Radiation and Leukemia

Goodbye Keanu my multiple myeloma story

My new vocabulary included anemia, bortezomib, hematopoietic stem cell transplant, chromosomal abnormalities, and staging systems. Like learning short hand, the next level was taking all the new words and learning their initials, a necessity to understanding medical reports. I learned: PCL (plasma cell leukemia), CR (complete recovery), PR (partial response) VGPR (very good partial response), TTP (time to progression), PFS (progression free survival), OS (overall survival), ORR (overall response rate), DOR (duration of response).  There were hundreds of them.

                On March 9th my word du jour was haemoglobin. It was the protein in red blood cells that carried oxygen from the lungs to the body and returned carbon dioxide. Low haemoglobin could cause shortness of breath, fatigue and a fast heartbeat. Haemoglobin under 90 usually necessitated a blood transfusion. In a chat room a woman in America was explaining that her son had a hemoglobin level of 6 (that translates to 60 in New Zealand. My hemoglobin level was 76 when I first got to the hospital. Normal for women is about 120). She was some sort of religious fanatic who didn’t want him to have a blood transfusion. The doctors warned her of the risk of heart failure. The heart had to work much harder to get oxygen around the body when the hemoglobin was so low. This was a new revelation to me. On top of everything else I was shortening the life of my heart. I also read that alcohol could lower your haemoglobin count. I wondered how much alcohol. Was it like the amount an alcoholic drinks or a couple of wines while watching American Idol? Apparently alcohol blocks the absorption of some vitamins and minerals your body needs to produce red blood cells.
                I took an interest in looking up the drugs I was taking. Dexamethasone was an anti-inflammatory (reduces swelling, fever and pain) and immunosuppressant (inhibits the body’s normal immune response). Side effects included stomach upset, increased appetite (This was definitely true. I should have bought stock in Cadburys), elevated liver enzymes (another reason I’d have to watch the evening wine consumption), dry skin and night sweats. These were just a handful of possible side effects. Cyclophosphamide was an “alkylating agent”.  It was converted in the liver to be therapeutic against cancer. Side effects included mouth sores, tiredness, joint pain and bruising. Velcade, which was being injected into my stomach weekly, was also known as bortezomib. It was a proteasome inhibitor. Proteasomes played a role in cell growth. By inhibiting them, hopefully velcade would cause cancer cells to die and stop the cancer from growing. Peripheral neuropathy (tingling and numbness in fingers and toes) was a fairly common side effect.

      Once I was educated on what I had, what I was being treated with and what my chances of surviving it were, I wanted to know what caused it in the first place. There was a strong link between leukaemia and radiation. I insisted we throw out our battered and rusting microwave immediately and buy a new one. I did not want to irradiate my family or make my cancer worse. I also wondered if all the dental x-rays I had in my life (I’ve had about six cavities filled and four root canals) may have contributed to my leukaemia.

                I learned there were two main types of radiation: non-ionizing and ionizing radiation. Non-ionizing radiation was weak and not capable of causing cell damage that could lead to cancer. Radio signals, heaters and computer screens were among the household items that put out non-ionizing radiation. Ionizing radiation was strong enough to damage the DNA in cells which could lead to cancer. Nuclear fallout came under this category but so did x-rays. I read that when the radiation scatters throughout the body, such as in dental X-rays, it has the power to pierce the bone marrow. According to a University of California Berkeley study in 2010, ionizing radiation was found to be carcinogenic (or cancer causing) only a few years after X-rays were discovered.

“…scientists know very little about the risk to people who are exposed to constant low levels of radiation. All of us are subjected to a certain amount of radiation every day, but we do not all get cancer. Researchers do not know how much is too much radiation and which levels are considered “safe” amounts of exposure. Specifically, the researchers found that children with acute lymphoid leukemia (ALL) had almost twice the chance of having been exposed to three or more X-rays compared with children who did not have leukemia. For B-cell ALL, even one X-ray was enough to moderately increase the risk…. While the relationship between high doses of radiation and cancer is well known, significant debate still surrounds the health impacts from the low doses of radiation typical of conventional X-rays, or radiographs.

 Natural sources of ionizing radiation are ubiquitous, from the air we breathe to the soil we walk on. Government sources say that, on average, each American is exposed to 360 millirems of radiation a year from both natural and man-made sources, including radon, air travel and diagnostic X-rays. (A rem is the standard unit of measurement of absorbed ionizing radiation in living tissue.) The dose of ionizing radiation from a single chest X-ray is roughly equivalent to the amount one would get from natural surroundings in 10 days, which is still considered low.

      I had never been near Chernobyl or any other nuclear meltdown so I could only blame bad teeth. With all my dental work I have had a lot of dental x-rays. I switched dentists a few times and each time was given new x-rays. I never knew I might be affecting my health by getting them. The dentists never tell you that. They never comment on the number of x-rays they are giving you from their safe shelter outside of the examination room. I would never have agreed to so many x-rays if I had known I was at risk of getting cancer. I want everyone to know that.