Barbarous Dissonance

2022 is well underway. I finished cancer treatment at the start of 2019, so have been recovering for three years. This has not been an active recovery; I simply assumed that things would return to normal with the passing of time.

As it turns out, progress has been very unsteady, and I realise now that I need to undertake a more active approach to recovery, late in the day as it is. It seems to me now that the treatment, particularly the chemotherapy, knocked my system very much out of equilibrium, and my constitution was on the weaker side to begin with—and so, in some ways my health has been in decline over the last three years, rather than rebounding by itself.

I’ve had a lot of problems with fatigue, headaches, and muscle aches, and various mental health difficulties of some severity. This has impacted every aspect of life, and is not getting better by itself—so it’s time to take up some form of intervention.

I have to start with understanding what’s happening. I’ve found this past winter particularly hard going, and that’s led me to look into the cold-sensitivity aspects of chemotherapy, particularly Oxaliplatin. The symptom is called cold hypersensitivity, or cold dysesthesia, and it’s a hallmark of the damage to the peripheral nervous system caused by chemo. In the simplest terms, it means in cold conditions the fingers and feet feel painfully cold.

I often wear two jumpers, under-trousers, and sometimes two pairs of socks to try to stay warm in the colder months, and lately have taken to wearing light gloves as much as possible, to counter the effects. None of this is any great inconvenience, except sometimes for the gloves, and people do find the numerous layers a bit eccentric if it comes up. And I spend a lot of money on heaters and heating, which is a pretty manageable strategy, though the effects of the heat are soporific and the cost is certainly noticeable.

I think the bigger issue with cold dysesthesia is that if I don’t recognise it as a symptom peculiar to myself, I feel that it’s a simple matter of the weather being cold, when in fact my perception of coldness is very different from that of those around me. So it can sometimes seem to me madness to think of going outside, or even of living in Ireland in winter, when for others the weather is mild or at worst brisk.

I’ve done a little Googling about it and it seems that this is one of the common symptoms of peripheral sensory neuropathy (PSN) associated with Oxaliplatin, and it can persist for some years after treatment in 10–15% of patients (e.g. source). It’s somewhat helpful to be able to attribute this to treatment, rather than to general age and decrepitude.

In terms of what to do about it, I think the first thing is not to complain about the cold before anyone else! And instead to ensure that I have a good stock of vests, long-johns, and whatever other accommodations I can quietly incorporate. For immediate relief, I do find that squeezing and releasing the toes and fingers, doing a short burst of cardio, or working on a walking treadmill helps to keep it at bay. Painkillers also help. I’m assuming that activities to improve the circulation, such as cold baths and showers, will help in general, so that the body can keep the periphery warmer itself, and so I suppose I should try once more with the Wim Hof method. I used to enjoy sea swimming; I can’t imagine it at the moment, but perhaps I could ready myself for it by the summer. And of course, exercise in general is part of every prescription; I find it very hard to stick with but this cold / circulation business is more weight in favour on the scale (vs the considerable load on the inertia / stress / activity aversion on the other…).

So action items for the next weeks are exercise, with a focus on intensity to push the heart rate up (as ever); cold showers / baths with some frequency; organise gloves etc. And the goal is sea swimming in May.