Friday, February 27, 2009

Pain scale

Whenever I'm at a doctor's office or hospital, the nurses and doctors ask me to rate my pain on a scale of 0 to 10. Apparently pain is a common symptom among cancer patients. Over the years I have experienced different kinds and degrees of pain across the spectrum. And with that experience I have developed a guide to keep my assessment consistent from week to week.

Pain scale
0: No pain.

1 or 2: Noticeable pain. Not enough to be bothersome, but enough to be aware that some part of my body is unhappy.

3 or 4: Distracting pain. It draws attention away from normal tasks and causes discomfort. It is not unbearable, but I would prefer to treat it if possible.

5 or 6: Constant pain. I am continually aware of the pain and unable to concentrate on anything else without great effort.

7 or 8: Writhing pain. Pain that makes me moan, yelp, grimace, and contort.

9 or 10: Blinding pain. Unendurable pain, greater than what I could imagine under normal circumstances.

During most of my treatment the pain has fortunately been in the 0 to 2 range. I have had frequent excursions into the 3 or 4 range with problems such as proctitis or healing after surgeries. When the source of that pain is unknown it can be useful for finding a new problem, but if the source is known then I prefer to medicate to a level where I can function normally.

The tumor that broke my pelvis caused pain in the 5 to 6 range. The radiation to treat it caused rectal pain shooting as high as 8, which made me wonder whether the cure was worse than the disease. After a few months it improved into the range of 1 to 4 which I medicated when necessary.

I am not conscious of experiencing a 9 or 10, but I think I did in the hours and days following major surgeries. Strong drugs or trauma have erased those memories.

Friday, February 6, 2009

Sense of touch

I lost some feeling in my hands and feet due to the various chemotherapy drugs I've taken over the past five years. I also lost my fingerprints thanks to Xeloda, which irritates the palms and soles in a reaction called hand-foot syndrome.

When I went to Disney World in 2007 I found that the entry gates use fingerprint scanners to ensure that the person using an electronic ticket is the same one who registered it. The scanner choked when I tried to register and an attendant had to override it. I bet that enough of the population has similar issues that it's in their training manual. I suppose it also means that people like me are a headache for anyone else trying to use fingerprints for identification.

Some of the numbness is nerve damage, particularly from the platinum-based drugs. The nerves do slowly heal, so I am getting some feeling back. In fact, now that I've been off of systemic chemo for four months I have enough feeling to realize that I lost more than I appreciated. Except for a period after a massive dose in 2005, the numbness hasn't been enough to interfere with tasks like holding a pen or buttoning a shirt. It's just been a dullness of sensation.

Today I learned that there's another explanation. According to research published in Science, fingerprints enhance the sense of touch. The ridges vibrate as they encounter bumps on a surface and transmit stronger signals to the nerve endings. So part of my numbness to texture is not just the nerve damage but the lack of fingerprints. I wonder if they, too, will regrow over time.