Topic: A rad onc weighs in on radiation "burns"

Forum: Radiation Therapy - Before, During, and After — What to expect from treatment and ways to cope with side effects.

Posted on: Feb 28, 2012 07:10AM

Posted on: Feb 28, 2012 07:10AM

Spinnerpom wrote:

I found this on another site and thought it was worth sharing here.  (Talk amonst yourselves.) 

Cool

 Hello- I am very sorry for your pain and suffering. I am going to offer some information, but it is important to me that you understand I am not arguing about what you have been through or trying to minimize it- just helping you with the terminology.

Radiation wounds are not really burns, and they are not rated by degree. Medical professional who are trained in radiation usage will generally not use degrees to rate the wounds. Instead, they will use "grades" from the internationally accepted CTC (Common Toxicity Criteria) that is used by all major cancer research organizations (that is why it is call "common"). The reason you can't use degrees is that burns start at the top, and spread downward, and the "degree" of the burn has to do with how far through the skin thickness it caused damage. That isn't at all what happens with radiation- therefore the degree system isn't very useful.

With regard to some of the advice in this thread- all I can say it that it is well intended, but perhaps not exactly accurate. I do not, in any way, discourage patients from forming communities and sharing information- but sadly that information is sometimes not accurate. Although we can't stop people from passing around bad information, we (physicians) can minimize that aspect of cancer care by slowly and patiently explaining what we are doing to your body and why- and of course, what you should expect as side effects. As a Radiation Oncologist, my consults generally go well over an hour, with an additional 15 minutes once a week during therapy, and 20 minutes at each follow up. So, for even the most routine case (which are never routine to the patient) I will spend several hours over the course of three months sharing information, explaining, listening, and responding to concerns. I am not a saint- I am paid to do that. The problem is not that physicians are lazy or greedy (some are) but instead perhaps the problem is that physicians often do not understand that their job is more than the performing of the service- their job is also the teaching, comforting, and true healing of the patient. I do not think that the accurate and safe delivery of radiation is good enough- it is only a small part of the job, and if you aren't going to do the whole job, send the patient to someone who will. I don't think I apply radiation with any more skill than other doctors, but perhaps I spend a little more time helping my patients understand and prepare for what I am recommending.

With that in mind, please allow me to share a little bit of general information about radiation wounds- although I cannot address your case specifically, having never examined you. There is zero build up of radiation in a patient from external beam radiation therapy (although there is from free isotope therapy or seed implantation- but those are very different). None. It does not happen. So you don't need to clear any residual radiation out, because there isn't any. I am not out to insult anyone, but to suggest that there is residual radiation following external beam radiotherapy is just plain incorrect.

Radiation wounds are not "damaged" skin, per se, as much as they are "missing" skin- let me explain- radiation causes skin to fail to reproduce properly, and thus as you "use up" your normal skin, like we all do all day, there are no new layers of skin coming up from the bottom. So eventually the area can ulcerate. This might look like a thermal burn, but it has very little in common with a thermal burn, and the treatments for thermal burns will not help much.

Let me be clear- many skin reactions don't need, nor will they find benefit from a 100 dollars worth of potions and lotions from the herbal medicine shop. You expect me to say that because I'm a doctor. Perhaps some will stop listening to me now because I don't think that a plant from the middle of the jungle ground up and slathered on your skin will fix the problem (why would it?). But, allow me to also say- most skin reactions don't need, nor will they benefit from 100 dollars worth of laboratory chemicals stuffed into a brand name prescription from the pharmacy.

Neither approach will help heal the skin very much, and neither will prevent the damage in the first place. Do I believe in natural cures? You bet. Your body, in its natural amazing way, can regenerate skin without lotions or potions or pills most of the time. Very few radiation reactions need serious supportive care, most (not all) will just get better. Of course, there are some severe wounds that will require medical attention, but without an understanding of what is wrong, no one, be they MD, DO, ND or Shaman, can be expected to properly assist you. If your medical professional is using terms like "second degree" to describe a radiation wound then there is a good chance (although I can't say for sure) that they are not trained in any of the more than 100 years of science and knowledge that can help you in this situation.

