The Redundant Bonjela

Originally written January 16th 2014

As I’ve previously mentioned in another post, chemo comes with its side effects. Most of us are probably aware of the most common adverse reactions experienced by oncology patients. Indeed, most Hollywood productions featuring characters going through treatment for cancer will be shown predominantly to be bald and vomiting. Losing my hair was hard. Before chemo I would look in the mirror to see thick, long, dark hair (don’t worry, it grew back!) and suddenly all I saw was a white, bald emaciated head and face. The nausea and vomiting was nothing short of horrific.

However, the one side effect which affected me more than any other was one of which most of the general public are unaware. It’s name is mucositis – inflammation of the lining of the mouth and entire gastrointestinal tract. The reason patients get mucositis is simple. Chemotherapy kills all fast growing cells, which includes hair, nails, white bloods cells (the body’s immune system), red blood cells (which carry oxygen around the body) and platelets (important for would healing), as well as the cells in the lining of the mouth and GI tract, which replace themselves several times a day. When these cells don’t replace themselves, what’s left is essential an ulcer.

Now it is time for me to introduce you to the villain (or some might say hero) of our story… Methotrexate.

Methotrexate is a nasty, mean drug. It even looks corrosive. Little did I know, when I was first introduced to the bright yellow intravenous poison, dripping slowly into my veins, the effects that it would have on my body. The day I had finished my second block of chemotherapy, one of the nurses, Rowena (who, very sadly, passed away a few years ago and was one of the best nurses I’ve ever met in my life) came to my bed with a bottle of bicarbonate of soda and told me to wash my mouth with it – in case I get some mouth ulcers. Of course, I followed her advice, for fear of getting one of those incredibly annoying, can’t stop licking it, can’t eat any ketchup little sores on the underside of my lip. Nothing could have prepared me for what happened next – not one, two or three ulcers appeared but rather my entire GI tract, from lips right through to the other end was one huge ulcer.

Imagine the worse niggling crater of an ulcer you’ve ever had…

Multiply the pain by 1,000…

Imagine the pain all around your mouth, all the time…

That is what I do to reimagine the pain I experienced back then, but it doesn’t ever come close. The mucositis caused my mouth to swell to the size of a small football. I was rendered unable to eat, drink, talk and even swallow my own saliva – which I would instead hoover up with a suction tube. I was put on a morphine PCA (Patient Controlled Analgesia) for pain relief, which provided its own side effects that I’m sure will come up in later posts. The situation got so bad so quickly that my doctors were even unable to give me a nasogastric tube (tube through the nose into the stomach which is used for feeding) which they would normally use to keep a patient’s nutritional status up, and I had to be fed through the vein. As a result I lost around 35 kilos in around 5 weeks – almost half my body weight.

Please be reassured, this DOES NOT happen to everyone! I was told by my oncology consultant at the time that in all of her years of experience in the field, she had never seen a case of mucositis as bad as this – I double checked with her this week and I’m pleased to say that my status as the only victim of such an award-winning mucositis is still intact! Why did I get it so badly though? As I mentioned, it’s all due to that dastardly methotrexate. Due to the extremely aggressive nature of my cancer, my treatment protocol involved very high doses of the dreaded drug. That, combined with my pre-existing kidney failure, meant that it took me about a week later than normal to get rid of the methotrexate from my body and explains why I had such bad toxicity from it. Despite all this, it also killed my cancer, so it can’t be all that bad!

My experience with the methotrexate and mucositis is something that will be with me forever. Every time I get an ulcer and reach for the Bonjela, I’m reminded of where I’ve been, how bad things have been and how good they really are. Every time I complain about the tiniest of sores, I think of the time where I could barely grunt (let alone speak) and it doesn’t seem at all so bad.