Coming Up For Air

“It’s not a question of fate, it’s not a question of hope…I’m coming up for air to work it out” — from the song, “Coming Up for Air,” sung by Siobhan Donaghy


You know, I’m really getting sick of this. Just when I seem to be conquering one cancer-related side effect, another one rears its ugly head. I am happy to report that my fatigue is starting to turn around, and I need to write a post about that. But right on its heels, I developed more axillary cording and pain in my chest and shoulders, secondary to the late effects of radiation, which I did blog about (see The Gift That Keeps On Giving). However, I am happy to report that this is being steadily sorted out by Randi, my PT, who may be found at Rhode Island Therapy & Wellness for Women.

So, now, just when my shoulder is starting to move without pain and my right breast doesn’t feel like overheated shrink-wrap, I seem to have a new problem. Also related to radiation. Also that no one warned me about. That I had to dig around, research and figure out myself. What else is new?

I swear I have absolutely, positively read more scientific research articles since I was diagnosed with breast cancer than I read in all the years I was in college, both undergrad and grad school. Believe me, I’ve searched “radiation side effects” extensively, but either I didn’t turn up anything about my latest problem or it didn’t register with me. Thanks again to my friend Deb in Ohio, who has herself been suffering from this problem, which did register on my brain and rang some kind of bell when I was getting sick of coughing all the time. Uh-oh, I thought, pneumonitis.

From Cancer.Net, here’s an excellent summary explanation of the potential side effects of radiation to the breast or chest area:

    Radiation therapy to the chest may cause difficulty swallowing, cough, fever, shortness of breath, breast or nipple soreness, and shoulder stiffness, as well as fatigue and skin irritation. A few people develop a cough, fever, and fullness of the chest that is diagnosed as radiation pneumonitis, an inflammation of the lung occurring between two weeks to six months after radiation therapy. Although sometimes very mild, radiation pneumonitis may lead to permanent scarring of the lungs called radiation fibrosis, which is associated with more serious heart and lung problems.

So, why couldn’t someone have told me this beforehand? Or even during one of my post-radiation check-ups? Huh? I mean, would it have killed them to provide some practical information about what to watch for after treatment? Well, what can you expect from a radiation oncologist who, when you develop a raging upper respiratory infection during treatment and feel like you’ve been run over by an eighteen-wheeler, merely says, “Oh, you’ll probably need an extra hour or two of sleep for a while.”

When I was a little kid, I was allergic to cats. Hard to believe now, when I’ve lived with them for thirty years. But then, if I petted a kitty and rubbed my eyes, my face would swell up until my eyes were slits. Not pretty. A few times, I’d also cough and cough and cough, and my parents would have to haul me to the pediatrician for a shot of adrenalin to relieve the asthma attack. I was simply NOT going to give up being friends with kitties, so I started my own desensitizing program, and my pediatrician gave me a prescription for Dimetapp syrup. It worked like a charm, and it was chocolate-flavored! I never see chocolate-flavored Dimetapp on the shelves these days, just boring ol’ cherry-flavored. Too bad! You kids don’t know what you’re missing. In any event, I outgrew my cat allergy, obviously, and after about the age of six, I never had another asthma attack.

Decades later, I watched the Boston Fire Department put out a fire that had started on the first floor of my friend’s triple-decker. We had found it early when we smelled smoke shortly after entering her third-floor digs, and were able to get everyone out of the building so that no one got hurt. Well, almost. It was nighttime, it was February in New England. It was twenty degrees Fahrenheit. We stood mutely on the sidewalk, watching the firefighters drown the flames, freezing our butts off and inhaling smoke. I developed bronchitis that would not go away for weeks, and thereafter, I also started having the odd occasional asthma attack if I was exposed to a fierce-enough allergen. Lovely. Allergy medication and inhalers became a part of my life again, although I managed to avoid setting off any asthma most of the time. I also continued to outgrow a lot of my seasonal allergies. As of two months ago, I don’t think I’d used my inhaler in two or three years.

