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I previously wrote a similar column about radiation and some of the effects it had on me during treatment for medullary thyroid cancer (MTC), In particular, the long-term effects. 

Over the last few months, I have dealt with some of those long–term effects. Sure, a lot of the things I am dealing with now, I have been dealing with for a while. However, my medical team comes up with more and more ideas to help me. Unfortunately, none of them are seeming to alleviate my issues for more than a few days, maybe weeks, if even that. 

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The side effect I am talking about is the stricture in my esophagus that the radiation has caused. I didn’t notice it at first. I believe it developed throughout the first year and a bit after I finished my 30 radiation treatments. 

I finally mentioned this to my oncologist in one of our follow-up appointments. Honestly, I didn’t really know how to describe the feeling I was having, which was also why I didn’t really know what to ask for to help alleviate it. Once I managed to explain what the sensation was like to constantly have something stuck in my throat, both while eating as well as taking pills, my oncologist decided to refer me to a gastroenterologist. It was his hope that by sending me to a GI specialist, there would be an easy explanation for the constant choking incidents.

Well, there was an explanation, however, it was far from easy to fix it. I began my journey in December 2018. Now at the beginning of 2023 (just over 4 years after beginning to have gastroscopes), I have had 19 gastroscopes. Nine of these were done within the first year. The only reason we started spreading them out longer was that I got pregnant. 

Any kind of sedation can be more dangerous in pregnancy, which is why my gastroenterologist decided he would only do gastroscopes in the second trimester. So, I had one at the beginning of my second trimester. 

My doctor decided to be more aggressive in his treatment plans since we would have to take longer breaks. I believe that this was the reason we actually ended up being able to extend the time between the scopes from 4-6 weeks all the way to 4-6 months now. 

Sure, I could probably still benefit from having them closer together, however, I also don’t love having to have conscious sedation that frequently. Sometimes I feel fine after; other times, I spend the remainder of the day on the couch hardly able to open my eyes without throwing up instantly. On a positive note, I figured out that fentanyl does not agree with me. Most of the times that I feel sick, is when the anesthesiologist has used fentanyl in my sedation regimen. 

Before my latest scope, I discussed the issue with my doctor again. He suggested I see a speech-language therapist for a swallow study. In my professional role as a nurse, I have seen one of those tests done before but never would have thought I would have to have one of those done myself. At least not at this age yet. 

A few weeks ago, as we were going through the test, the therapist handed me a pill to swallow. Before I even took it, I told her this would get stuck, which is exactly what happened. The pill got stuck and there was nothing I could do to get it down by myself. After multiple attempts and swallowing more barium and infused drinks and food, it finally went down. 

At the end of the test, the therapist basically told me that besides sticking to a softer diet (which I have been doing already), there isn’t really anything she can offer me. She showed me some exercises I could try to strengthen some of the muscles around my tongue and neck. None of which she believes would actually do a whole lot, but maybe alleviate the pressure on the stricture minimally. 

It was very helpful to see the test as she was doing it. My doctor explained where the stricture is and what it looks like. Moreover, actually seeing it on the screen as I swallowed was even more helpful. Knowing the areas where it gets stuck exactly, will help me in the future when all of my usual tricks don’t work. Only once did I have to basically guess and do a Heimlich maneuver on my throat. Now, that will be more precise, which will hopefully speed up the dislodging. 

If I knew then what I know now, I would never have agreed to radiation therapy. Especially not when I look back and remember that I had a reoccurrence within 6 months. If you are a health care provider and you have a patient with MTC, be really sure that radiation is the only possible treatment option for them. Please ensure that this course of treatment would actually be helpful for them. Most patients with MTC would recommend to other patients with MTC to only agree to radiation for bone metastasis.