Radiotherapy and Fatigue

RadioactivieWhy does radiotherapy (a.k.a. radiation therapy) make me so tired? I asked the technician. I didn’t find the actual treatment of radiotherapy (radiation) unpleasant once I’d got passed the severe discomfort of the position I had to lie in. It only took a few minutes. I was in and out of the department within about fifteen minutes each day. However I became baffled by the incredible fatigue and how quickly it set in.

In the beginning, I often chose to drive us into Johannesburg, chatting to my husband, Rob, as I negotiated the heavy traffic. When we arrived at the hospital, I would park the car in the parking bay, and together we would walk down the slight hill and across the road to the hospital, catching the lift to the sixth floor. I would walk into the treatment room with a spring in my step, greeting the two ladies cheerfully as I clambered up onto the steel table.

After the few minutes of therapy, however, I climbed off the table, got dressed, and made for the car as fast as possible. I knew that I didn’t have long before my energy faded like ice-cream in a hot oven.

Sometimes I made it, laboriously, to the car. Sometimes the slight hill proved too much for me, and I had to wait for Rob at the gate to the parking bay. And sometimes I only made it to the exit from the hospital, and I’d have to sit on the low wall outside the door, waiting for my husband to bring the car to me. On the way home I would lean my head back and use all my concentration to keep myself awake. The feeling of total exhaustion was unbelievable.

There was no way I could ever have driven myself home, a one-hour trip. I eventually brought up the subject with one of the technicians.

Why the Fatigue Sets In So Quickly: “The radioactivity actually destroys all the growing cells in the target area,” the technician explained. “Your white blood cells multiply back at a phenomenal rate, and within a few hours your blood count starts to rise again. Your red blood cells take a little longer to recover, but they also ‘bounce’ back quite quickly. The cancer cells, hopefully, never recover.”

She looked at me to make sure that I was following the lecture.

“Now when we give you your daily dose of radioactivity, we effectively kill a lot of cells. But we can’t remove the broken and dead pieces. They are immediately released into your circulatory system for your body to deal with.

“This happens within a very short space of time. By the time you reach your car, your body is waging a war against all the intruders. It is as if you have developed a massive infection. Within the space of a few hours your body starts to win the war, and build up its forces once again.”

She smiled. “But of course, along we come again. You will find that each day you seem to take a little longer to recover. Towards the end of the course of treatment, you will probably be so tired and depressed, even moody, you may even feel that you can’t go on. When that happens, cheer yourself up with the thought that this means it is nearing an end.”

As Time Progresses: I soon learned what she meant. As the time passed, I got more and more fatigued, and actually conjured a new word to describe the feeling: “wooshed”. This was a combination of the words, “bushed” and “worn out”. 

Eventually I didn’t have the strength to even drive to treatment, never mind home again. All I could think was that for me, this was the first of the treatments. I still faced two full courses of chemotherapy. However would I manage?

Fifteen Years Later: Fatigue is still a problem. How much of that is due to the chemo, and how much to the radiotherapy, I will never know. Plus of course, I am fifteen years older! I just know that I have never fully recovered my energy levels in all these years. The more people I talk to, the more I learn this is the norm.

I keep going, and I look fit and healthy. Others envy me my enthusiasm for life, and my vitality and productivity. But by afternoon I am often so tired I just want to go to sleep. And I’m not the only one! It is a common after-effect, yet for all that, I push through and rarely give in to the desire to sleep. Life is too good to waste it resting!

Over to You: Have you had radiation/radiotherapy? If so, was fatigue a problem? Help others by commenting on your experience in a few words.


the Challenge of Radiotherapy

Patient treating room of a neutron therapy

Patient treating room of a neutron therapy

How does radiation work and what can I expect?

How Radiation Works: Radiotherapy (radiation) depends upon the rapid multiplication of cancer cells. The most common type of radiation therapy is External Beam Radiation. The potentially dangerous machines bombard the selected area with high-energy rays to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm), whilst leaving the slower developing normal cells relatively unscathed.

 Apart from the awkward position I had to maintain on the metal bed, the actual treatment resembled a normal X-ray. The placement was very awkward, and because it was only a couple of weeks since my surgery, it was also painful. Often chemo is given first, and the radiation follows. Looking back, I think that would have been preferable as my scar would have healed and I would have regained movement to my arm and shoulder. Without a doubt, holding my arm in position was the worst part of the actual time under the machines. 

As I lay on my back, the technician guided my damaged arm up until my hand gripped a handle above and behind my head. For the first week or so, this was agony, and any attempt to ease my position brought me a scolding. I had to lie in that position for what seemed like hours, although it was actually only a few minutes. That First Treatment: When it came to the first treatment, the technicians warned me I might experience a slight tingling, but I felt nothing.

