or have not been proven to have a clinical effect under these conditions. This review reveals that there is currently insufficient biophysical evidence to provide a scientific foundation for the clinical use of therapeutic ultrasound …

There is nothing a cold slimy prickling ultrasound wand can do that a pair of warm hands can’t do way better.

So a masseuse it is then. You lie on the couch and she squirts lubricant on your neck.


Friday, April 04, 2014

Blog 25 - Cancer and sunburn


Blog 25 - Chemotherapy and Radiotherapy fall out with Sunshine

Sunshine is radiation. Radiotherapy is radiation. What’s radiotherapy for? To damage cells. Sunshine damages cells. If you’re having radiotherapy, you need your energy to repair cells, so avoid sunshine. (Cancer turns off cell repair in those cells that it has attached to, so irradiated cancer cells die, which is how we get rid of cancer, and the body replaces cells with new ones where it can, which is how we recover, after a while). Overexposure to the sun causes sunburn which is when cells in the base of the skin are killed (basal cells). When these cells rise to the surface of the skin, the skin turns red. If sunburn continues, more cells die and rise to the surface, which will flake, or blister or suppurate.

Why can some people take more sunshine than others? Because of the level of photo-sensitivity of the cells in their body. The repair rate of damaged cells and the tolerance of cells to damage (photo-sensitivity) – is governed by the number and quantity of up to 30 different proteins in the body. The more the better. If you are photosensitive, you probably have fewer proteins. You need to know your own tolerance to sunlight, measured in your own garden on a sunny day. 5 minutes to burn or 20? The SPF factor of a sun-cream tells you how many times longer you can stay exposed to the sun. (SPF. Sunburn Protection Factor, actually UVB protection factor – see later).

Chemotherapy, short term, and radiotherapy, longer term, can increase the level of photo-sensitivity of cells, and so you will not be able to spend as long a time in the sun as you used to. You should increase the SPF factor of your sun-cream accordingly (what the heck does accordingly mean!) – or experimentally if you want to try getting sunburn first.

Chemotherapy drugs that cause photosensitivity are dacarbazine, fluorouracil (by injection or applied to skin), masoprocol (applied to skin), methotrexate, mitomycin, and vinblastine. Alitretinoin applied to the skin may make your skin sunburn more easily.

Radiation therapy can cause radiation enhancement or radiation recall with some chemotherapy drugs, such as bleomycin, dactinomycin, daunorubicin, liposomal daunorubicin, doxorubicin, liposomal doxorubicin, fluorouracil, hydroxyurea, and methotrexate. Radiation recall can also occur with etoposide, idarubicin, interferons, paclitaxel, or vinblastine.

(Other literature also include tamociten, femara and arimidex)

Other factors related to cancer may cause or heighten photosensitivity including:
*      Changes in your physical appearance because of cancer or cancer treatment. Hair loss can make it easy to sunburn the top of your head.
*      Medications -- ganciclovir, some nausea medications (chlorpromazine, haloperidol, promethazine), quinolone antibiotics (ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin, and others), sulfamethoxazole, and others

Here’s a fascinating and informative publication on the way skin reacts/recovers during and after radiotherapy.
http://www.ycn.nhs.uk/html/downloads/ltht-managingradiotherapyinducedskinreactions-oct2011.pdf - According to this document, Cisplatin is bad, too.

Sunshine is electromagnetic radiation made up of, inter alia, three groups of Ultraviolet wavelengths. UVA suppresses the immune system, damages the eyes and may lead to indirect DNA damage: UVB may lead to direct DNA damage and sunburn: UVC has the highest potential for biological damage, but can’t get through the earth’s atmosphere. (UVB is partially blocked, depending on the level of ozone above you). (The bodies defense against UVB is to produce melanin, which has a dark pigment and this diffuses UVB into safe radiation – i.e. heat – so if you've not got sun-cream on you’ll feel hotter than if you have!). (Yes, UV radiation has benefits, but that’s not for this article).

Ultraviolet (UV) light is so-named because the electromagnetic spectrum consists of waves with frequencies higher than those that humans identify as the colour violet. These frequencies are invisible to most humans except those with aphakia. Near-UV is visible to a number of insects and birds.

UVA, UVB, and UVC can all damage collagen fibres and, therefore, accelerate aging of the skin. Both UVA and UVB destroy vitamin A in skin, which may cause further damage. UVA is immunosuppressive for the entire body and is mutagenic for basal cell keratinocytes in skin.

Physical sunblocks reflect UVA and UVB from the surface of the skin. Chemical sunblocks prevent UVB penetration by absorbing it, they generally don’t absorb UVA. Each chemical within the cream absorbs a different range of UVB radiation.

UVA sunblocks typically contain either titanium dioxide or zinc oxide.
When buying sunblock, avoid synthetic chemicals that can further damage your skin and weaken your defense systems: Including 4-Methyl-Benzylidencamphor (4-MBC), Oxybenzone, Benzophenone-3, and Octyl-methoyl-cinnamates (OMC). Or synthetic preservatives like parabens and synthetic fragrance.

If you've got this far, read this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263051/
and find out about herbals and sunshine – flowing into some other fascinating herbal information.