Then I started coughing. It was autumn here in New England, there were leaves falling — and rotting — on the ground. There was rain, there was mold, there were allergens aplenty. But I was okay, taking my allegra, just the infrequent sneeze, not even post-nasal drip. Nothing but this dry, aggravating cough. First it was just once in a while. I would drink something, eat an orange, clear my throat, and I’d be fine. As the weeks passed, I started coughing more and more, until it became chronic and frequent, interrupting my work day, but usually calming down by lunchtime. I was also feeling that familiar tightness and closed-up feeling in my throat and upper chest. So, I fished out my inhaler and puffed away. It helped at first, then stopped working. I figured it was just too old, so I called my doc for a new prescription, and I made an appointment to see him in a week or so. The new inhaler didn’t help much either and just pumped my resting heart rate up to 100. By now, I started coughing so much at the end of the day, I couldn’t get to sleep, so I took cough medicine. The shortness of breath was still fairly mild, but annoying enough that I had to sleep on two or three pillows so I could breathe. Then I started coughing and feeling short of breath in the morning, at home, outside, in the car, at work, everywhere I went, no matter what I did. I took some cough suppressant capsules so I could get through the day. I started those earlier this week. Thank goodness they work.

You may think I’m a dummy for not getting more suspicious more quickly. All I can say is that I’ve been so delighted to have turned the corner on the fatigue, I’ve been trying to shovel my way through the mess my everyday life has become in the last year. But I’m not a total idiot. Somewhere around last weekend, it occurred to me that I’d never had asthma like this before, constant, relentless, impervious to treatment. About the same time, it occurred to me that, hey, I’m a cancer patient, aren’t I? Oh, sh*t. Upper respiratory = chest = breast. I need to get this checked out. Like really. Then the light went off in my head and I remembered poor Deb’s struggles with radiation pneumonitis. Duh.

From Medscape Today:

    The pathophysiology of radiation pneumonitis is described as 2 distinct mechanisms. The first is classical radiation pneumonitis. Injury to capillary endothelial and epithelial cells of the lung from the radiation results in an acute alveolitis. The inflammatory process leads to pulmonary fibrosis and is confined to the field of radiation. The second mechanism is sporadic radiation pneumonitis or an “out-of-field” response. This is thought to be an immunologically mediated process resulting in bilateral lymphocytic alveolitis.

To put the above in plain English, here’s a blurb from eHow.com:

    Radiation pneumonitis is inflammation of the lungs caused from radiotherapy. Radiation treatments for cancer cells within the breast or the chest can affect your healthy cells. After receiving radiotherapy five days per week for about six weeks, you can be prone to radiation pneumonitis. The symptoms of radiation pneumonitis include cough, shortness of breath and fever. The symptoms are not always apparent. Radiation pneumonitis can be detected on a chest X-ray or CT scan.

From Medicine Net, a brief summary about diagnosis and treatment of radiation pneumonitis:

  • Radiation pneumonitis typically occurs after radiation treatments for cancers within the chest or breast.
  • Radiation pneumonitis usually manifests itself 2 weeks to 6 months after completion of radiation therapy. Symptoms include shortness of breath upon activity, cough and fever.
  • Radiation pneumonitis frequently is discovered serendipitously, as an incidental finding on chest x-ray in patients who have no symptoms.
  • Blood testing can indicate inflammation is present in the body. Abnormally elevated white blood counts and sedimentation rates are common.
  • If radiation pneumonitis persists, it can lead to scarring of the lungs, referred to as radiation fibrosis. Radiation fibrosis typically occurs a year after the completion of radiation treatments.
  • Radiation pneumonitis is often reversible with medications that reduce inflammation, such as cortisone drugs (prednisone and others).
  • Radiation fibrosis is usually irreversible and permanent.

Oh, goody.

Maybe it’s not that. I don’t know. So far, though, I’ve been right more than I’ve been wrong during this adventure. Deb’s radiation oncologist insisted that her pneumonitis had nothing to do with radiation. We’ll see what my doctor says. If you have one of those skeptical-type doctors, there are some down-loadable research articles below that you can use to edify him or her.

Excuse me. I’ve got to go cough now.


Further links and information about radiation pneumonitis:
Acute Radiation Pneumonitis in Breast Cancer Patients
Chronic Pneumonia After Radiation for Breast Cancer
Pneumonitis After Chemo and Radiation for Breast Cancer


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This entry was written by Kathi, posted on Friday, December 04, 2009 at 02:12 pm, filed under Fatigue, Health & Healthcare, Lymphedema & Cording, Nitty Gritty, Radiation, Research and tagged , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

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