The two girls who were working with me left the room, swinging the huge lead door closed. As I heard it clank shut, my heart seemed to leap within me. I wanted to yell, “Come back! Don’t leave me!” I don’t think I have ever felt so terrified as I was that day. I only learned several days later that they were monitoring me all the time on a screen. I wish I’d known that on the first day. 

The machines started a process of groaning and clicking. They changed position as they targeted different parts of my chest and underarm. I gritted my teeth and stared at the ceiling, visualising the face of Jesus smiling down on me. Remembering the injunction to praise in all situations, I started to sing . . . “Wherever I am, I’ll praise You . . . ” After a couple of minutes, I heard the huge lead door swing open.

The two girls rushed in and made some adjustments to the machinery. “Please, may I just rest my arm?” I begged. “Absolutely not!” one snapped back. “Don’t even think of moving!” They both raced from the room and I returned to singing, trying to ignore the cramp-like pain that gripped my arm. 

The Treatment Continues: Over the next nine weeks, Monday to Friday, I presented myself for a repeat treatment at the same time. Gradually my arm got used to the traumatic stretch to reach the handle, until I was able to do it without much discomfort. How much easier it would have been if I’d had the chemo first! I was extremely fortunate.

Despite having extremely fair skin (I’m a redhead) I didn’t burn badly. I only had a slight tinge of pink over the breast area which ended with a clear line down the middle of my chest. Yet the effects of radiation linger on. As a fifteen-year survivor, I still have to take special care when I go into the sun. If I stand or walk in the African sunshine for any length of time, the left side of my back starts to burn through my shirt. As long as I put sunscreen on under my top, I’m fine, but I often forget. Then I need to keep out of the sun. 

I don’t allow my hairdresser to blow-dry my hair, because if the hot air comes near my collar bone or shoulder blade on that side, it feels as if it’s burning. But was it worth it? Absolutely. And did I follow all their instructions, even though at times they seemed over the top? You bet! 


Visualisation for a Christian

ImaginationI’m a Christian. How can I use my imagination during treatment?

During my year of treatment, I read a good amount about the art of Visualisation. I knew that most Christians frowned on this, labelling it new-age, occult, weird, yet somehow I had a feeling that we were, to use a cliché, throwing the baby out with the bath water. I believed there was more to this subject. There had to be ways to use our God-given minds to encourage healing within our bodies, without entering into the field of mysticism.

Slowly, I experimented and soon found how well it worked for my time under the radiation machines. I decided to share the experiment with my minister husband, who was wary of the subject.

One day, while lying on a rug in the shade of a large thorn tree, I brought up the issue.

“Please allow me to explain what I’m trying,” I said. “Keep an open mind. If you’re not happy with what I share, I won’t bring up the subject again.”

“All right,” Rob nodded slowly. “Fair enough.”

“Well, you know how medical science has proved the effects of emotions on the body?”


“And you know for yourself that if you dwell on bad things, you find negative reactions within your body right?”

“Mmm . . .”

“Well then surely by deliberately changing our emotions, we should be able to affect our physical body? That just makes sense.”


“I know for a fact that if I allow myself to dwell on the negative ramifications of cancer, before long my heart-beat speeds up, my mouth turns dry, I start to feel agitated.”

“Agreed. That’s why you mustn’t dwell on negative issues.”

“Well then,” I continued, “If by dwelling on negative thoughts I can create a bad situation in my body, surely by thinking happy thoughts, I will be doing my body good?”

“Yes, I guess that makes sense.”

“If I allow myself to think bad thoughts about cancer, I am using my imagination, right?”

“Yes—but you’re using it wrongly. You’re creating things in your mind which hopefully will never happen. You are facing crises which you may never have to face.”

“Exactly!” I beamed in triumph. “That’s what I’m trying to say. So instead of allowing that, I want to use my God-given imagination to conjure up good scenarios. This can only benefit my body.”

“Yes, I can see that.”

“So where’s the problem?”

“You mean that’s it? That’s all you’re trying to say?”

“In essence, yes. Now look at it in action.”

I reminded him of a chorus we sang with our youth, which speaks of the love of God surrounding us like a sea.

“When I lie on that metal table in radiotherapy,” I said, “I sing that song, over and over again. At the same time, I picture the Lord’s love surrounding me like a sea. I imagine the sound of the waves and it takes my mind off the hum of the machines. “

With that description Rob was perfectly happy and showed no further concern about my “visualisation” during treatment.