The aftermarth of a disease

WHO would have thought you could get frostbite from treatment of Cervical Cancer – 15yrs on?
Or that my Diabetes Type II which I no longer have could have contributed?!
Or that this… isn’t actually going to get better, you cannot fix it – only manage it?!!
What IS surprising to me is that I am only learning this NOW.. I am only starting to understand the aftermath of the diseases that I have carried. Some unpreventable and others due to my Obesity.

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1: Nerve conduction studies NCS’s check the transmission of electrical current through a nerve. With this test, an image of the nerve conducting an electrical signal is projected onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage. This test allows the doctor to assess the condition of all the nerves in the arms and legs.
Result: This showed that my nerve impulses were strong [100% ] in your legs however in the toes they were significantly weaker [ down to 0% ] which indicated further testing via EMGs Left foot 2nd [45%], 4th [-10%}& 5th [-1%] Right foot 2nd [-20%], 3rd [40%], 4th [-10%] 5th [-10%]

2: Electromyography (EMG) shows how well muscles respond to electrical signals transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.
Results: Legs strong [100%] however muscular damaged appeared in several toes. Left foot 2nd [40%], 4th [10%}& 5th [ 10%] Right foot 2nd [25%], 3rd [50%], 4th [10%] 5th [10%] Due to strength and conditioning there is an increase in muscular % vs nerve damage.

3: Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, vibration, and temperature, to check for neuropathy.
Results: All fine EXCEPT in my toes. I have normal pressure and vibration and below normal stimuli and temperature.

4: A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture. 
Result: Above Healthy range.

5: An ultrasound uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can show how these organs preserve a normal structure and whether the bladder empties completely after urination.
Result: Above Healthy range.

Diagnosis: Chemo-induced Peripheral Neuropathy with the possibility of Diabetic Peripheral Neuropathy adding further damage.
Neuropathy is either inherited or a result of disease or trauma within the body. The 3 different chemotherapy drugs used is believed to have been the cause with 8yrs of Type II Diabetes possibly contributing to some of the damage.

Prognosis: There is nothing that can be done, this is about management. My toes don’t move** the way they should, they feel pain etc. but can’t hold in heat, they just give it out and they can’t regulate my body temp. This actually makes sense.. this is why my toes broke so easily and when they did they ended up facing 180 degrees and why when I swim in winter my toes don’t ‘walk right’ I have even ended up walking on and ripping my toe nails right off as I can’t feel them turning around.
They have predicted that I have had Frost Nip since I have lost weight. Prior to this my body composition meant my feet were actually 1.5 size bigger due to my weight now they are smaller. Also due to standing on concrete for so many hours unable to feel my heat going, I just feel my feet frozen I developed frostbite. Frostbite can’t really be treated when you can’t regulate your heat so it is a matter of managing it throughout the winter and ensuring I take care of my feet leading into next winter. This management will now be for life!

I do want to say that I am in no way complaining at this aftermath, as I am one of the blessed that have survived Cancer and would never begin to complain about being here AT ALL. I have lost one of my closest friends and countless family members to this horrid disease. This blog is about awareness, I am not the type of person who walks in and blindly accepts any Dr’s comments. I ask endless questions and always have. Yet I was never aware of this possibility and I had MANY indicators that had me in front of professionals during and since my Chemo. I then went onto develop Type II Diabetes and again NOTHING about this possibility was ever mentioned. Would I have changed my lifestyle back then?.. who knows and why even think that way. BUT if you are reading this and have had or have any Cancers OR are fighting Diabetes, ask ASK the relevant questions!
If you are displaying symptoms that don’t make sense to you, or you don’t understand the hows and whys ASK and ask again until it is clear. ASK MORE than I did.. the knowledge can only EMPOWER YOU!!!

If you are a Dr, Nutritionist, Dietician, Podiatrist, Physiotherapist, Chiropractor, Osteopath, Massage Therapist, actually IF YOU TREAT ANYONE in a Medical or Holistic manner listen, act and if you are unclear on a particular symptom it is your responsibility to seek clarification OR refer. I say this because I have in my 15+years seen ALL of the above from one time to another.
In those appointments, symptoms, pain, unexplainable-movement were mentioned and yet it was passed off as nothing of importance. Obviously that is not the case.

Below is a little information on the Peripheral Nervous System and the 3 key types of Neuropathy.

Because your Peripheral Nervous System is responsible for the transmitting of messages to the brain and spinal cord, any damage will interfere with your body’s ability to send and receive messages. Symptoms vary depending on which part of the nervous system is affected.  There are three key types of Neuropathy:

1. Motor Nerve Damage: your Motor Nerves are responsible for voluntary movements like walking, grasping and talking. Damage to this area can result in muscle weakness, cramps, uncontrollable twitching, muscle atrophy and decreased reflexes.

2. Sensory Nerve Damage: these nerves transmit the feeling you experience from a cut or a light touch.  Sensory Nerve damage causes a wide range of symptoms including decreased sensation of touch and loss of reflexes, fine motor or balance. It can also impact your ability to register pain or a change in temperature.  Others might suffer from an increase in pain receptors where severe pain is felt from even the lightest touch.  Over time sensory nerve damage can lead to joint and bone damage. Neuropathic pain can be debilitating and seriously impact your quality of life.

3. Autonomic Nerve Damage: these nerves control your organs and are responsible for core body functions such as breathing, digesting food and gland functions.  Common symptoms of Autonomic Neuropathy include loss of ability to regulate heat and loss of sweat, loss of bladder control, decreased blood pressure resulting in dizziness, light headedness, fainting and irregular heart rate. Gastrointestinal symptoms can result in diarrhoea, constipation, or incontinence. Many suffers will have issues with eating when autonomic nerves controlling these functions are affected.
Drugs Commonly Associated with CIPN
Platinum derivated
There are three members of the drug family are currently used: cisplatin, carboplatin (mainly in lung, breast, and ovarian cancer), and oxaliplatin (in metastatic colon cancer and other gastrointestinal malignancies).
 
1: Cusplatinum
CIPN is closely related to total cumulative drug dose for cisplatin. The neuropathy is predo­minantly sensory, with initial complaints of numbness or paresthesias in the distal parts of the extremities. Loss of large fiber sensory function with sensory ataxia is common. Lhermitte’s phenomenon can occur. Coasting is a unique feature. Many patients experience residual neuropathic pain after improvement in their neuropathy. Ototoxcity can result in hearing loss and dizziness.
2: Carboplatin
Carboplatin is less neurotoxic. In higher cumulative doses, however, carboplatin also produces a sensory neuropathy similar to that of cisplatin. Overall, 40% of patients receiving cisplatin and taxol develop CIPN.
3: Oxaliplatin
In addition to the cumulative dose-dependent neuropathy, about 80% of patients develop cold-induced paresthesiae and dysesthesiae in the throat, mouth, face, and hands. The symptoms settle a few days after the infusion is completed. Oxcarbazepine has been shown to be modestly effective in prophylaxis against the transient symptoms. The dose-related sensory neurotoxicity resembles cisplatin-induced neuropathy.

References

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