Now, keep in mind, I said herbal potions and laboratory chemicals won't heal the wound much faster- I didn't say they wouldn't sooth the area and ease your suffering while your body repaired the damage. That they are very good at. For a grade I skin reaction, a good non-alcohol containing aloe is about as good as anything that costs a hundred times of much, in my opinion. I would rather a patient use aloe, but there are also some lidocaine containing topical medications that are helpful if they insist. Colloidal silver (a very natural medication for the record, despite being sold at the pharmacy) can inhibit the growth of bacteria, although it may not cure an active infection. Infection in general is actually not that common in radiation wounds- but it can happen and should be treated when it does.

Rarely, radiation wounds do need more assertive supportive care. I'm truly very sorry that you had to experience such a situation. Keep in mind, you don't have to clear or remove dead skin from a radiation wound like you might from a thermal burn- at least not aggressively. The problem is missing skin, not damaged skin, or at least that is the more logical way to model the situation.

Missing skin can't be healed with an herb, or a medication, and missing skin sure as heck can't be scrubbed at until it isn't missing anymore. Missing skin, for the most part, needs to wait until the body grows more skin. That can take 2-4 weeks for very mild reactions, to several months for serious radiation injuries. Make sure your medical professional has training and certification in these issues, keep in close contact with them, and ask them in no uncertain terms for a timeline that you can use in your healing expectations.

Then, if your body does not respond on that timeline- ask them why, ask them if something is wrong, ask and then ask, and then ask some more, until your doctor explains what is going on with your body to your satisfaction. You have that right, and you also have that responsibility. Very few physicians, and far fewer patients, are qualified to give advice on radiation wounds. Find support and comfort on the internet- but find advice on the cause and cure for radiation damage to human tissues by consulting a board certified Radiation Oncologist- one that cares about your case, and takes the time to explain things to you.

God bless you and good luck.

 ***************

Discuss.....  

Sara
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Mar 30, 2022 05:39PM serendipity09 wrote:

gracestella1948 - Not completely like your experience, but I started turning red and had the burning feeling within the first few days, only in the area where I was being radiated. As the days went on and the treatments continued it became worse for me. The RO kept a close eye on my skin, but ultimately there was nothing that could be done. It peaked about a week after I finished treatment and the healing was literally overnight and my skin is back to normal, even better then before.

Did they give you any cream? I was given Miaderm, many will use 100% Aloe Vera gel. I found putting it in the refrigerator and applying cool cream was very soothing.

As the OP stated the "burn" is within and that is what you are experiencing.

Please be sure to advocate for yourself as celiac indicated.

I hope things have eased up for you.

Sending you warm thoughts!

"You can't wait until life isn't hard anymore, before you decide to be happy" - Nightbirde Dx IDC, ER-/PR-, HER2-
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Apr 27, 2022 07:18AM kc wrote:

I have just finished 15 days radiotherapy. Use Calendula cream twice a day, top with Aquaphor at night. On the second week, breast turn red with dark patches. On the third week, it becomes more red and sometimes I feels pain at the wound. It come and go in a few seconds, so not bad. My skin become more sensitive to sunlight, it will burn each time each is exposed to the sun. I got sun burn on arm, neck, legs, thigh......I walk 45 mn to an hour a day. Have to do it in the early hour to avoid the sun and wear thick clothes, cover my neck with a scarf , cover my face with a hat... I have dehydrated to the point that I had to drink more than a gallon and half of water per day to sustain thirst. I found that drinking milk would help with dehydration better than water alone. I have also stopped drinking tea and coffee. Also cut down the salt. Sometimes electrolyte water would help. At first , I thought I had a food allergies. Now I am sure that it is a side effect of having radiation. Another nephew had the same problem when he was in radiotherapy 2 years ago on the chest. .

Radiation Therapy 1/24/2022 Whole breast: Left breast Surgery 2/1/2022 Lumpectomy (Left) Surgery

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